Undersea Hyperb Med [JOURNAL]
Sun
200 papers
Hyperbaric Oxygen Therapy Regimens, Treated Conditions, and Adverse Effect Profile: an Undersea and Hyperbaric Medical Society Survey Study.
Laspro M, Wei LW, Brydges HT … +3 more , Gorenstein SA, Huang ET, Chiu ES
Undersea Hyperb Med · 2024 · PMID 39821765
INTRODUCTION: When administering HBO , pressures can range from 1.4 atmospheres absolute (ATA) to 3 ATA. While different treatment profiles have been proposed, there is a paucity of literature comparing the effectiveness...
INTRODUCTION: When administering HBO , pressures can range from 1.4 atmospheres absolute (ATA) to 3 ATA. While different treatment profiles have been proposed, there is a paucity of literature comparing the effectiveness and risk profile associated with different pressures treating the same condition. Considering the therapeutic divergence, this study aims to survey Undersea and Hyperbaric Medical Society (UHMS) members on pressure modalities and their use in different clinical conditions. METHODS: The study was a voluntary cross-sectional survey administered online and open to healthcare providers who were Undersea and Hyperbaric Medical Society members. UHMS itself distributed the survey link. The survey period lasted from November 2022 until January 2023. Data were collected utilizing the Qualtrics platform and analyzed through Microsoft Excel. RESULTS: A total of 265 responses were recorded. The majority responded with utilizing 2.4 ATA (35.2%) as the pressure of choice, followed by 2.0 ATA only (27.1%), and those who utilized differing therapeutic pressures (26.4%). The overwhelming choice for treatment of osteoradionecrosis (ORN) of the jaw, radiation proctitis/cystitis, diabetic foot ulcer, and chronic osteomyelitis was 2.0 ATA (68.0- 74.9%). Among listed adverse effects, myopia was the most commonly reported complication at 24.4%, followed by barotrauma (14.9%) and confinement anxiety (11.5%). CONCLUSIONS: There is currently little consensus regarding the best treatment modalities for conditions treated with HBO. As adverse effects appear non-negligible, future prospective studies must be conducted weighing the risks and benefits of higher-pressure therapies compared to safer lower-pressure options.
Behavior and changes in rectal temperature in dogs and cats undergoing hyperbaric oxygen therapy: clinical data review.
Antunes BN, Müller DCM, Milech V … +5 more , Caye P, Degregori EB, Vargas D, Reinstein RS, Brun MV
Undersea Hyperb Med · 2024 · PMID 39821764
The assessment of rectal temperature and behavior is an important parameter in all patients for whom hyperbaric oxygen (HBO) therapy is used. The study aims to verify if there is less reduction in body temperature after...
The assessment of rectal temperature and behavior is an important parameter in all patients for whom hyperbaric oxygen (HBO) therapy is used. The study aims to verify if there is less reduction in body temperature after HBO therapy in restless patients and their behavior during the therapeutic session. Clinical data from 217 HBO therapy sessions with 2 to 2,5 atmospheres absolute (ATA) were reviewed under therapy protocols of 30 (P1) or 45 (P2) minutes, covering 29 canines and 13 felines. Behavioral data, initial rectal temperature (iRT), final (fRT), and variation between them (RTv) of each patient were recorded. Parameters of oxygen concentration, humidity, temperature, and chamber flow rate were also recorded. Three of 217 patients experienced major adverse effects (seizure and auto-trauma). 144/217 HBO therapy session records were selected for statistical analysis. In P1 sessions, 33.3% of the canine and 33.3% of the feline patients were restless. In P2 sessions, 40.7% of the canine and 28.1% of the feline patients were restless. The study did not observe a correlation between vRT and patients' behavior (p> 0.089) or differences in vRT between quiet and restless patients. There was a difference between iRT and fRT only in canines submitted to P1 (p<0.001) and felines submitted to P2 (p<0.001). Older canine patients were more restless than young canine patients at P1 (p= 0.02). We conclude that there may be a reduction in the fRT of dogs and cats submitted to 2 ATA for 30 minutes and 2.5 ATA for 45 minutes, respectively.
