From the Guidelines
Hyperbaric oxygen therapy should be considered in all cases of serious acute carbon monoxide poisoning, as it has been shown to reduce the incidence of cognitive sequelae and improve outcomes. The use of hyperbaric oxygen therapy in carbon monoxide poisoning is supported by several studies, including a study by Weaver and colleagues published in 2002 1, which found that patients who received hyperbaric oxygen therapy had approximately half the rate of cognitive sequelae at 6 weeks, 6 months, and 12 months after treatment compared to those who received normobaric oxygen.
The optimal dose and frequency of hyperbaric oxygen treatments for acute carbon monoxide poisoning remain unknown, but a common regimen includes 1-3 sessions at 3.0 atm abs, with the option to retreat persistently symptomatic patients up to a maximum of three treatments 1. It is essential to note that hyperbaric oxygen therapy should not be withheld because a patient is doing well clinically and appears not likely to die from the event, as the goal of hyperbaric treatment is the prevention of long-term and permanent neurocognitive dysfunction, not enhancement of short-term survival rates.
Some special populations, such as pregnant women and young children, are at risk for permanent sequelae of carbon monoxide poisoning, and adult treatment criteria are generally applied to these patients 1. In pregnancy, fetal distress and fetal death are special concerns in carbon monoxide poisoning, and hyperbaric oxygen therapy has been administered safely to pregnant women, although there are no prospective studies of efficacy.
Key points to consider when using hyperbaric oxygen therapy for carbon monoxide poisoning include:
- The therapy should be administered by trained healthcare professionals in a hospital or specialized center, as it requires careful monitoring and is contraindicated in certain conditions like untreated pneumothorax.
- Side effects can include ear and sinus pain, temporary nearsightedness, claustrophobia, and rarely oxygen toxicity.
- The decision to use hyperbaric oxygen therapy should be made on a case-by-case basis, taking into account the severity of the poisoning, the patient's overall health, and the availability of hyperbaric oxygen therapy facilities.
- All patients treated for acute accidental carbon monoxide poisoning should be seen in clinical follow-up 1-2 months after the event to monitor for potential long-term cognitive impairments.
From the Research
Hyperbaric Oxygen Therapy Overview
- Hyperbaric Oxygen Therapy (HBOT) is a medical treatment that involves administering 100% oxygen at increased atmospheric pressure to enhance oxygen delivery to tissues 2.
- HBOT has been utilized for a wide range of medical conditions, including severe infections, non-healing wounds, and COVID-19 2, 3, 4.
Clinical Applications
- HBOT has been shown to enhance tissue oxygenation, reduce inflammation, and modulate oxidative stress, thereby improving clinical outcomes in patients with severe COVID-19 2.
- The therapy's ability to increase dissolved oxygen levels in blood and tissues makes it particularly beneficial in conditions like COVID-19, where hypoxemia and inflammation are prominent 2.
- HBOT can be used as an elective treatment for wound healing applications, and many hyperbaric centers exist to treat elective problems adjunctively 4.
Mechanisms and Indications
- The combined action of hyperoxia and hyperbaric pressure leads to significant improvement in tissue oxygenation, targeting both oxygen and pressure sensitive genes, resulting in improved mitochondrial metabolism with anti-apoptotic and anti-inflammatory effects 3.
- HBOT is the primary treatment for arterial gas embolism, decompression sickness, and acute carbon monoxide poisoning 5.
- HBOT has potential applications in inflammatory and systemic maladies, COVID-19, and cancer, and may exert antimicrobial, immunomodulatory, and angiogenic properties 6.
Availability and Capabilities
- A survey of hyperbaric centers in the United States found that only 11.9% of centers had the equipment, staff, and capabilities necessary to treat high-acuity patients, including those with arterial gas embolism and decompression sickness 5.
- There is a need for more hyperbaric centers to be equipped to accommodate emergency cases quickly and safely 5.