Ram A Sack, Yoav Yechezkel Pikkel, Ortal Leitner Shemy, Yitzhak Ramon, Yehuda Ullmann, Assaf A Zeltzer
Chronic wounds have a significant impact on a patient's quality of life. Different pathologies, such as poor blood supply and tissue breakdown, may lead to inadequate oxygenation of the wound. Hyperbaric oxygen (HBO2) is a widely used treatment for an increasing number of medical practices. A new so-called "hyperbaric treatment" trend has emerged. The use of low-pressure, soft-sided, or inflatable chambers represents a growing trend in hyperbaric medicine. Used in professional settings as well as directly marketed to individuals for home use, they are promoted as equivalent to clinical hyperbaric treatments provided in medical centers. However, these chambers are pressurized to 1.3 atmospheres absolute (ATA) on either air or with an oxygen concentrator, both generate oxygen partial pressures well below those used in approved hyperbaric centers for UHMS-approved indications. A total of 130 consecutive patients with chronic ulcers where tested. TcPO2 was measured near the ulcer area while the patient was breathing 100% O2 at 1.4 ATA for five and 10 minutes. The average TcPO2 at 1.4 ATA after 10 minutes of O2 breathing was 161 mmHg (1-601 mmHg, standard deviation 137.91), compared to 333 mmHg in 2 ATA (1-914±232.56), p < 0.001. Each electrode tested was also statistically significant, both after five minutes of O2 breathing and after 10 minutes. We have not found evidence supporting the claim that 1.4 ATA treatment can benefit a chronic ulcer patient. The field of HBO2 is constantly evolving. We have discovered new ways to treat previously incurable ailments. Nevertheless, it is important to note that new horizons must be examined scientifically, supported by evidence-based data. The actual effect of 1.4 ATA on many ailments is yet to be determined.
慢性伤口会严重影响患者的生活质量。血液供应不足和组织破坏等不同病理情况可能会导致伤口供氧不足。高压氧(HBO2)是越来越多医疗实践中广泛使用的一种治疗方法。一种新的所谓 "高压氧治疗 "趋势已经出现。使用低压、软边或充气室代表了高压氧医学日益增长的趋势。在专业环境中使用以及直接销售给个人在家中使用,它们被宣传为等同于医疗中心提供的临床高压氧治疗。然而,这些高压氧舱使用空气或氧气浓缩器加压到 1.3 个绝对大气压 (ATA),两者产生的氧分压都远远低于经批准的高压氧中心用于 UHMS 批准的适应症的氧分压。共有 130 名连续的慢性溃疡患者接受了测试。在溃疡区域附近测量 TcPO2,当时患者呼吸 1.4 ATA 的 100% 氧气,时间分别为 5 分钟和 10 分钟。呼吸氧气 10 分钟后,1.4 ATA 的平均 TcPO2 为 161 mmHg(1-601 mmHg,标准偏差 137.91),而 2 ATA 为 333 mmHg(1-914±232.56),P < 0.001。测试的每个电极在氧气呼吸 5 分钟后和 10 分钟后也都有统计学意义。我们没有发现证据支持 1.4 ATA 治疗能使慢性溃疡患者受益的说法。HBO2 领域在不断发展。我们发现了治疗以前无法治愈的疾病的新方法。尽管如此,重要的是要注意,必须以循证数据为支持,对新领域进行科学研究。1.4 ATA 对许多疾病的实际效果还有待确定。
{"title":"Transcutaneous oximetry values in chronic ulcer patients during Hyperbaric treatment at 1.4 ATA compared to 2 ATA.","authors":"Ram A Sack, Yoav Yechezkel Pikkel, Ortal Leitner Shemy, Yitzhak Ramon, Yehuda Ullmann, Assaf A Zeltzer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Chronic wounds have a significant impact on a patient's quality of life. Different pathologies, such as poor blood supply and tissue breakdown, may lead to inadequate oxygenation of the wound. Hyperbaric oxygen (HBO<sub>2</sub>) is a widely used treatment for an increasing number of medical practices. A new so-called \"hyperbaric treatment\" trend has emerged. The use of low-pressure, soft-sided, or inflatable chambers represents a growing trend in hyperbaric medicine. Used in professional settings as well as directly marketed to individuals