Human chlorine gas exposition and its management – an umbrella review on human data

Abstract

Even though exposure to chlorine gas has been quite frequent in the past few decades, no specific antidotes exist. This umbrella review aimed to investigate possible recommendations for treatment after a chlorine gas exposure. A published systematic review protocol that adapted the existing Navigation Guide methodology was used for including studies without comparator. Using PubMed, Web of Science, Google scholar for all potentially relevant systematic reviews, two authors independently included papers and extracted data. The risk of bias and quality of evidence was assessed by two independent review teams blinded to each other. A qualitative summary of the study findings was conducted for this overview. There were a total of 31 studies, from 4 systematic reviews, that met the inclusion criteria, comprising 3567 reported cases, with only two studies with comparators. Six studies reported pre-hospital management of patients after exposure to chlorine gas. With respect to the treatment, the most used were oxygen therapy, endotracheal intubation, β2-agonists, and corticosteroids. This review found a high quality of evidence for the effectiveness of pre-hospital management (i.e. exposure cessation) on survival at hospital discharge after exposure to chlorine gas. Oxygen administration was effective with moderate quality of evidence, as well as other types of treatment (e.g. β2, corticosteroids), but with a low level of evidence. This umbrella review highlighted the low level of evidence for existing treatments of chlorine gas poisoning. This project was supported by the French Pays de la Loire region and Angers Loire Métropole (TEC-TOP project). There is no award/grant number. The review protocol was registered on PROSPERO under the registration number CRD42021231524

Keywords:

• Toxicology
• chlorine gas
• chlorine exposure
• chlorine management
• umbrella review

Acknowledgments

We thank Dr. Gaël Le Roux and Dr. Corinne Dano, both affiliated with CHU Angers, University of Angers, and Poisoning Control Center, Clinical Data Center of Angers in France, for their review on the manuscript.

Author Contributors

The systematic review was designed by AD and GS. GC, JBBR, JB and NRD were significantly involved in the selection process, data extraction, and quality assessment of the articles included in this review. AN and GC wrote the manuscript. AD and GS significantly contributed to the improvement of the first draft of the manuscript. All authors reviewed and commented on the final manuscript. All authors read and approved the final manuscript to be published.

Declaration of interest

The authors declare that they have no competing interests associated with this manuscript.

Supplemental material

Supplemental data for this article is available online here.

Additional information

Funding

This project was supported by the French Pays de la Loire region and Angers Loire Métropole (TEC-TOP project). There is no award/grant number. None of the mentioned sources of funding had any role in the design, analysis or writing of this article.