© 2008 American Thoracic Society
CO Poisoning and Hyperbaric Oxygen Therapy: More Studies Need to Be DoneFrom the Authors:We appreciate the opportunity to address questions from Dr. Lo Vecchio and colleagues regarding our article (1). They state that hyperbaric oxygen may not be the standard of care for acute carbon monoxide poisoning; after 20 years of research in this area, we disagree. Hyperbaric oxygen is the standard of care for acute CO poisoning. All major insurers approve hyperbaric oxygen for CO poisoning. In the United States, 1,500 patients are treated with hyperbaric oxygen for CO poisoning annually (2). As stated in our METHODS (1), all 91 patients were eligible for our randomized trial (3), but declined or were excluded due to an interval from exposure of more than 24 hours. Figure 3 of our randomized trial depicts the patients excluded (3). All patients gave written consent and the study had institutional review board approval. The protocol was approved before commencing the study (1). Participation incentives were identical to our randomized trial (3). The cutoff of 36 years of age or older was chosen using age as a continuous variable initially, but data analysis indicated that age better identified risk of sequelae when assessed as a categorical variable. Our definition of cognitive sequelae is identical to that in our randomized trial (3), and has been discussed (4). Alcoholism, intoxication, and secondary gain were all considered and were not significant in the analyses. Dr. Lo Vecchio and colleagues mention the recent clinical policy statement by the American College of Emergency Physicians (ACEP) regarding hyperbaric oxygen and CO poisoning (5). This work contains several inaccuracies about our research. For example, the policy statement reports that subgroup data from our randomized trial (3) were never presented, although our recent article (1), quoted and referenced by the policy statement, presents subgroup data. Our randomized trial (3) was also downgraded from class I to class II. We and other CO researchers offered comments 2 years ago challenging the authors' conclusions, and none of these comments were incorporated. A rebuttal was not invited; none of the authors of our randomized trial were offered a forum by the ACEP to discuss the policy statement's treatment of our work. We call attention to a recent article about the lack of scientific validity of meta-analyses (6). Since many points made in that article are appropriate here, we hope that treating physicians will review the data and reach independent conclusions regarding this question.
Intermountain Healthcare
Intermountain Healthcare
Intermountain Healthcare FOOTNOTES Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