for home use, they are promoted as equivalent to clinical hyperbaric treatments provided in medical centers. However, these chambers are pressurized to 1.3 atmospheres absolute (ATA) on either air or with an oxygen concentrator, both generate oxygen partial pressures well below those used in approved hyperbaric centers for UHMS-approved indications. A total of 130 consecutive patients with chronic ulcers where tested. TcPO<sub>2</sub> was measured near the ulcer area while the patient was breathing 100% O<sub>2</sub> at 1.4 ATA for five and 10 minutes. The average TcPO<sub>2</sub> at 1.4 ATA after 10 minutes of O<sub>2</sub> breathing was 161 mmHg (1-601 mmHg, standard deviation 137.91), compared to 333 mmHg in 2 ATA (1-914±232.56), p < 0.001. Each electrode tested was also statistically significant, both after five minutes of O<sub>2</sub> breathing and after 10 minutes. We have not found evidence supporting the claim that 1.4 ATA treatment can benefit a chronic ulcer patient. The field of HBO<sub>2</sub> is constantly evolving. We have discovered new ways to treat previously incurable ailments. Nevertheless, it is important to note that new horizons must be examined scientifically, supported by evidence-based data. The actual effect of 1.4 ATA on many ailments is yet to be determined.</p>","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"51 1","pages":"1-5"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sotiris P Evgenidis, Konstantinos Zacharias, Virginie Papadopoulou, Sigrid Theunissen, Costantino Balestra, Thodoris D Karapantsios
Purpose: Ultrasound imaging is commonly used in decompression research to assess venous gas emboli (VGE) post-dive, with higher loads associated with increased decompression sickness risk. This work examines, for the first time in humans, the performance of a novel electrical impedance spectroscopy technology (I-VED), on possible detection of post-dive bubbles presence and arterial endothelial dysfunction that may be used as markers of decompression stress.
Methods: I-VED signals were recorded in scuba divers who performed standardized pool dives before and at set time points after their dives at 35-minute intervals for about two hours. Two distinct frequency components of the obtained signals, Low-Pass Frequency-LPF: 0-0.5 Hz and Band-Pass Frequency-BPF: 0.5-10 Hz, are extracted and respectively compared to VGE presence and known flow-mediated dilation trends for the same dive profile for endothelial dysfunction.
Results: Subjects with VGE counts above the median for all subjects were found to have an elevated average LPF compared to subjects with lower VGE counts, although this was not statistically significant (p=0.06), as well as significantly decreased BPF standard deviation post-dive compared to pre-dive (p=0.008).
Conclusions: I-VED was used for the first time in humans and operated to provide qualitative in-vivo electrical impedance measurements that may contribute to the assessment of decompression stress. Compared to ultrasound imaging, the proposed method is less expensive, not operator-dependent and compatible with continuous monitoring and application of multiple probes. This study provided preliminary insights; further calibration and validation are necessary to determine I-VED sensitivity and specificity.
