Diving and hyperbaric medicine最新文献

A 41-year-old female nurse had cutaneous decompression sickness on two occasions after acting as an inside chamber attendant for patients receiving hyperbaric oxygen. She breathed air during the treatments at pressures equivalent to 14 and 18 metres of seawater, but each time she decompressed whilst breathing oxygen. Latency was 2.5 hours and one hour. She was found to have an 11 mm diameter persistent foramen ovale. It was closed and she returned to work without recurrence of decompression sickness. Review of the literature suggests that shunt mediated decompression sickness is an important occupational risk for individuals with a large right-to-left shunt when working in hyperbaric air, but the manifestations of decompression sickness differ in those who decompress whilst breathing oxygen compared with those who decompress whilst breathing air.

Rothera is a British Antarctic Survey research station located on Adelaide Island adjacent, to the Antarctic Peninsula. Diving is vital to support a long-standing marine science programme but poses challenges due to the extreme and remote environment in which it is undertaken. We summarise the diving undertaken and describe the medical measures in place to mitigate the risk to divers. These include pre-deployment training in the management of emergency presentations and assessing fitness to dive, an on-site hyperbaric chamber and communication links to contact experts in the United Kingdom for remote advice. The organisation also has experience of evacuating patients, should this be required. These measures, as well as the significant infrastructure and logistical efforts to support them, enable high standards of medical care to be maintained to divers undertaking research on this most remote continent.

The authors have requested an update be made to the Acknowledgements statement in their article. The Acknowledgements should read: The authors would like to thank Senior Constable Scott Williams, Dr Chris Lawrence, Dr Andrew Reid, and Dr John Lippmann. The authors would also like to acknowledge and thank the support from the Tasmanian frontline agency representatives, and representatives from the Royal Hobart Hospital, Launceston General Hospital, North West Regional Hospital, Mersey Hospital, and Ochre Medical Group.

Introduction: Rapidly progressive necrotising soft tissue infections (NSTIs) are associated with high mortality and morbidity. Low incidence and disease heterogeneity contribute to low event rates and inadequately powered studies. The Necrotising Infections Clinical Composite Endpoint (NICCE) provides a binary outcome with which to assess interventions for NSTIs. Partly with a view towards studies of hyperbaric oxygen treatment in NSTIs we aimed to validate NICCE in a retrospective cohort of NSTI patients.

Methods: Eligible patients were admitted between 2012 and 2021 to an adult major referral hospital in Victoria, Australia with surgically confirmed NSTI. The NICCE and its constituents were assessed in the whole cohort (n = 235). The cohort was divided into two groups using the modified sequential organ failure assessment (mSOFA) score, with an admission mSOFA score ≥ 3 defined as high acuity.

Results: Baseline characteristics of the whole (n = 235), the high (n = 188) and the low acuity cohorts (n = 47) were similar. Survival rates were high (91.1%). Patients with an admission mSOFA ≥ 3 were less likely to meet NICCE criteria for 'success' compared to the lower acuity cohort (34.1% and 64.7% respectively). Meeting NICCE criteria was significantly associated with lower resource utilisation, measured by intensive care unit days, ventilator days, and hospital length of stay for all patients and for those with high acuity on presentation.

Conclusions: The NICCE provides greater discriminative ability than mortality alone. It accurately selects patients at high risk of adverse outcomes, thereby enhancing feasibility of trials. Adaptation of NICCE to include patient-centred outcomes could strengthen its clinical relevance.

Bispectral index with density spectral array (BIS-DSA) monitoring during hyperbaric oxygen therapy of a case with inner ear and cerebral decompression sickness is described. During the initial treatment, a particular DSA pattern was found, which resolved after four treatments. Clinical resolution of the symptoms accompanied this improvement. The particular BIS-DSA pattern described in this case is concordant with a potential hypo-perfusion of the cortex related to decompression stress. This case suggests that BIS-DSA monitoring may be an easy, cost-effective, and viable form of neuro-monitoring during hyperbaric oxygen treatment for decompression sickness.

