title: Complications and protocol considerations in carbon monoxide-poisoned patients who require hyperbaric oxygen therapy: report from a ten-year experience.
abstract: We conducted a study to determine the type, incidence, and timing of complications that occur in patients who have a carbon monoxide (CO) exposure serious enough to require hyperbaric oxygen therapy (HBOT). Complication data were retrospectively collected from a ten-year period for 297 consecutive CO-poisoned emergency department patients who received HBOT. HBOT was indicated for 41% of the patients because of an elevated carboxyhemoglobin (COHb) level alone. Central nervous system dysfunction, including loss of consciousness, and/or cardiovascular dysfunction, was the criteria for HBOT in 59% of patients, regardless of their COHb level. The mean peak COHb level was 38 mg%, with 88% of patients having a peak COHb level greater than 25 mg%. The mortality rate was 6% in this case series. Cardiac arrest occurred in 8% of patients; all experienced their first arrest prior to HBOT. The 3% of patients who sustained an isolated respiratory arrest and those who had a myocardial infarction did so prior to HBOT. Several complications, however, occurred for the first time or as a recurrent event during HBOT. These included emesis (6%), seizures (5%), agitation requiring restraints or sedation (2%), cardiac dysrhythmias or arrests (2%), and arterial hypotension (2%). No patient's level of consciousness deteriorated subsequent to the initial resuscitation except for those who later had a generalized seizure. The most significant complication attributable to HBOT was tension pneumothorax, noted in three patients (1%).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Division of Trauma Surgery, Cook County Hospital, Chicago, Illinois 60612.
authors.forename: E P
authors.initials: EP
authors.lastname: Sloan
authors.forename: D G
authors.initials: DG
authors.lastname: Murphy
authors.forename: R
authors.initials: R
authors.lastname: Hart
authors.forename: M A
authors.initials: MA
authors.lastname: Cooper
authors.forename: T
authors.initials: T
authors.lastname: Turnbull
authors.forename: R S
authors.initials: RS
authors.lastname: Barreca
authors.forename: B
authors.initials: B
authors.lastname: Ellerson
mesh_terms: D002249:Carbon Monoxide Poisoning / Q000097:blood / Q000150:complications* / Q000628:therapy; D002263:Carboxyhemoglobin / Q000032:analysis; D004630:Emergencies; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D014474:Unconsciousness / Q000097:blood / Q000209:etiology / Q000628:therapy
chemical_list: D002263:Carboxyhemoglobin