From the Guidelines
For high carboxyhemoglobin levels in burn patients, the primary treatment is administration of 100% normobaric oxygen, which should be initiated immediately, as recommended by the American Journal of Respiratory and Critical Care Medicine 1. This approach is crucial in reducing the half-life of carboxyhemoglobin and improving tissue oxygenation.
- The administration of 100% oxygen via a non-rebreather mask or mechanical ventilation, if required, is the cornerstone of treatment, as it competitively displaces carbon monoxide from hemoglobin binding sites, thereby reducing the half-life of carboxyhemoglobin.
- Additionally, fluid resuscitation following established burn protocols, such as the Parkland formula, is essential to maintain adequate tissue perfusion and oxygen delivery.
- Correction of metabolic acidosis with sodium bicarbonate may be necessary in severe cases, and bronchodilators like albuterol can be used if bronchospasm is present.
- Careful monitoring of cardiac function is also important, as myocardial injury is a common complication of carbon monoxide poisoning.
- Furthermore, antioxidant therapy with N-acetylcysteine may be considered to reduce oxidative stress, although its use should be guided by the most recent and highest quality evidence available. It is also critical to identify and eliminate the source of carbon monoxide exposure to prevent re-exposure, as emphasized in the guidelines for the management of carbon monoxide poisoning 1.
From the Research
Treatment Options for High Carboxyhemoglobin Levels
Besides hyperbaric oxygen chamber, there are other treatment options for high carboxyhemoglobin levels in burn patients:
- High flow nasal cannula oxygen therapy: This method has been shown to be effective in reducing carboxyhemoglobin levels, with a mean half-life of 36.8 minutes 2.
- Normobaric oxygen therapy: This is the standard of care for treatment of carbon monoxide intoxication, and can decrease the half-life of carboxyhemoglobin from 5 hours to 1 hour 3.
- Hydroxocobalamin treatment: This is used to treat cyanide poisoning, which can occur concurrently with carbon monoxide poisoning, and can also help reduce carboxyhemoglobin levels 3.
Considerations for Burn Patients
Burn patients with high carboxyhemoglobin levels are at risk for worse outcomes, including increased hospital and ICU length of stay, ventilator days, and in-hospital mortality 4.
- Elevated carboxyhemoglobin levels on admission can be a predictor of worse outcomes in burn patients.
- The presence of elevated carboxyhemoglobin levels suggests a higher need for resource utilization during hospital admission.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy has been shown to be effective in treating carbon monoxide poisoning, and can reduce the half-life of carboxyhemoglobin to 20 minutes 3, 5, 6.
- Hyperbaric oxygen therapy can provide a pharmacokinetic advantage over normobaric oxygen therapy in eliminating carboxyhemoglobin.
- Randomized controlled trials have shown hyperbaric oxygen to be the only efficacious therapy for acute carbon monoxide poisoning if delayed neurological sequelae are to be minimized 5.