Investigation Of The Effects Of Hyperbaric Oxygen Therapy On Hepatotoxicity Induced By Leflunomide in Rats.
Inal A, Hallak M, Baktir MA … +2 more , Ekebaş G, Atasever A
Undersea Hyperb Med · 2024 · PMID 39821763
BACKGROUND: Hyperbaric Oxygen Therapy (HBO) is a treatment modality that exposes patients to 100% oxygen at higher atmospheric pressures. Recently, HBO has emerged as a potential therapeutic option for various liver dise...
BACKGROUND: Hyperbaric Oxygen Therapy (HBO) is a treatment modality that exposes patients to 100% oxygen at higher atmospheric pressures. Recently, HBO has emerged as a potential therapeutic option for various liver diseases, offering advantages such as improved tissue oxygenation, anti-inflammatory effects, enhanced wound healing, and potential hepatoprotective properties. Understanding the benefits of HBO in liver diseases can pave the way for novel therapeutic strategies and improved patient outcomes. This study aimed to investigate the hepatoprotective effect of HBO in arthritic rats treated with leflunomide (LEF) through anti-inflammatory and antioxidant pathways. MATERIAL AND METHODS: 24 male Sprague-Dawley rats were divided into three groups (8 animals in each group (n = 8)). 1 group was the control group, which received no treatment. 2 group was RA + LEF 5 mg/kg, 3 group was RA + LEF 5 mg/kg + HBO. Rheumatoid arthritis was induced using Complete Freund's Adjuvant (CFA). The treatment was initiated on the 10 day following induction and lasted for a total of 18 days. The impact on disease progression was assessed through histological changes, which were evaluated using hematoxylin-eosin staining, while the Anti-TNF-α antibody levels were determined. RESULTS: TCompared with the RL group, the RLH group significantly decreases necrotic cells, Lymphocyte- rich mononuclear cells, and active anti-TNF-α . CONCLUSION: HBO showed a beneficial effect and decreased hepatotoxicity on Leflunomide-induced liver injury.
Influence of hyperbaric air exposure on the function of brachial artery.
Ting-Ting Z, Zhen-Biao G, Jia-Jun X … +2 more , Shi-Feng W, Wen-Wu L
Undersea Hyperb Med · 2024 · PMID 39821762
Decompression after diving may inevitably cause the production of bubbles in the body, even without protocol violation. Bubbles produced in the circulation may damage the vascular cells, leading to vascular dysfunction....
Decompression after diving may inevitably cause the production of bubbles in the body, even without protocol violation. Bubbles produced in the circulation may damage the vascular cells, leading to vascular dysfunction. In this study, five subjects were recruited and subjected to hyperbaric exposure (15 meters; 100 minutes). The function of the brachial artery was assessed by measuring diameter, systolic peak velocity (SPV), resistance index (RI), and flow-mediated dilation (FMD) of the brachial artery before and after hyperbaric exposure. Our results showed that hyperbaric air exposure slightly increased the diameter of the brachial artery and significantly increased its RI but reduced the FMD and markedly decreased the SPV. This study indicates that hyperbaric air exposure at low pressure may also alter the function of the brachial artery.
A comparison of the treatment outcomes of cerebral gas embolism at 2.8 ATA in comparison with 6 ATA.
Zhang B, Yi H, Jiang Y … +1 more , Zheng C
Undersea Hyperb Med · 2024 · PMID 39821761
OBJECTIVE: To investigate the effect of 6 ATA air/ oxygen treatment scheme and 2.8 ATA oxygen inhalation scheme on cerebral gas embolism. METHODS: 29 patients with cerebral gas embolism admitted from January 2014 to June...
