Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning
Cognitive sequelae often occur after acute carbon monoxide poisoning. This double-blind, randomized trial assigned subjects either to three sessions in a hyperbaric-oxygen chamber or to one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air, all administered within 24 h...
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| Published in | The New England journal of medicine Vol. 347; no. 14; pp. 1057 - 1067 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Boston, MA
Massachusetts Medical Society
03.10.2002
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0028-4793 1533-4406 1533-4406 |
| DOI | 10.1056/NEJMoa013121 |
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| Abstract | Cognitive sequelae often occur after acute carbon monoxide poisoning. This double-blind, randomized trial assigned subjects either to three sessions in a hyperbaric-oxygen chamber or to one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air, all administered within 24 hours after the end of exposure to carbon monoxide. Cognitive sequelae six weeks later were less frequent among persons who received hyperbaric-oxygen therapy (25.0 percent) than among those who received normobaric-oxygen treatment (46.1 percent, P=0.007). Differences were sustained 12 months after the episode of acute carbon monoxide poisoning.
The results of this double-blind trial support the use of hyperbaric oxygen.
Carbon monoxide poisoning is a serious health problem
1
,
2
resulting in approximately 40,000 visits to the emergency department annually in the United States.
2
,
3
Unfavorable cognitive sequelae (problems with memory, attention or concentration, and affect) can occur immediately after exposure and persist or can be delayed, but they generally occur within 20 days after carbon monoxide poisoning.
1
–
6
Cognitive sequelae lasting one month
5
,
7
–
9
or more
2
,
4
appear to occur in 25 to 50 percent of patients with loss of consciousness or with carboxyhemoglobin levels greater than 25 percent.
2
,
7
,
8
The recommended treatment for acute carbon monoxide poisoning . . . |
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| AbstractList | Patients with acute carbon monoxide poisoning commonly have cognitive sequelae. We conducted a double-blind, randomized trial to evaluate the effect of hyperbaric-oxygen treatment on such cognitive sequelae.BACKGROUNDPatients with acute carbon monoxide poisoning commonly have cognitive sequelae. We conducted a double-blind, randomized trial to evaluate the effect of hyperbaric-oxygen treatment on such cognitive sequelae.We randomly assigned patients with symptomatic acute carbon monoxide poisoning in equal proportions to three chamber sessions within a 24-hour period, consisting of either three hyperbaric-oxygen treatments or one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air. Oxygen treatments were administered from a high-flow reservoir through a face mask that prevented rebreathing or by endotracheal tube. Neuropsychological tests were administered immediately after chamber sessions 1 and 3, and 2 weeks, 6 weeks, 6 months, and 12 months after enrollment. The primary outcome was cognitive sequelae six weeks after carbon monoxide poisoning.METHODSWe randomly assigned patients with symptomatic acute carbon monoxide poisoning in equal proportions to three chamber sessions within a 24-hour period, consisting of either three hyperbaric-oxygen treatments or one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air. Oxygen treatments were administered from a high-flow reservoir through a face mask that prevented rebreathing or by endotracheal tube. Neuropsychological tests were administered immediately after chamber sessions 1 and 3, and 2 weeks, 6 weeks, 6 months, and 12 months after enrollment. The primary outcome was cognitive sequelae six weeks after carbon monoxide poisoning.The trial was stopped after the third of four scheduled interim analyses, at which point there were 76 patients in each group. Cognitive sequelae at six weeks were less frequent in the hyperbaric-oxygen group (19 of 76 [25.0 percent]) than in the normobaric-oxygen group (35 of 76 [46.1 percent], P=0.007), even after adjustment for cerebellar dysfunction and for stratification variables (adjusted odds ratio, 0.45 [95 percent confidence interval, 0.22 to 0.92]; P=0.03). The presence of cerebellar dysfunction before treatment was associated with the occurrence of cognitive sequelae (odds ratio, 5.71 [95 percent confidence interval, 1.69 to 19.31]; P=0.005) and was more frequent in the normobaric-oxygen group (15 percent vs. 4 percent, P=0.03). Cognitive sequelae were less frequent in the hyperbaric-oxygen group at 12 months, according to the intention-to-treat analysis (P=0.04).RESULTSThe trial was stopped after the third of four scheduled interim analyses, at which point there were 76 patients in each group. Cognitive sequelae at six weeks were less frequent in the hyperbaric-oxygen group (19 of 76 [25.0 percent]) than in the normobaric-oxygen group (35 of 76 [46.1 percent], P=0.007), even after adjustment for cerebellar dysfunction and for stratification variables (adjusted odds ratio, 0.45 [95 percent confidence interval, 0.22 to 0.92]; P=0.03). The presence of cerebellar dysfunction before treatment was associated with the occurrence of