Predicting poor outcome in patients with intentional carbon monoxide poisoning and acute respiratory failure: A retrospective study

Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning

“…In 2015, Shen et al 36 (Class III) also found acute myocardial injury to be the only independent predictor of poor outcome (OR¼2.8; 95% CI 1.2 to 6.5) in 148 intentionally poisoned patients with acute respiratory failure who underwent HBO 2 therapy. Poor outcome was defined as inhospital mortality or neurologic sequelae.…”

“…Studies have shown that acute myocardial injury occurs in 37% to 53% of patients with acute CO poisoning. 14,35,36 Typically, this injury is determined by abnormal laboratory test results (eg, elevated creatine kinase or troponin level) or ischemic electrocardiographic changes; some authors have specifically examined the T wave as an indicator. 37 It has been proposed that identifying cardiotoxicity might inform health care providers making treatment and follow-up decisions or considering an exposed patient's risk for morbidity and mortality; as such, authors have investigated whether cardiac testing can predict morbidity or mortality.…”

“…37 It has been proposed that identifying cardiotoxicity might inform health care providers making treatment and follow-up decisions or considering an exposed patient's risk for morbidity and mortality; as such, authors have investigated whether cardiac testing can predict morbidity or mortality. 14,36,37 In 2006, Henry et al (Class II) 14 published the only prospective study examining long-term mortality in patients poisoned with CO who demonstrated acute myocardial injury at the time of their exposure. In this study, 230 patients with moderate to severe poisoning were followed for a median of 7.6 years.…”

Impact of Hyperbaric Oxygen Therapy on Subsequent Neurological Sequelae Following Carbon Monoxide Poisoning

“…Another possible factor is that patients with a higher risk for NS were prone to receive HBOT ( Table 1 ) in this study. The general indications for HBOT are also risk factors for NS [ 24 , 25 , 26 , 27 , 28 , 29 , 30 ], and even though we have adjusted for age and comorbidities in the analyses, we were unable to adjust for all the other risk factors. As a results, patients who received HBOT had higher prevalence of having risk factors for NS in comparison with those who did not, and this would contribute to the higher incidence of NS associated with HBOT observed in this study.…”

“…The potential sources of the bias included the differences in the outcomes analyzed between the preliminary report and the final report, reassigning participants to different groups based on assumptions, and the premature termination of the trial [ 9 ]. In Taiwan, the following protocol is generally adopted, but variations exist due to the differences in facilities and staff: (1) first session within 6–24 h as soon as possible; (2) 2.5–3.0 ATA; (3) 60–120 min each session; (4) treatments of oxygen supply (non-rebreathing mask vs. endotracheal intubation) and chamber choice (monoplace vs. multiplace chamber) depending on the patient’s condition and medical resource; (5) one session each day; and (6) one to five sessions in total [ 13 , 30 ]. However, no studies have been conducted to compare the two protocols.…”