OBJECTIVE: To investigate the effect of 6 ATA air/ oxygen treatment scheme and 2.8 ATA oxygen inhalation scheme on cerebral gas embolism. METHODS: 29 patients with cerebral gas embolism admitted from January 2014 to June 2022 were retrospectively included. The patients were divided into 6 ATA air/ oxygen treatment scheme group (14 cases) and 2.8 ATA oxygen inhalation therapy scheme group (15 cases). Glasgow Coma Scale (GCS) was used to evaluate the therapeutic effect before and after treatment. The effective standard of treatment: recovery of consciousness (GCS scores>8). RESULTS: There was no significant difference between two groups in terms of gender, age, cause of disease, time of onset and GCS score before treatment (P>0.05). There was not significant difference between two groups in terms of GCS score after 1 day and 1 week of treatment (P>0.05). After 1 week of treatment, 78.6% (11/14) of patients in the 6 ATA group and 80.0% (12/15) in the 2.8 ATA group improved. CONCLUSION: The 2.8 ATA oxygen inhalation scheme can effectively treat cerebral gas embolism, and effect is similar to the 6 ATA air/ oxygen treatment scheme.
Carbon Monoxide Poisoning (Reprinted from the 2023 Hyperbaric Indications Manual 15 edition).
Weaver LK
Undersea Hyperb Med · 2024 · PMID 39348519
Despite established exposure limits and safety standards, and the availability of carbon monoxide (CO) alarms, each year an estimated 50,000 people in the United States visit emergency departments for CO poisoning. Carbo...
Despite established exposure limits and safety standards, and the availability of carbon monoxide (CO) alarms, each year an estimated 50,000 people in the United States visit emergency departments for CO poisoning. Carbon monoxide poisoning can occur from brief exposures to high levels of CO or from longer exposures to lower levels. If the CO exposure is sufficiently high, unconsciousness and death occur quickly, and without symptoms. With non-lethal exposures to CO, common symptoms include headaches, nausea and vomiting, dizziness, general malaise, and altered mental status. Some patients may have chest pain, shortness of breath, and myocardial ischemia, and may require mechanical ventilation and treatment of shock. Individuals poisoned by CO often develop brain injury. As with brain injury from non- CO causes such as traumatic brain injury, the clinical expression of brain injury caused by CO poisoning includes the domains of cognition, affect, neurological, and somatic. Common problems are neurological: imbalance, motor weakness, neuropathies, hearing loss, tinnitus, Parkinson's-like syndrome, vestibular, gaze, auditory processing, cognitive, anxiety and depression, posttraumatic stress, personality change, persistent headaches, dizziness, sleep problems, and others. In addition, some will have cardiac or other problems. While breathing oxygen hastens the removal of carboxyhemoglobin (COHb), hyperbaric oxygen (HBO) hastens COHb elimination and favorably modulates inflammatory processes instigated by CO poisoning, an effect not observed with breathing normobaric oxygen. Hyperbaric oxygen improves mitochondrial function, inhibits lipid peroxidation transiently, impairs leukocyte adhesion to injured microvasculature, and reduces brain inflammation caused by CO-induced adduct formation of myelin basic protein. Based upon supportive randomized clinical trials in humans and considerable evidence from animal studies, HBO should be considered for all cases of acute symptomatic CO poisoning. Hyperbaric oxygen is indicated for CO poisoning complicated by cyanide poisoning, often concomitantly with smoke inhalation.
Mass Carbon Monoxide Poisoning on a Train in Italy, March 1944. History Reconstructed.
Hampson NB
Undersea Hyperb Med · 2024 · PMID 39348518
World War II was approaching its end in Italy in 1944 when one of the worst train disasters in world history occurred near the small town of Balvano in the Apennine Mountains. The train did not derail or crash into somet...
World War II was approaching its end in Italy in 1944 when one of the worst train disasters in world history occurred near the small town of Balvano in the Apennine Mountains. The train did not derail or crash into something as in most major train disasters. Instead, it entered a mountainous railway tunnel, and when it emerged, over 500 passengers were dead from carbon monoxide poisoning. The event was not allowed to be publicized for almost two decades. This manuscript reconstructs the story of possibly the most significant incident of carbon monoxide mortality ever recorded.
