Published ahead of print on May 11, 2007, doi:10.1164/rccm.200701-026OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200701-026OC
Carbon Monoxide PoisoningRisk Factors for Cognitive Sequelae and the Role of Hyperbaric Oxygen1 Department of Internal Medicine, Pulmonary and Critical Care Division, Intermountain Healthcare, Salt Lake City, Utah; 2 Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah; 3 Institute for Health Care Delivery Research, Intermountain Healthcare, Salt Lake City, Utah; and 4 Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah Correspondence and requests for reprints should be addressed to Lindell K. Weaver, M.D., Critical Care Medicine, LDS Hospital, 8th Avenue & C Street, Salt Lake City, UT 84143. E-mail: lindell.weaver{at}intermountainmail.org Rationale: Carbon monoxide poisoning is common and causes cognitive sequelae. Hyperbaric oxygen (HBO2) reduces cognitive sequelae incidence, but which patients may benefit from HBO2 is unclear. Objectives: Risk factor determination for 6-wk cognitive sequelae from CO poisoning and risk modification with HBO2. Methods: Patients were from a randomized controlled trial, enrolling acutely CO-poisoned patients more than 15 years of age. Patients eligible but not enrolled in the randomized trial, and not receiving HBO2, were followed during the study interval. In patients not receiving HBO2, we performed univariate analyses including risk factors identified by randomized trial subgroup analyses. A multivariable analysis was performed using univariate results with and without HBO2. Measurements and Main Results: In 163 patients not receiving HBO2, 68 (42%) manifested sequelae. Risk factors for sequelae from subgroup analyses were loss of consciousness, age of 36 years or more, and carboxyhemoglobin levels greater than or equal to 25%. By univariate analyses, risks for sequelae were age of 36 years or more (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3–4.9; P = 0.005), and exposure intervals greater than or equal to 24 hours (OR, 2.4; 95% CI, 1.2–4.8; P = 0.019). Including 75 patients receiving HBO2, cognitive sequelae was reduced in patients age of 36 years or more (OR, 0.3; 95% CI, 0.2–0.6; P < 0.001). Exposure intervals greater than or equal to 24 hours are an independent risk factor for sequelae (OR, 2.0; 95% CI, 1.0–3.8; P = 0.046). Conclusions: HBO2 oxygen is indicated for patients with acute CO poisoning who are 36 years or older or have exposure intervals greater than or equal to 24 hours. In addition, subgroup analyses support that patients with loss of consciousness or higher carboxyhemoglobin levels warrant HBO2.
Key Words: carbon monoxide poisoning • hyperbaric oxygen therapy • cognitive outcome • neuropsychological outcome
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