{"title":"In-field use of I-VED electrical impedance sensor for assessing post-dive decompression stress in humans.","authors":"Sotiris P Evgenidis, Konstantinos Zacharias, Virginie Papadopoulou, Sigrid Theunissen, Costantino Balestra, Thodoris D Karapantsios","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Ultrasound imaging is commonly used in decompression research to assess venous gas emboli (VGE) post-dive, with higher loads associated with increased decompression sickness risk. This work examines, for the first time in humans, the performance of a novel electrical impedance spectroscopy technology (I-VED), on possible detection of post-dive bubbles presence and arterial endothelial dysfunction that may be used as markers of decompression stress.</p><p><strong>Methods: </strong>I-VED signals were recorded in scuba divers who performed standardized pool dives before and at set time points after their dives at 35-minute intervals for about two hours. Two distinct frequency components of the obtained signals, Low-Pass Frequency-LPF: 0-0.5 Hz and Band-Pass Frequency-BPF: 0.5-10 Hz, are extracted and respectively compared to VGE presence and known flow-mediated dilation trends for the same dive profile for endothelial dysfunction.</p><p><strong>Results: </strong>Subjects with VGE counts above the median for all subjects were found to have an elevated average LPF compared to subjects with lower VGE counts, although this was not statistically significant (p=0.06), as well as significantly decreased BPF standard deviation post-dive compared to pre-dive (p=0.008).</p><p><strong>Conclusions: </strong>I-VED was used for the first time in humans and operated to provide qualitative in-vivo electrical impedance measurements that may contribute to the assessment of decompression stress. Compared to ultrasound imaging, the proposed method is less expensive, not operator-dependent and compatible with continuous monitoring and application of multiple probes. This study provided preliminary insights; further calibration and validation are necessary to determine I-VED sensitivity and specificity.</p>","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"51 1","pages":"71-83"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anwei Liu, Xiaogan Hou, Jing Nie, Qiang Wen, Zhiguo Pan
Decompression sickness (DCS) is caused by abrupt changes in extracorporeal pressure with varying severity. Symptoms range from mild musculoskeletal pain to severe organ dysfunction and death, especially among patients with chronic underlying disease. Here, we report an unusual case of a 49-year-old man who experienced DCS after a dive to a depth of 38 meters. The patient's symptoms progressed, starting with mild physical discomfort that progressed to disturbance of consciousness on the second morning. During hospitalization, we identified that in addition to DCS, he had also developed diabetic ketoacidosis, septic shock, and rhabdomyolysis. After carefully balancing the benefits and risks, we decided to provide supportive treatment to sustain vital signs, including ventilation support, sugar-reducing therapy, fluid replacement, and anti-infection medications. We then administered delayed hyperbaric oxygen (HBO2) when his condition was stable. Ultimately, the patient recovered without any sequelae. This is the first case report of a diver suffering from DCS followed by diabetic ketoacidosis and septic shock. We have learned that when DCS and other critical illnesses are highly suspected, it is essential to assess the condition comprehensively and focus on the principal contradiction.
{"title":"Decompression sickness followed by diabetic ketoacidosis and sepsis shock: an unusual case report.","authors":"Anwei Liu, Xiaogan Hou, Jing Nie, Qiang Wen, Zhiguo Pan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Decompression sickness (DCS) is caused by abrupt changes in extracorporeal pressure with varying severity. Symptoms range from mild musculoskeletal pain to severe organ dysfunction and death, especially among patients with chronic underlying disease. Here, we report an unusual case of a 49-year-old man who experienced DCS after a dive to a depth of 38 meters. The patient's symptoms progressed, starting with mild physical discomfort that progressed to disturbance of consciousness on the second morning. During hospitalization, we identified that in addition to DCS, he had also developed diabetic ketoacidosis, septic shock, and rhabdomyolysis. After carefully balancing the benefits and risks, we decided to provide supportive treatment to sustain vital signs, including ventilation support, sugar-reducing therapy, fluid replacement, and anti-infection medications. We then administered delayed hyperbaric oxygen (HBO<sub>2</sub>) when his condition was stable. Ultimately, the patient recovered without any sequelae. This is the first case report of a diver suffering from DCS followed by diabetic ketoacidosis and septic shock. We have learned that when DCS and other critical illnesses are highly suspected, it is essential to assess the condition comprehensively and focus on the principal contradiction.</p>","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"51 1","pages":"41-46"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In-chamber pneumothorax has complicated medically remote professional diving operations, submarine escape training, management of decompression illness, and hospital-based provision of hyperbaric oxygen therapy. Attempts to avoid thoracotomy by combination of high oxygen partial pressure breathing (the concept of inherent unsaturation) and greatly slowed rates of chamber decompression proved successful on several occasions. When this delicate balance designed to prevent the intrapleural gas volume from expanding faster than it contracts proved futile, chest drains were inserted. The presence of pneumothorax was misdiagnosed or missed altogether with disturbing frequency, resulting in wide-ranging clinical consequences. One patient succumbed before the chamber had been fully decompressed. Another was able to ambulate unaided from the chamber before being diagnosed and managed conventionally. In between these two extremes, patients experienced varying degrees of clinical compromise, from respiratory distress to cardiopulmonary arrest, with successful resuscitation. Pneumothorax associated with manned chamber operations is commonly considered to develop while the patient is under pressure and manifests during ascent. However, published reports suggest that many were pre-existing prior to chamber entry. Risk factors included pulmonary barotrauma-induced cerebral arterial gas embolism, cardiopulmonary resuscitation, and medical or surgical procedures usually involving the lung. This latter category is of heightened importance to hyperbaric operations as an iatrogenically induced pneumothorax may take as long as 24 hours to be detected, perhaps long after a patient has been cleared for chamber exposure.