Hyperbaric oxygen therapy for avascular necrosis of the femoral head: A case report.
Pearl A, Pearl S
Undersea Hyperb Med · 2024 · PMID 39348517
The hip is the most common location for avascular necrosis of the femoral head (AVN), with an estimated incidence in the United States of 10,000 to 20,000 new cases per year. The current standard of care for early diseas...
The hip is the most common location for avascular necrosis of the femoral head (AVN), with an estimated incidence in the United States of 10,000 to 20,000 new cases per year. The current standard of care for early disease is core decompression, with bone marrow injections becoming more commonplace. Hyperbaric oxygen enhances oxygen delivery to tissue, promotes an anti-inflammatory and pro-healing environment, and helps initiate angiogenesis. We believe that these properties of HBO make it a unique tool for AVN and applied it in conjunction with the standard of care for our patient.
Stroke on ECG: a cerebral T-wave change secondary to acute carbon monoxide poisoning.
Xiao X, Jing X, Zhao Y … +2 more , Yao F, Sun Q
Undersea Hyperb Med · 2024 · PMID 39348516
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 - inc...
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 (HBO) 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.
Successful management of renal abscess secondary to diabetes mellitus with surgical treatment and hyperbaric oxygen therapy.
Yanagida K, Watanabe D, Yoshida T … +4 more , Nakagawa T, Mizushima A, Miura K, Ishihara T
Undersea Hyperb Med · 2024 · PMID 39348515
Renal abscess (RA) is a collection of infective fluid in or around the renal parenchyma. It typically occurs in immunocompromised patients, including those with diabetes mellitus (DM), poor nutritional status, or steroid...
Renal abscess (RA) is a collection of infective fluid in or around the renal parenchyma. It typically occurs in immunocompromised patients, including those with diabetes mellitus (DM), poor nutritional status, or steroid administration. We herein report a case of RA associated with DM in which hyperbaric oxygen (HBO) therapy greatly contributed to the resolution of this disease. The patient was an 85-year-old man with poorly controlled type 2 DM. Contrast-enhanced computed tomography for postoperative follow-up of appendiceal cancer showed a mass lesion with poor contrast enhancement extending from the upper pole of the left kidney to the dorsal side. Therefore, a diagnosis of RA was established. The lesion was percutaneously punctured, and a drainage tube was placed. Antibiotics following sensitivity testing were administered. The catheter was removed six days after its placement. However, pus discharge continued from the catheter removal site, with persistent redness around the wound. Therefore, a lumbotomy incision for abscess drainage was performed on the 49th day. However, the pus discharge persisted, and we decided to perform HBO therapy, expecting decreases in bacterial proliferation, reduction in local edema, and improvement of host defense. HBO therapy for 90 min at two atmospheres absolute was performed ten times. The amount of pus discharge decreased, and redness improved from the fifth day after HBO therapy. One month after starting HBO therapy, the wound was closed, and the pus discharge resolved completely. Four years have passed since the HBO therapy, and there have been no symptomatic or imaging relapses of RA.
Complications After Covid-19 Infection In Singapore Military Divers: A Retrospective Cohort Study.
Chung Wei N, Wei Ming K
Undersea Hyperb Med · 2024 · PMID 39348514
Studies suggest that COVID-19 infections may have longer-term and more significant complications, even with mild or absent symptoms. This may predispose divers to pulmonary barotrauma, arterial gas embolisms, and reduced...
