Key points
- We recommend to consult your poison centre with the use of this antidote.
- Hyperbaric chamber should not be used if the patient has an untreated pneumothorax or barotrauma.
- The decision to transfer a patient for treatment in a hyperbaric chamber must be made in consultation with a hyperbaric physician.
- The utility of hyperbaric oxygen therapy is controversial, and expected benefits have not yet been clearly identified. It is important to consider the risk-benefit ratio, especially if the patient needs to be transferred.
+ Synonyms and other terms
- O2
- Normobaric oxygen therapy
- Hyperbaric oxygen therapy
+ Indications
- Normobaric Oxygen Therapy: All suspected or proven exposures to carbon monoxide.
- Hyperbaric Oxygen Therapy: Contact your poison centre.
+ Dosage
+ Pediatric Dose
- Normobaric oxygen therapy: 100% with reservoir mask.
- Hyperbaric oxygen therapy: depending on hyperbaric chamber criteria
+ Adult Dose
- Normobaric oxygen therapy: 100% with reservoir mask.
- Hyperbaric oxygen therapy: depending on hyperbaric chamber criteria
+ Renal Impairment
No data suggests that the dose should be modified for short-term use.
+ Hepatic Impairment
No data suggests that the dose should be modified for short-term use.
+ Hemodialysis Patient
No data suggests that the dose should be modified for short-term use.
+ Pregnancy
- The hyperbaric chamber is possibly safe during pregnancy.
- Do not hesitate to use hyperbaric oxygen therapy during pregnancy to protect the mother and fetus.
- No data suggests that the dose should be modified for short-term use.
+ Obese or Overweight Patient
No data suggests that the dose should be modified for short-term use.
+ Adverse effects
- Possibility of barotrauma with hyperbaric oxygen therapy.
+ Monitoring
- Oxygen saturation
+ End of treatment
- Normobaric oxygen therapy: a minimum of 6 hours or until symptoms disappear for subjects ineligible for hyperbaric chamber.
+ References
American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Carbon Monoxide Poisoning:, Stephen J. Wolf, Gerald E. Maloney, Richard D. Shih, Bradley D. Shy, and Michael D. Brown. 2017. “Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning.” Annals of Emergency Medicine 69 (1):98–107.e6.
Buckley, Nicholas A., Geoffrey K. Isbister, Barrie Stokes, and David N. Juurlink. 2005. “A Systematic Review and Critical Analysis of the Evidence.” R Toxicol Rev 24 (2):75–92.
Buckley, Nick A., David N. Juurlink, Geoff Isbister, Michael H. Bennett, and Eric J. Lavonas. 2011. “Hyperbaric Oxygen for Carbon Monoxide Poisoning.” Cochrane Database of Systematic Reviews , no. 4 (April):CD002041.
Murad, Mohammad Hassan, Osama Altayar, Michael Bennett, Justin C. Wei, Paul L. Claus, Noor Asi, Larry J. Prokop, Victor M. Montori, and Gordon H. Guyatt. 2014. “Using GRADE for Evaluating the Quality of Evidence in Hyperbaric Oxygen Therapy Clarifies Evidence Limitations.” Journal of Clinical Epidemiology 67 (1):65–72.
Weaver, Lindell K. 2009. “Clinical Practice. Carbon Monoxide Poisoning.” The New England Journal of Medicine 360 (12):1217–25.
