From the Research
Introduction to Carbon Monoxide Poisoning Treatment
Carbon monoxide (CO) poisoning is a serious condition that requires immediate treatment. The primary goal of treatment is to remove CO from the body and restore oxygen delivery to tissues.
Treatment Options
Oxygen Therapy
The mainstay of treatment for CO poisoning is oxygen therapy, which can be administered in two forms: normobaric oxygen (NBO) and hyperbaric oxygen (HBO) 1, 2, 3, 4.
- NBO is typically administered at a dose of 100% oxygen via a non-rebreather mask or endotracheal tube.
- HBO is administered in a hyperbaric chamber at a pressure of 2-3 atmospheres absolute (ATA) with 100% oxygen.
Hyperbaric Oxygen Therapy (HBOT)
HBOT is often considered for patients with severe CO poisoning, including those with neurologic deficits, unconsciousness, cardiac ischemia, pregnancy, and/or a very high carboxyhemoglobin (COHb) concentration 3, 4.
- The ideal regimen of oxygen therapy has yet to be determined, and significant controversy exists regarding HBOT treatment protocols.
Dosing and Duration
The dosing and duration of oxygen therapy vary depending on the severity of the poisoning and the patient's response to treatment.
- NBO is typically administered for 4-6 hours or until the COHb level is less than 5% 3.
- HBOT is typically administered for 30-60 minutes at 2-3 ATA, with multiple treatments given over a 24-hour period if necessary.
Alternative Treatments
Alternative or supplementary pharmacological treatments, such as methylene blue, are being explored for the prevention of delayed encephalopathy after acute CO poisoning 5.
- Methylene blue has been shown to have protective effects against delayed encephalopathy in animal studies.
Caveats and Considerations
- The diagnosis of CO poisoning can be challenging due to the nonspecific symptoms, and a high index of suspicion is necessary to make the diagnosis.
- Smoke intoxication must be considered in the differential diagnosis.
- Therapeutic decision-making is directed toward the avoidance of sequelae such as cognitive dysfunction and cardiac complications, and the reduction of mortality.
- High-quality, prospective, randomized trials are needed to determine the efficacy of HBOT in the treatment of CO poisoning.