Use of Cyanide Antidotes in Burn Patients With Suspected Inhalation Injuries in North America: A Cross-Sectional Survey
Use of Cyanide Antidotes in Burn Patients With Suspected Inhalation Injuries in North America: A Cross-Sectional Survey
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DOI：
10.1097/bcr.0b013e31829b3868
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发表时间：
2014-03-01
影响因子：
1.4
通讯作者：
Nickerson, Duncan
中科院分区：
文献类型：
--
作者：
Dumestre, Danielle;Nickerson, Duncan
本研究旨在评估氰化物解毒剂的使用，并确定经验性给予羟钴胺素在北美烧伤患者疑似烟雾吸入性损伤的意见。一项在线横断面调查被发送给北美90个主要烧伤中心的主任，这些中心被列在美国烧伤协会网站上。采用多项选择的形式确定入院时接受氰化物中毒检测的患者的百分比，仅基于临床怀疑中毒的氰化物解毒剂的当前给药以及所使用的解毒剂。为了确定在确认氰化物中毒之前立即给予羟钴胺素的意见，包括了一个以书面形式扩大答复的选项。90名烧伤主任中有29名（32%）完成了调查。对于感兴趣的人群，大多数烧伤中心（59%）在入院时不进行氰化物中毒检测，并且仅基于临床怀疑氰化物中毒（58%）不给予解毒剂。最常用的解毒剂是羟钴胺素（50%），其次是氰化物解毒剂（29%）。关于吸入性损伤时立即给予羟钴胺素的意见是混合的：31%的人支持其经验性使用，17%的人不支持，其余52%的人对其效用有不同程度的信心。在北美，大多数在封闭空间火灾中烧伤的吸入性损伤患者既没有及时进行氰化物中毒测试，也没有经验性地使用氰化物解毒剂进行治疗。虽然研究表明经验性和立即给予羟钴胺素的安全性和有效性，但大多数中心不愿意这样做。
This study aimed to assess the use of cyanide antidotes and the determine the opinion on empiric administration of hydroxocobalamin in North American burn patients with suspected smoke inhalation injuries. An online cross-sectional survey was sent to directors of 90 major burn centers in North America, which were listed on the American Burn Association Web site. A multiple-choice format was used to determine the percentage of patients tested for cyanide poisoning on admission, the current administration of a cyanide antidote based solely on clinical suspicion of poisoning, and the antidote used. To ascertain views on immediate administration of hydroxocobalamin before confirmation of cyanide poisoning an option was included to expand the response in written format. Twenty-nine of 90 burn directors (32%) completed the survey. For the population of interest, the majority of burn centers (59%) do not test for cyanide poisoning on admission and do not administer an antidote based solely on clinical suspicion of cyanide poisoning (58%). The most commonly available antidote is hydroxocobalamin (50%), followed by the cyanide antidote kit (29%). The opinion regarding instant administration of hydroxocobalamin when inhalation injury is suspected is mixed: 31% support its empiric use, 17% do not, and the remaining 52% have varying degrees of confidence in its utility. In North America, most patients burnt in closed-space fires with inhalation injuries are neither tested for cyanide poisoning in a timely manner nor empirically treated with a cyanide antidote. Although studies have shown the safety and efficacy of empiric and immediate administration of hydroxocobalamin, most centers are not willing to do so.