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Published ahead of print on May 11, 2007, doi:10.1164/rccm.200701-026OC

Am. J. Respir. Crit. Care Med., Volume 176, Number 5, September 2007, 491-497

A more recent version of this article appeared on September 1, 2007
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Submitted on January 4, 2007
Accepted on May 11, 2007

Carbon Monoxide Poisoning: Risk Factors for Cognitive Sequelae and the Role of Hyperbaric Oxygen

Lindell K Weaver1*, Karen J Valentine2, and Ramona O Hopkins3

1 Department of Internal Medicine, Pulmonary and Critical Care Division, Intermountain Healthcare, Salt Lake City, UT, USA; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA, 2 Institute for Health Care Delivery Research, Intermountain Healthcare, Salt Lake City, UT, USA; Department of Internal Medicine, Pulmonary and Critical Care Division, Intermountain Healthcare, Salt Lake City, UT, USA, 3 Department of Internal Medicine, Pulmonary and Critical Care Division, Intermountain Healthcare, Salt Lake City, UT, USA; Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, USA

* To whom correspondence should be addressed. E-mail: lindell.weaver{at}intermountainmail.org.

Rationale: Carbon monoxide (CO) poisoning is common and causes cognitive sequelae. Hyperbaric oxygen (HBO2) reduces cognitive sequelae incidence, but which patients may benefit from HBO2 is unclear. Objective: Risk factor determination for 6-week cognitive sequelae from CO poisoning and risk modification with HBO2. Methods: Patients were from a randomized controlled trial, enrolling acutely CO-poisoned patients >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 ≥36 years, and carboxyhemoglobin levels ≥25%. By univariate analyses, risks for sequelae were age ≥36 years, odds ratio, 2.6 (95% confidence interval [CI], 1.3-4.9; P=0.005), and exposure intervals ≥24 hours, odds ratio, 2.4 (95% CI, 1.2-4.8; P=0.019). Including 75 patients receiving HBO≥, cognitive sequelae was reduced in patients age ≥36 years, odds ratio, 0.3 (95% CI, 0.2-0.6; P<0.001). Exposure intervals ≥24 hours are an independent risk factor for sequelae, odds ratio, 2.0 (95% CI, 1.0-3.8; P=0.046). Conclusions: Hyperbaric oxygen is indicated for patients with acute CO poisoning who are 36 years or older or have exposure intervals ≥24 hours. In addition, subgroup analyses support that patients with loss of consciousness or higher carboxyhemoglobin levels warrant HBO2.
Key words: carbon monoxide, carbon monoxide poisoning, hyperbaric oxygen, hyperbaric oxygen therapy




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