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Hyperbaric oxygen for acute carbon monoxide poisoning.
N Engl J Med 2002; 347(14):1057-67NEJM

Abstract

BACKGROUND

Patients with acute carbon monoxide poisoning commonly have cognitive sequelae. We conducted a double-blind, randomized trial to evaluate the effect of hyperbaric-oxygen treatment on such cognitive sequelae.

METHODS

We randomly assigned patients with symptomatic acute carbon monoxide poisoning in equal proportions to three chamber sessions within a 24-hour period, consisting of either three hyperbaric-oxygen treatments or one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air. Oxygen treatments were administered from a high-flow reservoir through a face mask that prevented rebreathing or by endotracheal tube. Neuropsychological tests were administered immediately after chamber sessions 1 and 3, and 2 weeks, 6 weeks, 6 months, and 12 months after enrollment. The primary outcome was cognitive sequelae six weeks after carbon monoxide poisoning.

RESULTS

The trial was stopped after the third of four scheduled interim analyses, at which point there were 76 patients in each group. Cognitive sequelae at six weeks were less frequent in the hyperbaric-oxygen group (19 of 76 [25.0 percent]) than in the normobaric-oxygen group (35 of 76 [46.1 percent], P=0.007), even after adjustment for cerebellar dysfunction and for stratification variables (adjusted odds ratio, 0.45 [95 percent confidence interval, 0.22 to 0.92]; P=0.03). The presence of cerebellar dysfunction before treatment was associated with the occurrence of cognitive sequelae (odds ratio, 5.71 [95 percent confidence interval, 1.69 to 19.31]; P=0.005) and was more frequent in the normobaric-oxygen group (15 percent vs. 4 percent, P=0.03). Cognitive sequelae were less frequent in the hyperbaric-oxygen group at 12 months, according to the intention-to-treat analysis (P=0.04).

CONCLUSIONS

Three hyperbaric-oxygen treatments within a 24-hour period appeared to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon monoxide poisoning.

Authors+Show Affiliations

Department of Internal Medicine, Pulmonary and Critical Care Division, LDS Hospital, Salt Lake City, Utah 84143, USA. lweaver@ihc.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12362006

Citation

Weaver, Lindell K., et al. "Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning." The New England Journal of Medicine, vol. 347, no. 14, 2002, pp. 1057-67.
Weaver LK, Hopkins RO, Chan KJ, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002;347(14):1057-67.
Weaver, L. K., Hopkins, R. O., Chan, K. J., Churchill, S., Elliott, C. G., Clemmer, T. P., ... Morris, A. H. (2002). Hyperbaric oxygen for acute carbon monoxide poisoning. The New England Journal of Medicine, 347(14), pp. 1057-67.
Weaver LK, et al. Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning. N Engl J Med. 2002 Oct 3;347(14):1057-67. PubMed PMID: 12362006.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperbaric oxygen for acute carbon monoxide poisoning. AU - Weaver,Lindell K, AU - Hopkins,Ramona O, AU - Chan,Karen J, AU - Churchill,Susan, AU - Elliott,C Gregory, AU - Clemmer,Terry P, AU - Orme,James F,Jr AU - Thomas,Frank O, AU - Morris,Alan H, PY - 2002/10/4/pubmed PY - 2002/10/9/medline PY - 2002/10/4/entrez SP - 1057 EP - 67 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 347 IS - 14 N2 - BACKGROUND: Patients with acute carbon monoxide poisoning commonly have cognitive sequelae. We conducted a double-blind, randomized trial to evaluate the effect of hyperbaric-oxygen treatment on such cognitive sequelae. METHODS: We randomly assigned patients with symptomatic acute carbon monoxide poisoning in equal proportions to three chamber sessions within a 24-hour period, consisting of either three hyperbaric-oxygen treatments or one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air. Oxygen treatments were administered from a high-flow reservoir through a face mask that prevented rebreathing or by endotracheal tube. Neuropsychological tests were administered immediately after chamber sessions 1 and 3, and 2 weeks, 6 weeks, 6 months, and 12 months after enrollment. The primary outcome was cognitive sequelae six weeks after carbon monoxide poisoning. RESULTS: The trial was stopped after the third of four scheduled interim analyses, at which point there were 76 patients in each group. Cognitive sequelae at six weeks were less frequent in the hyperbaric-oxygen group (19 of 76 [25.0 percent]) than in the normobaric-oxygen group (35 of 76 [46.1 percent], P=0.007), even after adjustment for cerebellar dysfunction and for stratification variables (adjusted odds ratio, 0.45 [95 percent confidence interval, 0.22 to 0.92]; P=0.03). The presence of cerebellar dysfunction before treatment was associated with the occurrence of cognitive sequelae (odds ratio, 5.71 [95 percent confidence interval, 1.69 to 19.31]; P=0.005) and was more frequent in the normobaric-oxygen group (15 percent vs. 4 percent, P=0.03). Cognitive sequelae were less frequent in the hyperbaric-oxygen group at 12 months, according to the intention-to-treat analysis (P=0.04). CONCLUSIONS: Three hyperbaric-oxygen treatments within a 24-hour period appeared to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon monoxide poisoning. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/12362006/Hyperbaric_oxygen_for_acute_carbon_monoxide_poisoning_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa013121?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -