Undersea and Hyperbaric Medicine最新文献

This article calls for a critical reevaluation of routine radiologic imaging, particularly chest X-rays (CXR) and chest computed tomography (CT), in fitness-to-dive assessments for occupational, military, and commercial divers. While these assessments aim to prevent diving incidents by identifying medical risks, the frequent inclusion of radiologic imaging for asymptomatic divers raises concerns due to limited sensitivity and specificity, incidental findings, and potential disqualification without clear evidence of increased diving-related risk. The authors advocate for a community-driven consensus to establish evidence-based guidelines and address the necessity of routine imaging in this context.

This retrospective study examines the effectiveness of Hyperbaric oxygen therapy in treating severe frostbite injuries. From October 2013 to March 2020, the study analyzed 214 patients, including 62 treated with HBO₂ therapy. This study aims to describe the impact of HBO₂ therapy on improving tissue salvage and reducing amputation rates in severe frostbite-injured patients. The data suggested that patients undergoing HBO₂ therapy were more likely to receive thrombolytics and have larger areas of tissue impacted. They tended to be younger and had longer hospital stays. A significantly larger proportion of HBO₂ therapy-treated patients required surgical interventions, including amputation and debridement, compared to those not treated with HBO₂ therapy, reflecting the severity of their initial injury. Results indicate a complex relationship between HBO₂ therapy treatment and patient outcomes, suggesting that factors such as severity of injury, patient demographics, and thrombolytic therapy treatment significantly influence severe frostbite outcomes. This study contributes valuable insights to the limited literature on HBO₂ therapy in frostbite management and underscores the need for further controlled trials to ascertain its effectiveness conclusively.

Postoperative paralytic ileus is one of the most common complications associated with abdominal surgery. Although the Japanese Society of Hyperbaric and Undersea Medicine officially approves paralytic ileus as an indication for hyperbaric oxygen therapy, the factors related to the prognosis of this therapy have not been determined. Accordingly, in this study, we evaluated factors that may be related to the prognosis of this therapy in patients with postoperative paralytic ileus. Patients in gastroenterological surgery, obstetrics and gynecology, and urology who underwent hyperbaric oxygen therapy for postoperative paralytic ileus from April 1, 2017, through March 31, 2022, were retrospectively evaluated. We set the primary outcome as the number of days to oral intake after the start of the therapy. First, we compared the differences in the number of days for various factors possibly related to its prognosis. Next, multivariate analysis using multiple linear regression analysis was performed. We evaluated 110 patients. Younger age, no prevalence of diabetes mellitus, the kind of surgery, no history of previous abdominal surgery, a shorter number of days from the onset to the start of therapy, and higher mean pressure of therapy had at least 1.5 fewer days of nothing by mouth. Multiple linear regression analysis revealed that only the mean pressure of therapy was a factor associated with the prognosis of hyperbaric oxygen therapy. Only the mean pressure of therapy is related to the prognosis of hyperbaric oxygen therapy. Further prospective studies adopting higher pressure therapy will be necessary to evaluate the efficacy of this treatment.

Background: Diving is a diffused recreational activity, and the number of divers carrying cardiac implanted devices is similarly growing. Due to the lack of guidelines or technical indications, the suitability of such devices for diving or the fitness to dive for these patients still needs to be determined.

Objective: This work summarizes implantable cardiac devices' suitability for recreational diving, technical vulnerability factors, and recommendations to improve implanted divers' safety.

Methods: Between May 1, 2021, and March 20, 2022, three interventional cardiologists retrieved the technical documentation of selected implantable cardiac devices. In particular, any suitability and tests conducted in hyperbaric environments were tracked.

Results: Technical documentation was recovered for four companies. Most devices were tested in hyperbaric conditions in single, prolonged, or repeated exposures to pressurized air; underwater tests were not mentioned. No company expressly disclosed the suitability of the devices for underwater activities.

