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Hyperbaric Oxygen for Carbon Monoxide Poisoning

Patients who received hyperbaric oxygen were at significantly lower risk for cognitive sequelae than were those who received normobaric oxygen.

Although most experts recommend hyperbaric-oxygen therapy for unconscious patients with carbon monoxide poisoning, the benefit of hyperbaric oxygen in a broader spectrum of cases remains controversial. In this double-blind study from Utah, researchers randomized 152 patients with symptomatic, acute carbon monoxide poisoning to receive either hyperbaric oxygen (3 treatments during a 24-hour period) or normobaric oxygen. Patients were excluded if more than 24 hours had elapsed since exposure; about half the patients had been unconscious at some point.

The primary outcome was the incidence of cognitive sequelae, as determined by abnormalities on a series of neuropsychological tests. At 6 weeks, cognitive sequelae were significantly less frequent in the hyperbaric-oxygen group than in the normobaric-oxygen group (25% vs. 46%). A significant difference persisted at 12 months (18% vs. 33%).

Comment: These authors concluded that hyperbaric oxygen generally should be used in patients with symptomatic, acute carbon monoxide poisoning. An editorialist agrees that this study's findings further support the use of hyperbaric oxygen, but he notes that the optimal dose, number of sessions, and time window for treatment remain unclear.

— Allan S. Brett, MD

Published in Journal Watch General Medicine October 15, 2002

Citation(s):

Weaver LK et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med 2002 Oct 3; 347:1057-67.

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• Medline abstract (Free)

Thom SR. Hyperbaric-oxygen therapy for acute carbon monoxide poisoning. N Engl J Med 2002 Oct 3; 347:1105-6.

• Original article (Subscription may be required)
• Medline abstract (Free)