Scheinkestel CD, Bailey M, Myles PS, Jones K, Cooper DJ, Millar IL, Tuxen DV, et al.
The Medical journal of Australia. Date of publication 1999 Mar 1;volume 170(5):203-10.
1. Med J Aust. 1999 Mar 1;170(5):203-10.
Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised
controlled clinical trial.
Scheinkestel CD(1), Bailey M, Myles PS, Jones K, Cooper DJ, Millar IL, Tuxen DV.
Author information:
(1)Alfred Hospital, Melbourne, VIC. cdsch@ozemail.com.au
Comment in
ACP J Club. 1999 Jul-Aug;131(1):11.
Med J Aust. 1999 Mar 1;170(5):197-9.
Med J Aust. 1999 Jun 7;170(11):563; author reply 564-5.
Med J Aust. 1999 Jun 7;170(11):563; author reply 564-5.
Med J Aust. 1999 Jun 7;170(11):563-4; author reply 564-5.
Med J Aust. 1999 Jun 7;170(11):564-5.
Med J Aust. 2000 Feb 7;172(3):141-2.
OBJECTIVE: To assess neurological sequelae in patients with all grades of carbon
monoxide (CO) poisoning after treatment with hyperbaric oxygen (HBO) and
normobaric oxygen (NBO).
DESIGN: Randomised controlled double-blind trial, including an extended series of
neuropsychological tests and sham treatments in a multiplace hyperbaric chamber
for patients treated with NBO.
SETTING: The multiplace hyperbaric chamber at the Alfred Hospital, a
university-attached quarternary referral centre in Melbourne providing the only
hyperbaric service in the State of Victoria.
PATIENTS: All patients referred with CO poisoning between 1 September 1993 and 30
December 1995, irrespective of severity of poisoning. Pregnant women, children,
burns victims and those refusing consent were excluded.
INTERVENTION: Daily 100-minute treatments with 100% oxygen in a hyperbaric
chamber--60 minutes at 2.8 atmospheres absolute for the HBO group and at 1.0
atmosphere absolute for the NBO group--for three days (or for six days for
patients who were clinically abnormal or had poor neuropsychological outcome
after three treatments). Both groups received continuous high flow oxygen between
treatments.
MAIN OUTCOME MEASURES: Neuropsychological performance at completion of treatment,
and at one month where possible.
RESULTS: More patients in the HBO group required additional treatments (28% v.
15%, P = 0.01 for all patients; 35% v. 13%, P = 0.001 for severely poisoned
patients). HBO patients had a worse outcome in the learning test at completion of
treatment (P = 0.01 for all patients; P = 0.005 for severely poisoned patients)
and a greater number of abnormal test results at completion of treatment (P =
0.02 for all patients; P = 0.008 for severely poisoned patients). A greater
percentage of severely poisoned patients in the HBO group had a poor outcome at
completion of treatment (P = 0.03). Delayed neurological sequelae were restricted
to HBO patients (P = 0.03). No outcome measure was worse in the NBO group.
CONCLUSION: In this trial, in which both groups received high doses of oxygen,
HBO therapy did not benefit, and may have worsened, the outcome. We cannot
recommend its use in CO poisoning.
PMID: 10092916 [Indexed for MEDLINE]