Studies suggest that COVID-19 infections may have longer-term and more significant complications, even with mild or absent symptoms. This may predispose divers to pulmonary barotrauma, arterial gas embolisms, and reduced exercise tolerance, and impact physical and cognitive performance during diving. Military diving is physically, physiologically, and psychologically taxing on the individual. This study aims to assess the incidence of complications after COVID-19 infections in a cohort of active military divers and the incidence of diving-related injuries such as decompression sickness and barotrauma following recovery from acute COVID-19 infections. A single-center, retrospective cohort study of complications after COVID-19 infections was done in a cohort of the Republic of Singapore Navy (RSN) Naval Diving Unit (NDU) Divers and involved the collection of retrospective data for 329 military divers who were diagnosed with COVID-19 infection from 25 Mar 2020 and 13 Feb 2023. We found no clinical or subclinical complications after COVID-19 infection in our fully vaccinated, low-risk population of NDU divers after asymptomatic or mild COVID-19 infection. There were also no incidences of diving-related injuries related to COVID-19 after recovery from the acute illness. Based on the study results, it is recommended that all military divers with asymptomatic or mild COVID-19 infections return to military diving activities immediately after recovery from acute COVID-19 infection with resolution of symptoms. As existing guidelines recommend, divers with moderate to critical COVID-19 infection should be reviewed by a diving physician and undergo necessary investigations before returning to military diving.
Higher proportion of prematurely born adults in elite breath-hold divers.
Pique H, Theunissen S, Balestra C … +2 more , Valdivia J, Melikhov O
Undersea Hyperb Med · 2024 · PMID 39348513
INTRODUCTION: Preterm birth may significantly impair the functional and anatomical development of the respiratory system and could be a background for various life-long medical sequelae. Prematurity has been recently con...
INTRODUCTION: Preterm birth may significantly impair the functional and anatomical development of the respiratory system and could be a background for various life-long medical sequelae. Prematurity has been recently connected to changes in hypercapnic reactions at adult age. Altered reactions to pCO in premature-born subjects may impact breath-hold underwater exercises (freediving) results. METHODS: AIDA International provided the list of top-100 rankings freediving athletes for the years 2016- 2021 with their personal best results. Data was collected using a subject questionnaire developed for the study (subject-reporting outcomes). PERIOD OF DATA COLLECTION: March 2022 to June 2022. RESULTS: Within the sample of divers (n=146), 17.1% (n=25) were born prematurely. 13.7% (n=20) were moderate to late preterm, and 3.4% (n=6) were very preterm. The proportion of the athletes whose birth was premature was 18.1% for females and 16.2% for males. These figures are higher than the standardized estimated mean of the preterm birth rate of 8.5% calculated based on the geographical distribution of our sample. There was no difference in best personal results in freediving between the preterm and full-term elite freedivers. CONCLUSIONS: The proportion of preterm within the elite freedivers is higher than could be estimated for the general population. There is no difference in best personal results between preterm and full-term elite freedivers.
Effects of submersion on VO: comparing maximum aerobic exertion on land and underwater.
Bartlett NC, Makowski MS, Ellis MC … +5 more , Natoli MJ, Maggiore GH, Wright MC, Derrick BJ, Moon RE
Undersea Hyperb Med · 2024 · PMID 39348512
INTRODUCTION: Submersion results in blood redistribution into the pulmonary circulation, causing changes in pulmonary compliance and increased cardiac preload. Few studies have compared incremental exercise to exhaustion...
INTRODUCTION: Submersion results in blood redistribution into the pulmonary circulation, causing changes in pulmonary compliance and increased cardiac preload. Few studies have compared incremental exercise to exhaustion (VO max testing) in a dry environment with exercise underwater. We hypothesized that the physiological effects of submersion would result in lower heart rate (HR), minute ventilation (V), and peak oxygen uptake (VO peak) compared with dry conditions. METHODS: Fourteen male and four female volunteers completed two VO peak testing sessions with approximately two hours between trials: first in the dry laboratory on a cycle ergometer and second while fully submersed in a prone position with zero static lung load. HR was monitored via ECG, and inspiratory and expiratory gas compositions were recorded using a metabolic cart. The tests were terminated once the subject reached exhaustion. RESULTS: Absolute VO peak was lower in the submersed VO max trial (37.1 ± 7.0 mL•kg•min) compared with dry exercise (45.8 ± 8.9 mL•kg•min) p < 0.001. HR and V were also lower in the submersed trial. CONCLUSIONS: VO peak while submersed is reduced relative to dry VO peak, which may be partly due to a decrease in heart rate and a reduction in V.
