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Hyperventilation with Maintenance of Isocapnia. An “Old New” Method in Carbon Monoxide Intoxication

INTRODUCTION: Exposure to carbon monoxide (CO) is among the most common causes of acute and chronic poisonings worldwide. The crucial point of treatment of such acute poisonings is to eliminate CO from the body as fast as possible. There are currently two approaches to the management of the CO intox...

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Autores principales: Sein Anand, Jacek, Schetz, Daria, Waldman, Wojciech, Wiśniewski, Marek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5249161/
https://www.ncbi.nlm.nih.gov/pubmed/28107437
http://dx.doi.org/10.1371/journal.pone.0170621
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author Sein Anand, Jacek
Schetz, Daria
Waldman, Wojciech
Wiśniewski, Marek
author_facet Sein Anand, Jacek
Schetz, Daria
Waldman, Wojciech
Wiśniewski, Marek
author_sort Sein Anand, Jacek
collection PubMed
description INTRODUCTION: Exposure to carbon monoxide (CO) is among the most common causes of acute and chronic poisonings worldwide. The crucial point of treatment of such acute poisonings is to eliminate CO from the body as fast as possible. There are currently two approaches to the management of the CO intoxication: hyperbaric oxygen therapy (HOT) and normobaric oxygen therapy (NOT). HOT is highly effective and capable of achieving the CO elimination half-time (T½) as low as 15 minutes. Unfortunately this method is expensive and not always readily available. The elimination of CO with the use of NOT (T½~70 min) is slower, but treatment can be started even on the site of the exposure and continued while the patient is transported to a hospital. The aim of the study was to evaluate the effectiveness of a method using therapeutic hyperventilation with maintenance of isocapnia (IH) in the elimination of CO in volunteers exposed to CO and to compare selected gasometric and respiratory parameters during IH with the values obtained during hyperventilation with pure oxygen (“non-isocapnic hyperventilation”–NIH). MATERIAL AND METHODS: The study involved 13 healthy, chronically-smoking volunteers. Each of them participated in two independent hyperventilation tests: IH and NIH. The levels of carboxyhemoglobin (COHb) and selected gasometric, cardiac and respiratory parameters were measured at 0, 10 and 20 minutes during both tests. Among 13 volunteers (8 women and 5 men) the initial COHb level was 5.0±1.5% (mean±SD) before the IH tests and 5.1±1.9% before the NIH tests (p>0.05). After 20 minutes of the procedures the mean COHb level was 2.9±0.9% for IH and 3.6±1.2% for NIH (p<0.01). The T½ of COHb was 29.6±12.2 min and 47.3±19.2 min respectively (p<0.01). After 10 minutes of NIH respiratory alkalosis was noted in 11 participants (84.6%). Such problem was not seen during the IH procedures. No serious adverse effects were recorded during either IH or NIH. Mild symptoms such as: dyspnea, headache and paresthesias were reported by 6 volunteers (46%) during both IH and NIH tests. It is worth noting that paresthesias were only reported during NIH, by 2 participants (15.4%). CONCLUSIONS: The elimination T½ of CO during IH was comparable with the values reported during HOT, and lower than can be achieved with NOT or NIH. No serious adverse effects were reported during IH procedures. Further studies, especially direct comparisons with NOT and HOT, are necessary to evaluate the effectiveness of IH in the treatment of acute CO poisoning.
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spelling pubmed-52491612017-02-06 Hyperventilation with Maintenance of Isocapnia. An “Old New” Method in Carbon Monoxide Intoxication Sein Anand, Jacek Schetz, Daria Waldman, Wojciech Wiśniewski, Marek PLoS One Research Article INTRODUCTION: Exposure to carbon monoxide (CO) is among the most common causes of acute and chronic poisonings worldwide. The crucial point of treatment of such acute poisonings is to eliminate CO from the body as fast as possible. There are currently two approaches to the management of the CO intoxication: hyperbaric oxygen therapy (HOT) and normobaric oxygen therapy (NOT). HOT is highly effective and capable of achieving the CO elimination half-time (T½) as low as 15 minutes. Unfortunately this method is expensive and not always readily available. The elimination of CO with the use of NOT (T½~70 min) is slower, but treatment can be started even on the site of the exposure and continued while the patient is transported to a hospital. The aim of the study was to evaluate the effectiveness of a method using therapeutic hyperventilation with maintenance of isocapnia (IH) in the elimination of CO in volunteers exposed to CO and to compare selected gasometric and respiratory parameters during IH with the values obtained during hyperventilation with pure oxygen (“non-isocapnic hyperventilation”–NIH). MATERIAL AND METHODS: The study involved 13 healthy, chronically-smoking volunteers. Each of them participated in two independent hyperventilation tests: IH and NIH. The levels of carboxyhemoglobin (COHb) and selected gasometric, cardiac and respiratory parameters were measured at 0, 10 and 20 minutes during both tests. Among 13 volunteers (8 women and 5 men) the initial COHb level was 5.0±1.5% (mean±SD) before the IH tests and 5.1±1.9% before the NIH tests (p>0.05). After 20 minutes of the procedures the mean COHb level was 2.9±0.9% for IH and 3.6±1.2% for NIH (p<0.01). The T½ of COHb was 29.6±12.2 min and 47.3±19.2 min respectively (p<0.01). After 10 minutes of NIH respiratory alkalosis was noted in 11 participants (84.6%). Such problem was not seen during the IH procedures. No serious adverse effects were recorded during either IH or NIH. Mild symptoms such as: dyspnea, headache and paresthesias were reported by 6 volunteers (46%) during both IH and NIH tests. It is worth noting that paresthesias were only reported during NIH, by 2 participants (15.4%). CONCLUSIONS: The elimination T½ of CO during IH was comparable with the values reported during HOT, and lower than can be achieved with NOT or NIH. No serious adverse effects were reported during IH procedures. Further studies, especially direct comparisons with NOT and HOT, are necessary to evaluate the effectiveness of IH in the treatment of acute CO poisoning. Public Library of Science 2017-01-20 /pmc/articles/PMC5249161/ /pubmed/28107437 http://dx.doi.org/10.1371/journal.pone.0170621 Text en © 2017 Sein Anand et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Sein Anand, Jacek
Schetz, Daria
Waldman, Wojciech
Wiśniewski, Marek
Hyperventilation with Maintenance of Isocapnia. An “Old New” Method in Carbon Monoxide Intoxication
title Hyperventilation with Maintenance of Isocapnia. An “Old New” Method in Carbon Monoxide Intoxication
title_full Hyperventilation with Maintenance of Isocapnia. An “Old New” Method in Carbon Monoxide Intoxication
title_fullStr Hyperventilation with Maintenance of Isocapnia. An “Old New” Method in Carbon Monoxide Intoxication
title_full_unstemmed Hyperventilation with Maintenance of Isocapnia. An “Old New” Method in Carbon Monoxide Intoxication
title_short Hyperventilation with Maintenance of Isocapnia. An “Old New” Method in Carbon Monoxide Intoxication
title_sort hyperventilation with maintenance of isocapnia. an “old new” method in carbon monoxide intoxication
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5249161/
https://www.ncbi.nlm.nih.gov/pubmed/28107437
http://dx.doi.org/10.1371/journal.pone.0170621
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