Severe Cerebral Ischemia: Early Treatment With Corticosteroids Improves Outcome
Severe carbon monoxide (CO) intoxication is a life-threatening condition that has been increasing in prevalence and affecting a greater number of patients. A major challenge in treating CO-induced coma and death is the failure to diagnose CO poisoning. This may be due to difficulty in determining the CO concentration in the blood. Recent advances in our understanding of CO-induced hypoxia have enabled the diagnosis of CO poisoning in a subset of patients, which may facilitate the early identification of those who will benefit from early medical intervention. In this study, we examined the predictive value of age, sex, and blood levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in patients with CO intoxication who subsequently died. We found that patients with a prior history of head injury and normal brain imaging, a lower serum ALT level, and an early presentation of respiratory distress, improved more rapidly than those with a higher serum ALT level, normal brain imaging, and an earlier presentation of respiratory distress.
Adequate hydration, medical management, and oxygenation are the most effective therapies for patients with severe CO poisoning. Oxygen and hyperbaric oxygen therapy (HBOT) have a role in the management of patients with CO intoxication, as these agents have been shown to decrease the carbon monoxide concentration in the blood and thereby decrease the likelihood of development of respiratory distress and coma. However, the benefits of HBOT do not persist beyond 48 hours after administration, and HBOT is no longer effective after 24 hours.