Hyperbaric Oxygen Therapy for the Prevention and Treatment of Delayed Neurological Sequelae after Carbon Monoxide Poisoning
Article Sidebar
Main Article Content
Abstract
Carbon monoxide (CO) poisoning remains a prevalent medical emergency with potentially fatal outcomes. Long-term neurological consequences, known as delayed neurological sequelae (DNS), may manifest several days to weeks following the acute exposure. Hyperbaric oxygen (HBO2) has appeared as a valuable intervention in severe cases, enhancing the CO dissociation from hemoglobin and aiding tissue oxygenation. Recent case studies and clinical reports suggest that HBO2 not only reduces the severity of acute CO poisoning but also plays a critical role in preventing and treating DNS, leading to improvements in neurocognitive function. The article aims to describe DNS and discuss the demonstrated benefits of HBO2 in the treatment and prevention of neurological sequelae, emphasizing its potential to enhance recovery and reduce long-term neurological damage.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Mattiuzzi C, Lippi G. Worldwide epidemiology of carbon monoxide poisoning. Hum Exp Toxicol 2020;39(4):387-92.
Hampson NB, Hauschildt KL, Deru K, Weaver LK. Carbon monoxide poisonings in hotels and motels: the problem silently continues. Prev Med Rep 2019;16:100975.
Khodmanee S, Amnuaylojaroen T. Impact of biomass burning on ozone, carbon monoxide, and nitrogen dioxide in Northern Thailand. Front Environ Sci 2021;9:641877.
Velasco E, Ho KJ, Ziegler AD. Commuter exposure to black carbon, carbon monoxide, and noise in the mass transport khlong boats of Bangkok, Thailand. Transportation Research Part D: Transport and Environment 2013;21:62-5.
Manaker S, Perry H. Carbon monoxide poisoning. [Internet]. [cited 2024 Aug 12]. Available from: https://www.uptodate.com/contents/carbon-monoxide-poisoning.
Huang E. UHMS hyperbaric medicine indications manual. 15th ed. North Palm Beach, FL: Best Publishing; 2024.
Creswell PD, Meiman JG, Nehls-Lowe H, Vogt C, Wozniak RJ, Werner MA, et al. Exposure to elevated carbon monoxide levels at an indoor ice arena-Wisconsin, 2014. MMWR Morb Mortal Wkly Rep 2015;64(45):1267-70.
Savioli G, Gri N, Ceresa IF, Piccioni A, Zanza C, Longhitano Y, et al. Carbon monoxide poisoning: from occupational health to emergency medicine. J Clin Med 2024;13(9):2466.
Palmeri R, Gupta V. Carboxyhemoglobin toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-PMID: 32491811.
Ning K, Zhou YY, Zhang N, Sun XJ, Liu WW, Han CH. Neurocognitive sequelae after carbon monoxide poisoning and hyperbaric oxygen therapy. Med Gas Res 2020;10(1):30-6.
Huang CC, Ho CH, Chen YC, , Hsu CC, Wang YF, Lin HJ, et al. Impact of hyperbaric oxygen therapy on subsequent neurological sequelae following carbon monoxide poisoning. J Clin Med 2018;7(10):349.
Han S, Choi S, Nah S, Lee SU, Cho YS, Kim GW, et al. Cox regression model of prognostic factors for delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning: a prospective observational study. Neurotoxicology 2021;82:63-8.
Fujita M, Todani M, Kaneda K, Suzuki S, Wakai S, Kikuta S, et al. Use of hyperbaric oxygen therapy for preventing delayed neurological sequelae in patients with carbon monoxide poisoning: a multicenter, prospective, observational study in Japan. PLoS One 2021;16(6):e0253602.
Lee H, Kang H, Ko BS, Oh J, Lim TH, Cho Y. Initial creatine kinase level as a predictor for delayed neuropsychiatric sequelae associated with acute carbon monoxide poisoning. Am J Emerg Med 2021;43:195-9.
Gaballah SZ, elkhishen IAR, Hashim NA, Hamid OIA. Predictors of delayed neurological sequelae after acute carbon monoxide poisoning at Zagazig University hospitals. Zagazig Journal of Forensic Medicine 2020;18(2):105-21.
Martani L, Giovanniello A, Bosco G, Cantadori L, Calissi F, Furfaro D, et al. Delayed neurological sequelae successfully treated with adjuvant, prolonged hyperbaric oxygen therapy: review and case report. Int J Environ Res Public Health 2022;19(9):5300.
Zhang JH. Hyperbaric oxygen for neurological disorders. Flagstaff, Az: Best Publishing; 2008.
Ahn C, Oh J, Kim CW, Lee H, Lim TH, Kang H. Early neuroimaging and delayed neurological sequelae in carbon monoxide poisoning: a systematic review and meta-analysis. Sci Rep 2022;12(1):3529.
Jüttner B, Busch HJ, Callies A, Dormann H, Janisch T, Kaiser G, et al. S2k guideline diagnosis and treatment of carbon monoxide poisoning. Ger Med Sci 2021;19:Doc13.
Eichhorn L, Thudium M, Jüttner B. The diagnosis and treatment of carbon monoxide poisoning. Dtsch Arztebl Int 2018;115(51-52):863-70.
Chambers CA, Hopkins RO, Weaver LK, Key C. Cognitive and affective outcomes of more severe compared to less severe carbon monoxide poisoning. Brain Inj 2008;22(5):387-95.
Huang CC, Ho CH, Chen YC, Lin HJ, Hsu CC, Wang JJ, et al. Hyperbaric oxygen therapy is associated with lower short- and long-term mortality in patients with carbon monoxide poisoning. Chest 2017;152(5):943-53.