UHMS Position Statement: Physician's Duties in Hyperbaric Medicine - 99183.
Kelly M, Gelly H, O'Neill O … +1 more , Shapshak D
Undersea Hyperb Med · 2024 · PMID 38985156
INTRODUCTION: The Undersea and Hyperbaric Medical Society (UHMS) is at the forefront of advancing medical knowledge and promoting patient safety in the field of hyperbaric medicine. In the dynamic landscape of healthcare...
INTRODUCTION: The Undersea and Hyperbaric Medical Society (UHMS) is at the forefront of advancing medical knowledge and promoting patient safety in the field of hyperbaric medicine. In the dynamic landscape of healthcare, physicians' critical role in overseeing hyperbaric oxygen treatment (HBO) cannot be overstated. This position statement aims to underscore the significance of physician involvement in delivering HBO and articulate UHMS's commitment to maintaining the highest standards of care and safety for patients undergoing hyperbaric treatments. ABSTRACT: Hyperbaric oxygen treatment demands a meticulous approach to patient management. As the complexity of hyperbaric patients continues to evolve, the direct oversight of qualified physicians becomes paramount to ensuring optimal patient outcomes and safeguarding against potential risks. In this statement, we outline the key reasons physician involvement is essential in every facet of HBO, addressing the technical intricacies of the treatment and the broader spectrum of patient care. RATIONALE: Physician oversight for hyperbaric oxygen treatment is rooted in the technical complexities of the treatment and the broader responsibilities associated with clinical patient care. The responsibilities outlined below delineate services intrinsic to the physician's duties for treating patients undergoing hyperbaric oxygen treatments.
Cardiovascular effects of breath-hold diving at altitude.
Marabotti C, Laurino M, Passera M … +4 more , Cialoni D, Franzino E, Benvenuti C, Pingitore A
Undersea Hyperb Med · 2024 · PMID 38985155
Hypoxia, centralization of blood in pulmonary vessels, and increased cardiac output during physical exertion are the pathogenetic pathways of acute pulmonary edema observed during exposure to extraordinary environments....
Hypoxia, centralization of blood in pulmonary vessels, and increased cardiac output during physical exertion are the pathogenetic pathways of acute pulmonary edema observed during exposure to extraordinary environments. This study aimed to evaluate the effects of breath-hold diving at altitude, which exposes simultaneously to several of the stimuli mentioned above. To this aim, 11 healthy male experienced divers (age 18-52y) were evaluated (by Doppler echocardiography, lung echography to evaluate ultrasound lung B-lines (BL), hemoglobin saturation, arterial blood pressure, fractional NO (Nitrous Oxide) exhalation in basal condition (altitude 300m asl), at altitude (2507m asl) and after breath-hold diving at altitude. A significant increase in E/e' ratio (a Doppler-echocardiographic index of left atrial pressure) was observed at altitude, with no further change after the diving session. The number of BL significantly increased after diving at altitude as compared to basal conditions. Finally, fractional exhaled nitrous oxide was significantly reduced by altitude; no further change was observed after diving. Our results suggest that exposure to hypoxia may increase left ventricular filling pressure and, in turn, pulmonary capillary pressure. Breath-hold diving at altitude may contribute to interstitial edema (as evaluated by BL score), possibly because of physical efforts made during a diving session. The reduction of exhaled nitrous oxide at altitude confirms previous reports of nitrous oxide reduction after repeated exposure to hypoxic stimuli. This finding should be further investigated since reduced nitrous oxide production in hypoxic conditions has been reported in subjects prone to high-altitude pulmonary edema.
Acute aortic dissection during scuba diving.
Yanagawa Y, Ohsaka H, Yatsu S … +1 more , Suwa S
Undersea Hyperb Med · 2024 · PMID 38985154
A 60-year-old man with hypertension and dyslipidemia complained of chest pain upon ascending from a maximum depth of 27 meters while diving. After reaching the shore, his chest pain persisted, and he called an ambulance....
