Hyperbaric oxygen in the treatment of carbon monoxide poisoning

Carbon monoxide, a byproduct of incomplete hydrocarbon combustion, has been responsible for many accidental poisonings worldwide. The signs and symptoms of poisoning are diverse, ranging from headache, dizziness, and confusion to cardiac and neurological disturbances. Oxygen is the cornerstone of treatment, because it accelerates the dissociation of carbon monoxide from heme proteins. The role of hyperbaric oxygen in the treatment of CO poisoning is still questionable. Only a few randomized, controlled studies have been conducted, and their results are inconsistent. In the present review, we discuss the conclusions of four randomized controlled studies and propose a hyperbaric oxygen treatment protocol based on these conclusions.     

高压氧治疗一氧化碳中毒的护理体会

目的：探讨一氧化碳（CO）中毒患者高压氧治疗的护理措施。方法：对本院28例高压氧治疗的急性CO中毒患者的护理经验进行总结。结果：经过精心护理,28例中,治愈26例,好转2例。结论：早期高压氧治疗CO中毒,可以提高一氧化碳中毒患者的治愈率,减少或减轻迟发性脑病的发生,同时在整个高压氧治疗过程中做好每个环节的护理,是一氧化碳中毒患者救治成功的关键。     

高压氧联合依达拉奉和尼莫地平治疗重度急性一氧化碳中毒的临床分析

目的 探讨高压氧联合依达拉奉和尼莫地平治疗重度急性一氧化碳(CO)中毒的疗效.方法 将60例重度急性CO中毒患者随机分为对照组和治疗组各30例,对照组予以高压氧、甘露醇、纳洛酮、胞二磷胆碱等治疗;治疗组在对照组治疗的基础上加用依达拉奉30 mg静脉点滴2次/d,尼莫地平30 mg 3次/d,疗程均为14 d.结果 治疗组平均昏迷时间(3.54±1.62)h,对照组平均昏迷时间(6.52±2.08)h,治疗组明显短于对照组(P<0.05);治疗组有效率96.6%,对照组有效率73.3%,治疗组明显高于对照组(P<0.05);治疗组迟发性脑病6.9%,对照组迟发性脑病36.4%,治疗组明显低于对照组(P<0.05).结论 高压氧联合依达拉奉和尼莫地平治疗重度急性CO中毒疗效显著.     

Recipients of hyperbaric oxygen treatment for carbon monoxide poisoning and exposure circumstances

Background

Unintentional carbon monoxide poisoning is preventable. Severe cases are often referred for hyperbaric oxygen treatment. To guide prevention efforts and treatment practices, this study provides some of the most detailed current information about patients with carbon monoxide poisoning who have been treated at hyperbaric facilities across the United States and the circumstances surrounding their exposures. This study can help improve efforts to prevent carbon monoxide poisoning and enhance treatment practices.

Methods

From August 2008 to January 2010, nonidentifiable, patient-level data were reported by 87 hyperbaric facilities in 39 states via an online reporting system. This reporting system was developed collaboratively by the Undersea and Hyperbaric Medical Society and the Centers for Disease Control and Prevention.

Results

Among the 864 patients reported to receive hyperbaric oxygen treatment for unintentional, non–fire-related, carbon monoxide poisoning, most of the patients were white men aged between 18 and 44 years. Only 10% of patients reported the presence of a carbon monoxide alarm at their exposure location, and 75% reported being part of a group exposure. Nineteen patients (2%) reported a prior carbon monoxide exposure. About half (55%) of the patients treated were discharged after treatment; 41% were hospitalized.

Conclusions

The findings in this report expand the knowledge about patients with carbon monoxide poisoning. These results suggest that prevention efforts, such as educating the public about using carbon monoxide alarms and targeting the most at-risk populations, may help reduce the number of exposures, the number of persons with chronic cognitive sequelae, and the resulting burden on the health care system.     

