poster otrava co barcelona

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HYPERBARIC OXYGEN FOR TREATMENT OF CARBON MONOXIDE POISONING: OUR EXPERIENCE FROM THE LAST DECADE (1995-2004) Hajek M., Centre of Hyperbaric medicine, Department of Anaesthesiology and Critical Care, City Hospital of Ostrava, Czech Republic Introduction The aim of this observational study was to analyse epidemiology, treatment background and final neurological outcome with emphasis on true incidence of delayed neuropsychologic sequelae (DNS) after CO poisoning in period 1995-2004. Material and methods - retrospective analyse of epidemiology, treatment conditions, complications rate and discharge neurological outcome of patients treated for CO poisoning in period 1995-2004 - inquiry forms have been sent to patients with aim to analyse current neuropsychological , social status (change of activities, occupation, family relations) and comparing with discharge datas to find true incidence of DNS Results - in observational period we have treated 46 patients - Males 29 (63%) / Females 17 ( 37%) - Age 31.3 years (11-61) - Admission - primary 18 (39%) - secondary 28 (61%) Epidemiology and treatment background - Mechanism – 28 (61%) boiler,geyser,cooker - 11 (24%) car, motor exhaust - 7 (15%) fire, smoke exhaust - Motivation - 35 (76%) accident - 8 (17.5%) suicide - 3 (6.5%) working enviroment - Insult-start HBO (I-T time) – 6.6 hours (2-21) (preexist DNS patients not involved) - HBO on 2-3 ATA 60-120 min - Sessions 3.3 (1-30) Severity - Mild - I., II.gr. -18 patients (39.1%) - Severe - III., IV.gr. – 28 patients (60.9%) ( „Ostrava“ classification according to the severity and clinical signs (neurological, circulation, respiration and vegetative status) - COHb 32% (1.5-86%), GCS 8.4 (3-15) - BD 3.78 mmol/l (0.4-22.3), lactate 2.5 mmol/l (0.77-7.55) - Arteficial mechanical ventilation -10 (22%), CPR 1 (2.2%), tracheostomy 1 (2.2%), gravidity 1 (2.2 %), 2nd-degree burn 1 ( 2.2%) Effects of treatment - marked 39 (85%) - mild 4 (8.5%) - no effect 3 (6.5%) -evaluation - HBO clinician or intensivist, neurologist, psychologist, CT, MRI Complications rate - middle ear equilibration problems 4 (8.6%), pneumothorax 1 (2.2%), aspiration pneumonia 1 ( 2.2%), total 13%, no interruption sessions Inquiry forms - returned 13 (28%) - asymptomatic 8 (61.5% of respondents) - symptomatic 5 (39.5% of respondents) - memory impair 4x, dislogia 1x, depression 1x - social sphere problems - family 5x, occupation 2x, study 1x - new case of DNS was found –patient poisoned in 1997 DNS 7 patients– 3 pre-HBO- delay 19.3 days (12-30) GCS 3: 13.7 HBO sessions 2-3 ATA (5-29), Effect of HBO- mild (2x), no effect (1x) -3 post- HBO– I-T time 11 hrs (6-15) GCS 3: 13 HBO sessions 2-3 ATA (4-30) Effect - mild (2x) , no (1x) - 1 inquiry – I-T time 4 hrs GCS 3 : 1 HBO session 2 ATA 60 minutes Conclusions 61% of severe poisoning, 85% marked improvement, complications rate 13% 15.2% DNS incidence, DNS linked with higher severity score (GCS 3 vs. 8.7 , p=0.05), late start of HBO (9.3 vs. 6.3 hours) and higher amount of HBO sessions (11.6 vs. 1.8) follow-up methods can be benefitial to find true incidence of DNS hours INTERNATIONAL CONFERENCE ON DIVING AND HYPERBARIC MEDICINE BARCELONA, 7-10 September, 2005