Effect of Pressure Support Ventilation on Carboxyhemoglobin Toxicokinetic after Acute Carbon Monoxide Intoxication: a Swine Model.

Delvau, Nicolas;Penaloza-Baeza, Andrea;Liistro, Giuseppe;Thys, Frédéric;Roy, Pierre-Marie;et.al.
(2018) Journal of Medical Toxicology : official journal of the American College of Medical Toxicology — Vol. 14, n° 2, p. 128-133 (2018)

Files

Delvau-2018-Effectofpressuresupport.pdf
  • Closed Access
  • Adobe PDF
  • 642.19 KB
Request a copy

Details

Authors
Show more
Abstract
In an experimental study on carbon monoxide (CO) exposure in swine, we aimed to compare the influence of oxygen therapy using a non-rebreathing mask (NRM) to continuous positive airway pressure (CPAP) and two pressure support ventilation (PSV) devices on the decrease of the terminal elimination half-life of carboxyhemoglobin (COHb t). This was the primary outcome. Eight spontaneously breathing pigs were sedated by propofol and exposed to 940 ppm CO several times (n = 25) to obtain COHb levels of 30%. CPAPb (high flow open system, CPAP Boussignac® [7.5 cmHO]), PSV-Vy (open system, Vylife Boussignac®), and PSV-Leg (closed system, Legendair® [inspiratory/expiratory airway pressure 12/4 cmHO]) devices were used in a randomized order and compared to NRM (O at 15 l min) and atmospheric air (AA). The primary outcome was COHb t. Multiple comparisons were performed using Dunn's tests. Median FiO and minute ventilation were significantly higher in the PSV-Leg group than the NRM group (p < 0.05). Median COHb t was 251, 85, 82, 93, and 58 min for AA, NRM, CPAPb, PSV-Vy, and PSV-Leg, respectively. All the interventions were superior to AA in terms of CO elimination (p < 0.001), but there was no statistically significant difference between CPAP or PSV and NRM. There was only a trend between PSV-Leg and NRM (p = 0.18). The median AUCs for ln (COHb) × time (h) were 170, 79, 83, 100, and 64 for AA, NRM, CPAPb, PSV-Vy, and PSV-Leg respectively, with a statistically significant difference only between AA and PSV-Leg (p = 0.002). In conclusion, in our study on CO intoxication in swine, the use of the closed PSV-Leg system led to the shortest COHb t. These results suggest that PSV-Leg can be more efficient than NRM in eliminating CO and support the design of a clinical study to assess this hypothesis.
Affiliations

Citations

  • APA
  • Chicago
  • FWB

Delvau, N., Penaloza-Baeza, A., Liistro, G., Thys, F., Delattre, I., Hantson, P., Gianello, P., & Roy, P.-M. (2018). Effect of Pressure Support Ventilation on Carboxyhemoglobin Toxicokinetic after Acute Carbon Monoxide Intoxication: a Swine Model. Journal of Medical Toxicology : official journal of the American College of Medical Toxicology, 14(2), 128-133. https://doi.org/10.1007/s13181-018-0654-8 (Original work published 2018)