Conclusion: In the absence of technical indications or guidelines, a multidisciplinary evaluation between cardiology, diving medicine, and sports medicine is essential to establish the suitability for underwater sports in implanted patients. Before each diving trip, device control is advisable, and underwater physiological adaptations should be considered, especially in the cardiovascular domain. Stressors other than water and pressure must be considered during diving, such as lead strain caused by arm movements and pressure exerted by suits or buoyancy control devices on the chest. Future directions point towards a follow-up of implanted, active divers and developing leadless devices and underwater telemonitoring.

Clostridial myositis and myonecrosis, or gas gangrene, is an acute, rapidly progressive, non-pyogenic, invasive clostridial infection of the muscle tissue characterized by profound toxemia, extensive edema, massive death of tissue, and a variable degree of gas production [1-2]. Gas gangrene is either an endogenous infection caused by contamination from a clostridial focus in the body (spontaneous, atraumatic) or an exogenous infection found mostly in patients with compound and/or complicated fractures with extensive soft tissue injuries after trauma (non-spontaneous, traumatic). The onset of gas gangrene may occur between one to six hours after injury or operation and begins with severe and sudden pain in the infected area before the clinical signs appear. In atraumatic clostridial myonecrosis there are certain predisposing risks such as colonic and gynecologic malignancy, radiation, chemotherapy, and neutropenia. Seemingly disproportionate pain in a clinically still-normal area must make the clinician highly suspicious for developing gas gangrene, especially after trauma or operation. In the early phases, the skin overlying the infected area appears shiny and tense. In the next phase it becomes dusky and progresses to a bronze discoloration. The infection can advance very rapidly, and the patient may become moribund within 12 hours [3]. Hemorrhagic bullae or vesicles may be noted. A thin, serosanguinolent exudate with a sickly, sweet odor is present. Swelling and edema of the infected area is pronounced. The muscles appear dark red to black or greenish. They are noncontractile and do not bleed when cut. The tissue gas seen on radiographs appears as featherlike figures between muscle fibers and is an early and highly characteristic sign of clostridial myonecrosis. Crepitus is usually present as well. Systemic toxicity presents as high fever and tachycardia, followed by shock and multiorgan failure [3].

Acute concussion is a significant health issue among youth athletes, affecting their quality of life and performance. However, the standard of care, rest, has been questioned, while treatments are lacking. This pilot case series used an FDA-cleared electroencephalogram-based brain biomarker (EEGBB) to demonstrate hyperbaric oxygen therapy (HBO₂) improvement for treating concussion. From December 31, 2021, through May 27, 2022, school-aged patients presenting at two HBO₂ clinics within ten days of injury with an acute concussion confirmed by an initial EEGBB assessment were evaluated. The EEGBB diagnoses concussions using artificial intelligence to yield a score between 0-100, with scores ≤70 considered concussed. HBO₂ using 1.5-2.0 ATA, progressing stepwise per patient tolerance, was administered in ≥4-hour intervals until sustained symptom-free. EEGBB assessment was performed before and after each treatment. Eleven patients [mean age: 16±2.2; six male (55%)] participated. Patients presented one to nine days (median: three) after injury. Their median baseline EEGBB score was 18 (range: 1 to 35). The median first and last post-treatment scores available were 84 (range: 32-90) and 85 (range: 75-89), respectively. The median number of HBO₂ treatments was three (range: 2-8) administered over a median of two days (range: two to five). All patients except one (due to a technical error) received a post-treatment follow-up score 2- 22 days after treatment completion. The median final score was 85 (range: 64-90). There were no adverse events. Preliminary data demonstrate that the EEGBB objectively supports the use of HBO₂ to treat acute concussions. Further research should confirm the appropriate HBO₂ regimen to treat concussions.

Background: Delayed-onset neurologic sequelae (DNS) is a devastating complication of carbon monoxide poisoning. Despite abundant research studies on DNS, the definition remains unclear, with a wide range of symptoms. This review aims to identify the different symptoms and definitions that have been associated with DNS in available research.

