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Number 4

  09-17-2018

Surviving Sepsis Campaign guidelines for a diver with DCI: case report

Severe decompression illness (DCI) is an uncommon medical issue affecting divers and results mainly from rapid surfacing using inadequate decompression protocols. Massive gas embolism with central nervous system involvement often leads to a poor prognosis, with permanent residual neurologic defects. Moreover, DCI complicated with multiple organ dysfunction syndrome (MODS) is tremendously rare and difficult to cure, although hyperbaric oxygen (HBO2) therapy following the U.S. Navy Treatment Tables is a consensus. We report a case of severe DCI with profound shock and MODS after an initial treatment with HBO2 therapy using U.S. Navy Treatment Table 6A. Following the Surviving Sepsis Campaign ..

  09-17-2018

Benefit of hyperbaric oxygen therapy treatment in direct traumatic optic neuropathy: case report

Direct traumatic optic neuropathy (TON) is a devastating condition and clinical challenge. Its adequate treatment remains controversial. Hyperbaric oxygen (HBO2) therapy has been proposed as an adjunctive treatment for eye disease but has rarely been used in optic neuropathy. The patient was a 57-year-old woman who had direct TON and brain injury after contusion injury. After receiving delayed HBO2 therapy her visual acuity got better – from hand motion to 6/60 – along with improvement of visual field and color vision. She was treated at 2.5 atmospheres absolute for 100 minutes, five times a week, for a total of 61 ..

  09-17-2018

Use of hyperbaric oxygen therapy in quinine-associated visual disturbances

Introduction: Hyperbaric oxygen (HBO2) therapy is infre- quently reported as a treatment for poison-induced retinal damage. We describe a case in which HBO2 therapy was used to treat suspected retinal toxicity induced by quinine. Case report: We present a case in which HBO2 was used to treat visual disturbances thought to be caused by quinine- induced retinal damage. The patient intentionally ingested undisclosed amounts of citalopram and quinine. Following a complicated hospital course, including profound shock requiring treatment with four vasopressors and a peripheral left-ventricular assist device, the patient, once extubated, reported visual abnormalities consistent with those described from quinine-induced retinal toxicity. Visual disturbances ..

  09-17-2018

Severe unintentional first trimester carbon monoxide poisoning: case report

Background: The fetus is uniquely susceptible to carbon monoxide (CO) exposure. We present a case of severe unintentional CO poisoning in the first trimester of pregnancy. Case: A 23-year-old G5P2022 female at 11 weeks' gestational age sat in a car with the engine idling. She was unaware that the vehicle’s exhaust pipe was blocked with snow. She was found to be unresponsive, with an initial carboxyhemoglobin (COHb) concentration of 47.1%. She underwent emergent treatment with hyperbaric oxygen therapy. The remainder of her pregnancy was complicated by a diagnosis of myasthenia gravis. She delivered a full-term infant who was noted to have ..

  09-17-2018

Body mass index in association with decompression sickness events: cross-sectional study among small-scale fishermen-divers in southeast Mexico

Introduction: Decompression sickness is endemic to small- scale fishermen-divers from coastal communities in southeast Mexico; overweight and obesity are also highly prevalent in the region. Existing literature suggests it is possible that fat tissue could play a role in decompression sickness pathophysiology. Our aim in this study is to describe the association between the number and severity of DCS events treated at the hyperbaric program and fishermen-diver body mass index. Methods: In this cross-sectional study, we obtained anthropometric measurements of 105 fishermen-divers and reviewed clinical records of each participant at a hyperbaric program. Results: Average BMI among participants was 34.5±4.7, while 9.5% (n=10) were ..

  09-17-2018

Tympanometric evaluation of Eustachian tube function in Polish scuba divers

Background: Scuba divers are subjected to relatively high ambient pressures while descending. Equalizing man- euvers (e.g., Valsalva) are necessary to open the Eustachian tube (ET) and allow air into the middle ear (ME) cavity. Insufficient opening of the ET leads to ME barotrauma, which is the most common injury related to scuba diving. The study aims were to assess the incidence of ME barotrauma and to compare tympanometric parameters and stapedial reflexes in scuba divers and non-diving individuals. Material and methods: 60 scuba divers participated in the study; control consisted of 90 non-diving volunteers without a history of otolaryngologic problems. All participants ..

  09-17-2018

Oxygen exposures at NASA’s Neutral Buoyancy Lab: a 20-year experience

Astronauts training for extravehicular activity (EVA) operations can spend many hours submerged underwater in a pressurized suit, called an extravehicular mobility unit (EMU), exposed to pressures exceeding 2 atmospheres absolute (ATA). To minimize the risk of decompression sickness (DCS) a 46% nitrox mixture is used. This limits the nitrogen partial pressure, decreasing the risk of DCS. The trade-off with using a 46% nitrox mixture is the increased potential for oxygen toxicity, which can lead to severe neurologic symptoms including seizures. Suited runs, which typically expose astronauts of 0.9-1.1 ATA for longer than six hours, routinely exceed the recommendation for ..

