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Hyperbaric Oxygen Therapy
In Treatment of CO Intoxication
Kun-Lun Huang
Undersea and Hyperbaric Medicine Tri-Service General Hospital
Case 1
F/8, studentHeat bedroom with hot charcoal brazier in winterUnconsciousness at midnightPrimary management at other hospital with oxygen breathingDifficulty in concentratingCompletely recovered after 3 treatments of HBO with 2 ATA 90 min
Case 2
F/63. Visited ER 3 times in 3 months due to headache, nausea, and vomiting. The symptoms improved after I.v. fluid and 2-3 hr ER stay every time. Patient was discharged without a definite diagnosis until an incidental finding of elevated serum CK level. Exposed to incomplete gas combustion when her family was using water heater. Completely recovered after 3 HBO2 treatments No more CO intoxication after relocation of the water heater.
Case 3-5
M/23, M/25, F/23, students/roommates Exposed to incomplete gas combustion of a water heater for more than 3 hours One deep coma with cardiopulmonary distress and two transient unconsciousnessTwo completely recovered after 3 HBO treatment One became vegetable even vigorous HBO treatment for 40 times
Symptoms of CO IntoxicationSymptom Percentage of Patients
Headache 9177Dizziness
NauseaWeakness 53
47Difficulty in concentrating 43Shortness of breath 40Visual changes 25Chest pain 9Loss of consciousness 6Abdominal pain 5Muscle cramping 5
Data are from Ely, 1995; Myers, 1985; and Burney, 1982.
Carbon Monoxide Intoxication
02468
10121416182022
0 25 50 75 100PO2, mmHg
O2
cont
ent,
ml/d
l
Normal
Anemia
CO intoxication
COHb and Clinical FeaturesSeverity COHb Clinical features
Occult < 5% No apparent symptomsMild 5 ~ 10% Decreased exercise tolerance
Moderate 10 ~ 20% Exertional dyspnea, headache, dizzinessImpairment of high cerebral functions
20 ~ 30% Irritability, impaired judgementSevere headache, visual disturbance, nausea、
Severe 30 ~ 40% Cardiac disturbance, muscle weakness40 ~ 50% Fainting, mental confusion
VerySevere
50 ~ 60% Collapse convulsion, paralysis
60 ~ 70%> 70%
Coma, fatal in a few minutesCardiac and respiratory arrest
Kindwall EP, 1994
CO Elimination
0102030405060708090
100
0 5 10 15 20Time, hour
CO
-Hgb
, % o
f ini
tial
100% O2
Room air
HBO
Oxygen Content in Blood on HBO2
0
5
10
15
20
25
30
0 500 1000 1500 2000
PO2, mmHg
Dissolved
Hgb-bound
Total
O2
cont
ent,
ml/d
l
VO2/VB = α × PO2
VO2/VB = 1.39 × Hb × SO2
α × PO2 + 1.39 × Hb × SO2
3 ATA
Indication for HBO2 Therapy
ComaAny period of unconsciousnessCarboxyhemoglobin level > 40% Pregnancy and carboxyhemoglobin level > 15% Sign of cardiac ischemia or arrhythmiaHistory of CAD and carboxyhemoglobin level > 20%Recurrent symptoms for up to 3 wksPersistent symptoms for 4-6 hours with 100% O2
Data are from Myers and Thom, 1994.
Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning
Volume 347:1057-1067
October 3, 2002
Lindell K. Weaver, M.D., Ramona O. Hopkins, Ph.D., Karen J. Chan, B.S., Susan Churchill, N.P., C. Gregory Elliott, M.D., Terry P. Clemmer, M.D., James F. Orme, Jr.,
M.D., Frank O. Thomas, M.D., and Alan H. Morris, M.D.
Case 5
A 66-year-old femaleLoss of consciousness as she was rescued from a fire environment a few minutes before her arrival ER
Lab Data on ArrivalCBC ABGBiochem.
pH 7.097
PaCO2 53.6
HCO3- 16.2
PaO2 16.2
COHb, % 61.0
Na+ 146
K+ 3.2
AST/ALT 26/
BUN/Cr 12/0.7
Glucose 274
WBC 11500
N/L 90/6
Hct 33.5
Hgb 12.0
Platelet 157000CPK 168
Follow-up ABG AnalysisIntubation
(1 hr)HBO2(6 hr)On arrival
7.315pH
PaCO2
HCO3-
PaO2
COHb, %
7.097
53.6
16.2
16.2
61.0
7.413
33.6 42.0
17.1 25.8
22.6 186.1
23.9 0.2
Follow-up ABG AnalysisHBO2(6 hr)
2nd HBO2(40 hr)On arrival
7.193pH
PaCO2
HCO3-
PaO2
COHb, %
7.097
53.6
16.2
16.2
61.0
7.413
69.142.0
26.025.8
64.5186.1
0.10.2
Differential DiagnosisRecurrent Dyspnea in 2nd HBO2 Therapy
Complication of HBO2: PneumothoraxAcute MI with LV failureBronchial asthma in acute exacerbationThermal inhalation injury
Final Diagnosis
Acute smoke inhalation with acute carbon monoxide intoxication, thermal lung injury, and delayed respiratory failure
Outcome of Intensive Care
The ventilator was weaned off and endotracheal tube was removed in a week and patient was discharged from the hospital in another two weeks. The pulmonary function test before her discharge revealed normal ventilatoryfunction.
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