Klinik Araştırma
BibTex RIS Kaynak Göster

Comparing Noninvasive Pulse CO-Oximeter vs Blood Gas Analysis in Emergency Department Patients with Carbon Monoxide Poisoning

Yıl 2018, Cilt: 1 Sayı: 1, 1 - 4, 21.09.2018

Öz

Introduction: In order to diagnose carbon monoxide (CO) poisoning, clinical suspicion, a reliable history, and the detection of high level of carboxyhemoglobin (COHb) in blood gas analysis are required. The purpose of this study is to compare noninvasive pulse CO-oximetry versus blood gas analysis (BGA) in emergency department (ED) patients with CO poisoning.

Methods: From the patients, who were 18 years of age or over, presenting with suspicion of CO poisoning and who were eligible for inclusion in the study, arterial/venous blood gas samples were collected and SpCO was measured by pulse CO-oximetry and recorded by the time of ED visit. Sensitivity and specificity percentages, positive and negative predictive values were determined with ROC analysis. Bland-Altman analysis was used to assess the agreement between two measurement methods.

Results: The study was carried out prospectively on 213 patients in total, 133 (62%) of whom were female with a mean age of 38 ± 15. The limits of agreement were -6.5 to 9.9% COHb (bias 1.7%, precision 4.1%). Cut off value in CO measurement was 23, sensitivity was 97.2%, specificity was 80.4%, NPV was 96.6%, and PPV was 83%. Concordance coefficient value (0.868) between BGA, and pulse CO-oximetry was found out to be significantly high.

Conclusion: When pulse CO-oximetry is compared with BGA, it appears to diagnose CO poisoning rapidly and accurately and therefore, it may be used both in pre-hospital period and EDs as a screening test for CO poisoning.

Kaynakça

  • Van Weter KW. Carbon Monoxide Poisoning. In: Tintinalli JE, Kelen GD, Stapczynski JS, editors. Tintinalli’s Emergency Medicine 6th ed. New York: McGraw-Hill; 2004.p.1238–42.
  • Iqbal S, Law HZ, Clower JH, et al. Hospital burden of unintentional carbon monoxide poisoning in the United States, 2007. Am J Emerg Med 2012;30:657-64.
  • Besli G, Ergüven M, Karadoğan M,et al. Çocuklarda Karbon Monoksit Zehirlenmesi. Akademik Acil Tıp Dergisi 2010;9:26-30.
  • Centers for Disease Control and Prevention (CDC). Nonfatal, unintentional, non–fire-related carbon monoxide exposures-United States, 2004-2006. MMWR 2008;57:896-9.
  • Centers for Disease Control and Prevention (CDC). Carbon monoxide-related deaths-United States, 1999-2004. MMWR2007;56:1309-12.
  • Hampson NB, Weaver LK. Carbon monoxide poisoning: a new incidence for an old disease. Undersea Hyperb Med2007;34:163-8.
  • Roth D, Herkner H, Schreiber W,et al. Accuracy of Noninvasive Multiwave Pulse Oximetry Compared With Carboxyhemoglobin From Blood Gas Analysis in Unselected Emergency Department Patients. Ann Emerg Med 2011;58:74-9.
  • Touger M, Birnbaum A, Wang J, et al. Performance of the RAD-57 PulseCO-oximeter Compared With Standard Laboratory Carboxyhemoglobin Measurement. Ann Emerg Med 2010;56:382-8.
  • Prockop LD, Chichkova RI. Carbon monoxide intoxication: an updated review. Journal of the neurological sciences 2007;262(1):122-30.
  • Hampson NB, Scott KL, Zmaeff JL. Carboxyhemoglobin measurement by hospitals: implications for the diagnosis of carbon monoxide poisoning. J Emerg Med 2006;31:13-6.
  • Wilcox SR, Richards JB. Noninvasive carbon monoxide detection: insufficient evidence for broad clinical use. Respir Care 2013;58:376-9.
  • Barker SJ, Curry J, Redford D, et al. Measurement of carboxyhemoglobin and methemoglobin by pulse oximetry: a human volunteer study. Anesthesiology 2006;105:892-7.
  • Suner S, Partridge R, Sucov A, et al. Non-invasive pulse CO-oximetry screening in the emergency department identifies occult carbon monoxide toxicity. J Emerg Med 2008;34:441-50.
  • Coulange M, Barthelemy A, Hug F, et al. Reliability of new pulse CO-oximeter in victims of carbon monoxide poisoning. Undersea Hyperb Med 2008;35:107-11.
  • Piatkowski A, Ulrich D, Grieb G, et al. A new tool for the early diagnosis of carbon monoxide intoxication. Inhal Toxicol 2009;21:1144-7.
  • Mottram CD, Hanson LJ, Scanlon PD. Comparison of the Masimo Rad 57 pulse oximeter with SpCO technology against a laboratory CO-oximeter using arterial blood. Respir Care 2005;50:1471.
  • Zaouter C, Zavorsky GS. The measurement of carboxyhemoglobin and methemoglobin using a non-invasive pulse CO-oximeter. Respir Physiol Neurobiol 2012;182:88-92.
  • Chee KJ, Nilson D, Partridge R, et al. Finding needles in a haystack: a case series of carbon monoxide poisoning detected using new technology in the emergency department. Clin Toxicol (Phila) 2008;46:461-9.
  • Kot J, Sićko Z, Góralczyk P. Carbon monoxide pulse oximetry vs direct spectrophotometry for early detection of CO poisoning. Anestezjol Intens Ter 2008;40:75-8.

