Carbon monoxide poisoning
ICD-10 T58 · ICD-11 NE61&XM3PB9

CO Poisoning in Pregnancy: Next Step When Oxygen Therapy Has Not Achieved Normalisation

This protocol addresses adults aged 18 years and over who are pregnant and have experienced carbon monoxide (CO) poisoning, specifically in the situation where initial oxygen-based therapy has not reached the required clinical goals.

Clinical Scenario

Pregnancy is a recognised indication for escalated management of CO poisoning in adults. Some authors consider it a strict indication for intensified treatment, particularly when neurological symptoms, signs of fetal stress, syncope, or a markedly elevated carboxyhaemoglobin (COHb) level are present.

Previous Treatment: Goals Not Met

First-line management — high-concentration oxygen delivered via mask, CPAP/NIV, or with invasive airway protection when indicated — targets reduction of COHb to normal values (below 3%) with full resolution of symptoms. This next-line protocol is indicated when those goals have not been achieved.

Next-Line Approach (Partial Overview)

When initial oxygen therapy has not normalised COHb or resolved symptoms in a pregnant patient, hyperbaric oxygen therapy (HBOT) is the indicated next step. The structured protocol specifies multiple HBOT sessions delivered within a defined time window, each following a specific pressure schedule — the complete sequence and parameters are available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

  1. In the case of signs of severe CO poisoning (including continued impaired consciousness, metabolic acidosis, respiratory insufficiency, and/or cardiac ischemia), as well as during pregnancy, HBOT ought to be administered in adults (aged 18 years and over).
  2. Thus, some authors consider pregnancy to be a strict indication for HBOT, especially when neurological symptoms, signs of fetal stress, syncope, or a high COHb level are present.
  3. HBOT should be initiated within 6 h.
  4. HBOT should be performed three times within 24 h.
  5. The initial HBOT session should correspond to the therapy schedule (TS) 300/90 (according to Boerema schedule).
  6. A second and third HBOT session should be performed at a treatment pressure greater than/equal to 2.4 bar (TS 240/90).
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