Barosinusitis, or sinus barotrauma, is a sinonasal injury and/or inflammation that results when the aerated spaces of the nose and sinuses are exposed to an uncompensated change in ambient pressure. We describe a 19-year-old male diver who presented to our clinic on the fourth day following a breath-hold diving session. During descent on a constant weight monofin dive at the South Cyprus World Championship he began to experience symptoms due to the inability to equalise the pressure, particularly in the Eustachian tubes and middle ear cavities. He felt pain and pressure in the upper left half of his face, left upper molars, and under his left eye at 60 metres, and he continued diving down to 74 metres. At presentation to our clinic, he still had ecchymosis under his right eye and pain in his upper right teeth, half of his face, and ear. He also described tingling in the lower left half of his nose and the left half of his upper lip. He received decongestants, B vitamins, and underwent endoscopic sinus drainage which alleviated his symptoms alleviated over time. The diver reported complete resolution of tingling, numbness, and pain after three months. It should not be forgotten that if appropriate treatment is delayed, permanent changes may occur as a result of long-term compression of the nerve, and therefore patients should be monitored closely.

Introduction: Assessing a diver's fitness to dive enhances diving safety, with medical examiners of diving (MED) being entrusted with this responsibility. However, the effectiveness of MED training in preparing physicians for this task remains underexplored. In the Netherlands, where any physician can pursue MED qualification, challenging cases can be presented to a board of experts.

Methods: This retrospective analysis included all cases presented to a board of experts in the period 2013-2023. Aside from baseline information, cases were coded using the International Classification of Diseases 11th Revision (ICD-11). Additionally, the type of advice given by the board was also recorded.

Results: A total of 291 cases could be included, 62.5% were male divers with a median age of 47 years old (interquartile range 29-55). Circulatory (20.9%), respiratory (16.2%), neurologic (14.4%), psychiatric (9.6%) and endocrine (6.5%) disease comprised more than two-thirds of all presented cases. Problems for the MED included multimorbidity, knowledge of guidelines and interpretation of diagnostic data.

Conclusions: These results could be used to improve MED courses or serve as a topic for continuing medical education for MEDs, however, further research into generalisability is required.

Introduction: The COVID-19 pandemic raised significant concerns about fitness to dive due to potential damage to the pulmonary and cardiovascular systems. Our group previously published guidelines (original and revised) for assessment of these divers. Here, we report a prospective, observational study to evaluate the utility of these guidelines.

Methods: Recreational, commercial, and scientific divers with a history of COVID-19 were consented and enrolled. Subjects were evaluated according to the aforementioned guidelines and followed for any additional complications or diving related injuries.

Results: One-hundred and twelve divers (56 male, 56 female, ages 19-68) were enrolled: 59 commercial, 30 scientific, 20 recreational, two unknown (not documented), one military. Cases were categorised according to two previous guidelines ('original' n = 23 and 'revised' n = 89): category 0 (n = 6), category 0.5 (n = 64), category 1 (n = 38), category 2 (n = 2), category 3 (n = 1), uncategorisable due to persistent symptoms (n = 1). One hundred divers (89.3%) were cleared to return to diving, four (3.6%) were unable to return to diving, four (3.6%) were able to return to diving with restrictions, and four (3.6%) did not complete testing. Regarding diving related complications, one diver had an episode of immersion pulmonary oedema one year later and one diver presented with decompression sickness and tested positive for COVID-19.

Conclusions: Most divers who presented for evaluation were able to return to diving safely. Abnormalities were detected in a small percentage of divers that precluded them from being cleared to dive. Guidelines were easily implemented by a variety of clinicians.

We report an unusual decompression sickness (DCS) incident in a commercial diving project. Eleven divers completed 91 dives to 23.5-36.2 m with bottom times ranging 23-67 min. The divers were breathing compressed air while immersed. Decompression was planned as surface decompression in a deck decompression chamber breathing oxygen typically for 15-30 min. Due to a technical error the divers breathed air rather than oxygen during the surface decompression procedure. Two divers suffered DCS. Both were recompressed on site with the same error resulting in them breathing compressed air rather than oxygen. One of them experienced a severe relapse with cardiovascular decompensation following recompression treatment. While DCS was expected due to the erroneous decompression procedures, it is noteworthy that only two incidents occurred during 91 dives with surface decompression breathing air instead of oxygen. Accounting for this error, the median omitted decompression time was 17 min (range 0-26 min) according to the Bühlmann ZHL-16C algorithm. These observations suggest that moderate omission of decompression time has a relatively small effect on DCS incidence rate. The other nine divers were interviewed in the weeks following completion of the project. None of them reported symptoms at the time, but five divers reported having experienced minor symptoms compatible with mild DCS during the project which was not reported until later.