Karbonmonoksit Zehirlenmesi ile Acil Servise Başvuran Hastalarda Noninvaziv Nabız CO-oksimetre ile Kan Gazı Analizinin Karşılaştırılması

Yıl 2018, Cilt: 1 Sayı: 1, 1 - 4, 21.09.2018

Öz

Giri: Karbon monoksit (CO) zehirlenmesinin tanısı için klinik üphe, güvenilir bir anamnez ve kan gazında yüksek karboksihemoglobin (COHb) düzeyinin saptanması gereklidir. Bu çalımada CO zehirlenmesi ile acil servise bavuran hastalarda noninvaziv nabız CO-oksimetre ile kan gazı analizinin karılatırılması amaçlanmıtır.

Metot: CO zehirlenmesi üphesi olan ve çalımaya dahil edilmeye uygun 18 ya ve üzeri hastalarda, acil servis bavurusu esnasında arteriyel/venöz kan gazı örnekleri alınmı ve nabız CO- oksimetre ile SpCO düzeyleri ölçülmütür. ROC analizi yapılarak sensitivite, spesifite, negatif prediktif deer (NPD) ve pozitif prediktif deer (PPD) saptanmıtır. ki ölçüm metodu arasındaki uyumu deerlendirmek için Bland-Altman analizi kullanılmıtır.

Bulgular: Çalıma toplam 213 hasta üzerinde prospektif olarak yapılmıtır. Hastaların 133’ü (%62) kadın olup ortalama ya 38 ± 15’tir. Uyum sınırları -6.5 ila 9,9% COHb’dir (bias %1,7, kesinlik %4,1). CO ölçümü için sınır deeri 23, sensitivite %97,2, spesifite %80,4, NPD %96,6, PPD %83 olarak hesaplanmıtır. Kan gazı analizi ile nabız CO-oksimetre arasındaki uyum katsayısı deeri (0,868) anlamlı ölçüde yüksek bulunmutur.

Sonuç: Nabız CO-oksimetre, kan gazı ile karılatırıldıında CO zehirlenmesinde hızlı ve hassas bir biçimde tanı koymaktadır ve hem hastane öncesi dönemde hem de acil servislerde CO zehirlenmesi için bir tarama testi olarak kullanılabilir.

