Abstract
Introduction
Although hyperbaric oxygen therapy (HBO) is broadly used for carbon monoxide (CO) poisoning, its efficacy and practical modalities remain controversial.
Objectives
To assess HBO in patients poisoned with CO.
Design
Two prospective randomized trial on two parallel groups.
Setting
Critical Care Unit, Raymond Poincaré Hospital, Garches, France.
Subjects
Three hundred eighty-five patients with acute domestic CO poisoning.
Intervention
Patients with transient loss of consciousness (trial A, n = 179) were randomized to either 6 h of normobaric oxygen therapy (NBO; arm A0, n = 86) or 4 h of NBO plus one HBO session (arm A1, n = 93). Patients with initial coma (trial B, n = 206) were randomized to either 4 h of NBO plus one HBO session (arm B1, n = 101) or 4 h of NBO plus two 2 HBO sessions (arm B2, n = 105).
Primary endpoint
Proportion of patients with complete recovery at 1 month.
Results
In trial A, there was no evidence for a difference in 1-month complete recovery rates with and without HBO [58% compared to 61%; unadjusted odds ratio, 0.90 (95% CI, 0.47–1.71)]. In trial B, complete recovery rates were significantly lower with two than with one HBO session [47% compared to 68%; unadjusted odds ratio, 0.42 (CI, 0.23–0.79)].
Conclusion
In patients with transient loss of consciousness, there was no evidence of superiority of HBO over NBO. In comatose patients, two HBO sessions were associated with worse outcomes than one HBO session.
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References
Weaver LK (1999) Carbon monoxide poisoning. Crit Care Clin 15:297–317
Thom SR, Taber RL, Mendiguern II, Clark JM, Hardy KR, Fisher AB (1995) Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen. Ann Emerg Med 25:474–480
Ducasse JL, Celsis P, Marc-Vergnes JP (1995) Non-comatose patients with acute carbon monoxide poisoning hyperbaric or normobaric oxygenation? Undersea Hyperb Med 22:9–15
Raphael JC, Elkharrat D, Jars-Guincestre MC, Chastang C, Chasles V, Vercken JB, Gajdos P (1989) Trial of normobaric and hyperbaric oxygen for acute carbon monoxide intoxication. Lancet 2:414–419
Mathieu D, Mathieu-Nolf M, Wattel F (1996) Intoxications par le monoxyde de carbone: aspects actuels. Bull Acad Natl Med 180:965–971
Scheinkestel CD, Bailey M, Myles PS, Jones K, Cooper DJ, Millar IL, Tuxen DV (1999) Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial. Med J Aust 170:203–210
Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, Orme JF, Thomas FO, Morris AH (2002) Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med 347:1057–1067
Juurlink DN, Buckley NA, Stanbrook MB, Isbister GK, Bennett M, McGuigan MA (2005) Hyperbaric oxygen for carbon monoxide poisoning. Cochrane database of systematic reviews, Issue 1. Art. no: CD002041. doi: 10.1002/14651858.CD002041.pub2
Buyse M (1993) Interim analyses, stopping rules and data monitoring in clinical trials in Europe. Stat Med 12:509–520
Hollis S (2002) A graphical sensitivity analysis for clinical trials with non-ignorable missing binary outcome. Stat Med 21:3823–3834
Smith G, Sharp GR (1960) Treatment of carbon monoxide poisoning with oxygen under pressure. Lancet 2:905–906
Goulon M, Barois A, Nouailhat F, Grosbuis S, Gajdos P, Babinet P (1971) Intoxications oxycarbonées et anoxie aigues par inhalation de gaz de charbon et d′hydrocarbures. Rev Prat 21:2290–2320
Messiers LD, Myers RAM (1991) A neuropsychological screening battery for emergency assessment of carbon monoxide-poisoned patients. J Clin Psychol 47:675–684
Haberstock D, Hopkins RO, Weaver LK et al (1988) Prospective longitudinal assessment of symptoms in acute carbon monoxide (CO) poisoning. Undersea Hyperb Med 25(Suppl):48
Gorman DF, Clayton D, Gilligan JE, Webb RK (1992) A longitudinal study of 100 consecutive admissions for carbon monoxide poisoning to the Royal Adelaide hospital. Anaesth Intensive Care 20:311–316
Barois A, Grosbuis S, Goulon M (1979) Les intoxications aigues par l’oxyde de carbone et les gaz de chauffage. Rev Prat 29:1211–1231
Zimmermann SS, Truxal B (1981) Carbon monoxide poisoning. Pediatrics 68:215–224
Garland H, Pearce J (1967) Neurological complications of carbon monoxide poisoning. Q J Med 36:445–455
Choi IS (1983) Delayed neurologic complications of carbon monoxide intoxication. Arch Neurol 40:433–435
Norris CR, Trench JM, Hook R (1982) Delayed carbon monoxide encephalopathy: clinical and research implications. J Clin Psychiatry 43:294–295
Acknowledgments
The study was supported by the Assistance Publique des Hôpitaux de Paris. The sponsor had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript. Registration numbers were NCT01100515 for trial A and NCT01099995 for trial B. The authors are grateful to the physicians and nursing staff of Raymond Poincaré Teaching Hospital and to Paris area emergency departments for their valuable contribution.
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The full trial protocol can be obtained by direct contact with the corresponding author.
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Annane, D., Chadda, K., Gajdos, P. et al. Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning: two randomized controlled trials. Intensive Care Med 37, 486–492 (2011). https://doi.org/10.1007/s00134-010-2093-0
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DOI: https://doi.org/10.1007/s00134-010-2093-0