{"title":"Pneumothorax during manned chamber operations: A summary of reported cases.","authors":"Richard E Clarke, Keith Van Meter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In-chamber pneumothorax has complicated medically remote professional diving operations, submarine escape training, management of decompression illness, and hospital-based provision of hyperbaric oxygen therapy. Attempts to avoid thoracotomy by combination of high oxygen partial pressure breathing (the concept of inherent unsaturation) and greatly slowed rates of chamber decompression proved successful on several occasions. When this delicate balance designed to prevent the intrapleural gas volume from expanding faster than it contracts proved futile, chest drains were inserted. The presence of pneumothorax was misdiagnosed or missed altogether with disturbing frequency, resulting in wide-ranging clinical consequences. One patient succumbed before the chamber had been fully decompressed. Another was able to ambulate unaided from the chamber before being diagnosed and managed conventionally. In between these two extremes, patients experienced varying degrees of clinical compromise, from respiratory distress to cardiopulmonary arrest, with successful resuscitation. Pneumothorax associated with manned chamber operations is commonly considered to develop while the patient is under pressure and manifests during ascent. However, published reports suggest that many were pre-existing prior to chamber entry. Risk factors included pulmonary barotrauma-induced cerebral arterial gas embolism, cardiopulmonary resuscitation, and medical or surgical procedures usually involving the lung. This latter category is of heightened importance to hyperbaric operations as an iatrogenically induced pneumothorax may take as long as 24 hours to be detected, perhaps long after a patient has been cleared for chamber exposure.</p>","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"51 1","pages":"29-35"},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ram A. Sack, Y. Pikkel, Ortal Leitner-Shemi, Yitzhak Ramon, Yehuda Ullmann, Assaf A. Zeltzer
Chronic wounds have a significant impact on a patient’s quality of life. Different pathologies, such as poor blood supply and tissue breakdown, may lead to inadequate oxygenation of the wound. Hyperbaric oxygen (HBO2) is a widely used treatment for an increasing number of medical practices. A new so-called “hyperbaric treatment” trend has emerged. The use of low-pressure, soft-sided, or inflatable chambers represents a growing trend in hyperbaric medicine. Used in professional settings as well as directly marketed to individuals for home use, they are promoted as equivalent to clinical hyperbaric treatments provided in medical centers. However, these chambers are pressurized to 1.3 atmospheres absolute (ATA) on either air or with an oxygen concentrator, both generate oxygen partial pressures well below those used in approved hyperbaric centers for UHMS-approved indications. A total of 130 consecutive patients with chronic ulcers where tested. TcPO2 was measured near the ulcer area while the patient was breathing 100% O2 at 1.4 ATA for five and 10 minutes. The average TcPO2 at 1.4 ATA after 10 minutes of O2 breathing was 161 mmHg (1-601 mmHg, standard deviation 137.91), compared to 333 mmHg in 2 ATA (1-914±232.56), p < 0.001). Each electrode tested was also statistically significant, both after five minutes of O2 breathing and after 10 minutes. We have not found evidence supporting the claim that 1.4 ATA treatment can benefit a chronic ulcer patient. The field of HBO2 is constantly evolving. We have discovered new ways to treat previously incurable ailments. Nevertheless, it is important to note that new horizons must be examined scientifically, supported by evidence-based data. The actual effect of 1.4 ATA on many ailments is yet to be determined.
