What is the evidence supporting the use of hyperbaric oxygen therapy in the management of carbon monoxide poisoning?

Hyperbaric oxygen therapy (HBOT) is supported by evidence as an effective treatment modality in the management of carbon monoxide (CO) poisoning, particularly for reducing the risk of delayed neurological sequelae and improving clinical outcomes. The UK clinical guidelines acknowledge the role of oxygen therapy as a primary intervention, with HBOT considered in cases of severe poisoning or when neurological symptoms are present NICE NG115. This aligns with the detailed evidence from recent literature, which highlights that HBOT accelerates the dissociation of carbon monoxide from haemoglobin, thereby restoring oxygen delivery to tissues more rapidly than normobaric oxygen Weaver 2025.

Furthermore, HBOT has been shown to reduce oxidative stress and lipid peroxidation caused by CO poisoning, mechanisms implicated in delayed neurological damage Tetzlaff & Jüttner 2015. Clinical trials and systematic reviews cited in the literature support HBOT’s efficacy in decreasing the incidence of cognitive and neurological impairments post-CO exposure Jüttner & Tetzlaff 2015Weaver 2025.

While UK guidelines recommend HBOT primarily for patients with severe poisoning, loss of consciousness, or neurological deficits NICE NG115, the literature suggests that early initiation of HBOT may improve outcomes even in moderate cases Weaver 2025. However, the availability and logistical considerations of HBOT facilities remain a practical limitation in routine use.

In summary, the evidence base from both UK guidelines and recent peer-reviewed literature supports the use of hyperbaric oxygen therapy as a beneficial adjunct in the management of carbon monoxide poisoning, especially in severe cases or when neurological symptoms are evident.