Abstract

Amaç: Karbon-monoksit (CO) yüksek mortalite ve morbiditeye sahip sık karşılaşılan bir toksisitedir. Akut CO zehirlenmesi olan hastalarda hiperbarik oksijen (HBO) tedavisi ve normobarik oksijen (NBO) tedavileri kullanılır, ancak uzun dönem nörokognitif sonlanımda HBO’nun NBO’ya göre etkisi halen belirsizdir. Bu çalışmanın amacı bizim kliniğimize CO zehirlenmesi ile başvuran hastaların HBO tedavisi alma oranlarını incelemektir.
Gereç ve yöntem: Bu bir araştırma hastanesinde yapılan retrospektif, kesitsel, gözlemsel, tek merkezli bir çalışmadır. Ocak 2018 ile Aralık 2019 arasında  ICD10 kodlarına göre CO zehirlenmesi tanısı konan hastaların dosyaları incelenmiştir. Demografik veri, acil serviste (AS) ortalama kalış süresi, HBO tedavi endikasyonları ve hastanın HBO alıp almadığı incelenmiştir. Karboksihemoglobin seviyesinin (COHb) %25’ten büyük olması HBO için endikasyon kabul edilmiştir. İstatistiksel analiz SPSS versiyon 22.0 ile yapılmıştır. Bağımsız gruplar arasında numerik değişkenlerin karşılaştırılmasında Mann–Whitney’s U testi ve Student t testi kullanılmıştır. Kategorik değişkenler Pearson ki-kare testi ile analiz edilmiştir. P değeri <0.05 istatistiksel açıdan anlamlı kabul edilmiştir.
Bulgular: Toplam 152 dosya incelenmiş CO seviyesi %5’ten büyük olan 80 vaka dahil edilmiştir. HBO endikasyonu olan ki bu COHb seviyesi %25’ten büyük olanlar olarak belirlenmiştir, 30 olup sadece 8 (26,6%) tanesi HBO tedavisi almıştır. Ortama AS’de kalış süresi HBO endikasyonu olan grupta belirgin olarak daha yükseltir (p < .001). HBO endikasyonu olan hastalarda HBO tedavisi alma durumuna göre başvurudaki COHb seviyeleri ve ortalama AS’de kalış süresi açısından fark yoktur; ancak taburculuk öncesi COHb seviyesi HBO tedavisi alan grupta belirgin olarak daha düşüktür (p .019).
Sonuç: Çalışmamız HBO endikasyonu olan CO zehirlenmesi olan hastaların çoğunun bu tedaviyi almadığını göstermiştir. Her ne kadar CO zehirlenmesinde HBO’nun etkinliğiyle ilgili mevcut literatür tutarsız veri sunsa da, biz ciddi CO zehirlenmesi olan hastalarda mortaliteyi ve gecikmiş nörolojik sekeli azaltmak için HBO verilmesi gerektiğini düşünüyoruz. Ancak, CO zehirlenmesi yaygın bir durum olduğundan, bu konuda bir konsensusa ulaşmak ve bir yönetim kılavuzu oluşturmak için hastaların mortalite ve morbidite açısından daha uzun süreli takip edildiği çok-merkezli, prospektif ileri çalışmalara ihtiyaç vardır.

Keywords

• Karbon-monoksit zehirlenmesi,hiperarik oksijen,nörolojik sekel,mortalite

The Importance of Hyperbaric Oxygen Therapy in the Management of Carbon Monoxide Poisoning is Neglected

Abstract

Introduction: Carbon-monoxide (CO) is a common cause of toxicity with high morbidity and mortality. Hyperbaric oxygen (HBO) therapy or normobaric oxygen (NBO) therapy should be used for acute CO-poisoned patients, though the effects of HBO versus NBO therapy on long-term neurocognitive outcomes remain unclear. The aim of this study is to investigate the rates of HBO therapy in patients admitted to our clinic with CO poisoning. Material and Methods: This is a retrospective, cross sectional, observational, single centered study that was conducted in a research hospital. Patient files with a diagnosis of CO poisoning based on the ICD10 codes between January 2018 to December 2019 were investigated. Demographic data, median time of stay in emergency department (ED), indication of HBO treatment and if the patient administered HBO were investigated. Carboxyhemoglobin level (COHb) greater than 25% considered as the indication of HBO. The statistical analysis was performed using the Statistical Package for the Social Sciences version 22.0. Mann–Whitney’s U test and Student t test were used for the comparison of numerical variables in independent groups. Categorical variables were analyzed using the Pearson chi-squared test. A p-value of <0.05 was considered to be statistically significant. Results: A total of 152 files were investigated, 80 cases with CO level higher than 5% at admission were included. Number of patients with HBO indication, which considered as COHb level greater than 25%, was 30 and only 8 (26.6%) of them received HBO therapy. Average length of stay at ED was significantly higher at HBO indication positive group (p < .001). There was no difference in terms of COHb level at admission and average length of stay at ED according to HBO treatment status in patients with HBO indication; but COHb level before discharge was significantly lower at the HBO therapy administered group (p .019). Conclusion: Our study demonstrated that most of the CO poisoned patients with HBO indication were not administered this therapy. Although the current literature provides conflicting data on the effectiveness of HBO therapy at CO poisoning, we considered that HBO should be administered in case of severe CO poisoning to reduce mortality and delayed neurological sequel. However, since CO poisoning is a common condition, there is a need for multicenter, prospective, advanced studies in which patients are followed up for a long time in terms of mortality and morbidity in order to reach consensus and create a management guide.