慢性伤口会严重影响患者的生活质量。血液供应不足和组织破坏等不同病理情况可能会导致伤口供氧不足。高压氧(HBO2)是越来越多医疗实践中广泛使用的一种治疗方法。一种新的所谓 "高压氧治疗 "趋势已经出现。使用低压、软边或充气室代表了高压氧医学日益增长的趋势。在专业环境中使用以及直接销售给个人在家中使用,它们被宣传为等同于医疗中心提供的临床高压氧治疗。然而,这些高压氧舱使用空气或氧气浓缩器加压到 1.3 个绝对大气压 (ATA),两者产生的氧分压都远远低于经批准的高压氧中心用于 UHMS 批准的适应症的氧分压。共有 130 名连续的慢性溃疡患者接受了测试。在溃疡区域附近测量 TcPO2,当时患者呼吸 1.4 ATA 的 100% 氧气,时间分别为 5 分钟和 10 分钟。氧气呼吸 10 分钟后,1.4 ATA 的平均 TcPO2 为 161 mmHg(1-601 mmHg,标准偏差 137.91),而 2 ATA 为 333 mmHg(1-914±232.56),p < 0.001)。测试的每个电极在氧气呼吸 5 分钟后和 10 分钟后也都有统计学意义。我们没有发现证据支持 1.4 ATA 治疗能使慢性溃疡患者受益的说法。HBO2 领域在不断发展。我们发现了治疗以前无法治愈的疾病的新方法。尽管如此,重要的是要注意,必须以循证数据为支持,对新领域进行科学研究。1.4 ATA 对许多疾病的实际效果还有待确定。
{"title":"Transcutaneous oximetry values in chronic ulcer patients during Hyperbaric treatment at 1.4 ATA compared to 2 ATA","authors":"Ram A. Sack, Y. Pikkel, Ortal Leitner-Shemi, Yitzhak Ramon, Yehuda Ullmann, Assaf A. Zeltzer","doi":"10.22462/587","DOIUrl":"https://doi.org/10.22462/587","url":null,"abstract":"Chronic wounds have a significant impact on a patient’s quality of life. Different pathologies, such as poor blood supply and tissue breakdown, may lead to inadequate oxygenation of the wound. Hyperbaric oxygen (HBO2) is a widely used treatment for an increasing number of medical practices. A new so-called “hyperbaric treatment” trend has emerged. The use of low-pressure, soft-sided, or inflatable chambers represents a growing trend in hyperbaric medicine. Used in professional settings as well as directly marketed to individuals for home use, they are promoted as equivalent to clinical hyperbaric treatments provided in medical centers. However, these chambers are pressurized to 1.3 atmospheres absolute (ATA) on either air or with an oxygen concentrator, both generate oxygen partial pressures well below those used in approved hyperbaric centers for UHMS-approved indications. A total of 130 consecutive patients with chronic ulcers where tested. TcPO2 was measured near the ulcer area while the patient was breathing 100% O2 at 1.4 ATA for five and 10 minutes. The average TcPO2 at 1.4 ATA after 10 minutes of O2 breathing was 161 mmHg (1-601 mmHg, standard deviation 137.91), compared to 333 mmHg in 2 ATA (1-914±232.56), p < 0.001). Each electrode tested was also statistically significant, both after five minutes of O2 breathing and after 10 minutes. We have not found evidence supporting the claim that 1.4 ATA treatment can benefit a chronic ulcer patient. The field of HBO2 is constantly evolving. We have discovered new ways to treat previously incurable ailments. Nevertheless, it is important to note that new horizons must be examined scientifically, supported by evidence-based data. The actual effect of 1.4 ATA on many ailments is yet to be determined.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139001437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In clinical management of carbon monoxide (CO) poisoning, serum cardiac enzyme biomarkers and electrocardiogram (ECG) are both highly recommended emergency check-ups to evaluate myocardial injuries. Medical imaging – including head CT or MRI – are not routine for CO poisoning emergency management. We herein report on a comatose patient who was diagnosed with cerebral infarction secondary to 24 hours previous acute CO poisoning, warned by a typical cerebral-type T waves on ECG in advance, and confirmed by a head MRI. Fortunately, the patient made a full recovery based on a timely treatment with medications and hyperbaric oxygen (HBO2) therapy. We would like to propose that a vital, stable, conscious CO poisoning patient who remains a higher risk for hemorrhagic or ischemic stroke should be closely monitored for potential neurological abnormalities, and a continuous ECG monitoring should be reinforced throughout the treatment. A head MRI or CT is a priority in evaluating the secondary cerebral stroke and should be arranged immediately in the event of an abnormal ECG or if unusual new symptoms are apparent.
