Undersea and Hyperbaric Medicine最新文献

Background: Two significant earthquakes struck southeastern Turkey on February 6. The study aimed to evaluate the effect of HBO₂ on patients with crush injuries who received therapy at the Akyurt Hyperbaric Oxygen Therapy Center following the earthquakes.

Methods: Thirty-three crush injury patients were included in the study. The Gustilo crush injury grading system, the Mangled Extremity Severity Score (MESS), and the five assessment host function scores were used to evaluate patients. Additionally, the duration from the time under the rubble until HBO₂ started, as well as the presence of fasciotomy/amputation before or after HBO₂, was recorded.

Results: The mean duration from rescue to the initiation of HBO₂ was 195 hours. Of the patients, 63.6% were severely injured according to the MESS (≥7). The Gustilo crush injury classification distribution was 30.3% IIIC, 42.4% IIIB, and 27.3% IIIA. Before HBO₂, 87.9% of the patients had fasciotomies. Fasciotomy lines were closed (without requiring another fasciotomy or additional complications) during or immediately after HBO₂ in 72.4% of 29 patients. Following HBO₂, 78.8% of the patients did not require amputation, while 21.2% had amputations. All patients who underwent amputation after HBO₂ were in the Gustilo IIIC group and scored MESS ≥ 7. Furthermore, 71.4% of patients who had an amputation scored MESS ≥ 10.

Conclusions: Hyperbaric oxygen therapy is beneficial in limb salvage and reduces complications in crush injuries and should be included in treatment plans. In countries with active tectonic activity, appropriate planning should be implemented to ensure patients' access to HBO₂, and the number of HBO₂ centers should be increased.

Introduction: There is no established specific treatment for long-COVID syndrome (LCS), yet hyperbaric oxygen (HBO₂) treatment has been studied as a potential option. Therefore, we conducted a systematic review to evaluate the benefits of HBO₂ treatment in LCS patients.

Methods: We systematically searched PubMed, Embase, and Cochrane databases until April 2024. Risk of bias and GRADE quality assessment were evaluated. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID CRD42024530421.

Results: Seven studies from seven countries, divided into RCTs and observational studies, included 199 participants. HBO₂ treatment protocols included breathing 100% oxygen at 2.0 ATA until 2.5 ATA; the number of sessions varied from ten to 60 depending on the patient's comorbidities and symptoms. Memory, executive function, attention, fatigue, and pain level improved with HBO2 treatment. The intervention had minimal side effects, and none were serious.

Conclusion: HBO₂ treatment might be a potential option and safe treatment in LCS patients. However, further research should be focused on evaluating its efficacy in a larger number of patients through randomized studies.

Background: Pulmonary overinflation syndrome (POIS) is a group of barotrauma-related conditions caused by the expansion of gas trapped in the lung or over-pressurization of the lung with subsequent overexpansion and rupture of the alveolar air sacs. We report a case in which neurological sequelae (arterial gas embolism-AGE) and pneumothorax occurred after breath-hold diving. Treatment with Hyperbaric Oxygen Therapy (HBO₂) led to resolution.

Case report: A 20-year-old male diver was transferred to the Athens Naval Hospital with symptoms after breath-hold diving. He developed neurological deficits presenting as reduced visual acuity and hemiparesis, along with subcutaneous emphysema, pneumomediastinum, and bilateral pneumothoraces. The treatment strategy involved initial management of the pneumothorax, followed by HBO₂ combined with medication to resolve the neurological injury. The patient's clinical improvement was remarkable a week later, and he was discharged.

Central retinal artery occlusion (CRAO) is a relatively rare emergent condition of the eye resulting in sudden painless vision loss. This vision loss is usually dramatic and permanent, and the prognosis for visual recovery is poor. Patients particularly at risk include those with giant cell arteritis, atherosclerosis, and thromboembolic disease. A wide variety of treatment modalities have been tried over the last one hundred years with little to no success, with the exception of hyperbaric oxygen therapy (HBO₂).

Arterial gas embolism (AGE) is a rare complication of percutaneous lung biopsy. We report a case of a patient undergoing lung biopsy complicated by AGE and transient ventricular tachycardia. The patient was placed in the Trendelenburg position, treated with normobaric oxygen therapy, and ultimately discharged from the emergency department. We review the evidence regarding optimal patient positioning for AGE management.

Objective: This study aimed to evaluate the effect of prolonged oxygen inhalation during decompression on the cardiovascular function in divers with hyperbaric air exposure.

Methods: Eight divers were pressurized to 400 kPa and then depressurized 30 minutes later. During the decompression, the time of oxygen breathing was prolonged at different depths. The cardiac, carotid, and brachial arterial functions were evaluated by ultrasonography immediately before and after exposure and then compared.

