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How to Decide Oxygen Therapy in Childhood Carbon Monoxide Poisoning?
Metin Uysalol1, Sühelya Gümüş1, Raif Yıldız1
1Division of Pediatric Emergency, Department of Pediatrics, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey.
Insights
Longer carbon monoxide exposure, elevated lactate, and neurological symptoms indicate a need for hyperbaric oxygen therapy in pediatric cases. These factors guide treatment decisions when guidelines are lacking.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Hyperbaric Medicine
Background:
- Carbon monoxide poisoning is a significant global health concern causing severe morbidity and mortality.
- Effective management strategies, particularly the indication for hyperbaric oxygen therapy (HBOT), require further definition in pediatric populations.
Purpose of the Study:
- To identify clinical and laboratory parameters that can guide the decision-making process for administering hyperbaric oxygen therapy in pediatric carbon monoxide poisoning cases.
Main Methods:
- A retrospective study of 83 pediatric patients diagnosed with carbon monoxide poisoning between 2012 and 2019.
- Evaluation of demographic data, exposure details, clinical findings (including Glasgow Coma Score), laboratory results, and diagnostic imaging.
Main Results:
- Patients receiving HBOT had significantly longer carbon monoxide exposure durations compared to those receiving normobaric oxygen therapy.
- Median lactate levels were significantly higher in the HBOT group (3.7 mmol/L) than in the normobaric oxygen group (1.5 mmol/L).
- No cases of myocardial ischemia, chest pain, pulmonary edema, or renal failure were observed.
Conclusions:
- Clinical and laboratory indicators such as duration of carbon monoxide exposure, carboxyhemoglobin levels, neurological status, and lactate levels are crucial for determining the need for HBOT.
- The development of precise guidelines for HBOT in pediatric carbon monoxide poisoning remains an unmet need.
Objective:
Carbon monoxide poisoning is an important cause of morbidity and mortality all over the world. In our study, it was aimed to determine the clinical and laboratory parameters that may be effective in deciding the need for hyperbaric oxygen therapy in the management of cases.
Materials And Methods:
From January 2012 to the end of December 2019, 83 patients who applied to a university hospital pediatric emergency department in İstanbul with the diagnosis of carbon monoxide poisoning were included. Demographic characteristics, carbon monoxide source, exposure duration, treatment approach, physical examination findings, Glasgow Coma Score, laboratory results, electrocardiogram, cranial imaging, and chest x-ray were evaluated from the records.
Results:
The median age of the patients was 56 (37.0-100.0) months and 48 (57.8%) of them were male. The median time of exposure to carbon monoxide was 5.0 (0.5-3.0) hours in those who received hyperbaric oxygen therapy and was significantly higher than those who received normobaric oxygen therapy (P < .001). Myocardial ischemia, chest pain, pulmonary edema, and renal failure were not detected in any of the cases. The median lactate level was detected as 1.5 (1.0-2.15) mmol/L in those who received normobaric oxygen therapy and 3.7 (3.17-4.62) mmol/L in those who received hyperbaric oxygen therapy, and the difference between them was statistically significant (P < .001).
Conclusions:
A guideline containing precise clinical and laboratory parameters for hyperbaric oxygen therapy in children has not been developed yet. In our study, carbon monoxide exposure duration, carboxyhemoglobin levels, neurological symptoms, and lactate levels were found to be guiding parameters in determining the need for hyperbaric oxygen therapy.
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