Undersea and Hyperbaric Medicine最新文献

Elite athletes who sustain severe injuries may experience physiological, psychological, and financial repercussions. Many therapies, including hyperbaric oxygenation (HBO₂), have been investigated as potential methods of preventing and treating injuries in elite athlete populations. This narrative review explores several applications of HBO₂ therapy relevant to athletes, based on the available human and animal literature. In animal studies, the administration of HBO₂ is associated with improved muscle healing after soft tissue injury. Although human studies are inconclusive, some data suggest that short courses of HBO₂ may result in reduced pain and faster return to play after soft tissue musculoskeletal injury. For individuals with sequelae of traumatic brain injury, limited data suggest that HBO₂ may improve neurobehavioral symptoms. However, studies involving the use of hyperbaric oxygen therapy to treat concussions in athletes are limited. Mild HBO₂ has been used to facilitate post-exercise recovery and reduce fatigue and performance decrements. The treatment vessels used to deliver mild HBO₂ are typically intended for treating altitude sickness only. They are associated with safety and regulatory concerns when used for other purposes, including athletic recovery. Overall, there is limited evidence to support the use of HBO₂ to enhance recovery in athletes with musculoskeletal and mild traumatic brain injury. Further investigations should explore the optimal use of this therapy in the elite athlete population.

COVID-19 has been associated with an increased risk of avascular necrosis (AVN), which affects various joints, including the hip, vertebrae, knee, and jaw. Understanding AVN's pathogenesis and risk factors as a consequence of COVID-19 is essential for improving treatment and identifying preventive measures. This retrospective cohort study aims to assess the impact of COVID-19 on the etiology of AVN and raise awareness among clinicians. The study analyzed patients diagnosed with AVN and treated with Hyperbaric Oxygen Therapy at Gülhane Training and Research Hospital from January 2018 to January 2023. Patients were categorized into two groups: those admitted before the pandemic (the control group) and those admitted after (the study group). The results showed a significant increase in AVN cases during the post-pandemic period, with a higher incidence of femoral head involvement and more advanced stages of AVN in patients with a history of COVID-19. The findings suggest that COVID-19 and high-dose steroid use may increase AVN risk, highlighting the need for careful steroid management and monitoring for joint pain in these patients. Further research is recommended to explore the link between COVID-19 and AVN, the duration of symptoms, and the prognostic implications.

Objective: This study aims to analyze whether receiving Hyperbaric oxygen (HBO₂) therapy affects oral cancer prognosis using real-world data from the National Health Insurance Research Database (NHIRD) in Taiwan.

Method: This study is a retrospective cohort study. Cancer registration files, the NHIRD, and death statistics files from 2011 to 2019 were used for data extraction. We identified 6,297 oral cancer patients, all of whom underwent tumor resection surgery and radiation therapy. Among them, 254 patients received HBO₂ therapy for osteoradionecrosis. We then divided them into two groups for comparison based on whether they received HBO₂ therapy or not. First, propensity score matching was used to eliminate basic characteristic differences between the groups, and then Kaplan-Meier survival analysis was conducted. To eliminate immortal time bias and obtain hazard ratios, a time-dependent Cox proportional hazards model was used for estimation.

Result: After undergoing curative tumor resection combined with adjunctive radiation therapy, oral cancer patients were divided into two groups based on whether they received hyperbaric oxygen therapy. The estimation using a time-dependent Cox proportional hazards model showed no statistically significant differences in the three follow-up endpoints of this study: incidence of second primary cancer, disease-specific mortality, and all-cause mortality, in terms of hazard ratios.

Conclusion: In Taiwan, whether oral cancer patients receive hyperbaric oxygen therapy after curative tumor resection surgery combined with radiation therapy does not affect the incidence of second primary cancer, disease-specific mortality rate, and all-cause mortality rate.