Methods: For this review, searches were conducted in PubMed and Scopus. Two authors screened research studies by abstract and title, and a third resolved conflicts. After the full-text review, one author extracted the data. Only original full-text research studies in English with a clear definition of DNS were included.

Results: This review included 127 studies. Signs and symptoms associated with DNS were categorized into twelve groups. The most used symptom categories to define DNS were general neurological and cognitive/learning dysfunctions. Imaging studies, clinical testing, and neuropsychiatric testing used to define DNS were also documented.

Conclusions: The literature did not consistently define DNS attributed to CO toxicity. Standardizing the definition and diagnostic criteria would benefit clinical research.

Arterial gas embolism can be fatal and should be treated with care. Typically, the patient is placed in the supine position during treatment. However, we present a case where the patient's position was changed to facilitate treatment. A 78-year-old man with severely reduced heart function underwent cryoablation for chronic atrial fibrillation. During the procedure, he accidentally inhaled rapidly. Subsequently, he presented with stroke symptoms. Computed tomography (CT) revealed air in the brain and left ventricle, leading to a diagnosis of arterial gas embolism. He underwent hyperbaric oxygen (HBO₂) therapy as per the US NAVY Table 6 protocol. The air embolism in the brain reduced but that in the apex of the left ventricle persisted. Subsequently, HBO₂, as per the US NAVY Table 5 protocol, was performed along with a position change to the right lateral and manual vibration. The position change was based on the three-dimensional structures of the left ventricle, aortic arch, and descending aorta. Subsequently, no air was observed on CT, and rehabilitation was initiated. Safe body positions for arterial and venous gas embolisms differ. Therefore, understanding the vascular anatomy is imperative for treating gas embolism.

Objective: The etiology and diagnosis of air embolism (AE), including approaches for prevention and management based on experimental and clinical data, have been presented. However, these publications may not reach all the intended audience (e.g., surgeons), and thus, the use of bibliometric analyses is encouraged.

Methods: We queried the Web of Science database using bibliometric analysis to identify publications related to AE from 1995 to 2022.

Results: The literature search retrieved 2463 publications that met the inclusion criteria. In AE research, the total number of articles published every year was 80±16, and it increased gradually in recent years. Many published articles and most of the top ten research institutions (8/10) were from the USA (n = 826, 33.5%). The USA also has the highest citations and the most extensive cooperation with most countries. However, the proportion of the top ten journals is not too high, and the quality of these papers is not sufficiently good. The mean number of citations for the top ten articles was 105.8 (range: 68-298). Moreover, ten authors contributed to 146 manuscripts from eight countries. A total of 7926 keywords were found. Among these, 135 were hotspot keywords that appeared at least 20 times. The keywords with strong citation bursts changed from dog to risk factors of AE (7.66 versus 9.81).

Conclusions: We explore the citation relevance and collaboration map and their hotspots in AE and provide a foundational understanding of the research progress and trends of AE.

Decompression sickness (DCS, "bends") is the clinical condition triggered by generation of bubbles in tissues or blood due to supersaturation of inert gas during or after a reduction in ambient pressure. The condition can occur in association with compressed gas diving, compressed air ("caisson") work or rapid decompression to high altitude or reduced cabin pressure such as extravehicular activity (EVA) in space suits. It can also be triggered by mild reduction in ambient pressure such as during commercial aircraft flight after scuba diving. Its manifestations range from joint or muscle pain, lymphedema and skin rash to severe neurological abnormalities and cardiorespiratory collapse. Immediate evaluation should include a history of the diving/altitude event and timing of symptom onset, in addition to a careful neurological exam. Immediate treatment should include oxygen administration and appropriate resuscitation with oral or intravenous fluids; definitive treatment of DCS consists of hyperbaric oxygen. While residual manifestations may persist in severe instances, in most cases appropriate treatment results in good outcome.