Kaynakça

  • Van Weter KW. Carbon Monoxide Poisoning. In: Tintinalli JE, Kelen GD, Stapczynski JS, editors. Tintinalli’s Emergency Medicine 6th ed. New York: McGraw-Hill; 2004.p.1238–42.
  • Iqbal S, Law HZ, Clower JH, et al. Hospital burden of unintentional carbon monoxide poisoning in the United States, 2007. Am J Emerg Med 2012;30:657-64.
  • Besli G, Ergüven M, Karadoğan M,et al. Çocuklarda Karbon Monoksit Zehirlenmesi. Akademik Acil Tıp Dergisi 2010;9:26-30.
  • Centers for Disease Control and Prevention (CDC). Nonfatal, unintentional, non–fire-related carbon monoxide exposures-United States, 2004-2006. MMWR 2008;57:896-9.
  • Centers for Disease Control and Prevention (CDC). Carbon monoxide-related deaths-United States, 1999-2004. MMWR2007;56:1309-12.
  • Hampson NB, Weaver LK. Carbon monoxide poisoning: a new incidence for an old disease. Undersea Hyperb Med2007;34:163-8.
  • Roth D, Herkner H, Schreiber W,et al. Accuracy of Noninvasive Multiwave Pulse Oximetry Compared With Carboxyhemoglobin From Blood Gas Analysis in Unselected Emergency Department Patients. Ann Emerg Med 2011;58:74-9.
  • Touger M, Birnbaum A, Wang J, et al. Performance of the RAD-57 PulseCO-oximeter Compared With Standard Laboratory Carboxyhemoglobin Measurement. Ann Emerg Med 2010;56:382-8.
  • Prockop LD, Chichkova RI. Carbon monoxide intoxication: an updated review. Journal of the neurological sciences 2007;262(1):122-30.
  • Hampson NB, Scott KL, Zmaeff JL. Carboxyhemoglobin measurement by hospitals: implications for the diagnosis of carbon monoxide poisoning. J Emerg Med 2006;31:13-6.
  • Wilcox SR, Richards JB. Noninvasive carbon monoxide detection: insufficient evidence for broad clinical use. Respir Care 2013;58:376-9.
  • Barker SJ, Curry J, Redford D, et al. Measurement of carboxyhemoglobin and methemoglobin by pulse oximetry: a human volunteer study. Anesthesiology 2006;105:892-7.
  • Suner S, Partridge R, Sucov A, et al. Non-invasive pulse CO-oximetry screening in the emergency department identifies occult carbon monoxide toxicity. J Emerg Med 2008;34:441-50.
  • Coulange M, Barthelemy A, Hug F, et al. Reliability of new pulse CO-oximeter in victims of carbon monoxide poisoning. Undersea Hyperb Med 2008;35:107-11.
  • Piatkowski A, Ulrich D, Grieb G, et al. A new tool for the early diagnosis of carbon monoxide intoxication. Inhal Toxicol 2009;21:1144-7.
  • Mottram CD, Hanson LJ, Scanlon PD. Comparison of the Masimo Rad 57 pulse oximeter with SpCO technology against a laboratory CO-oximeter using arterial blood. Respir Care 2005;50:1471.
  • Zaouter C, Zavorsky GS. The measurement of carboxyhemoglobin and methemoglobin using a non-invasive pulse CO-oximeter. Respir Physiol Neurobiol 2012;182:88-92.
  • Chee KJ, Nilson D, Partridge R, et al. Finding needles in a haystack: a case series of carbon monoxide poisoning detected using new technology in the emergency department. Clin Toxicol (Phila) 2008;46:461-9.
  • Kot J, Sićko Z, Góralczyk P. Carbon monoxide pulse oximetry vs direct spectrophotometry for early detection of CO poisoning. Anestezjol Intens Ter 2008;40:75-8.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Orijinal Çalışma
Yazarlar

Sinan Kaya Bu kişi benim

Mehtap Bulut

Behçet Varışlı Bu kişi benim

Yalçın Katı Bu kişi benim

Ulaş Karaoğlu 0000-0001-8769-1470

Yayımlanma Tarihi 21 Eylül 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 1 Sayı: 1

Kaynak Göster

AMA Kaya S, Bulut M, Varışlı B, Katı Y, Karaoğlu U. Comparing Noninvasive Pulse CO-Oximeter vs Blood Gas Analysis in Emergency Department Patients with Carbon Monoxide Poisoning. Anatolian J Emerg Med. Eylül 2018;1(1):1-4.