The Importance of Hyperbaric Oxygen Therapy in the Management of Carbon Monoxide Poisoning is Neglected

Year 2020, Volume: 2 Issue: 1, 23 - 28, 24.03.2020

Gülşah Çıkrıkçı Işık , Tuba Şafak Hikmet Şencanlar Yunsur Çevik

Abstract

Introduction: Carbon-monoxide (CO) is a common cause of toxicity with high morbidity and mortality. Hyperbaric oxygen (HBO) therapy or normobaric oxygen (NBO) therapy should be used for acute CO-poisoned patients, though the effects of HBO versus NBO therapy on long-term neurocognitive outcomes remain unclear. The aim of this study is to investigate the rates of HBO therapy in patients admitted to our clinic with CO poisoning.
Material and Methods: This is a retrospective, cross sectional, observational, single centered study that was conducted in a research hospital. Patient files with a diagnosis of CO poisoning based on the ICD10 codes between January 2018 to December 2019 were investigated. Demographic data, median time of stay in emergency department (ED), indication of HBO treatment and if the patient administered HBO were investigated. Carboxyhemoglobin level (COHb) greater than 25% considered as the indication of HBO. The statistical analysis was performed using the Statistical Package for the Social Sciences version 22.0. Mann–Whitney’s U test and Student t test were used for the comparison of numerical variables in independent groups. Categorical variables were analyzed using the Pearson chi-squared test. A p-value of <0.05 was considered to be statistically significant.
Results: A total of 152 files were investigated, 80 cases with CO level higher than 5% at admission were included. Number of patients with HBO indication, which considered as COHb level greater than 25%, was 30 and only 8 (26.6%) of them received HBO therapy. Average length of stay at ED was significantly higher at HBO indication positive group (p < .001). There was no difference in terms of COHb level at admission and average length of stay at ED according to HBO treatment status in patients with HBO indication; but COHb level before discharge was significantly lower at the HBO therapy administered group (p .019).
Conclusion: Our study demonstrated that most of the CO poisoned patients with HBO indication were not administered this therapy. Although the current literature provides conflicting data on the effectiveness of HBO therapy at CO poisoning, we considered that HBO should be administered in case of severe CO poisoning to reduce mortality and delayed neurological sequel. However, since CO poisoning is a common condition, there is a need for multicenter, prospective, advanced studies in which patients are followed up for a long time in terms of mortality and morbidity in order to reach consensus and create a management guide.

Keywords

Carbon monoxide poisoning; Hyperbaric oxygen, neurological sequela, mortality

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