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http://dx.doi.org/10.22537/jksct.17.2.86

PaCO2 at Early Stage is Associated with Adverse Cardiovascular Events in Acute Carbon Monoxide Poisoning  

Yang, Keun Mo (Department of Emergency Medicine, Chonnam National University Medical School)
Chun, Byeong Jo (Department of Emergency Medicine, Chonnam National University Medical School)
Moon, Jeong Mi (Department of Emergency Medicine, Chonnam National University Medical School)
Cho, Young Soo (Department of Emergency Medicine, Chonnam National University Medical School)
Publication Information
Journal of The Korean Society of Clinical Toxicology / v.17, no.2, 2019 , pp. 86-93 More about this Journal
Abstract
Purpose: The objective was to determine the association between PaCO2 and adverse cardiovascular events (ACVEs) in carbon monoxide (CO)-poisoned patients. Methods: This retrospective study included 194 self-breathing patients after CO poisoning with an indication for hyperbaric oxygen therapy and available arterial blood gas analysis at presentation and 6 hours later. The baseline characteristics and clinical course during hospitalization were collected and compared. The mean PaCO2 during the first 6 hours after presentation was calculated. Results: The incidence rates of moderate (30 mmHg< PaCO2 <35 mmHg) or severe (PaCO2 ≤30 mmHg) hypocapnia at presentation after acute CO poisoning were 40.7% and 26.8%, respectively. The mean PaCO2 during the first 6 hours was 33 (31-36.7) mmHg. The incidence of ACVEs during hospitalization was 50.5%. A significant linear trend in the incidence of ACVEs was observed across the total ranges of PaCO2 variables. In multivariate regression analysis, mean PaCO2 was independently associated with ACVEs (OR 0.798 (95% CI 0.641-0.997)). Conclusion: Mean PaCO2 during the first 6 hours was associated with increased ACVEs. Given the high incidence of ACVEs and PaCO2 derangement and the observed association between PaCO2 and ACVEs, this study suggests that 1) PaCO2 should be monitored at the acute stage to predict and/or prevent ACVEs; and 2) further study is needed to validate this result and investigate early manipulation of PaCO2 as treatment.
Keywords
Carbon monoxide; Carbon dioxide; Poisoning; Blood gas analysis;
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1 Hajsadeghi S, Tavakkoli N, Jafarian Kerman SR, et al. Electrocardiographic findings and serum troponin I in carbon monoxide poisoned patients. Acta Med Iran 2012;50(3):185-91.
2 Case RB, Greenberg H, Moskowitz R. Alterations in coronary sinus pO2 and O2 saturation resulting from pCO2 changes. Cardiovasc Res 1975;9:167-77.   DOI
3 Kreck TC, Shade ED, Lamm WJ, et al. Isocapnic hyperventilation increases carbon monoxide elimination and oxygen delivery. Am J Respir Crit Care Med 2001;163:458-62.   DOI
4 Sasano H, Vesely AE, Iscoe S, et al. A simple apparatus for accelerating recovery from inhaled volatile anesthetics. Anesth Analg 2001;93:1188-91.   DOI
5 Turner M, Esaw M, Clark RJ. Carbon monoxide poisoning treated with hyperbaric oxygen: metabolic acidosis as a predictor of treatment requirements. J Accid Emerg Med 1999;16(2):96-8.   DOI
6 Hampson NB, Hauff NM. Risk factors for short-term mortality from carbon monoxide poisoning treated with hyperbaric oxygen. Crit Care Med 2008;36(9):2523-37.   DOI
7 Lippi G, Tastelli G, Meschi T, et al. Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning. Clin Biochem 2012:45:1276-85.   DOI
8 Kao HK, Lien TC, Kou YR, et al. Assessment of myocardial injury in the emergency department independently predicts the short-term poor outcome in patients with severe carbon monoxide poisoning receiving mechanical ventilation and hyperbaric oxygen therapy. Pulm Pharmacol Ther 2009;22(6):473-7.   DOI
9 Crystal GJ. Carbon dioxide and the heart: physiology and clinical implications. Anesth Analg 2015;121:610-23.   DOI
10 Henry CR, Satran D, Lindgren B, et al. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA 2006;295(4):398-402.   DOI
11 Aslan S, Uzkeser M, Seven B, et al. The evaluation of myocardial damage in 83 young adults with carbon monoxide poisoning in the East Anatolia region in Turkey. Hum Exp Toxicol 2006;25:439-46.   DOI
12 Norman JN, Douglas TA, Smith G. Respiratory and metabolic changes during carbon monoxide poisoning. J Appl Physiol 1966;21(3):848-52.   DOI
13 Moon JM, Chun BJ, Cho YS, et al. Diagnostic Value of Parameters Related to White Blood Cell Counts for Troponin I Elevation in CO Poisoning Cardiovasc Toxicol. 2019;19(4):334-43   DOI
14 Moon JM, Chun BJ, Cho YS. The predictive value of scores based on peripheral complete blood cell count for long-term neurological outcome in acute carbon monoxide intoxication. Basic Clin Pharmacol Toxicol 2019;124(4):500-10.   DOI
15 Teerapuncharoen K, Sharma NS, Barker AB, et al. Successful Treatment of Severe Carbon Monoxide Poisoning and Refractory Shock Using Extracorporeal Membrane Oxygenation. Respir Care 2015;60(9):e155-60.   DOI
16 Moon JM, Chun BJ, Cho YS, et al. Cardiovascular Effects and Fatality May Differ According to the Formulation of Glyphosate Salt Herbicide. Cardiovasc Toxicol 2018;18(1):99-107.   DOI
17 Manini AF, Nelson LS, Skolnick AH, et al. Electrocardiographic predictors of adverse cardiovascular events in suspected poisoning. J Med Toxicol 2010;6:106-15.   DOI
18 Liao WC, Cheng WC, Wu BR, et al. Outcome and prognostic factors of patients treated in the intensive care unit for carbon monoxide poisoning. J Formos Med Assoc 2019;118(4):821-7.   DOI