cognitive sequelae (odds ratio, 5.71 [95 percent confidence interval, 1.69 to 19.31]; P=0.005) and was more frequent in the normobaric-oxygen group (15 percent vs. 4 percent, P=0.03). Cognitive sequelae were less frequent in the hyperbaric-oxygen group at 12 months, according to the intention-to-treat analysis (P=0.04).Three hyperbaric-oxygen treatments within a 24-hour period appeared to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon monoxide poisoning.CONCLUSIONSThree hyperbaric-oxygen treatments within a 24-hour period appeared to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon monoxide poisoning. Cognitive sequelae often occur after acute carbon monoxide poisoning. This double-blind, randomized trial assigned subjects either to three sessions in a hyperbaric-oxygen chamber or to one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air, all administered within 24 hours after the end of exposure to carbon monoxide. Cognitive sequelae six weeks later were less frequent among persons who received hyperbaric-oxygen therapy (25.0 percent) than among those who received normobaric-oxygen treatment (46.1 percent, P=0.007). Differences were sustained 12 months after the episode of acute carbon monoxide poisoning. The results of this double-blind trial support the use of hyperbaric oxygen. Carbon monoxide poisoning is a serious health problem 1 , 2 resulting in approximately 40,000 visits to the emergency department annually in the United States. 2 , 3 Unfavorable cognitive sequelae (problems with memory, attention or concentration, and affect) can occur immediately after exposure and persist or can be delayed, but they generally occur within 20 days after carbon monoxide poisoning. 1 – 6 Cognitive sequelae lasting one month 5 , 7 – 9 or more 2 , 4 appear to occur in 25 to 50 percent of patients with loss of consciousness or with carboxyhemoglobin levels greater than 25 percent. 2 , 7 , 8 The recommended treatment for acute carbon monoxide poisoning . . . Background Patients with acute carbon monoxide poisoning commonly have cognitive sequelae. We conducted a double-blind, randomized trial to evaluate the effect of hyperbaric-oxygen treatment on such cognitive sequelae. Methods We randomly assigned patients with symptomatic acute carbon monoxide poisoning in equal proportions to three chamber sessions within a 24-hour period, consisting of either three hyperbaric-oxygen treatments or one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air. Oxygen treatments were administered from a high-flow reservoir through a face mask that prevented rebreathing or by endotracheal tube. Neuropsychological tests were administered immediately after chamber sessions 1 and 3, and 2 weeks, 6 weeks, 6 months, and 12 months after enrollment. The primary outcome was cognitive sequelae six weeks after carbon monoxide poisoning. Results The trial was stopped after the third of four scheduled interim analyses, at which point there were 76 patients in each group. Cognitive sequelae at six weeks were less frequent in the hyperbaric-oxygen group (19 of 76 [25.0 percent]) than in the normobaric-oxygen group (35 of 76 [46.1 percent], P=0.007), even after adjustment for cerebellar dysfunction and for stratification variables (adjusted odds ratio, 0.45 [95 percent confidence interval, 0.22 to 0.92]; P=0.03). The presence of cerebellar dysfunction before treatment was associated with the occurrence of cognitive sequelae (odds ratio, 5.71 [95 percent confidence interval, 1.69 to 19.31]; P=0.005) and was more frequent in the normobaric-oxygen group (15 percent vs. 4 percent, P=0.03). Cognitive sequelae were less frequent in the hyperbaric-oxygen group at 12 months, according to the intention-to-treat analysis (P=0.04). Conclusions Three hyperbaric-oxygen treatments within a 24-hour period appeared to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon monoxide poisoning. Patients with acute carbon monoxide poisoning commonly have cognitive sequelae. We conducted a double-blind, randomized trial to evaluate the effect of hyperbaric-oxygen treatment on such cognitive sequelae. We randomly assigned patients with symptomatic acute carbon monoxide poisoning in equal proportions to three chamber sessions within a 24-hour period, consisting of either three hyperbaric-oxygen treatments or one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air. Oxygen treatments were administered from a high-flow reservoir through a face mask that prevented rebreathing or by endotracheal tube. Neuropsychological tests were administered immediately after chamber sessions 1 and 3, and 2 weeks, 6 weeks, 6 months, and 12 months after enrollment. The primary outcome was cognitive sequelae six weeks after carbon monoxide poisoning. The trial was stopped after the third of four scheduled interim analyses, at which point there were 76 patients in each group. Cognitive sequelae at six weeks were less frequent in the hyperbaric-oxygen group (19 of 76 [25.0 percent]) than in the normobaric-oxygen group (35 of 76 [46.1 percent], P=0.007), even after adjustment for cerebellar dysfunction and for stratification variables (adjusted odds ratio, 0.45 [95 percent confidence interval, 0.22 to 0.92]; P=0.03). The presence of cerebellar dysfunction before treatment was associated with the occurrence of cognitive sequelae (odds ratio, 5.71 [95 percent