A 60-year-old man with hypertension and dyslipidemia complained of chest pain upon ascending from a maximum depth of 27 meters while diving. After reaching the shore, his chest pain persisted, and he called an ambulance. When a physician checked him on the doctor's helicopter, his electrocardiogram (ECG) was normal, and there were no bubbles in his inferior vena cava or heart on a portable ultrasound examination. The physician still suspected that he had acute coronary syndrome instead of decompression illness; therefore, he was transported to our hospital. After arrival at the hospital, standard cardiac echography showed a flap in the ascending aorta. Immediate enhanced computed tomography revealed Stanford type A aortic dissection. The patient obtained a survival outcome after emergency surgery. To our knowledge, this is the first reported case of aortic dissection potentially associated with scuba diving. It highlights the importance of considering aortic dissection in patients with sudden-onset chest pain during physical activity. In addition, this serves as a reminder that symptoms during scuba diving are not always related to decompression. This report also suggests the usefulness of on-site ultrasound for the differential diagnosis of decompression sickness from endogenous diseases that induce chest pain. Further clinical studies of this management approach are warranted.
Acute effects of apnea bouts on hemoglobin concentration and hematocrit: a systematic review and meta-analysis.
López-Rebenaque O, Solís-Ferrer L, Fierro-Marrero J … +1 more , de Asís-Fernández F
Undersea Hyperb Med · 2024 · PMID 38985153
OBJECTIVE: This study aimed to systematically analyze the existing literature and conduct a meta-analysis on the acute effects of apnea on the hematological response by assessing changes in hemoglobin (Hb) concentration...
OBJECTIVE: This study aimed to systematically analyze the existing literature and conduct a meta-analysis on the acute effects of apnea on the hematological response by assessing changes in hemoglobin (Hb) concentration and hematocrit (Hct) values. METHODS: Searches in Pubmed, The Cochrane Library, and Web of Science were carried out for studies in which the main intervention was voluntary hypoventilation, and Hb and Hct values were measured. Risk of bias and quality assessments were performed. RESULTS: Nine studies with data from 160 participants were included, involving both subjects experienced in breath-hold sports and physically active subjects unrelated to breath-holding activities. The GRADE scale showed a "high" confidence for Hb concentration, with a mean absolute effect of 0.57 g/dL over control interventions. "Moderate" confidence appeared for Hct, where the mean absolute effect was 2.45% higher over control interventions. Hb concentration increased to a greater extent in the apnea group compared to the control group (MD = 0.57 g/dL [95% CI 0.28, 0.86], Z = 3.81, p = 0.0001) as occurred with Hct (MD = 2.45% [95% CI 0.98, 3.93], Z = 3.26, p = 0.001). CONCLUSIONS: Apnea bouts lead to a significant increase in the concentration of Hb and Hct with a high and moderate quality of evidence, respectively. Further trials on apnea and its application to different settings are needed.
Advanced high pressure hyperbaric techniques in tunnelling.
Lamont D, Colvin A, Heili A … +3 more , Ridley T, Slocombe R, Wendling J
Undersea Hyperb Med · 2024 · PMID 38985152
Work in compressed air and diving are both occupational activities that have been around since the mid-19th century, and those undertaking their work under elevated pressure. Meeting the demand to go to "higher pressure...
Work in compressed air and diving are both occupational activities that have been around since the mid-19th century, and those undertaking their work under elevated pressure. Meeting the demand to go to "higher pressure for longer" in tunneling has lagged in diving, but both activities have found it necessary to adopt mixed gas breathing and saturation exposure techniques. This paper explains how work in hyperbaric conditions at high pressure is undertaken in tunneling and is illustrated by the hyperbaric activity likely to be involved in constructing a large-diameter road tunnel below a body of water such as an estuary. It also explores the practical differences between work in compressed air and diving.
Controlled CMS Data Demonstrates a Cost and Clinical Advantage for Hyperbaric Oxygen for Radiation Cystitis.
