Effect of hyperbaric oxygen on delayed neuropsychiatric sequelae followed carbon monoxide poisoning

Abstract

Objective To explore the effect of different hyperbaric oxygen treatment (HBOT) on delayed neuropsychiatric sequelae followed carbon monoxide (CO) poisoning (DNS). Methods Patients diagnosed acute carbon monoxide poisoning (ACOP) or DNS due to CO poisoning in the hospital from October 2015 to October 2016 were included.Patients who died of ACOP or in persisting unconsciousness condition were excluded.Information of the patients were retrospectively collected including personal data, clinical features and treatment course of hyperbaric oxygen (HBO). All subjects were divided into two groups,consisting of cases who developed into DNS and who fully recovered, according toclinical symptoms.The differences of personal data, clinical features and treatment course of HBO were compared between the two groups. After adjusting the confounding factors, hyperbaric oxygen treatment program of the two groups were analyzed. Results DNS occurred in 39 patients with acute CO poisoning, while 130 patients were fully recovery. The ratio of patients over 55 years old or with smoking history in the DNS group were higher than that in the good outcome group (82.1% vs. 60.8%, 23.1% vs.10.8%). Patients who awoke from unconsciousness but left cognitive impairment were more likely to develop into DNS (P=0.017). Patients who treated with HBO within the first 24 hours, risk of developing into DNS were decreased(OR=0.14, P 0.05);The proportion of patients in the good outcome group accepted HBO for more than six days after poisoning was higher than that in the DNS group (68.5% vs. 48.7%). After adjusting confounding factors, patients who treated with HBO within the first 24 hours (OR=0.22, 95%CI: 0.09-0.52), 2 times per day(OR=0.30, 95%CI: 0.10-0.87)and lasted for more than 6 days(OR=0.30, 95%CI: 0.10-0.87)were in a lower risk of involving to DNS. Conclusions For patients diagnosed ACOP, HBOT began in the first 24 hours, 1 or 2 times per day or early sustaining to give HBO for more than 6 days could reduce the risk of DNS. Key words: Carbon monoxide poisoning; Delayed neuropsychiatric sequelae followed carbon monoxide poisoning; Hyperbaric oxygen therapy