• Chien-Cheng Huang, Chung-Han Ho, Yi-Chen Chen, Hung-Jung Lin, Chien-Chin Hsu, Jhi-Joung Wang, Shih-Bin Su, and How-Ran Guo.
• Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
• Chest. 2017 Nov 1; 152 (5): 943-953.

BackgroundTo date, there has been no consensus about the effect of hyperbaric oxygen therapy (HBOT) on the mortality of patients with carbon monoxide poisoning (COP). This retrospective nationwide population-based cohort study from Taiwan was conducted to clarify this issue.MethodsUsing the Nationwide Poisoning Database, we identified 25,737 patients with COP diagnosed between 1999 and 2012, including 7,278 patients who received HBOT and 18,459 patients who did not. The mortality risks of the two cohorts were compared, including overall mortality, and stratified analyses by age, sex, underlying comorbidities, monthly income, suicide attempt, drug poisoning, acute respiratory failure, and follow-up until 2013 were conducted. We also tried to identify independent mortality predictors and evaluated their effects.ResultsPatients who received HBOT had a lower mortality rate compared with patients who did not (adjusted hazard ratio [AHR], 0.74; 95% CI, 0.67-0.81) after adjusting for age, sex, underlying comorbidities, monthly income, and concomitant conditions, especially in patients younger than 20 years (AHR, 0.45; 95% CI, 0.26-0.80) and those with acute respiratory failure (AHR, 0.43; 95% CI, 0.35-0.53). The lower mortality rate was noted for a period of 4 years after treatment of the COP. Patients who received two or more sessions of HBOT had a lower mortality rate than did those who received HBOT only once. Older age, male sex, low monthly income, diabetes, malignancy, stroke, alcoholism, mental disorders, suicide attempts, and acute respiratory failure were also independent mortality predictors.ConclusionsHBOT was associated with a lower mortality rate in patients with COP, especially in those who were younger than 20 years and those with acute respiratory failure. The results provide important references for decision-making in the treatment of COP.Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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