{"title":"Stroke on ECG: a cerebral T-wave change secondary to acute carbon monoxide poisoning","authors":"Xin Xiao, MD, Xiuna Jing, MD, Yun Zhao, MD, Fei Yao, MD, Qing Sun, MD","doi":"10.22462/630","DOIUrl":"https://doi.org/10.22462/630","url":null,"abstract":"In clinical management of carbon monoxide (CO) poisoning, serum cardiac enzyme biomarkers and electrocardiogram (ECG) are both highly recommended emergency check-ups to evaluate myocardial injuries. Medical imaging – including head CT or MRI – are not routine for CO poisoning emergency management. We herein report on a comatose patient who was diagnosed with cerebral infarction secondary to 24 hours previous acute CO poisoning, warned by a typical cerebral-type T waves on ECG in advance, and confirmed by a head MRI. Fortunately, the patient made a full recovery based on a timely treatment with medications and hyperbaric oxygen (HBO2) therapy. We would like to propose that a vital, stable, conscious CO poisoning patient who remains a higher risk for hemorrhagic or ischemic stroke should be closely monitored for potential neurological abnormalities, and a continuous ECG monitoring should be reinforced throughout the treatment. A head MRI or CT is a priority in evaluating the secondary cerebral stroke and should be arranged immediately in the event of an abnormal ECG or if unusual new symptoms are apparent.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"102 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79431018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In-chamber pneumothorax has complicated medically remote professional diving operations, submarine escape training, management of decompression illness and hospital-based provision of hyperbaric oxygen therapy. Attempts to avoid thoracotomy by combination high oxygen partial pressure breathing (the concept of inherent unsaturation) and greatly slowed rates of chamber decompression proved successful on several occasions. When this delicate balance designed to prevent intrapleural gas volume expanding faster than it contracts proved futile, chest drains were inserted. The presence of pneumothorax was misdiagnosed or missed altogether with disturbing frequency resulting in wide-ranging clinical consequences. One patient succumbed before the chamber had been fully decompressed. Another was able to ambulate unaided from the chamber before being diagnosed and managed conventionally. In between these two extremes, patients experienced varying degrees of clinical compromise, from respiratory distress to cardiopulmonary arrest, with successful resuscitation. Pneumothorax associated with manned chamber operations has commonly been considered to develop while the patient was under pressure and manifest during ascent. Published reports suggest, however, that many were pre-existing prior to chamber entry. Risk factors included pulmonary barotrauma-induced cerebral arterial gas embolism, cardiopulmonary resuscitation and medical or surgical procedures usually involving the lung. This latter category is of heightened importance to hyperbaric operations as an iatrogenically induced pneumothorax may take as long as 24 hours to be detected, perhaps long after a patient has been cleared for chamber exposure.
{"title":"Pneumothorax during manned chamber operations: A summary of reported cases","authors":"Richard E. Clarke, CHT-A, Keith Van Meter, MD","doi":"10.22462/652","DOIUrl":"https://doi.org/10.22462/652","url":null,"abstract":"In-chamber pneumothorax has complicated medically remote professional diving operations, submarine escape training, management of decompression illness and hospital-based provision of hyperbaric oxygen therapy. Attempts to avoid thoracotomy by combination high oxygen partial pressure breathing (the concept of inherent unsaturation) and greatly slowed rates of chamber decompression proved successful on several occasions. When this delicate balance designed to prevent intrapleural gas volume expanding faster than it contracts proved futile, chest drains were inserted. The presence of pneumothorax was misdiagnosed or missed altogether with disturbing frequency resulting in wide-ranging clinical consequences. One patient succumbed before the chamber had been fully decompressed. Another was able to ambulate unaided from the chamber before being diagnosed and managed conventionally. In between these two extremes, patients experienced varying degrees of clinical compromise, from respiratory distress to cardiopulmonary arrest, with successful resuscitation. Pneumothorax associated with manned chamber operations has commonly been considered to develop while the patient was under pressure and manifest during ascent. Published reports suggest, however, that many were pre-existing prior to chamber entry. Risk factors included pulmonary barotrauma-induced cerebral arterial gas embolism, cardiopulmonary resuscitation and medical or surgical procedures usually involving the lung. This latter category is of heightened importance to hyperbaric operations as an iatrogenically induced pneumothorax may take as long as 24 hours to be detected, perhaps long after a patient has been cleared for chamber exposure.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"52 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73666939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The presence of a pneumothorax within a pressurized chamber represents unique diagnostic and management challenges. This is particularly the case in the medical and geographic remoteness of many chamber locations. Upon commencing chamber decompression unvented intrapleural air expands. If its initial volume and/or degree of chamber pressure reduction is significant enough a tension pneumothorax will result. Numerous reports chronicle failure to diagnose and manage in-chamber pneumothorax with resultant morbidity and one fatal outcome. Such cases have occurred in both medically remote and clinically based settings. This paper reviews pneumothorax and tension pneumothorax risk factors and clinical characteristics. It suggests primary medical management using the principal of oxygen-induced inherent unsaturation in concert with titrated chamber decompression designed to prevent intrapleural air expanding any faster than it contracts. Should this conservative approach prove unsuccessful, and surgical venting becomes necessary or otherwise immediately indicated, interventional options are reviewed.