confidence interval, 1.69 to 19.31]; P=0.005) and was more frequent in the normobaric-oxygen group (15 percent vs. 4 percent, P=0.03). Cognitive sequelae were less frequent in the hyperbaric-oxygen group at 12 months, according to the intention-to-treat analysis (P=0.04). Three hyperbaric-oxygen treatments within a 24-hour period appeared to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon monoxide poisoning. Patients with acute carbon monoxide poisoning commonly have cognitive sequelae. We conducted a double-blind, randomized trial to evaluate the effect of hyperbaric-oxygen treatment on such cognitive sequelae. We randomly assigned patients with symptomatic acute carbon monoxide poisoning in equal proportions to three chamber sessions within a 24-hour period, consisting of either three hyperbaric-oxygen treatments or one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air. Oxygen treatments were administered from a high-flow reservoir through a face mask that prevented rebreathing or by endotracheal tube. Neuropsychological tests were administered immediately after chamber sessions 1 and 3, and 2 weeks, 6 weeks, 6 months, and 12 months after enrollment. The primary outcome was cognitive sequelae six weeks after carbon monoxide poisoning. The trial was stopped after the third of four scheduled interim analyses, at which point there were 76 patients in each group. Cognitive sequelae at six weeks were less frequent in the hyperbaric-oxygen group (19 of 76 [25.0 percent]) than in the normobaric-oxygen group (35 of 76 [46.1 percent], P = 0.007), even after adjustment for cerebellar dysfunction and for stratification variables (adjusted odds ratio, 0.45 [95 percent confidence interval, 0.22 to 0.92]; P = 0.03). The presence of cerebellar dysfunction before treatment was associated with the occurrence of cognitive sequelae (odds ratio, 5.71 [95 percent confidence interval, 1.69 to 19.31]; P = 0.005) and was more frequent in the normobaric-oxygen group (15 percent vs. 4 percent, P = 0.03). Cognitive sequelae were less frequent in the hyperbaric-oxygen group at 12 months, according to the intention-to-treat analysis (P = 0.04). Three hyperbaric-oxygen treatments within a 24-hour period appeared to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon monoxide poisoning. |
| Author | Elliott, C. Gregory Hopkins, Ramona O Orme, James F Weaver, Lindell K Thomas, Frank O Morris, Alan H Churchill, Susan Chan, Karen J Clemmer, Terry P |
| Author_xml | – sequence: 1 givenname: Lindell K surname: Weaver fullname: Weaver, Lindell K – sequence: 2 givenname: Ramona O surname: Hopkins fullname: Hopkins, Ramona O – sequence: 3 givenname: Karen J surname: Chan fullname: Chan, Karen J – sequence: 4 givenname: Susan surname: Churchill fullname: Churchill, Susan – sequence: 5 givenname: C. Gregory surname: Elliott fullname: Elliott, C. Gregory – sequence: 6 givenname: Terry P surname: Clemmer fullname: Clemmer, Terry P – sequence: 7 givenname: James F surname: Orme fullname: Orme, James F – sequence: 8 givenname: Frank O surname: Thomas fullname: Thomas, Frank O – sequence: 9 givenname: Alan H surname: Morris fullname: Morris, Alan H |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13950242$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/12362006$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | Copyright © 2002 Massachusetts Medical Society. All rights reserved. 2002 INIST-CNRS Copyright 2002 Massachusetts Medical Society |
| Copyright_xml | – notice: Copyright © 2002 Massachusetts Medical Society. All rights reserved. – notice: 2002 INIST-CNRS – notice: Copyright 2002 Massachusetts Medical Society |
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| DOI | 10.1056/NEJMoa013121 |
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| Keywords | Human Treatment Cognitive disorder Complication Sequela Poisoning Carbon monoxide Hyperbaric oxygenotherapy |
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| Snippet | Cognitive sequelae often occur after acute carbon monoxide poisoning. This double-blind, randomized trial assigned subjects either to three sessions in a... Patients with acute carbon monoxide poisoning commonly have cognitive sequelae. We conducted a double-blind, randomized trial to evaluate the effect of... Background Patients with acute carbon monoxide poisoning commonly have cognitive sequelae. We conducted a double-blind, randomized trial to evaluate the effect... |
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| SubjectTerms | Acute Disease Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Carbon monoxide poisoning Carbon Monoxide Poisoning - complications Carbon Monoxide Poisoning - therapy Chemical and industrial products toxicology. Toxic occupational diseases Cognition Disorders - etiology Cognition Disorders - prevention & control Consciousness Depression - etiology Depression - prevention & control Double-Blind Method Emergency and intensive care: techniques, logistics Female Gas, fumes Humans Hyperbaric Oxygenation - methods Intensive care medicine Logistic Models Male Medical sciences Memory Disorders - etiology Memory Disorders - prevention & control Neuropsychological Tests Oxygen Inhalation Therapy Oxygen therapy Patients Perfusions. Catheterizations. Hyperbaric oxygenotherapy Toxicology |
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