From the Guidelines
Carbon monoxide poisoning with normal pH and PaO2 levels still requires immediate treatment with high-flow oxygen therapy, and the standard approach is 100% oxygen via a non-rebreather mask for at least 6 hours, as recommended by the American Journal of Respiratory and Critical Care Medicine 1.
Treatment Approach
The goal of treatment is to displace carbon monoxide from hemoglobin and reduce the risk of long-term neurological complications.
- Administer 100% oxygen via a non-rebreather mask for at least 6 hours to increase the oxygen concentration gradient and displace carbon monoxide from hemoglobin.
- For severe cases or pregnant patients, hyperbaric oxygen therapy (HBOT) at 2.5-3.0 atmospheres for 90-120 minutes may be recommended, even with normal lab values, as it accelerates carbon monoxide elimination and reduces long-term neurological complications 1.
Monitoring and Follow-up
- Monitor carboxyhemoglobin (COHb) levels until they fall below 5% to ensure that the treatment is effective.
- Ensure cardiac monitoring for arrhythmias, as carbon monoxide poisoning can cause cardiac complications.
- Assess for neurological symptoms that may develop or persist after treatment, such as headache, dizziness, and confusion.
- Patients should be evaluated for delayed neurological sequelae 2-4 weeks after exposure, regardless of initial presentation, to detect any potential long-term effects of carbon monoxide poisoning 1.
Special Considerations
- In cases of intentional CO poisoning, consider toxicology screening to assess for toxic coingestions, as coingestion of other substances can worsen the outcome 1.
- If the CO exposure is believed to be from a house fire, consider empiric treatment for cyanide poisoning, as severe metabolic acidosis correlates with a high short-term mortality rate in CO-poisoned patients 1.