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Is an increased PaO 2 in a normobaric state safe in acute CO poisoning?
Author(s) -
Moon Jeong Mi,
Chun Byeong Jo,
Cho Yong Soo
Publication year - 2020
Publication title -
basic and clinical pharmacology and toxicology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.805
H-Index - 90
eISSN - 1742-7843
pISSN - 1742-7835
DOI - 10.1111/bcpt.13361
Subject(s) - medicine , carbon monoxide poisoning , incidence (geometry) , anesthesia , co poisoning , surgery , poison control , emergency medicine , biochemistry , chemistry , catalysis , physics , optics
Abstract Our objective was to determine how much PaO 2 levels increase after normobaric oxygen (NBO) therapy and whether NBO therapy exerts therapeutic effects regardless of the PaO 2 level. We suggest the optimal PaO 2 level to use during NBO therapy for the acute treatment of carbon monoxide (CO) poisoning. This retrospective study included 311 patients who received oxygen administration after CO poisoning and had a measurable PaO 2 level upon arrival. Baseline characteristics, clinical courses and long‐term neurological outcome were collected and compared. The PaO 2 level upon arrival was 192 (161‐225) mm Hg, and 272 (87.5%) of the patients presented with hyperoxia. The incidence of poor long‐term neurological outcome was 11.3% at a median follow‐up period of 35 months. PaO 2 levels upon arrival were higher in patients with good long‐term neurological outcome than in those with poor outcome. The incidence of poor long‐term neurological outcome was significantly dependent on the PaO 2 level when patients were stratified at 100‐mm Hg increments. A multivariate regression analysis showed that PaO 2 levels, when considered a continuous, interval or ordinal variable, were associated with long‐term neurological outcome in separate models. According to the three models, a PaO 2 level of 200‐300 mm Hg has the lowest risk of poor long‐term neurological outcome. The results of the analysis of the predicted probability of poor long‐term outcome according to the PaO 2 level exhibited a U‐shaped curve. Further large‐scale studies are needed to confirm the association between 200‐300 mm Hg of PaO 2 and long‐term neurological outcome and evaluate the impact of PaO 2 levels above 300 mm Hg on acute CO poisoning outcome.