Outcome of children with carbon monoxide poisoning treated with normobaric oxygen

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Abstract

Objective: To evaluate the clinical characteristics and neurologic outcome of children with carbon monoxide poisoning treated with normobaric oxygen therapy. Methods: We reviewed the medical records of all children with a diagnosis of carbon monoxide exposure admitted during a 10-year period. Exposures were categorized as (1) severely toxic, carboxyhemoglobin level > 25%; (2) toxic, carboxyhemoglobin level 10.1 to 25%; (3) suspected toxic, carboxyhemoglobin level ≤10% with acute neurologic manifestations; or (4) nontoxic, carboxyhemoglobin ≤10% without acute neurologic manifestations. Results: One hundred six patients (median age, 3.5 years; range, 0.1-14.9 years) were identified, 37 with severe toxic, 37 with toxic, 13 with suspected toxic, and 19 with nontoxic exposures. The most common presenting signs or symptoms included altered level of consciousness, metabolic acidosis, tachycardia, and hypertension. All patients received normobaric oxygen for 5.5 hours (range, 0.6-44 hours). Carboxyhemoglobin levels decreased to less than 3% in 3.6 hours (range, 0-15.5 hours). Fifteen patients died, three from massive burn injury, eight from hypoxic-ischemic encephalopathy after cardiopulmonary arrest at presentation, and four from late complications of burn injury. Seven survivors did not recover their premorbid neurologic state, four of whom had respiratory arrest when rescued. Two patients had initial neurologic recovery followed by transient deterioration at 4 and 14 days after exposure. One patient developed seizures and was found to have bilateral occipital lobe infarctions 51 days after exposure. Conclusion: Acute neurologic manifestations after carbon monoxide exposure are common in children. These resolve rapidly with normobaric oxygen, however. Persistent sequelae are primarily related to asphyxia. Delayed neurologic syndromes are uncommon in children treated with normobaric oxygen.

Original languageEnglish
Pages (from-to)149-154
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume44
Issue number1
DOIs
StatePublished - Jan 1998

Keywords

  • Burns
  • Carbon monoxide
  • Children
  • Inhalation injury
  • Outcome
  • Oxygen

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