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Number 4

Comparison of two hyperbaric oxygen regimens: 2.0 ATA for 120 minutes to 2.4 ATA for 90 minutes

Introduction: Hyperbaric oxygen dosing variations exist in radiation cystitis treatment. The objectives of this study were to compare response and safety rates among patients with radiation cystitis treated with different protocols: 2.0 ATA (atmospheres absolute) for 120 minutes at the University of Pennsylvania; and 2.4 ATA for 90 minutes at Hennepin Healthcare. Materials and Methods: Retrospective chart review of radiation cystitis patients treated with hyperbaric oxygen at the University of Pennsylvania (January 2010-December 2018) and Hennepin Healthcare Minnesota (January 2014-December 2018). Primary outcome was response to treatment. Complications were limited to hyperbaric-related conditions. Regression analysis was performed with ordinal logistic ..

  11-25-2020

The effect of hyperbaric oxygen on compromised grafts and flaps

The use of grafts and flaps serves as an integral tool in the armamentarium of the reconstructive surgeon. Proper planning and surgical judgment are critical in the ultimate success of these procedures. However, there are situations when grafts and/or flaps can become compromised and require urgent intervention for salvage. These instances can include irradiated or otherwise hypoxic wound beds, excessively large harvested grafts, random flap ischemia, venous or arterial insufficiency, and ischemia-reperfusion injury. Alternatively, compromised grafts and flaps can be inadvertently created secondary to trauma. It is in these types of cases, hyperbaric oxygen (HBO2) therapy can serve as ..

  11-25-2020

Repetitive 1.6 ATA hyperbaric oxygen therapy for bilateral ARCO Stage II steroid-associated osteonecrosis of the femoral head

Hyperbaric oxygen (HBO2) therapy has been demonstrated to have beneficial effects on the early stages of steroid-associated osteonecrosis (SAON) of the femoral head. Since high HBO2 pressure (e.g., 2.4-2.5 atmospheres absolute/ATA) has been commonly considered to have a greater ability to restore tissue oxygenation in the femoral head than low pressure (e.g., 1.6 ATA), the latter HBO2 protocol is rarely used for SAON treatment. In this paper, we present the case of a 36-year-old female diagnosed with bilateral early stage (Association for Research on Osseous Circulation, ARCO stage II) SAON caused by steroid therapy for neuromyelitis optica spectrum disorder ..

  11-25-2020

Diving medical officers as hospitalists: a case of arterial gas embolism following a routine GI procedure

Arterial gas embolism is a well-described and frequently seen injury encountered in both civilian and military diving operations. It is becoming increasingly reported and potentially increasingly more common in the hospital environment as a complication of more frequent gastroenterology procedures. We present a case of a 49-year-old, active-duty female who developed significant left-sided neurological deficits manifesting as diffuse left-sided weakness, subjective confusion, and severe headache following esophagogastroduodenoscopy. With increased clinical suspicion for arterial gas embolism, the patient was evaluated by the hyperbaric medicine team at our facility and subsequently treated to near-resolution of symptoms by multiple hyperbaric oxygen treatments. ..

  11-25-2020

Effects of hyperbaric oxygen on NLRP3 inflammasome activation in the brain after carbon monoxide poisoning

Neuroinflammation plays an important role in brain damage after acute carbon monoxide poisoning (ACOP). The nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing (NLRP) 3 inflammasome triggers the activation of inflammatory caspases and maturation of interleukin (IL)-1β and -18, and has been linked to various human autoinflammatory and autoimmune diseases. In this study we investigated the effects of hyperbaric oxygen (HBO2) on NLRP3 inflammasome activation after ACOP. Mice were randomly divided into four groups: sham group (exposure to normobaric air – i.e., 21% O2 at 1 atmosphere absolute); HBO2-only group; CO + normobaric air group; and CO + HBO2 group. Cognitive ..

  11-25-2020

Platelet activation in rabbits with decompression sickness

Platelets are the most easily altered type of peripheral blood cell in decompression sickness (DCS), which can feature decreased platelet count and the appearance of platelet microparticles in plasma. We hypothesized that DCS results in platelet activation in the bloodstream. The present study was carried out on 45 rabbits. The platelet count and concentration of plasma platelet markers were determined in 35 rabbits; the platelet shape was observed under scanning electron microscope in 10 rabbits. All indexes were collected at two points: 24 hours before the simulated dive and 30 minutes after the simulated dive. Platelet count decreased noticeably ..

  11-25-2020

Influence of hyperbaric oxygen therapy on thrombus formation ability in humans

Background: Hyperbaric oxygen (HBO2) therapy was introduced nearly 300 years ago. However, its effect on thrombus formation is unclear. This may be because platelet and coagulation functions are unstable, yielding variable results; hence, accurate measurement is difficult. Our study aimed to analyze changes in thrombus formation before and after HBO2 therapy by using a total thrombus formation analysis system (T-TAS). Methods: Six patients were prescribed HBO2 therapy for skin and soft tissue ulcers, and necrotic fasciitis. Blood samples were collected immediately before and after treatment. Then samples were put into a reservoir that connected to AR-chip to assess changes in ..

