OUTCOME OF CHILDREN WITH CARBON-MONOXIDE POISONING TREATED WITH NORMOBARIC OXYGEN

Objective: To evaluate the clinical characteristics and neurologic out come of children with carbon monoxide poisoning treated,vith normobari c oxygen therapy. Methods: We reviewed the medical records of all chil dren with a diagnosis of carbon monoxide exposure admitted during a 10 -year period. Exposures were categorized as (1) severely toxic, carbox yhemoglobin level >25%; (2) toxic, carboxyhemoglobin level 10.1 to 25% ; (3) suspected toxic, carboxyhemoglobin level less than or equal to 1 0% with acute neurologic manifestations; or (4) nontoxic, carboxyhemog lobin less than or equal to 10% without acute neurologic manifestation s. 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 recei ved normobaric oxygen for 5.5 hours (range, 0.6-44 hours). Carboxyhemo globin levels decreased to less than 3% in 3.6 hours (range, 0-15.5 ho urs). Fifteen patients died, three from massive burn injury, eight fro m hypoxic-ischemic encephalopathy after cardiopulmonary arrest at pres entation, and four from late complications of burn injury. Seven survi vors did not recover their premorbid neurologic state, four of whom ha d respiratory arrest when rescued. Two patients had initial neurologic recovery followed by transient deterioration at 4 and 14 days after e xposure. One patient developed seizures and was found to have bilatera l occipital lobe infarctions 51 days after exposure. Conclusion: Acute neurologic manifestations after carbon monoxide exposure are common i n children. These resolve rapidly with normobaric oxygen, however. Per sistent sequelae are primarily related to asphyxia. Delayed neurologic syndromes are uncommon in children treated with normobaric oxygen.