Otto CN. Hemoglobin metabolism. In: Keohane EM, Smith LJ, Walenga JM. Rodak's hematology: clinical, principle and applications. 6th ed. St.Louis: Elsevier; 2020. p. 91-103.
Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, et al. Carbon monoxide poisoning: pathogenesis, management, and future directions of therapy. Am J Respir Crit Care Med 2017;195(5):596-606.
Guo D, Hu H, Pan S. Oligodendrocyte dysfunction and regeneration failure: a novel hypothesis of delayed encephalopathy after carbon monoxide poisoning. Medical Hypotheses 2020;136:109522.
Tsai PH, Chou MC, Chiang SW, Chung HW, Liu HS, Kao HW, et al. Early white matter injuries in patients with acute carbon monoxide intoxication: a tract-specific diffusion kurtosis imaging study and STROBE compliant article. Medicine 2017;96(5):e5982.
Nah S, Choi S, Lee SU, Kim GW, Lee YH, Han S. Effects of smoking on delayed neuropsychiatric sequelae in acute carbon monoxide poisoning: a prospective observational study. Medicine (Baltimore) 2021;100(20):e26032.
Han S, Nah S, Choi S, Kim GW, Lee YH. Optimal sessions of hyperbaric oxygen therapy in patients with carbon monoxide poisoning: a prospective observational study. Am J Emerg Med 2021;44:132-36.
Ouahmane Y, Hattimy FE, Soulaymani A, Mounach J, Satte A, Bourazza A, et al. Hyperbaric oxygen therapy in carbon monoxide poisoning in Moroccan patients. Acta Neurologica Belgica 2023;123(1):139-43.
Pepe G, Castelli M, Nazerian P, Vanni S. Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department. A retrospective study. Scand J Trauma Resusc Emerg Med 2011;19:16.
Kim YS, Cha YS, Kim MS, Kim HJ, Lee YS, Youk H, et al. The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning. Hum Exp Toxicol 2018;37(6):587-95.
Beppu T. The role of MR imaging in assessment of brain damage from carbon monoxide poisoning: a review of the literature. AJNR Am J Neuroradiol 2014;35(4):625-31.
Sert ET, Kokulu K, Mutlu H. Clinical predictors of delayed neurological sequelae in charcoal-burning carbon monoxide poisoning. Am J Emerg Med 2021;48:12-17.
Choi S, Nah S, Han S. Correlation between time to hyperbaric oxygen therapy and delayed neurological sequelae in acute carbon monoxide poisoning patients. Diagnostics (Basel) 2024;14(2):186.
Liao SC, Mao YC, Hung YM, Lee CH, Yang CC. Predictive role of QTc prolongation in carbon monoxide poisoning-related delayed neuropsychiatric sequelae. Biomed Res Int 2018;2018: 2543018.
Lee H, Kang H, Ko BS, Oh J, Lim TH, Cho Y. Initial creatine kinase level as a predictor for delayed neuropsychiatric sequelae associated with acute carbon monoxide poisoning. Am J Emerg Med 2021;43:195-9.
Lin CH, Su WH, Chen YC, Feng PH, Shen WC, Ong JR, et al. Treatment with normobaric or hyperbaric oxygen and its effect on neuropsychometric dysfunction after carbon monoxide poisoning: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018;97(39):e12456.38.
Nakajima M, Aso S, Matsui H, Fushimi K, Yasunaga H. Hyperbaric oxygen therapy and mortality from carbon monoxide poisoning: a nationwide observational study. Am J Emerg Med 2020;38 (2):225-30.
Han S, Nah S, Choi S, Lee YH, Kim GW, Cho YS. Hyperbaric oxygen therapy did not prevent delayed neuropsychiatric sequelae in a prospective observational study with propensity score matching in 224 patients with acute carbon monoxide toxicity. J Emerg Med 2021;60(4):498-505.
Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med 2002;347(14):1057-67.
Lee JS, Cha YS, Lim J. Association between number of hyperbaric oxygen therapy sessions and neurocognitive outcomes of acute carbon monoxide poisoning. Front Med (Lausanne) 2023;10:1127978.
Wang W, Cheng J, Zhang J, Wang K. Effect of hyperbaric oxygen on neurologic sequelae and all-cause mortality in patients with carbon monoxide poisoning: a meta-analysis of randomized controlled trials. Med Sci Monit 2019;25:7684-93.
Liao SC, Mao YC, Yang KJ, Wang KC, Wu LY, Yang CC. Targeting optimal time for hyperbaric oxygen therapy following carbon monoxide poisoning for prevention of delayed neuropsychiatric sequelae: A retrospective study. J Neurol Sci 2019;396:187-92.
Mathieu D, Marroni A, Kot J. Correction to Mathieu D, Marroni A, Kot J: Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med 2017;47(1):24-32.
Liao SC, Shao SC, Yang KJ, Yang CC. Real-world effectiveness of hyperbaric oxygen therapy for delayed neuropsychiatric sequelae after carbon monoxide poisoning. Sci Rep 2021;11(1):19212.
Hu Q, Manaenko A, Xu T, Guo Z, Tang J, Zhang JH. Hyperbaric oxygen therapy for traumatic brain injury: bench-to-bedside. Med Gas Res 2016;6(2):102-10.
Wong ZK, Teo CK, Kwek JW, Kim SJ, See HG. Hyperbaric oxygen for the treatment of carbon monoxide-induced delayed neurological sequelae: a case report and review of the literature. Diving Hyperb Med 2024;54(1):65-8.
Tapeantong T, Poungvarin N. Delayed encephalopathy and cognitive sequelae after acute carbon monoxide poisoning: report of a case and review of the literature. J Med Assoc Thai 2009;92(10):1374-9.