Pacific partnership 2010: Anesthesia support aboard the USNS Mercy humanitarian civic assistance.

INTRODUCTION: The USNS Mercy has been integral in providing humanitarian and civic assistance as part of the Department of Defense's ongoing Combatant Commander Theater Security Cooperation Plans. The purpose of this study was to critically assess patient demographics and procedures performed to provide guidance for future missions. METHODS: A retrospective review was performed on a cohort of 825 surgical patients who underwent surgery during a 4-month period during Pacific Partnership 2010. Patient demographics, anesthesia exam findings, comorbidities, and surgical data were compared among the mission sites. RESULTS: Of the 825 patients, the mean age ranged from 39.7 to 24.7 with a statistical difference between Vietnam (39.7, p < 0.0087 for all tests) and the remaining sites. Poorer health by American Society of Anesthesiologist grading was noted in Vietnam (1.61) as compared to patients in Cambodia (1.21, p < 0.001) and Timor-Leste (1.40, p = 0.001). No difference in complication rates was noted. DISCUSSION: The reason for apparent differences in age or health status by site weren't clearly explained, but these differences had no bearing on surgical outcome. CONCLUSION: Analysis of anesthesia data compiled during Pacific Partnership 2010 provided meaningful data for future humanitarian efforts at these sites.

Increased long-term mortality among survivors of acute carbon monoxide poisoning.

OBJECTIVE: Recent data suggest that patients surviving acute carbon monoxide (CO) poisoning (COP) may have increased risk for long-term mortality. The objective of this study was to analyze long-term mortality of a large population of CO-poisoned patients treated at one medical center over three decades. DESIGN: Retrospective cohort study of patients treated with hyperbaric oxygen and surviving the acute poisoning episode. Long-term mortality was compared to a standard population. Comparison of mortality within the cohort by clinical indicators of poisoning severity was assessed using Cox proportional hazards regression analysis. SETTING: Regional referral center for hyperbaric treatment of COP. PATIENTS: One thousand seventy-three patients aged >or=18 years treated from 1978 to 2005. INTERVENTIONS: All patients received hyperbaric oxygen treatment. MEASUREMENTS AND MAIN RESULTS: During 11,741 person-years of follow-up, 162 subjects died. The expected number of deaths was 87 (standardized mortality ratio [SMR]), 1.9; 95% confidence interval [CI], 1.6-2.2). Most of the excess mortality was in the group treated initially for intentional COP (58 excess deaths; SMR, 3.7; 95% CI, 2.9-4.6) vs. those treated for accidental COP (17 excess deaths; SMR, 1.3; 95% CI, 1.01-1.6). For the entire cohort, the major causes of death with significantly raised mortality were mental and psychiatric disorders, injuries, and violence. More specific causes of death with significantly raised mortality were alcoholism, motor vehicle accidents with pedestrians, motor vehicle accidents of unspecified type, accidental poisonings, and intentional self-harm. Within cohort comparisons showed that no difference in survival was observed by measure of CO poisoning severity, after controlling for age at poisoning, sex, race, and intent of CO poisoning. CONCLUSIONS: Adult survivors of acute CO poisoning treated with hyperbaric oxygen were at increased risk for long-term mortality. Such patients should be followed closely after discharge with consideration given to psychiatric and/or neurocognitive evaluation, as appropriate.

Risk factors for short-term mortality from carbon monoxide poisoning treated with hyperbaric oxygen.

OBJECTIVE: Carbon monoxide (CO) poisoning is common in the United States, accounting for approximately 2,700 deaths annually. Few publications have described the mortality rate of CO-poisoned patients who survive to reach a hospital and die despite maximal medical care. Further, while risk factors for cognitive sequelae in survivors of CO poisoning have become clearer recently, factors associated with death are less well defined. This study was conducted to 1) determine the short-term mortality risk for patients treated with hyperbaric oxygen for CO poisoning, and 2) determine whether any factors related to the poisoning episode are predictive of mortality. DESIGN/SETTING/PATIENTS: A departmental database and medical records of 1,505 consecutive patients treated with hyperbaric oxygen at a single institution from 1978 to 2005 were reviewed. MEASUREMENTS: Demographic and clinical data were extracted for analysis. Mortality data, including cause of death, were obtained through a search of the National Death Index of the National Center for Health Statistics. MAIN RESULTS: A total of 38 patients experienced short-term mortality from their episode of CO poisoning, yielding a death rate of 2.6% in medically treated patients. Characteristics significantly associated with mortality included fire as a source of CO, loss of consciousness, carboxyhemoglobin level, arterial pH, and presence of endotracheal intubation during hyperbaric treatment. CONCLUSIONS: The mortality rate for medically treated CO-poisoned patients in this series was 2.6%, similar to the limited combined experience previously reported in the literature. Factors most strongly associated with mortality were severe metabolic acidosis and need for endotracheal intubation.

Carboxyhemoglobin levels in carbon monoxide poisoning: do they correlate with the clinical picture?

OBJECTIVE: It is commonly written that carboxyhemoglobin (COHb) measurements correlate with the clinical presentation of patients poisoned with carbon monoxide (CO). However, the evidence supporting this concept is scanty. The present study was performed to analyze COHb measurements in a large population of patients with CO poisoning to determine whether clinically significant correlates exist. METHODS: Records of all patients treated with hyperbaric oxygen for acute CO poisoning at a single private academic medical center from 1978 to 2005 were reviewed. The COHb measurements were analyzed with regard to sex, age, source of CO, loss of consciousness, endotracheal intubation, arterial pH, and death. RESULTS: Data from 1603 CO-poisoned patients were reviewed, and 1407 were included in the final analysis. Statistically higher COHb measurements were associated with male sex (24.2% +/- 11.2% vs 21.5% +/- 11.6), adult age range (24.0% +/- 11.0% vs 19.5% +/- 10.3%), poisoning by CO from fires (25.7% +/- 12.1%) or motor vehicles (22.7% +/- 24.7%), loss of consciousness (24.3% +/- 12.2% vs 22.3% +/- 9.4%), lower arterial pH, and death (32.1% +/- 12.8% vs 23.1% +/- 0.9%). CONCLUSIONS: Despite the fact that statistically significant differences in average COHb measurements were seen with regard to a number of variables, the clinical significance of these differences appeared to be minimal. Moreover, the utility of COHb measurements as predictors of clinical status in CO poisoning was not apparent. At least in part, this likely relates to delay and interval oxygen administration before obtaining COHb measurements.