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July 1979, Vol 139, No. 7 >
ARTICLE | July 1979

Carbon Monoxide and Hyperbaric Oxygen

Richard A. Neubauer, MD
Arch Intern Med. 1979;139(7):829. doi:10.1001/archinte.1979.03630440087030.
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To the Editor.—  Carbon monoxide (CO) poisoning remains a problem for two easons. First, routine treatment with oxygen will reduce the carboxyhemoglobin (HbCO) level but will not correct the primary problem, poisoning of the cytochrome oxidase a3 system with associated cerebral and myocardial anoxia. It is not just competition of oxygen and CO for the hemoglobin. Second, heavy reliance on the HbCO level for determining the degree of poisoning is not advisable. This level may drop considerably if the patient is given oxygen on the way to the hospital. These levels may not reflect the length of exposure or rate of respirations during exposure.As Smith and Brandon1 have observed, survivors of CO poisoning often have higher morbidity and mortality. Deterioration of personality and memory impairment along with other gross neuropsychiatric sequelae can be directly attributed to CO poisoning in some cases. Delayed, unexpected death from progressive cerebral

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