Factors that Affect Prognosis and Morbidity in Pediatric Patients with Carbon Monoxide Poisoning

Abstract

Carbonmonoxide poisoning continues to be a major health problem worldwide, especially in developing countries, and constitutes an important part of the patients admitted to the pediatric emergency clinics due to poisoning. The aim of this study was to evaluate the correlation between clinical severity, morbidity, hospital stay, intensive care need, and full systemic effects in patients who were followed up and treated for carbon monoxide poisoning in our pediatric emergency clinic. Methods: The study was performed between January 2013 and 2015. We included patients under 18 years of age who were admitted to the pediatric emergency with carbon monoxide poisoning. Assessments were made prospectively. The epidemiological characteristics, complaints, physical examination and vital findings of all patients were recorded. Carboxyhemoglobin (COHb) level, oxygen saturation, electrocardiography, complete blood count, liver and kidney functions, and cardiac enzymes were studied, and Glasgow Coma scale (GCS) was calculated. Results: The mean length of hospital stay for 232 patients was calculated as 7.08±1 hours and the mean duration of exposure to carbon monoxide gas was 3.17±2.5 hours. Higher COHb levels and cardiotoxicity were detected in patients with a longer duration of exposure and a lower GCS and an increased intensive care need (p<0.01). There was no correlation between COHb levels and clinical severity, GCS, or intensive care unit need. However, it was found that high COHb levels (especially above 30%) increased cardiac injury and neurological symptoms but did not cause a permanent sequela (p<0.05). None of the patients had permanent neurological, cardiac, or renal damage. Conclusion: We found that duration of exposure is the most important and accurate parameter for the evaluation of clinical course and morbidity. In patients with high COHb levels, the effects are more prominent, however, we considered that there was no change in sequelae at long-term follow up.

How to Decide Oxygen Therapy in Childhood Carbon Monoxide Poisoning?

“…In our country, gas cylinder or gas-fired water heaters used in baths and coal stoves are reported to be among the main causes of accidental CO poisoning. 12 , 13 In line with the results found in our study, the importance of raising awareness with intermittent warnings and trainings should be emphasized in our country where the use of wood-coal stoves is common.…”

“…Although there are studies reporting that there is no relationship between clinical status of patients at the time of admission and COHb levels, 8 , 18 there are also articles reporting that COHb level is related to severity of clinical signs. 12 , 14 In our study, a significant correlation was found between the presence of blurred vision, syncope, seizure, altered consciousness, weakness, confusion, restlessness, or pathological neurological examination and HBOT. Moon et al 14 evaluated the presence of neurological symptoms as an indicator of severe CO intoxication and reported COHb levels to be significantly higher in patients who presented with lethargy and confusion.…”

“…The retrospective study of Huysal et al 20 reported that troponin levels increased significantly in patients with high COHb levels. Seçilmiş and Öztürk 12 reported that there was no significant difference between the clinical condition of the patient, need for intensive care, and COHb level. They stated that as the exposure duration to CO increased, COHb level, cardiotoxicity, and neurological symptoms increased.…”

Usefulness of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) as a marker for cardiotoxicity and comparison with echocardiography in paediatric carbon monoxide poisoning

“…13,24 There have been a few studies performed to demonstrate the positive contribution of ECG and routine cardiac markers (CK, CKMB) in the diagnosis of carbon monoxide-induced myocardial injury; however, findings on whether it is clinically useful are still uncertain. 17,[25][26][27][28] The total CK, Troponin-T/I, CK-MB level begin to rise 4-6 hours after the onset of the myocardial damage which is the most crucial time period for patients with carbon monoxide poisoning. 20,26,27 This may be the best explanation for not using the conventional tests since good time management with earlier detection of carbon monoxide-induced myocardial injury improves the outcome.…”