Real-world effectiveness of hyperbaric oxygen therapy for delayed neuropsychiatric sequelae after carbon monoxide poisoning

Abstract

To assess real-world effectiveness of hyperbaric oxygen therapy (HBOT) on delayed neuropsychiatric sequelae (DNS) after carbon monoxide (CO) poisoning we conducted a retrospective review of patients with CO poisoning admitted to Linkou Chang-Gung Memorial Hospital, Taiwan’s largest medical center, during 2009–2015. We included patients developing DNS after CO poisoning and compared improvements in neuropsychiatric function, with and without HBOT, after 12 months post-DNS to understand differences in recovery rates. DNS improvement-associated factors were also evaluated. We used receiver operating characteristic (ROC) curve analysis to assess the role of time elapsed between DNS diagnosis and HBOT initiation in predicting DNS improvement. A total of 62 patients developed DNS, of whom 11 recovered while the rest did not. Possible factors predicting DNS improvement included receiving HBOT post-DNS (72.7% vs 25.5%; P = 0.006), and treatment with more than three HBOT sessions during acute stage CO poisoning (81.8% vs 27.5%; P = 0.003). The relevant area under the ROC curve was 0.789 (95% CI 0.603–0.974), and the best cut-off point was 3 days post-DNS diagnosis, with 87.5% sensitivity and 61.5% specificity. Early HBOT in patients who developed DNS after CO poisoning significantly improved their DNS symptoms, with treatment effects sustained for 1 year after DNS diagnosis.

Delayed neuropsychiatric sequelae with improvement of decreased cerebral bold flow by single‐photon emission computed tomography during hyperbaric oxygen therapy: A case report with a 10‐year follow‐up

“…The optimal number of HBO therapy sessions for DNS remains unknown. However, additional sessions of HBO therapy for acute CO poisoning were considered sufficient to prevent subsequent poisoning 7,17 . In the present case, the patient received 89 sessions of HBO therapy, and his cognitive function continued to improve.…”

“…5 Hyperbaric oxygen (HBO) therapy is reportedly an effective treatment for DNS in the acute phase. [6][7][8] Predictive factors for favorable prognosis following HBO therapy include younger age, longer interictal periods, and independence in performing activities of daily living during intermittent CO poisoning. 9 However, the relationship between these factors and neuroimaging findings remains unclear.…”

“…Patients with this condition present with higher brain dysfunction, such as disorientation and memory loss 5 . Hyperbaric oxygen (HBO) therapy is reportedly an effective treatment for DNS in the acute phase 6–8 …”

Multi-Modal Synergistic 99mTc-TRODAT-1 SPECT and MRI for Evaluation of the Efficacy of Hyperbaric Oxygen Therapy in CO-Induced Delayed Parkinsonian and Non-Parkinsonian Syndromes

“…Clinical evidence suggests hyperbaric oxygen therapy (HBOT) should be administered to all patients with CO intoxication to prevent the development of DNS [ 31 , 32 ]. Huang et al (2017) suggested that HBOT is associated with lower short- and long-term mortality in patients with significant CO poisoning, especially those with acute respiratory failure and patients younger than 20 years of age [ 33 ].…”

Therapeutic study of hyperbaric oxygen on Heme Oxygenase-1 (HO-1) in patients with acute carbon monoxide poisoning and myocardial injury

“…This process allows a lot of dissolved oxygen to reach the bloodstream so that the cells' needs can be met by dissolved oxygen in the blood (16). In hyperbaric oxygen therapy, increasing the oxygen content of the blood (O 2 content) increases the transfer of oxygen from the blood to the tissues and facilitates the release of oxygen (17).…”