Citation

Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, Gladwin MT. Am. J. Respir. Crit. Care Med. 2016; 195(5): 596-606.

Affiliation

University of Pittsburgh, 6614, Vascular Medicine Institute, Pittsburgh, Pennsylvania, United States ; gladwinmt@upmc.edu.

Copyright

(Copyright © 2016, American Thoracic Society)

DOI

10.1164/rccm.201606-1275CI

PMID

27753502

Abstract

Carbon monoxide (CO) poisoning affects 50,000 people a year in the United States. The clinical presentation runs a spectrum, ranging from headache and dizziness to coma and death, with a mortality rate ranging from 1-3%. A significant number of patients who survive CO poisoning suffer from long term neurologic and affective sequelae. The neurologic deficits do not necessarily correlate with blood CO levels, but likely result from the pleiotropic effects of CO on cellular mitochondrial respiration, cellular energy utilization, inflammation and free radical generation, especially in the brain and heart. Long-term neurocognitive deficits occur in 15-40% of patients while approximately one third of moderate to severely poisoned patients exhibit cardiac dysfunction, including arrhythmia, left ventricular systolic dysfunction and myocardial infarction. Imaging studies reveal cerebral white matter hyperintensities, with delayed post-hypoxic leukoencephalopathy or diffuse brain atrophy. Management of these patients requires the identification of accompanying drug ingestions, especially in the setting of intentional poisoning, fire-related toxic gas exposures, and inhalational injuries. Conventional therapy is limited to normobaric and hyperbaric oxygen, with no available antidotal therapy. While hyperbaric oxygen significantly reduces the permanent neurological and affective effects CO poisoning, a portion of survivors still remain with substantial morbidity. There is some early success in therapies targeting the downstream inflammatory and oxidative effects of CO poisoning. New methods to directly target the toxic effect of CO, such as CO scavenging agents, are currently under development.

Language: en