title: Variability in hyperbaric oxygen treatment for acute carbon monoxide poisoning.
abstract: BACKGROUND
  In patients with acute carbon monoxide (CO) poisoning, we have noted wide clinical variability in both criteria for hyperbaric oxygen (HBO2) treatment as well as HBO2 treatment regimens. Our aim was to survey Midwest hyperbaric centers for insight into specific criteria and protocols for treating acute CO toxicity with HBO2.
  
  
  METHODS
  Hyperbaric centers were identified from the published list of the Undersea and Hyperbaric Medical Society. Ninety-three centers from nine Midwestern states were contacted via telephone. A standard script was used to minimize surveyor bias.
  
  
  RESULTS
  Thirty centers that treat CO poisonings were identified. One did not participate in the study. Nineteen reported a specific level of carboxyhemoglobin (COHb) that served as an independent indication for initiation of HBO2 treatment. Four centers used the COHb level as the exclusive indication for HBO2 treatment. Ten centers relied solely on reported symptoms, while the remaining centers used a combination of symptoms plus COHb levels. There were 19 separate treatment protocols.
  
  
  CONCLUSIONS
  No uniform practice for either the initiation or implementation of HBO2 therapy for CO poisoning exists among U.S. Midwest hyperbaric centers responding to a survey. We see opportunity for specific targeted educational programs as well as further study.
authors.affiliation: SCAPT James A Lovell Federal Health Care Center, Great Lakes, Illinois, USA. btbyrne@gmail.com
authors.forename: Brendan T
authors.initials: BT
authors.lastname: Byrne
authors.forename: Jenny J
authors.initials: JJ
authors.lastname: Lu
authors.forename: Matthew
authors.initials: M
authors.lastname: Valento
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bryant
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D002249:Carbon Monoxide Poisoning / Q000175:diagnosis / Q000628:therapy*; D002263:Carboxyhemoglobin / Q000032:analysis; D002985:Clinical Protocols; D003657:Decision Making; D023381:Endpoint Determination; D019538:Health Care Surveys; D006782:Hospitals, Special; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000592:standards*; D015146:Midwestern United States
chemical_list: D015415:Biomarkers; D002263:Carboxyhemoglobin