Hyperbaric oxygen therapy
Use of hyperbaric oxygen therapy to accelerate clearance of carbon monoxide in carbon monoxide poisoning is controversial. A Cochrane review concluded there is insufficient evidence to determine if hyperbaric oxygen reduces the incidence of adverse neurological outcomes. Consequently it is not recommended for most patients with carbon monoxide poisoning1. Opinions vary between Australian hyperbaric units regarding the potential benefit of hyperbaric oxygen therapy for individual patients with ongoing symptoms.
If patients have persistent neurological or cardiovascular toxicity despite high-flow oxygen therapy, discuss the use of hyperbaric oxygen therapy with a clinical toxicologist or local hyperbaric unit.
The potential benefits of hyperbaric oxygen therapy may be outweighed by the potential harms of transporting the critically ill patient to a hyperbaric unit. Placing intubated or unstable patients in the confines of a hyperbaric chamber also poses significant logistical problems and potential harms.
Use of hyperbaric oxygen therapy in pregnant patients with carbon monoxide poisoning has theoretical benefits for improving fetal oxygenation (fetal haemoglobin has a higher affinity for carbon monoxide); however, clinical evidence is lacking. The theoretical benefit must be balanced against the potential harms of therapy, time delays and transport of the pregnant patient to a hyperbaric unit. Seek advice from a clinical toxicologist or local hyperbaric unit.