{"title":"Medical and surgical management of pneumothorax in diving and hyperbaric chambers","authors":"Richard E. Clarke, CHT-A, Keith Van Meter, MD","doi":"10.22462/651","DOIUrl":"https://doi.org/10.22462/651","url":null,"abstract":"The presence of a pneumothorax within a pressurized chamber represents unique diagnostic and management challenges. This is particularly the case in the medical and geographic remoteness of many chamber locations. Upon commencing chamber decompression unvented intrapleural air expands. If its initial volume and/or degree of chamber pressure reduction is significant enough a tension pneumothorax will result. Numerous reports chronicle failure to diagnose and manage in-chamber pneumothorax with resultant morbidity and one fatal outcome. Such cases have occurred in both medically remote and clinically based settings. This paper reviews pneumothorax and tension pneumothorax risk factors and clinical characteristics. It suggests primary medical management using the principal of oxygen-induced inherent unsaturation in concert with titrated chamber decompression designed to prevent intrapleural air expanding any faster than it contracts. Should this conservative approach prove unsuccessful, and surgical venting becomes necessary or otherwise immediately indicated, interventional options are reviewed.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"43 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86776953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christian Smolle M.D., Daniel Auinger M.D., Jörg Lindenmann M.D, Josef Smolle M.D., Freyja-Maria Smolle-Juettner M.D., Lars-Peter Kamolz M.D.
Throughout more than five decades a multitude of experimental and clinical studies has shown predominantly positive, but also controversial results on the efficacy of hyperbaric oxygen (HBO2) therapy in burns. Aim of the study was to define a common denominator or constellations, respectively, linked to the effects of HBO2 in burns with special focus on dosage parameters. Based on original work since 1965, species, number of individuals, type of study, percentage of total body surface area (TBSA), region, depth of burn, causative agent, interval between burn and first HBO2 session, pressure, duration of individual session, number of HBO2 sessions per day, cumulative number of HBO2 sessions and type of chamber were assessed. Out of 47 publications included, 32 were animal trials, four were trials in human volunteers and 11 clinical studies. They contained 94 experiments whose features were processed for statistical evaluation. 64 (67.4%) showed a positive outcome, 16 (17.9%) an ambiguous one and 14 (14.7%) a negative outcome. The only factor independently influencing the results was pressure with ATA (atmospheres absolute) lower than 3 ATA being significantly associated with better outcome (p=0.0005). There is a dire need for well-designed clinical studies in burn centers equipped with hyperbaric facilities to establish dedicated treatment protocols.
