Document Detail


Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial.
MedLine Citation:
PMID:  10092916     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
C D Scheinkestel; M Bailey; P S Myles; K Jones; D J Cooper; I L Millar; D V Tuxen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Review    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  170     ISSN:  0025-729X     ISO Abbreviation:  Med. J. Aust.     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-04-13     Completed Date:  1999-04-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  AUSTRALIA    
Other Details:
Languages:  eng     Pagination:  203-10     Citation Subset:  IM    
Affiliation:
Alfred Hospital, Melbourne, VIC. cdsch@ozemail.com.au
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MeSH Terms
Descriptor/Qualifier:
Adult
Animals
Carbon Monoxide Poisoning / complications,  physiopathology,  therapy*
Double-Blind Method
Female
Humans
Hyperbaric Oxygenation / adverse effects,  methods*
Male
Neuropsychological Tests
Oxygen Inhalation Therapy*
Severity of Illness Index
Suicide, Attempted
Treatment Outcome
Victoria
Comments/Corrections
Comment In:
Med J Aust. 1999 Jun 7;170(11):563; author reply 564-5   [PMID:  10397051 ]
Med J Aust. 1999 Jun 7;170(11):563; author reply 564-5   [PMID:  10397050 ]
Med J Aust. 1999 Jun 7;170(11):563-4; author reply 564-5   [PMID:  10397052 ]
ACP J Club. 1999 Jul-Aug;131(1):11
Med J Aust. 2000 Feb 7;172(3):141-2   [PMID:  10735028 ]
Med J Aust. 1999 Jun 7;170(11):564-5   [PMID:  10397053 ]
Med J Aust. 1999 Mar 1;170(5):197-9   [PMID:  10092913 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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