  09-17-2018

Effect of hyperbaric oxygen treatment in central retinal artery occlusion

Background: Central retinal artery occlusion (CRAO) is a rare and serious ophthalmologic emergency with a bad prognosis. Hyperbaric oxygen (HBO2) treatment has been reported to improve visual acuity of CRAO patients. However, there are unknown variables for HBO2 treatment such as initiation period, number of sessions and efficacy. In this study, we aimed to investigate efficacy of HBO2 treatment in CRAO patients. Methods: Patients who had been diagnosed with CRAO and referred to our Hyperbaric Oxygen Treatment Unit with the indication of HBO2 treatment were included in the study. Patient demographics, their systemic diseases, best-corrected visual acuity (BCVA) and the time of visual loss were ..

  09-17-2018

Effect of adjuvant hyperbaric oxygen on healing of cartilage lesions treated with microfracture: an experimental study in rats

Purpose: The purpose of this experimental study was to investigate the effect of hyperbaric oxygen (HBO2) therapy combined with microfracture technique in the treatment of cartilage lesions. Methods: Adult Wistar rats (n=44) were divided into six groups. In Groups A, B, C and D, ICRS* grade 4 cartilage lesions were made on the femoral sulcus of both knees. Lesions were microfractured on the left knees; the right knees had no further procedure. Groups E and F had no surgery. Groups A, C and E received HBO2 therapy once a day, six days a week postopera- tively. Groups B, D and F had no ..

  09-17-2018

Evaluation of hyperbaric oxygen effects on slow coronary flow patients using gated myocardial perfusion imaging tomography

Hyperbaric oxygen (HBO2) is widely used in clinical settings for many disease treatments. To investigate the potential effects of hyperbaric oxygen on patients with slow coronary flow (SCF) we retrospectively analyzed 98 patients who were diagnosed with SCF by coronary artery angiography. Of these, 50 patients received conventional treatment only (control group; the other 48 patients received hyperbaric oxygen treatment for four weeks in addition to the routine therapy (HBO2 group). By using gated myocardial perfusion tomography examination before and after treatment, we observed that 71 out of 148 (47.9%) subsegments of injured myocardium improved in the control group, while 108 ..

  09-17-2018

Short-term effects on ocular variables immediately after hyperbaric oxygen exposures

Purpose: To determine ocular refraction, corneal thickness, corneal radius, corneal power, corneal astigmatism and intraocular pressure in patients before and immediately after repeated hyperbaric oxygen (HBO2) exposures twice a week during six weeks of HBO2 therapy. Methods: 23 patients received HBO2 therapy at 2.4 ATA for 90 minutes daily in monoplace chambers for six weeks, five days a week. The Topcon TRK-1P instrument was installed next to the hyperbaric chambers to record the ocular measurements. Results: A gross myopic shift developed at -0.95 ± 0.54 D (P < 0.001) in the right eye and -0.95 ± 0.53 D (P < 0.001) in the left eye during ..

  09-17-2018

Use of in-chamber transcutaneous oxygen measurement to determine optimal treatment pressure in patients undergoing hyperbaric oxygen therapy

Introduction: Hyperbaric oxygen (HBO2) therapy is used to promote healing in select problem wounds. Transcutaneous oxygen measurement (TCOM) can be used to predict the re- sponse of these wounds to HBO2, with in-chamber TCOM values shown to be the most predictive. We evaluated the use of in-chamber TCOM values to determine optimal treatment pressure. Methods: A retrospective review was completed of patients undergoing HBO2 therapy for a lower-extremity wound and who had in-chamber TCOM. Data collected included TCOM values, treatment profile, and patient outcome. Results: A total of 142 patients were identified. The overall results demonstrated healing in 59%, minor amputation (below ankle) in 11.3%, ..

  09-17-2018

Injection of SVF combined with HBO2 improves viability of unfavorably designed flaps

 Purpose: Soft-tissue reconstruction is complicated by ischemia and reperfusion injury. Animal trials have documented the independent healing benefits of hyperbaric oxygen preconditioning (HBOP) and stem cell delivery in cutaneous flaps. We explored the role of HBOP and stem cell delivery in flap preconditioning and survival. Methods: We designed a randomized controlled trial to assess the effects of hyperbaric oxygen preconditioning and stromal vascular fraction (SVF) delivery on flap survival. Of the first 24 guinea pigs, six received neither HBOP nor injections, and six underwent HBOP without injections. Of the remaining 12 animals, six received SVF or saline injections in the absence of ..

  09-17-2018