Keywords

• Carbon monoxide poisoning; Hyperbaric oxygen,neurological sequela,mortality

References

1. 1. Temrel TA, Bilge S. Myocardial Repolarization Parameters and Neutrophil-to-Lymphocyte Ratio are Associated with Cardiotoxicity in Carbon Monoxide Poisoning. Cardiovasc Toxicol. 2019. doi: 10.1007/s12012-019-09560-7
2. 2. Irem G, Çevik Y, Keskin AT, Emektar E, Demirci OL, Şafak T, et al. Copeptin levels in carbon monoxide poisoning. Turk J Med Sci. 2017; 47(2):653-657.
3. 3. Lettow I, Hoffmann A, Burmeister HP, Toepper R. Delayed neuropsychological sequelae after carbon monoxide poisoning]. Fortschr Neurol Psychiatr. 2018; 86(6): 342-347.
4. 4. Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002; 347(14):1057-67.
5. 5. Kuo SC, Hsu CK, Tsai CT, Chieh MJ. Hyperbaric Oxygen Therapy and Acute Carbon Monoxide Poisoning. Hu Li Za Zhi. 2018; 65(4): 11-17.
6. 6. Lin CH, Su WH, Chen YC, Feng PH, Shen WC, Ong JR, et al. Treatment with normobaric or hyperbaric oxygen and its effect on neuropsychometric dysfunction after carbon monoxide poisoning: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018; 97(39):e12456. doi: 10.1097/MD.0000000000012456.
7. 7. Juurlink DN, Buckley NA, Stanbrook MB, Isbister GK, Bennett M, McGuigan MA. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev. 2005; (1):CD002041.
8. 8. Çorbacıoğlu ŞK, Çıkrıkçı G, Çevik Y. ST-Segment Elevation Myocardial Infarction Due to Carbon Monoxide Poisoning. JAEMCR 2015; 6: 46-8

9. 9. Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J et al. Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. Am J Respir Crit Care Med. 2017; 195(5):596-606.
10. 10. Eichhorn L, Thudium M, Jüttner B. The Diagnosis and Treatment of Carbon Monoxide Poisoning. Dtsch Arztebl Int. 2018; 115(51-52): 863-870.
11. 11. Rose JJ, Nouraie M, Gauthier MC, Pizon AF, Saul MI, Donahoe MP et al. Clinical Outcomes and Mortality Impact of Hyperbaric Oxygen Therapy in Patients With Carbon Monoxide Poisoning. Crit Care Med. 2018; 46(7):e649-e655. doi: 10.1097/CCM.0000000000003135.
12. 12. Wang W, Cheng J, Zhang J, Wang K. Effect of Hyperbaric Oxygen on Neurologic Sequelae and All-Cause Mortality in Patients with Carbon Monoxide Poisoning: A Meta-Analysis of Randomized Controlled Trials. Med Sci Monit. 2019; 25:7684-7693.
13. 13. Ng PC, Long B, Koyfman A. Clinical chameleons: an emergency medicine focused review of carbon monoxide poisoning. Intern Emerg Med. 2018; 13(2):223-229.
14. 14. Huang CC, Ho CH, Chen YC, Hsu CC, Wang YF, Lin HJ et al. Impact of Hyperbaric Oxygen Therapy on Subsequent Neurological Sequelae Following Carbon Monoxide Poisoning. J Clin Med. 2018; 7(10). pii: E349. doi: 10.3390/jcm7100349.
15. 15. Liao SC, Mao YC, Yang KJ, Wang KC, Wu LY, Yang CC. Targeting optimal time for hyperbaric oxygen therapy following carbon monoxide poisoning for prevention of delayed neuropsychiatric sequelae: A retrospective study. J Neurol Sci. 2019; 396: 187-192.
16. 16. Altintop I, Akcin ME, Tatli M, Ilbasmis MS. Factors that influence the decision for hyperbaric oxygen therapy (HBOT) in cases of carbon monoxide poisoning: a retrospective study. Ann Burns Fire Disasters. 2018; 31(3):168-173.