{"title":"Hyperbaric oxygen (HBO2) therapy in thermal burn injury revisited. Pressure does matter. Review.","authors":"Christian Smolle M.D., Daniel Auinger M.D., Jörg Lindenmann M.D, Josef Smolle M.D., Freyja-Maria Smolle-Juettner M.D., Lars-Peter Kamolz M.D.","doi":"10.22462/617","DOIUrl":"https://doi.org/10.22462/617","url":null,"abstract":"Throughout more than five decades a multitude of experimental and clinical studies has shown predominantly positive, but also controversial results on the efficacy of hyperbaric oxygen (HBO2) therapy in burns. Aim of the study was to define a common denominator or constellations, respectively, linked to the effects of HBO2 in burns with special focus on dosage parameters. Based on original work since 1965, species, number of individuals, type of study, percentage of total body surface area (TBSA), region, depth of burn, causative agent, interval between burn and first HBO2 session, pressure, duration of individual session, number of HBO2 sessions per day, cumulative number of HBO2 sessions and type of chamber were assessed. Out of 47 publications included, 32 were animal trials, four were trials in human volunteers and 11 clinical studies. They contained 94 experiments whose features were processed for statistical evaluation. 64 (67.4%) showed a positive outcome, 16 (17.9%) an ambiguous one and 14 (14.7%) a negative outcome. The only factor independently influencing the results was pressure with ATA (atmospheres absolute) lower than 3 ATA being significantly associated with better outcome (p=0.0005). There is a dire need for well-designed clinical studies in burn centers equipped with hyperbaric facilities to establish dedicated treatment protocols.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"361 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76471723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edwin López Ramos, Manuel Rivera Bengoechea, Silvina Cancelos Mancini, Carlos Marín Martín
Objective: The presentation of a novel prospective treatment for scenarios where bubble presence in the bloodstream poses a clinical risk. The method relies on generating resonant acoustic standing waves within a limb to non-invasively accelerate dissolution of bubbles present in the bloodstream via bubble rupture. Additionally, a preliminary assessment of the effects of the resonant acoustic waves and bubble rupture events on red blood cell viability is provided. Methods: Two semicircular piezoelectric (PZT) transducers electrically connected to each other were assembled around a small-girth segment of a rear thigh removed from a swine specimen. When driven at the frequency of electric resonance, this swine thigh and PZT transducer arrangement generates resonant acoustic standing waves within the swine thigh. Consequently, mechanical resonance of the system was non-invasively established by monitoring the electric response of the PZT to the applied frequency. The resonant acoustic field generated was used for the detection and rupture of bubbles that travel through a simulated blood vessel installed across the swine thigh. Two sets of experiments were carried out using this methodology, one with the artificial blood vessel filled with saline solution and one with defibrinated sheep blood. For the latter case, a preliminary hematologic assessment was done with red blood cell counts. Conclusion: Resonant acoustic standing waves effectively rupture bubbles of 300µm to 900µm within a simplified swine thigh model. The average dissolved gas content was 44% due to resonant acoustic waves at powers above 20W. No significant effect on red blood cell counts was observed.
{"title":"Bubble rupture & viability of red blood cells under resonant acoustic standing waves","authors":"Edwin López Ramos, Manuel Rivera Bengoechea, Silvina Cancelos Mancini, Carlos Marín Martín","doi":"10.22462/575","DOIUrl":"https://doi.org/10.22462/575","url":null,"abstract":"Objective: The presentation of a novel prospective treatment for scenarios where bubble presence in the bloodstream poses a clinical risk. The method relies on generating resonant acoustic standing waves within a limb to non-invasively accelerate dissolution of bubbles present in the bloodstream via bubble rupture. Additionally, a preliminary assessment of the effects of the resonant acoustic waves and bubble rupture events on red blood cell viability is provided. Methods: Two semicircular piezoelectric (PZT) transducers electrically connected to each other were assembled around a small-girth segment of a rear thigh removed from a swine specimen. When driven at the frequency of electric resonance, this swine thigh and PZT transducer arrangement generates resonant acoustic standing waves within the swine thigh. Consequently, mechanical resonance of the system was non-invasively established by monitoring the electric response of the PZT to the applied frequency. The resonant acoustic field generated was used for the detection and rupture of bubbles that travel through a simulated blood vessel installed across the swine thigh. Two sets of experiments were carried out using this methodology, one with the artificial blood vessel filled with saline solution and one with defibrinated sheep blood. For the latter case, a preliminary hematologic assessment was done with red blood cell counts. Conclusion: Resonant acoustic standing waves effectively rupture bubbles of 300µm to 900µm within a simplified swine thigh model. The average dissolved gas content was 44% due to resonant acoustic waves at powers above 20W. No significant effect on red blood cell counts was observed.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"33 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89825692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}