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Original Research |

Hyperbaric oxygen therapy is associated with lower short- and long-term mortality in patients with carbon monoxide poisoning

Chien-Cheng Huang, MD; Chung-Han Ho, PhD; Yi-Chen Chen, MS; Hung-Jung Lin, MD, MBA; Chien-Chin Hsu, MD, PhD; Jhi-Joung Wang, MD, PhD; Shih-Bin Su, MD, PhD; How-Ran Guo, MD, MPH, ScD
Author and Funding Information

Conflicts of Interest

No conflicts of interest were declared.

1Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan

2Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

3Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan

4Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan

5Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan

6Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan

7Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

8Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan

9Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan

10Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan

11Department of Medical Research, Chi-Mei Medical Center, Liouying, Tainan, Taiwan

12Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan

Corresponding Author: How-Ran Guo, MD, MPH, ScD, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, East District, Tainan City 701, Taiwan.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.03.049
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Abstract

Background  To 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.

Methods  Using the Nationwide Poisoning Database, we identified 25,737 COP patients 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, drug poisoning, acute respiratory failure, and follow-up periods until 2013 were conducted. We also tried to identify independent mortality predictors and evaluated their effects.

Results  Patients who received HBOT had a lower mortality rate compared to patients who did not (adjusted hazard ratio [AHR]: 0.74; 95% confidence interval [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 COP. Patients who received two or more sessions of HBOT had a lower mortality rate than those who received once only. Older age, male sex, low monthly income, diabetes, malignancy, stroke, alcoholism, mental disorders, suicide attempts, and acute respiratory failure were also independent mortality predictors.

Conclusions  HBOT is 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.


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