This study evaluated the physical parameters, lactatemia, glycemia, and tolerability in canines with pyometra and sepsis who underwent hyperbaric oxygen therapy (HBO₂). Eighteen female dogs were randomly assigned to two groups: the hyperbaric group (HG) (three sequential sessions of HBO₂ [O₂ with 2 ATA for 45 min] after ovariohysterectomy) and the control group (CG) (ovariohysterectomy). Glycemia and lactatemia were measured at admission (T0), 1 hour after the end of the surgical procedure (T1), 24 hours (T2), 48 hours (T3), and 72 hours (T4) after surgery. Physical assessments were conducted at the same times, except for HG, which was assessed before and after each HBO session. There was no difference between the groups in relation to the physical parameters evaluated; however, rectal temperature was reduced in the group subjected to HBO₂. We observed an increase in lactate at T0 and T2, and a reduction at T3 and T4 in both groups. We did not identify changes in blood glucose levels. HBO₂ is acceptable and safe, but may reduce rectal temperature, although hypothermia can be expected in dogs with pyometra following the surgical procedure. Lactate may take up to 48 hours to begin, but it does not appear to be linked to prognosis or length of stay.

Acute traumatic ischemias are a constellation of disorders that range from crush injuries to compartment syndromes, from burns to frostbite, and from threatened flaps to compromised re-implantations. They represent a significant economic burden to the health care system. In 2016, the National Trauma Organization reported that $672 billion was spent on trauma care without consideration for loss of employment income and psychological trauma associated with the problems. In the most severe orthopedically related traumatic ischemias, for example, Gustilo Grade III-B & C open fractures [1]. Fifty percent complication rates occur even with state of the art orthopaedic and other optimal ancillary care. Hyperbaric oxygen (HBO₂) has mechanisms that mitigate the pathophysiology of the traumatic ischemias with the potential for improving those that have predicably less than optimal outcomes. This selection discusses the surgical types of traumatic ischemias, focusing primarily on crush injuries. It is noteworthy that all the traumatic ischemias have similar pathophysiology. Other sections of this Hyperbaric Medicine Indications Manual are specifically devoted to burn injuries and threatened flaps and grafts.

Background: This systematic review evaluated comparative studies to determine if hyperbaric oxygen therapy (HBO₂) is beneficial to late radiation tissue injury (LRTI) of the bowel/bladder.

Methods: We included adequately powered, comparative studies evaluating the effect of HBO₂ on patients with LRTI (≥3 months duration and/or ≥6 months after radiation therapy) to the bowel/bladder compared to no HBO₂ or placebo/sham; complete outcomes data must have corresponded to the tools used to measure change in LRTI symptoms. Medline was searched through May 4, 2023, Embase through May 29, 2023, and Google Scholar through May 5, 2023. The Cochrane risk-of-bias tool and GRADE approach were used with a certainty of outcomes assessment.

Results: Three RCTs were included with 273 subjects. Two double-blinded studies evaluated rectal symptoms; one open study evaluated cystitis. One study had a low risk of bias; two had some concerns. All had moderate certainty of outcomes. There is moderate certainty with a weak recommendation for using HBO₂ for rectal complications or cystitis, which (in context of GRADE terminology) means the decision to treat depends on a case-by-case basis.

Discussion: The highly heterogeneous design of the trials made meta-analysis impossible, but moderate certainty of the beneficial effect of HBO₂ on LRTI to the rectum and bladder was confirmed. With the weak recommendation, a discussion should take place between the patient and their physician as to whether or not the patient is likely to benefit from HBO₂.

Purpose: To evaluate the characteristics of tidal volume (VT) delivered by a Shangrila590 ventilator with preset tide volume (VTset) 50-300 mL in volume-controlled ventilation (VCV) during hyperbaric oxygen (HBO₂) therapy.

Methods: Experiments were conducted in a multi-place HBO₂ chamber at 1.0, 2.0, and 2.8 atmospheres absolute (ATA abs) and were divided into three groups accordingly. The ventilator was connected to the test lung in the chamber. The VTset of the ventilator was adjusted before the experiments. At five VTset levels (50, 100, 150, 200, 300 mL), the VT and inspiratory peak pressure (Ppeak) detected by the ventilator and the test lung were recorded for 30 cycles (n=30). The measurements of the test lung were considered to be the true value, and the ventilator and test lung data were compared to evaluate the accuracy of the ventilator. Test lung compliance (CTL) was detected by the ventilator, and breathing circuit compliance (CBC) was calculated by measuring the pressure and volume of the breathing circuit. Ventilation data were compared among three groups to clarify the change during HBO₂.

