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Indications for Hyperbaric Oxygen Therapy in Carbon Monoxide Poisoning

Description

The role of hyperbaric oxygen therapy in patients with carbon monoxide poisoning is controversial. Hyperbaric oxygen provides tissue oxygenation by dissolving oxygen in plasma, shortens the half-life of carboxyhemoglobin from 240-320 minutes to 20 minutes, and dissociates carbon monoxide from cytochrome c oxidase. Results in clinical studies have been conflicting, but benefits may be seen in patients with severe acute symptoms, loss of consciousness or neurological abnormality.


 

Indications for hyperbaric oxygen:

(1) transient loss of consciousness, coma, seizures, focal neurological impairment, abnormal gait or abnormal psychometric testing

(2) cardiovascular instability, ECG evidence of ischemia or arrhythmia

(3) respiratory failure and/or pulmonary edema

(4) severe metabolic acidosis

(5) peak carboxyhemoglobin > 25% even with minor symptoms (headache, nausea, etc.)

(6) children or pregnant women, if carboxyhemoglobin > 20% and/or if persistently symptomatic

 

Contraindications:

(1) prolonged resuscitation with external cardiac compression

(2) pulmonary disorders (emphysema, chronic bronchitis)

 

Patients with less severe poisoning should be treated with 100% oxygen.

 

While a single hyperbaric session may reverse acute effects of the carbon monoxide poisoning, multiple sessions may be necessary to reduce delayed neuropsychological sequelae.

 


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