Ice Hockey Lung - A Case Of Mass NO2 Poisoning In The Czech Republic
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| Year of publication | 2012 |
| Type | Appeared in Conference without Proceedings |
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| Description | Nitric dioxide and carbon monoxide are toxic gases. Both are combustion products of gasoline-, diesel- or propane-butane-powered ice resurfacing machines. An accumulation of the gases may occur under certain conditions. Exposure to these gases in an indoor ice rink may result in damage to the lung tissue and severe pneumonitis called "ice hockey lung". The main symptoms of the disease are cough, dyspnoea, headache and haemoptysis. In severe poisoning, respiratory insufficiency or even respiratory distress syndrome may develop. The duration of the disease usually does not exceed 4-6 days with complete recovery in most cases. We report a case of nitric dioxide and carbon monoxide poisoning in November 2010 in the Czech Republic. Fifteen ice hockey players were treated at the Department of Respiratory Diseases in Brno Faculty Hospital in November 2010 and then followed up till November 2011. In these patients, nitric dioxide and carbon monoxide poisoning was diagnosed in cooperation with the regional sanitary service. Most of the patients developed symptoms within 4 hours following the exposure and complained mostly of dyspnoea, cough and chest pain. Three out of the 15 patients were treated as inpatients for severe symptoms and hypoxaemia. Pathological chest X-ray (CXR) and CT scan findings were present in 5 patients; pulmonary function tests showed abnormality in 6 patients. The examination of carbonylhaemoglobin arterial blood level showed an increase in 4 patients, the levels of methaemoglobin were normal in all patients. We present a list of symptoms, types of CXR findings, results of pulmonary function tests and of further laboratory blood tests. Moreover, exhaled nitric oxide levels (FeNO) were measured and showed an elevation in 5 out of 8 patients. Following the current recommendations, most of the patients were treated with corticosteroids (intravenous, oral or inhaled). Methylxanthines, antibiotics and oxygen were also frequently used, often in combination. Complete recovery with restoration of pulmonary function and normalization of CXR findings occured within 4-6 days after exposure in all patients but one. Obstructive ventilatory disorder persisted in one patient. FeNo levels decreased in 7 out of 8 patients. The replacement of the ice resurfacing machine in the ice skating arena was arranged for. There is no consensus on treatment of ice hockey lung and the usefulness of corticosteroids remains unclear. However, our results seem to vindicate the use of corticosteroids. Non-electric-powered ice resurfacing machines should not be used in indoor ice rinks. |