This protocol addresses acute CO poisoning in patients under 18 years of age where first-line high-flow oxygen therapy has been given but the child remains symptomatic or carboxyhaemoglobin (COHb) has not normalised. It describes the evidence-based next step for this paediatric subgroup.
Children and adolescents under 18 years presenting with acute CO poisoning. Symptoms in school-aged children and adolescents range from headache, nausea, and vomiting to neurological symptoms and coma — a spectrum comparable to that seen in adults.
Standard first-line management requires the earliest possible administration of 100% high-flow oxygen by mask or via high-flow nasal cannulae (HFNC) — or FiO₂ 1.0 ventilation for intubated children — continued until the child is symptom-free and COHb has dropped to normal levels (<3%).
This next-step protocol applies when that defined endpoint — a symptom-free child with COHb normalised below 3% — has not been achieved despite first-line oxygen treatment.
In carefully selected individual cases meeting a specific indication, hyperbaric oxygen therapy (HBOT) may be considered — but only when performed under special conditions. Its use in paediatric CO poisoning is restricted to particular circumstances. The full criteria, structured schedule, and clinical decision pathway are in the complete protocol below.
The symptoms of acute CO poisoning in school-aged children and adolescents are comparable to those in adults, ranging from headache, nausea, and vomiting to neurological symptoms and coma.
HBOT for CO poisoning in children can only be considered in specific individual cases.
HBOT may be considered in individual cases where severe disturbance of consciousness caused by CO poisoning persists for several hours despite administration of oxygen, stabilization of vital signs, and in the absence of any other plausible explanation for the impaired vigilance (e.g., traumatic brain injury, cyanide poisoning).
HBOT in pediatric patients with CO poisoning only ought to be performed under special conditions with a specific indication.
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