Results: At every VTset, the VT detected by the test lung was different from the ventilator at 1.0~2.8 atm abs (p<0.05), and the VT changed differently among the three groups (p<0.05). CTL and the CBC decreased with increasing ambient pressure (p<0.05). The Ppeak of VCV increased (p<0.05) with increasing ambient pressure.

Conclusions: The Shangrila590 ventilator has limitations in small VTset (50- 300 mL) VCV during HBO₂ therapy. CBC and CTL levels change due to high gas density. High Ppeak may occur in VCV with stable VT, also caused by high gas density.

Background: SCUBA diving involves exposure to a hyperbaric environment that can induce oxidative stress and inflammation. This study investigates the evolution of oxy-inflammation status in divers who performed repetitive dives in cold water.

Methods: In the Baltic Sea, nine expert divers were recruited to perform five dives (T1-T5). Urine and saliva were collected before (A) and after (B) each dive. Reactive Oxygen Species (ROS), total antioxidant capacity (TAC), lipid peroxidation (8-iso-PGF2α), DNA damage (8-OH-dG), inflammatory status (IL-6), nitric oxide metabolites, neopterin, and electrolyte balance changes were investigated.

Results: Pre-dive values showed significant increases at the fourth to fifth days in ROS (+45 and +89%) and consequently in lipid peroxidation (+65%) at the fourth day and in DNA damage (+49 and +61%) at the fourth to fifth days, respectively, compared to the first day value. Post-dive significant increases were recorded at the fourth to fifth days in ROS (+83 % and +146%), and at the fifth day in lipid peroxidation (+59%) and DNA damage (+41%) with respect to the post-dive value of the first day. TAC showed a decrease from the fourth to fifth days post-dive (-15% and -24%) compared to the value on the first day post-dive. Finally, IL-6 increased at the basal level of the fifth day (+183%) and post dive (+154%) with respect to the corresponding values of the first day.

Conclusion: Repetitive dives in cold water induced a progressive increase in pre-dive ROS, 8-iso-PGF2α, 8-OH-dG, and IL-6. Oxidative stress was only partially contained by activation of endogenous antioxidant defenses, while IL-6 variation resulted from diving-related physical effort or oxy-inflammation. We did not find notable changes in the electrolyte balance, probably because all subjects examined were well- trained and experienced divers.

Surface-oriented diving with nitrogen-oxygen breathing gases (nitrox) other than air will commonly be planned according to the Equivalent Air Depth (EAD) principle. EAD is the depth at which a diver breathing air will inhale the same pN₂ as the nitrox-breathing diver. Using conventional air decompression tables based on the EAD depth will allow longer bottom times or shorter decompression times compared to air breathing at the same water depth. This scoping review aimed to investigate the validity of the EAD principle. A literature review identified 13 eligible studies that reported DCS incidence or vascular bubbles following air and nitrox exposures in humans and experimental animals. Four experimental (N=1,597 mandives) and two epidemiological (N=249,109 mandives) studies on humans did not disclose a higher DCS incidence or bubble scores following nitrox dives compared to air dives of similar EAD. Seven experimental animal studies consistently showed that a high pO₂ (>2 atm) increased DCS susceptibility in goats and rats. This can likely be explained by the reduction of the "oxygen window" due to the high tissue and venous pO₂. There is insufficient data from animal studies to conclude whether this can be reproduced within a pO₂ range applicable for human operational diving (<1.6 atm). There is presently no reason to modify the EAD principle for manned diving. Still, we would advise improving the monitoring of operational nitrox dives to confirm that nitrox dives have a DCS incidence similar to that of EAD- and bottom time-matched air dives.

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 that HBO₂ therapy can serve as a useful adjunct in the salvage of compromised flaps and grafts. This review outlines the extensive basic science and clinical evidence available in support of the use of HBO₂ therapy for compromised grafts and flaps. The literature demonstrates the benefit of adjunctive HBO₂ therapy for multiple types of grafts and flaps with various etiologies of compromise. HBO₂ therapy can enhance graft and flap survival by several methods including decreasing the hypoxic insult, enhancing fibroblast function and collagen synthesis, stimulating angiogenesis, and inhibiting ischemia-reperfusion injury. The expedient initiation of hyperbaric oxygen therapy as soon as flap or graft compromise is identified maximizes tissue viability and ultimately graft/flap salvage.