When do you recommend hyperbaric therapy referral for patients having carbon monoxide poisoning?

by
Marilyn F. Althoff, MD
Director of Hyperbaric Medicine
Attending Physician
Department of Emergency Medicine
Morristown Memorial Hospital

In my practice, I recommend hyperbaric oxygen therapy in carbon monoxide poisoning based on patients with the greatest risk for morbidity and mortality. An elevated carboxyhemoglobin level is used to initially confirm the diagnosis of carbon monoxide poisoning, but is not a reliable indicator of severity. Clinical exceptions should be made if there is a strong history of exposure and the patient has been given oxygen for a prolonged period. Normal COHb levels range from 0%-5% and up to 6-10% in smokers. Most hyperbaric physicians will treat patients if the COHb levels are over 25-30%, even if the symptoms are not serious.

The clinical severity of the exposure must be also determined. Signs of serious intoxication include evidence of cardiovascular dysfunction or any change in mental status including unconsciousness or abnormal neurological signs. These patients should be referred regardless of their CO level. A neuropsychiatric screening test can also be used to detect and measure subtle neurological impairment. Patients with significant abnormalities should undergo hyperbaric treatment and then be re-evaluated to determine improvement.

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