February 1, 2005
By WILLIAM HATHAWAY, Courant Staff Writer
In two separate incidents
after the Jan. 22 snowstorm, three Boston-area residents were
poisoned by carbon monoxide as they sat in cars warming up in the
frigid weather. Snow had clogged the tailpipes of the vehicles, and
the odorless, colorless and potentially deadly gas backed up inside
the idling cars.
Instead of being rushed to one of Boston's many hospitals, the victims
were sent to Hartford Hospital, one of the few institutions in New
England with a hyperbaric chamber big enough to care for more than
one person at a time. Using the same technology that saves the lives
of deep-sea divers who decompress too rapidly, the chamber fills
with 100 percent oxygen pressurized to 2.5 atmospheres.
A 90-minute treatment, repeated three times in the next 24 hours,
helps flush toxic gas from the bloodstream of poisoning victims and
prevent brain damage, said Dr. George A. Perdrizet, director of the
Hartford Hospital Center for Wound Healing and Hyperbaric Medicine.
The incident serves as a reminder about the potential danger of
carbon monoxide poisoning from inefficient burning or ventilation
of fossil fuel. It also illustrates the peculiar and as-yet not fully
understood healing properties of oxygen under pressure.
Hartford's hyperbaric chamber looks like a mini-submarine, a steel
cylinder about 6 feet wide and 20 feet long. Several hospitals in
Connecticut have at least one mono-place chamber; these look more
like coffins and can treat only one patient at a time. The multiplex
chamber in Hartford makes it a common destination in cases of multiple
poisonings by carbon monoxide.
Carbon monoxide poisoning cases were not the reason Hartford Hospital
in the summer of 2003 entered into a lease-purchase agreement for
the chamber, which is valued at $900,000. In the past year, staffers
at the wound center have treated about 50 carbon monoxide cases.
They also have used the chamber to treat wounds of about 500 people,
most of them suffering from diabetic ulcers.
Use of hyberbaric chambers to treat wounds has not been widely accepted
until recently and still is considered "fringe medicine" by
many, Perdrizet said.
"Historically, the treatment had been misused" to treat
diseases that compressed oxygen did nothing to help, he said.
Perdrizet said his experience five years ago working with investigators
at the University of California, San Francisco, convinced him that
pressurized chambers helped cure wounds.
Perdrizet said he lobbied Hartford Hospital officials for a wound
center with "all the bells and whistles," including the
hyberbaric oxygen chamber. He said on average 10 percent to 15 percent
of wound patients met criteria for hyberbaric oxygen treatment. The
patients usually suffer from diabetes or are recovering from radiation
treatments for a variety of cancers. Their wounds have failed to
heal after six weeks of standard care. The treatment also seems to
benefit patients who suffer from infection by flesh-eating bacteria,
a rare but grisly infection.
Studies have shown treatment in hyperbaric chambers can reduce the
amputation rate for diabetic foot ulcers by 40 percent, Perdrizet
said. And since the chamber was installed at Hartford Hospital, the
federal government approved reimbursement for the treatment of diabetic
Scientists still are not sure exactly how the therapy helps heal
wounds, although one recent study has shown that compressed oxygen
seems to trigger angiogenesis, or the growth of new blood vessels
in wounds, Perdrizet said.
The way hyperbaric chambers treat carbon monoxide poisoning patients
is much better understood, however. For more than a century, medical
science has known that when mining tunnels were cleared of water
with compressed air, the miners who worked in those tunnels tended
to get sick after they moved to areas without compressed air. And
since the early part of the 20th century, they have also known that
decompression in divers can cause the formation of potentially lethal
nitrogen gas bubbles in the bloodstream.
Workers on the Hudson River tunnel in New York who suffered what
later would be known to deep-sea divers as "the bends" were
treated in 1889 with compressed air. Increased pressure from the
hyperbaric chamber forces potentially dangerous bubbles of nitrogen
to dissolve in the bloodstream. A gradual reduction of pressure allows
gases to be safely absorbed and exhaled through the lungs. Compressed
oxygen allows carbon monoxide patients to absorb and eliminate the
Officials at the wound center say they are plenty busy treating
wounds and hope that education decreases their need to treat carbon
monoxide poisoning cases.
Everybody should install carbon monoxide detectors for their homes
with audible alarms, urged Dr. Charles McKay, director of medical
toxicology at Hartford Hospital and associate medical director at
the Connecticut Poison Control Center.
He stressed that any source of fossil fuel - if it burns inefficiently
or is not properly ventilated - can cause carbon monoxide poisoning.
That means people should not run generators indoors or use alternative
heating sources such as charcoal grills. One local man was treated
for carbon monoxide poisoning this year after working on a snow blower
in an enclosed area.
The symptoms of carbon monoxide poisoning can be subtle, with victims
suffering mild headaches, nausea and lightheadedness. Poisoning victims
should be immediately given fresh air and taken to the hospital,
where a blood test can confirm carbon monoxide poisoning, he said.
Reprinted with permission of the Hartford Courant.
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