Results: After hyperbaric exposure, diastolic blood pressure increased significantly, heart rate reduced markedly, but systolic blood pressure tended to reduce. The peak systolic velocity and end diastolic velocity of the common carotid artery reduced markedly, but its resistance index slightly increased, and the diameter of the brachial artery tended to increase. In addition, the end-diastolic volume, cardiac output, E wave, and A wave of the heart reduced markedly, but the flow velocity of the pulmonary artery tended to reduce.

Conclusion: Hyperbaric air exposure at 400 kPa with prolonged oxygen inhalation during decompression mildly affects divers' cardiovascular function.

Prior work demonstrated challenges with ventilators in the hyperbaric environment; few ventilators are fully equipped to address these concerns. We hypothesized the Zoll Z-vent® would deliver set tidal volumes incorrectly in volume control mode, but we could correct it using an algorithm. We used the Zoll Z-vent® in assist control mode in a Class A multiplace chamber and the Michigan test lung system. We identified the set tidal volumes on the ventilator that were necessary to achieve target tidal volumes at various depths. We graphed set tidal volume as a function of depth and performed linear regression modeling. From the regressions, we graphed the slope of each versus the target tidal volume and performed a second set of regressions. We generated an equation from our data to predict set tidal volumes. Set tidal volumes necessary to deliver target tidal volumes were directly proportional to depth in a linear manner. The slope of the regressions as a function of target tidal volume was also linearly proportional. The slope of the second set of regressions generated an equation that is used to predict set tidal volume for a given target tidal volume, PEEP, and gas. The Z-vent® can safely deliver mechanical ventilation under hyperbaric conditions with correction using our model. We use a spreadsheet to calculate set tidal volume for any given depth in clinical practice. We have internally validated this model on over 100 patients with multiple quality control measures in place.

We evaluated the efficacy of hyperbaric oxygen (HBO₂) therapy used to salvage sudden sensorineural hearing loss (SSNHL) at a short distance from ineffective primary treatment. We examined the data on 70 patients who suffered from SSNHL. The treatment was administered from 1 to 3 months after the onset of the hearing loss, i.e., after ineffective primary corticosteroid therapy. The monitored group was divided into three subgroups according to the degree of hearing impairment. Treatment success was assessed by using pre- and post-treatment audiograms. A statistically significant improvement in auditory threshold in all three frequency bands was observed in patients with severe hearing impairment of more than 60 dB, with mean auditory gains of 14.5 dB in low frequencies, 11.2 dB in middle (spoken speech) frequencies, and 13.2 dB in high frequencies. In this subgroup, 54.17 % of patients with severe hearing impairment experienced an improvement in hearing gain by 5 dB or more, 33.33 % by > 10 dB, and 25.00 % by > 20 dB. In patients with moderate and slight hearing impairments, the tendency to improve the hearing gain was not statistically significant. Based on our findings, we conclude that salvage HBO₂ treatment in patients with SSNHL is apparently most efficacious for individuals with severe hearing impairment. This finding is valuable for effective resource management in healthcare and public health.

Objective: Surgical site infections are difficult complications to manage in neurosurgery practice. We aimed to evaluate the use of hyperbaric oxygen (HBO₂) therapy in neurosurgery practice through cases followed in our clinic.

Method: HBO₂ therapy was performed in 13 cases between 2019-2022 at our neurosurgery clinic. We retrospectively evaluated the cases in terms of the age at the time of treatment, the primary pathology, the number of sessions in which HBO2 therapy was performed, the sedimentation and CRP values and radiological images.

Results: The mean age of the cases was 55.2 ± 16.4 years. Seven of the cases were female, and six of them were male. While 9 cases had infection secondary to spinal surgery performed for different indications, 1 case had wound site infection due to cranial surgery, 1 case had infection at the cranioplasty site, 1 case had infection in the area where a pain pacemaker was inserted, and 1 case had wound site infection after a carpal tunnel syndrome operation. The cases received an average of 30 sessions of HBO₂ therapy. While a significant decrease was seen in the sedimentation and CRP values, in all cases, a significant radiological improvement was seen in all the cases that were followed. In seven cases with surgical implants, there was no need for implant revision or removal.

Conclusion: In our study, we observed that HBO₂ therapy is a good adjuvant treatment option to be used together with antibiotherapy in surgical site infections with and without implants, which are difficult to manage clinically.

A common complication of hyperbaric oxygen (HBO₂) treatment is middle ear barotrauma (MEB), which can lead to pain, treatment abandonment, or delay in treatment. Studies have shown that pseudoephedrine decreases MEB for pressure changes in SCUBA divers and airplane travelers. We conducted a randomized, double-blind, placebo-controlled trial to determine if pseudoephedrine effectively decreases MEB rates in patients receiving their first HBO₂ treatment. There was no statistically significant difference between the pseudoephedrine and placebo groups concerning ear pain ratings, tympanic membrane injury, or rescue medication to help equalize ear pressure. Pseudoephedrine prophylaxis, given between 45 minutes and two hours before multiplace HBO₂ treatment, does not mitigate MEB or treatment delays.