Feldmeier JJ, Kirby JP, Gelly HB … +4 more , Robins M, Peters J, Gruhn P, Pal S
Undersea Hyperb Med · 2024 · PMID 38985151
INTRODUCTION: Increasing cancer survivorship, in part due to new radiation treatments, has created a larger population at risk for delayed complications of treatment. Radiation cystitis continues to occur despite targete...
INTRODUCTION: Increasing cancer survivorship, in part due to new radiation treatments, has created a larger population at risk for delayed complications of treatment. Radiation cystitis continues to occur despite targeted radiation techniques. MATERIALS AND METHODS: To investigate value-based care applying hyperbaric oxygen (HBO) to treat delayed radiation cystitis, we reviewed public-access Medicare data from 3,309 patients from Oct 1, 2014, through Dec 31, 2019. Using novel statistical modeling, we compared cost and clinical effectiveness in a hyperbaric oxygen group to a control group receiving conventional therapies. RESULTS: Treatment in the hyperbaric group provided a 36% reduction in urinary bleeding, a 78% reduced frequency of blood transfusion for hematuria, a 31% reduction in endoscopic procedures, and fewer hospitalizations when study patients were compared to control. There was a 53% reduction in mortality and reduced unadjusted Medicare costs of $5,059 per patient within the first year after completion of HBO treatment per patient. When at least 40 treatments were provided, cost savings per patient increased to $11,548 for the HBO study group compared to the control group. This represents a 37% reduction in Medicare spending for the HBO-treated group. We also validate a dose-response curve effect with a complete course of 40 or more HBO treatments having better clinical outcomes than those treated with fewer treatments. CONCLUSION: These data support previous studies that demonstrate clinical benefits now with cost- effectiveness when adjunctive HBO treatments are added to routine interventions. The methodology provides a comparative group selected without bias. It also provides validation of statistical modeling techniques that may be valuable in future analysis, complementary to more traditional methods.
Trends in Medicare Costs of Hyperbaric Oxygen Therapy, 2013 through 2022.
Gelly HB, Fife CE, Walker D … +1 more , Eckert KA
Undersea Hyperb Med · 2024 · PMID 38985150
OBJECTIVE: To analyze Hyperbaric Oxygen Therapy Registry (HBOTR) data to estimate the Medicare costs of hyperbaric oxygen therapy (HBO) based on standard treatment protocols and the annual mean number of treatments per p...
OBJECTIVE: To analyze Hyperbaric Oxygen Therapy Registry (HBOTR) data to estimate the Medicare costs of hyperbaric oxygen therapy (HBO) based on standard treatment protocols and the annual mean number of treatments per patient reported by the registry. METHODS: We performed a secondary analysis of deidentified data for all payers from 53 centers registered in the HBOTR from 2013 to 2022. We estimated the mean annual per-patient costs of HBO based on Medicare (outpatient facility + physician) reimbursement fees adjusted to 2022 inflation using the Medicare Economic Index. Costs were calculated for the annual average number of treatments patients received each year and for a standard 40-treatment series. We estimated the 2022 costs of standard treatment protocols for HBO indications treated in the outpatient setting. RESULTS: Generally, all costs decreased from 2013 to 2022. The facility cost per patient per 40 HBO treatments decreased by 10.7% from $21,568.58 in 2013 to $19,488.00 in 2022. The physician cost per patient per 40 treatments substantially decreased by -37.8%, from $5,993.16 to $4,346.40. The total cost per patient per 40 treatments decreased by 15.6% from $27,561.74 to $23,834.40. In 2022, a single HBO session cost $595.86. For different indications, estimated costs ranged from $2,383.4-$8,342.04 for crush injuries to $17,875.80-$35,751.60 for diabetic foot ulcers and delayed radiation injuries. CONCLUSIONS: This real-world analysis of registry data demonstrates that the actual cost of HBO is not nearly as costly as the literature has insinuated, and the per-patient cost to Medicare is decreasing, largely due to decreased physician costs.
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