HBO in CO

 Q: What are the indications for hyperbaric oxygen in carbon mono-oxide (CO) poisoning?

Answer: There are two major interventions required in the acute management of CO poisoning.

1. Removal of the source
2. Oxygen

Hyperbaric oxygen if available should be considered in the following situations:

• CO level >25% 
• CO level >20% in pregnant patients 
• Loss of consciousness 
• PH less than 7.1 by arterial blood gas (ABG) 
• End-organ ischemia evident by EKG changes, chest pain, encephalopathy, and others

#toxicology

References:

1. Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med 1998; 339:1603. 

2. Hampson NB, Dunford RG, Kramer CC, Norkool DM. Selection criteria utilized for hyperbaric oxygen treatment of carbon monoxide poisoning. J Emerg Med 1995; 13:227. 

3. Huang CC, Ho CH, Chen YC, et al. Hyperbaric Oxygen Therapy Is Associated With Lower Short- and Long-Term Mortality in Patients With Carbon Monoxide Poisoning. Chest 2017; 152:943.

4. Elkharrat D, Raphael JC, Korach JM, et al. Acute carbon monoxide intoxication and hyperbaric oxygen in pregnancy. Intensive Care Med 1991; 17:289.