Indications

Treatment of CO poisoning with HBO is superior to NBO in its ability to reduce PNM. However, treatment by HBO is not required for all forms of CO poisoning unless there is a risk for long-term sequelae28. Under these conditions HBO should be used. The ongoing dilemma is to identify those who are at risk and this requires further study.

From the published studies26,29 the following patient subgroups are at risk: comatose patients; those with loss of consciousness or neurological abnormality, especially cerebellar impairment; those with COHb levels greater than 25 %; and those with metabolic acidosis. Neuropsychological testing could perhaps be an important tool in the future. Pregnancy is an additional indication due to risks to the fetus.

There is no randomized study for CO poisoned children. However it would seem appropriate to extend the same clinical principles as are applicable to adults. Cognitive function, as indication for treatment, may be more difficult to assess in a young child than in an adult. Thus, HBO indicators may be broader for children.

In 2004, the European Consensus Conference on Indications for HBO recommended its use in cases of CO poisoning if there is / are:

(1) persisting coma

(2) history of loss of consciousness,

(3) neuropsychological impairment,

(4) abnormal neurological signs (e.g., exaggerated tendon reflexes, hypertonia, pyramidal signs, etc).

These criteria are very similar to those recommended in North America63-65.

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