Treating carbon monoxide poisoning

Hyperbaric oxygen therapy is currently used in various clinical treatment regimens like for treating carbon monoxide poisoning. These include decompression sickness, carbon monoxide poisoning, cyanide poisoning, gas embolus, gas gangrene, resistant anaerobic infections, and threatened split-thickness skin grafts.

The mechanism of action in treating carbon monoxide poisoning purportedly involves increasing tissue oxygenation, which increases collagen and fibroblast formation and suppresses Clostridia toxin production. It also enhances the killing ability of the leukocyte and capillary proliferation.

This mechanism has primarily been established in animal models and limited human trials. At best, hyperbaric oxygen in the management of soft tissue infections can be promoted only as part of a coordinated medical and surgical approach.

It has been postulated that hyperbaric oxygen in burn wounds potentially exhibits some benefit by stimulating vasoconstriction and counteracting hypoxia. This theory is based on the possibility that hyperbaric oxygen may decrease acute edema, fluid requirements, and infection rates and promote re-epithialization.

There have been several animal models that demonstrated varied results. However, the use and efficacy of hyperbaric oxygen in burn wound therapy is not established.

Recent studies have not been able to demonstrate a statistically significant difference in the length of hospital stay, the number of operations required, and morbidity and/or mortality when comparing hyperbaric oxygen supplementation versus standard burn therapy. Thus, hyperbaric oxygen has no place in the acute management of thermal injuries.

Carbon monoxide (CO) poisoning should be suspected in virtually every fire victim. It remains one of the most frequent causes of death in smoke inhalation injuries.

Hyperbaric oxygen has demonstrated value in treating carbon monoxide poisoning. It decreases the high affinity that CO has for hemoglobin. Hyperbaric oxygen decreases the half-life of CO from about 4 hours to about 25 minutes, which leads to quicker restoration of oxygenation.

Thus, hyperbaric oxygen therapy may have a place in the care for burn patients for treating carbon monoxide poisoning.

However, hyperbaric oxygen therapy in burn patients with CO poisoning is of unknown therapeutic value or efficacy and should only be used when

  • (1) the CO bound to hemoglobin is greater than 25%,
  • (2) a neurologic deficit exists,
  • (3) no formal burn resuscitation is required (typically, total body surface area burned is <10% to 15%),
  • (4) pulmonary function is stable with an intact airway, and
  • (5) inter facility transfer does not compromise burn care.

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