Undersea Hyperb Med [JOURNAL]
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200 papers
Efficacy of hyperbaric oxygen after microtia reconstruction using costal cartilage: A retrospective case-control study.
Murao N, Oyama A, Yamamoto Y … +3 more , Funayama E, Ishikawa K, Maeda T
Undersea Hyperb Med · 2023 · PMID 38055882
INTRODUCTION: Microtia reconstruction with autologous costal cartilage framework grafting is challenging because the three-dimensional structure of the ear is highly complex, and meeting the high aesthetic demands of pat...
INTRODUCTION: Microtia reconstruction with autologous costal cartilage framework grafting is challenging because the three-dimensional structure of the ear is highly complex, and meeting the high aesthetic demands of patients can be difficult. If the skin flap overlying the framework is thinned to achieve a smooth and accentuated outline, a poor blood supply in the thin skin flap may lead to skin necrosis, exposure of the framework, and poor surgical results. Hyperbaric oxygen (HBO2) therapy can promote the healing of complex wounds and flaps. This study sought to determine the effectiveness of HBO2 therapy for the prevention of postoperative complications after framework grafting in microtia reconstruction. METHODS: We retrospectively evaluated postoperative complications and compared outcomes in pediatric patients who underwent costal cartilage grafting for microtia reconstruction at our institution between 2011 and 2015, according to whether or not they received postoperative HBO2 therapy. HBO2 therapy was applied once daily for a total of 10 sessions starting on the first postoperative day. RESULTS: During the study period, eight patients received HBO2 therapy after costal cartilage grafting, and 12 did not. There was no significant difference in the incidence of postoperative ulcers. However, the incidence of framework exposure was lower, and the healing time was shorter in patients who received HBO2 therapy than in those who did not. DISCUSSION: HBO2 therapy can be used safely in pediatric patients to reduce postoperative complications and improve the aesthetic outcome of microtia reconstruction. After costal cartilage grafting, HBO2 therapy should be considered as adjuvant therapy.
Hyperbaric hydrogen therapy improves secondary brain injury after head trauma.
Otsuka Y, Tomura S, Toyooka T … +5 more , Takeuchi S, Tomiyama A, Omura T, Saito D, Wada K
Undersea Hyperb Med · 2023 · PMID 38055881
BACKGROUND: The pathophysiology of traumatic brain injury (TBI) is caused by the initial physical damage and by the subsequent biochemical damage (secondary brain injury). Oxidative stress is deeply involved in secondary...
BACKGROUND: The pathophysiology of traumatic brain injury (TBI) is caused by the initial physical damage and by the subsequent biochemical damage (secondary brain injury). Oxidative stress is deeply involved in secondary brain injury, so molecular hydrogen therapy may be effective for TBI. Hydrogen gas shows the optimal effect at concentrations of 2% or higher, but can only be used up to 1.3% in the form of a gas cylinder mixed with oxygen gas, which may not be sufficiently effective. The partial pressure of hydrogen increases in proportion to the pressure, so hyperbaric hydrogen therapy (HBH2) is more effective than that at atmospheric pressure. METHODS: A total of 120 mice were divided into three groups: TBI + non-treatment group (TBI group; n = 40), TBI + HBH2 group (n = 40), and non-TBI + non-treatment group (sham group; n = 40). The TBI and TBI + HBH2 groups were subjected to moderate cerebral contusion induced by controlled cortical impact. The TBI + HBH2 group received hyperbaric hydrogen therapy at 2 atmospheres for 90 minutes, at 30 minutes after TBI. Brain edema, neuronal cell loss in the injured hippocampus, neurological function, and cognitive function were evaluated. RESULTS: The TBI + HBH2 group showed significantly less cerebral edema (p ≺ 0.05). Residual hippocampal neurons were significantly more numerous in the TBI + HBH2 group on day 28 (p ≺ 0.05). Neurological score and behavioral tests showed that the TBI + HBH2 group had significantly reduced hyperactivity on day 14 (p ≺ 0.01). CONCLUSION: Hyperbaric hydrogen therapy may be effective for posttraumatic secondary brain injury.
Memory surfacing among veterans with PTSD receiving hyperbaric oxygen therapy.
Doenyas-Barak K, Kutz I, Lang E … +2 more , Levi G, Efrati S
Undersea Hyperb Med · 2023 · PMID 38055880
INTRODUCTION: Growing evidence demonstrates that hyperbaric oxygen therapy (HBO2) induces neuroplasticity and can benefit individuals with post-traumatic stress disorder (PTSD). The aim of the current study was to evalua...
