I think the paper abstract is pretty irrelevant, but was the only reference
to endobronchial NaHCO3 I could find. Its just there for info rather than
"evidence".
Simon Carley
SpR in Emergency Medicine
Manchester Royal Infirmary
England
[log in to unmask]
Evidence based Emergency Medicine
http://www.bestbets.org
----- Original Message -----
From: S A Hughes <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, October 20, 2000 10:42 PM
Subject: Re: endobronchial sodium bicarb in inhalational lung injury
> In message <000a01c03ab3$36601f40$ed4301d5@tinypc>, Simon Carley
> <[log in to unmask]> writes
> >I have had the misfortune to be involved in some pretty nasty burns
patients
> >over the last year, most with inhalational injury and poor outcomes.
> >
> >When liasing with the burns centres I have been advised on a number of
> >occasions to instill NaHCO3 endobronchially. This has been advised as
> >something to be done prior to transfer using the following:-
> >
> >Mix 4ml of 8.4% bicarb with 20ml of saline. Instill down the ET tube
using a
> >suction catheter. Wait a bit. Suck it out.
> >
> >This was a bit of a surprise as I was always taught on courses such as
ACLS
> >that bicarb is one thing you should not give down the ETT (though that
may
> >just be the 8.4% stuff). I have looked (briefly) on Medline and only
found
> >one vaguely relevant paper (see below). Has anyone else had
> >experience/evidence of the same technique being used in these patients.
The
> >rationale when I spoke to a (junior) intensivist on the burns ICU was
that
> >some of the lung injury is purported to be due to the acidification of
> >secretions by smoke.
> >
> >Simon
> >
> >Simon Carley
> >SpR in Emergency Medicine
> >Manchester Royal Infirmary
> >England
> >[log in to unmask]
> >Evidence based Emergency Medicine
> >http://www.bestbets.org
> >
> >Unique Identifier
> >94275911
> >
> >Authors
> >Bosse GM.
> >Institution
> >Department of Emergency Medicine, University of Louisville, Kentucky.
> >Title
> >Nebulized sodium bicarbonate in the
> >treatment of chlorine gas inhalation.
> >
> >Source
> >Journal of Toxicology - Clinical Toxicology. 32(3):233-41, 1994.
> >
> >Abstract
> >In this two year retrospective review, 86 cases of chlorine gas
inhalation
> >from 49 medical facilities were treated with nebulized sodium bicarbonate
on
> >the recommendation of the Kentucky Regional Poison Center. Typical
> >manifestations included cough, chest discomfort, shortness of breath, and
> >wheezing. No patients developed pulmonary edema or respiratory
insufficiency
> >requiring ventilatory support. Sixty-three cases (73.3%) were exposures
to
> >chlorine producing acid/hypochlorite mixtures. Six (7.0%) were exposed to
> >chlorine gas in industrial settings. Twelve (14.0%) were exposed to
chlorine
> >gas in swimming pool settings. Sixty-nine (80.2%) were treated and
released
> >from the emergency department. In 53 patients, clinical condition was
> >clearly improved on emergency department discharge. Seventeen (19.8%)
were
> >admitted to the hospital. All admitted patients gradually improved and
had a
> >mean hospital stay of 1.4 days (range 1 to 3 days). No patients in this
> >study deteriorated clinically after nebulized sodium bicarbonate use.
> >Nebulized sodium bicarbonate appears safe and merits prospective
evaluation
> >in the therapy of chlorine gas inhalation.
> >
> Simon,
> I think we need to look at the paper. I am a little suspicious as there
> appears to be zero mortality. In airway burns series, surely there has
> to be mortality. This abstract refers to chlorine inhalation and not
> smoke inhalation. Of course, smoke contains acidic components, so there
> may be some relevance here albeit indirect.
>
> I think that doing a study would be rather difficult because of numbers.
> In 'Arlow, I reckon we only see one or two a year.
>
> I wonder if nebulised steroid or adrenaline might be of use in reducing
> upper airway oedema. Would this make intubation easier and safer? Could
> we then administer Bicarb to reduce lung injury?
>
> Does anyone know of any animal work where this has been looked at? (will
> look myself in shortly)
> --
> Stephen Hughes SpR Harlow
>
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|