Neurological Sequelae of Carbon Monoxide Poisoning: Role of Hyperbaric Oxygen

Severe carbon monoxide (CO) poisoning causes fulminant deaths in common environment as well as neurological sequelae to survivors. Prevention of delayed neurological syndrome (DNS) after exposure to CO, the most important sequela, is based up to date on hyperbaric oxygen administration. Nevertheless, its use remains controversial due to the lack of evidence regarding its efficacy. The aim of this review is to report therapies under investigation for preventing or improving DNS, some of them with promising results in humans.

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Impact of Hyperbaric Oxygen Therapy on Subsequent Neurological Sequelae Following Carbon Monoxide Poisoning

Journal of Clinical Medicine ◽

10.3390/jcm7100349 ◽

2018 ◽

Vol 7 (10) ◽

pp. 349 ◽

Cited By ~ 4

Author(s):

Chien-Cheng Huang ◽

Chung-Han Ho ◽

Yi-Chen Chen ◽

Chien-Chin Hsu ◽

Yi-Fong Wang ◽

...

Keyword(s):

Carbon Monoxide ◽

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Carbon Monoxide Poisoning ◽

Population Based ◽

Chronic Obstructive ◽

Monthly Income ◽

Neurological Sequelae ◽

Increased Risk

The purpose of this study was to evaluate the effects of hyperbaric oxygen therapy (HBOT) on reducing neurological sequelae (NS) in patients with carbon monoxide poisoning (COP). Using a nationwide database of insurance claims in Taiwan, we conducted a population-based cohort study to identify 24,046 patients with COP diagnosed between 1999 and 2012, including 6793 (28.2%) patients who received HBOT and 17,253 (71.8%) patients who did not. We followed the two cohorts of patients and compared the occurrence of NS. The two cohorts had similar sex ratios, but patients who received HBOT were younger (34.8 ± 14.8 vs. 36.1 ± 17.2 years, p < 0.001). Patients who received HBOT had a higher risk for NS (adjusted hazard ratio [AHR]: 1.4; 95% confidence interval [CI]: 1.4–1.5), after adjusting for age, sex, underlying comorbidities (hypertension, diabetes, chronic obstructive pulmonary disease, hyperlipidemia, malignancy, coronary artery disease, congestive heart failure, liver disease, renal disease, connective tissue disease, human immunodeficiency virus [HIV] infection, and alcoholism), monthly income, suicide, drug poisoning, and acute respiratory failure. We observed similar findings when we stratified the patients by age, sex, underlying comorbidities, and monthly income. The increased risk was most prominent in the first 2 weeks (AHR: 2.4; 95% CI: 2.1–2.7) and remained significant up to 6 months later (AHR: 1.6; 95% CI: 1.4–1.7). The risk for NS was higher in patients with COP who received HBOT than in those who did not, even after considering the possible impact of longer observation periods on survivors. Further studies that included the potential confounding factors we did not measure are needed to confirm findings in this study.

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Hyperbaric oxygen decreases the incidence of neurological sequelae in acute carbon monoxide poisoning

Thorax ◽

10.1136/thorax.58.2.126 ◽

2003 ◽

Vol 58 (2) ◽

pp. 126-126

Author(s):

S Shah

Keyword(s):

Carbon Monoxide ◽

Hyperbaric Oxygen ◽

Carbon Monoxide Poisoning ◽

Neurological Sequelae ◽

Acute Carbon Monoxide Poisoning

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‘Dexamethasone–mannitol–hyperbaric oxygen’ combination therapy is effective for patients with delayed neurological sequelae after acute carbon monoxide poisoning

Neurology Asia ◽

10.54029/2021zsy ◽

2021 ◽

Vol 26 (3) ◽

pp. 545-552

Author(s):

Dazhi Guo ◽

Ruijun Xue ◽

Ya’nan Qi ◽

Yan Lv ◽

Xiang'en Meng ◽

...

Keyword(s):

Carbon Monoxide ◽

Combination Therapy ◽

Hyperbaric Oxygen ◽

Mmse Score ◽

Remission Rate ◽

Carbon Monoxide Poisoning ◽

Control Group ◽

Neurological Sequelae ◽

Nihss Score ◽

Experimental Group

Background: Delayed neurological sequelae after carbon monoxide poisoning (DNS) is the most common neuropsychiatric sequelae of acute carbon monoxide (CO) poisoning. At present, there is no effective method to prevent or treat DNS. This study was performed to evaluate the efficacy of the combined application of dexamethasone, mannitol and hyperbaric oxygen (HBO2) in the treatment of patients with DNS. Methods: A total of 312 patients with DNS were recruited and randomly assigned into the experimental group (10 mg/day dexamethasone, 100 ml/12 h mannitol + HBO2 therapy) and the control group (HBO2 only). All patients received conventional treatment. We used the Mini-Mental State Examination (MMSE) scale to assess the cognitive function, the remission rate (RR) to assess the clinical efficacy and the National Institutes of Health Stroke Scale (NIHSS) to assess the neurological function. In addition, we measured myelin basic protein (MBP) levels in the cerebrospinal fluid (CSF) to assess the extent of nerve damage. Results: Compared with the control group, the experimental group had significantly increased average MMSE score (P = 0.035) and RR (P = 0.021), significantly reduced average NIHSS score (P = 0.028) and significantly lower MBP level in CSF (P = 0.0019) after 4 weeks of treatment. Furthermore, compared with patients who received dexamethasone alone, patients who received dexamethasone and mannitol had higher average MMSE score (P = 0.012) and RR (P = 0.038) and lower average NIHSS score (P = 0.022) and MBP level in CSF (P = 0.002). Dexamethasone and mannitol combined with HBO2 did not significantly increase adverse effects. Conclusion: The combination therapy of dexamethasone–mannitol–HBO2 is better in treating DNS than HBO2 alone and HBO2 combination with dexamethasone, and it can be used as a potential new therapy in the future.

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Hyperbaric Oxygen Therapy for Carbon Monoxide Poisoning can Lead a Perfect Result: A Case Report

10.33844/cjm.2021.60510 ◽

2021 ◽

Keyword(s):

Carbon Monoxide ◽

Female Patient ◽

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Carbon Monoxide Poisoning ◽

Neurological Complications ◽

Treatment Modalities ◽

Conventional Medical Treatment

Carbon monoxide poisoning (COP) is a common emergency worldwide, especially in the wintertime. It is known to cause serious morbidities, resulting in high mortality risk. COP is also reported to result in neurological complications for which hyperbaric oxygen therapy is likely to offer some benefits, which certainly makes it one of the potential treatment modalities. Here, Case in the paper is of a 64-year-old female patient with carbon monoxide poisoning. Her neurological symptoms nearly disappeared after the application of hyperbaric oxygen therapy (HBOT) and conventional medical treatment. Our case guides for the key role of HBOT in the treatment process of a 64-year-old female patient with COP. Our clinical experience revealed that hyperbaric oxygen therapy could successfully reverse the symptoms of delayed neurological findings caused by COP, a serious and preventable health problem.

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