  11-25-2020

Hyperbaric oxygen therapy for the treatment of moderate to severe periodontitis: a clinical pilot study

Objectives: To clinically and microbiologically evaluate the effects of hyperbaric oxygen (HBO2) therapy in addition to full-mouth ultrasonic subgingival debridement (FM-UD), in the initial treatment of chronic periodontitis.  Methods: Twenty patients presenting moderate to severe generalized forms of chronic periodontitis were included in a three-month randomized, parallel-group, single-blinded, prospective study. At baseline patients were randomly assigned to two treatment groups [Test Group (FM-UD+HBO2) and Control Group (FM-UD)]. Both groups were treated with an FM-UD session. Ten HBO2 sessions (one session per day for 10 days at a pressure of 2.5 ATA) were additionally administered to the Test Group. Soft tissues ..

  11-25-2020

Avascular necrosis of the femoral head: Evaluation of hyperbaric oxygen therapy and quality of life

Introduction: The treatment of avascular necrosis of the femoral head (AVNFH) is based on invasive (e.g., core decompression) and non-invasive methods (e.g., hyperbaric oxygen therapy – HBO2). The purpose of the present study is to evaluate the effect of HBO2 on the quality of life (QoL) of patients with AVNFH. Methods: This was a prospective observational non-controlled study of patients with AVNFH treated by HBO2. It was conducted, with the use of Steinberg scale, on 73 patients with AVNFH Stage I or II who were treated with HBO2. Patients’ QoL was assessed with EuroQol-5D-5L (EQ), Harris Hip Score (mHHS), MAHORN ..

  11-25-2020

A case of a critically injured diver with multiorgan failure and severe pulmonary overinflation syndrome in a resource-limited setting

A diver practicing controlled emergency ascent training on the island of Guam suffered bilateral pneumothorax, pneumomediastinum, coronary arterial gas embolism, and developed multiple organ dysfunction syndrome. Due to limitations of available resources he was medically managed in the intensive care unit until he could be transferred to University of California San Diego for definitive management. We provide an account of our management of the patient, the pathophysiology of injury as well as a review of the safety of recreational diving skills training, current standards of practice and potential pitfalls when considering proper management of a critically injured diver. DOI Number: 10.22462/10.12.2020.4

  11-25-2020

Decompression sickness responsive to delayed treatment with hyperbaric oxygen: a case report of two divers

With the increasing popularity of recreational scuba diving, rare complications are becoming more commonly encountered. Although diving is generally safe, novice divers may be unfamiliar with the potential hazards of scuba diving and the resulting sequelae. Dive-related injuries are commonly due to barotrauma or from breathing gas at increased pressures, resulting in decompression illness (DCI), a term that includes both decompression sickness (DCS) and arterial gas embolism (AGE). Symptoms can range from minor aches and pains to neurologic or cardiopulmonary complications resulting in death. Clinical symptoms and diagnosis may initially go unrecognized and can present in a delayed manner, ..

  11-25-2020

Changes in PUFA and eicosanoid metabolism during/after apnea diving: a prospective single-center study

Background: The popularity of apneic diving is continually growing. As apnea diving substantially burdens the cardiovascular system, special focus is warranted. Regarding inflammation processes and associated inflammatory-related diseases (e.g., cardiovascular diseases), eicosanoids play an important role. This study aims to investigate polyunsaturated fatty acids (PUFAs) and eicosanoids in voluntary apnea divers, and so to further improve understanding of pathophysiological processes focusing on proinflammatory effects of temporarily hypercapnic hypoxia. Methods: The concentration of PUFAs and eicosanoids were investigated in EDTA plasma in apnea divers (n=10) before and immediately after apnea, 0.5 hour and four hours later, applying liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results: ..

  11-25-2020

Pulmonary fluid shifts occur as a result of scuba diving at NASA’s Neutral Buoyancy Lab

Introduction: Pulmonary fluid shifts can occur while scuba diving. Such shifts, generally thought to be rare, may result in a life-threatening phenomenon known as immersion pulmonary edema (IPE). This study aims to better classify the normal physiology of diving using ultrasound (US) to determine if these fluid shifts occur routinely during commercial diving work at the NASA Neutral Buoyancy Laboratory (NBL). Methods: Chest US was performed on commercial divers prospectively pre- and post-dive to evaluate the presence of B-lines in a total of 12 intercostal points on the anterior, posterior, and lateral chest wall. The number of B-lines at each anatomic site was recorded and scored by two independent reviewers. An ..

  11-25-2020


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