Management of acute intoxication with carbon monoxide - Polish Medical Society, Section of Clinical Toxicology position statement.

Abstract

Carbon monoxide (CO) poisoning remains a significant public health concern, often leading to both acute and delayed neurological and cardiac complications.This article presents the official position statement of the Section of Clinical Toxicology of the Polish Medical Society regarding the management of acute CO poisoning, with particular emphasis on oxygen therapy. The cornerstone of CO poisoning treatment is the immediate initiation of normobaric oxygen therapy using 100% oxygen at the highest possible flow rate, preferably via a non-rebreather mask. Oxygen administration should continue until the carboxyhemoglobin (COHb) level drops to approx. 3%, but for no less than 6 h. In pregnant patients, extended oxygen therapy is recommended due to slower fetal CO elimination. Hyperbaric oxygen therapy (HBOT) is not mandatory in all cases but should be considered in selected patients-primarily those with persistent neurological or cardiac symptoms or metabolic acidosis despite normobaric oxygen, regardless of COHb levels. In pregnant women, HBOT is always indicated, irrespective of COHb concentration or clinical presentation. When indicated, the first HBOT session should be performed as soon as possible - ideally within 6 h of exposure-taking into account the availability of hyperbaric facilities and transport logistics. This article provides detailed, practical recommendations for the management of CO poisoning, highlighting the essential role of normobaric oxygen therapy and the complementary use of HBOT in appropriately selected cases. Int J Occup Med Environ Health. 2025;38(5):457-73.