Selection criteria utilized for hyperbaric oxygen treatment of carbon monoxide poisoning

Medical directors of North American hyperbaric oxygen (HBO) facilities were surveyed to assess selection criteria applied for treatment of acute carbon monoxide (CO) poisoning within the hyperbaric medicine community. Responses were received from 85% of the 208 facilities in the United States and Canada. Among responders, 89 monoplace and 58 multiplace chamber facilities treat acute CO poisoning, managing a total of 2,636 patients in 1992. A significant majority of facilities treat CO-exposed patients with coma (98%), transient loss of consciousness (LOC) (77%), ischemic changes on electrocardiogram (91%), focal neurologic deficits (94%), or abnormal psychometric testing (91%), regardless of carboxyhemoglobin (COHb) level. Although 92% would use HBO for a patient presenting with headache, nausea, and COHb 40%, only 62% of facilities utilize a specified minimum COHb level as the sole criterion for HBO therapy of an asymptomatic patient. When COHb is used as an independent criterion to determine HBO treatment, the level utilized varies widely between institutions. Half of responding facilities place limits on the delay to treatment for patients with only transient LOC. Time limits are applied less often in cases with persistent neurologic deficits. While variability exists, majority opinions can be derived for many patient selection criteria regarding the use of HBO in acute CO poisoning.     

高压氧用于一氧化碳中毒患者的护理

对34例一氧化碳中毒患者进行高压氧治疗及全方位护理,经过及时的救治及有效护理,33例痊愈,无后遗症,1例因抢救无效死亡。     

重症CO中毒性脑病的MRI表现动态研究

目的:探讨重症CO中毒性脑病不同时期的MRI表现。材料和方法:分析了10例重症CO中毒患者不同时期的MRI表现。结果:急性期主要表现为两侧大脑半球皮层及皮层下白质广泛脑水肿;1个月左右复查主要表现为大脑皮层软化和皮质下白质脱髓鞘,增强扫描可见颞、顶、枕叶广泛强化信号灶;恢复期主要表现为弥漫性脑萎缩。结论:MRI动态观察对确定治疗方案、高压氧疗程及判断预后有重要意义。     

Hyperbaric oxygen therapy in carbon monoxide poisoning in pregnancy: Maternal and fetal outcome

ObjectiveCloser monitoring and treatment is vital for pregnant carbon monoxide (CO) poisoning cases due to fetal poisoning component. Permanent damage can occur in both the mother and the baby. It may cause stillbirth even though no serious clinical symptoms occur in the mother. Hyperbaric oxygen (HBO) treatment is advised for all pregnant patients regardless of their clinical symptoms. Pregnant CO poisoning patients that received HBO treatment and their fetal status were evaluated in this study.MethodsPregnant patients poisoned with CO treated in the same hyperbaric clinic were evaluated. Pregnant patients that received HBO treatment in a multiplace chamber were evaluated in terms of clinical status, demographic structure, laboratory tests, fetal effects and progress of the fetus until birth and 6 months postpartum.ResultsA total number of 32 pregnant cases were treated. COHb values were over 20% (min 6.9- max 40.2) in 23 patients, 11 patients had a history of syncope. All patients took HBO treatment under 2.4 ATA pressure for 120 min. 3 patients received more than 1 session of HBO treatments due to fetal stress; all other cases took 1 session of HBO treatment. No spontaneous abortus occurred in early follow-ups; only 4 babies were born prematurely. 2 of the babies were lost in the early phases after birth, due to causes non-related to CO poisoning complications (cyanotic heart disease, necrotising enterocolitis). No significant difference were observed in the comparison of laboratory results of patients with syncope and of those who did not have syncope and comparison of patients with COHb value higher than 20% and patients with COHb value lower than 20% (p > 0.05).ConclusionHBO is not advisable for pregnant patients except for CO poisoning. In this study it is observed that HBO treatment under 2.4 ATA pressure for 120 min has no harmful effects on the mother and the fetus. It is observed that continuation of HBO treatment in the cases with fetal distress findings has beneficial effects. COHb levels and syncope were shown to have no significant effect on clinical symptoms and on blood tests.