Perceptions and utilization of hyperbaric oxygen therapy for carbon monoxide poisoning in an academic setting

The routine use of hyperbaric oxygen as therapy for carbon monoxide intoxication is being critically reexamined nationally. There are no controlled prospective clinical studies that show this modality to clearly be superior to the more traditional use of high concentrations of supplemental oxygen. Proponents of hyperbaric therapy often claim that such studies would now be unethical, would violate the accepted standard of care for this medical emergency, and would place the treating physician in an indefensible medical-legal position. In an attempt to determine the status of hyperbaric oxygen in our community as treatment for significant carbon monoxide exposure, we surveyed physicians practicing at the university regional trauma center to determine their perception of the indications for hyperbaric oxygen therapy for carbon monoxide poisoning. We then audited the medical records of all patients treated during a four-year period with the diagnosis of carbon monoxide poisoning or smoke inhalation to determine the actual utilization of this therapeutic modality. The results of our study indicate that hyperbaric referral is not the standard treatment for significant carbon monoxide intoxication in this academic setting.