Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning: two randomized controlled trials.
BACKGROUND
Although hyperbaric oxygen therapy (HBO) is broadly used for carbon monoxide (CO) poisoning, its efficacy and practical modalities remain controversial.


OBJECTIVE
To assess HBO in patients poisoned with CO.


METHODS
Two prospective randomized trial on two parallel groups.


METHODS
Critical Care Unit, Raymond Poincaré Hospital, Garches, France.


METHODS
Three hundred eighty-five patients with acute domestic CO poisoning.


METHODS
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).


METHODS
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)].


CONCLUSIONS
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.
Medical Intensive Care Unit and Hyperbaric Center, Raymond Poincaré Teaching Hospital, University of Versailles SQY, Garches, 92380, France. djillali.annane@rpc.aphp.fr
Djillali
D
Annane
Karim
K
Chadda
Philippe
P
Gajdos
Marie-Claude
MC
Jars-Guincestre
Sylvie
S
Chevret
Jean-Claude
JC
Raphael
D000208:Acute Disease; D000328:Adult; D002249:Carbon Monoxide Poisoning / Q000503:physiopathology / Q000628:therapy*; D003128:Coma; D005260:Female; D005602:France; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D055815:Young Adult