INTRODUCTION: Growing evidence demonstrates that hyperbaric oxygen therapy (HBO2) induces neuroplasticity and can benefit individuals with post-traumatic stress disorder (PTSD). The aim of the current study was to evaluate the rate and pattern of memory surfacing during the course of HBO2 among veterans with combat-related PTSD. METHODS: In a post-hoc analysis of a prospective study of the effect of HBO2 on PTSD symptoms in veterans, we evaluated the rate and character of memory surfacing during the course of HBO2 treatment. The treatment consisted of 60 daily 90-minute sessions, at 2 atmospheres absolute (ATA) pressure and 100% oxygen. RESULTS: For 10 (35.7%) of the 28 participants, surfacing of new memories was reported during the HBO2 treatment course. Memories surfaced mainly during the second month of the treatment, at the mean session of 30.5±13.2. For 9 of these 10 participants, prodromal symptoms such as distress, anxiety, or worsening depression were documented; and in four, somatic pain was reported prior to memory surfacing. The pain and distress of memory surfacing resolved over the course of one to 10 days. DISCUSSION: Among individuals with PTSD, the surfacing of new memories, accompanied by emotional distress and somatic pain, is common during HBO2. The surfacing of memories sheds light on the biological effect of HBO2 on the brain sequela of PTSD. It is highly important that in treating patients for any indication, HBO2 medical teams be aware and capable of addressing memory surfacing, particularly in those with a history of trauma.
Altitude Diving on a Closed Circuit Oxygen Rebreather.
Conard J
Undersea Hyperb Med · 2023 · PMID 38055879
Closed-circuit rebreather diving is becoming more common. Rebreathers are complicated, adding to the stress of diving. Also adding to this complexity in the presented case is diving at a high-altitude, cold-water reservo...
Closed-circuit rebreather diving is becoming more common. Rebreathers are complicated, adding to the stress of diving. Also adding to this complexity in the presented case is diving at a high-altitude, cold-water reservoir in Colorado. One diver experienced an oxygen-induced seizure at depth. The other diver had a rapid ascent with loss of consciousness. In this case, two experienced divers recovered from a possible devastating dive. Fortunately, they both returned to their pre-dive baseline health. Dive plan- ning is important, but as in this case, dive execution is paramount. This is a clinical case for an uncommon event presenting to an emergency department.
Hyperbaric treatment deviations for U.S. Navy divers: Spinal DCS.
DeMis J, Keuski BM, Due A
Undersea Hyperb Med · 2023 · PMID 38055878
INTRODUCTION: The United States Navy (USN) developed and refined standardized oxygen treatment tables for diving injuries, but USN tables may not address all situations of spinal decompression sickness (DCS). We describe...
INTRODUCTION: The United States Navy (USN) developed and refined standardized oxygen treatment tables for diving injuries, but USN tables may not address all situations of spinal decompression sickness (DCS). We describe a detailed recompression treatment regimen that deviated from standard USN protocol for an active-duty USN diver with a severe, delayed presentation of spinal cord DCS. CASE REPORT: A USN diver surfaced from his second of three dives on a standard Navy 'no-Decompression' Air SCUBA dive (Max depth 101 fsw utilizing a Navy Dive Computer) and developed mid-thoracic back pain, intense nausea, paresthesias of bilateral feet, and penile erection. Either not recognizing the con- stellation of symptoms as DCS and after resolution of the aforementioned symptoms, he completed the third planned dive (essentially an in-water recompression). Several hours later, he developed paresthesias and numbness of bilateral feet and legs and bowel incontinence. He presented for hyperbaric treatment twenty hours after surfacing from the final dive and was diagnosed with severe spinal DCS. Based on the severity of clinical presentation and delay to treatment, the initial and follow-on treatments were modified from standard USN protocol. MRI of the spine four days after initial presentation demonstrated a 2.2 cm lesion at the T4 vertebral level extending caudally. Follow-up examinations over two years demonstrated almost complete return of motor and sensory function; however, the patient continued to suffer fecal incontinence and demonstrated an abnormal post-void residual urinary volume. An atypical presenting symptom, a discussion of MRI findings, and clinical correlations to the syndrome of spinal DCS are discussed throughout treatment and long-term recovery of the patient.
Bubble rupture & viability of red blood cells under resonant acoustic standing waves.
Ramos EL, Bengoechea MR, Mancini SC … +1 more , Martín CM
Undersea Hyperb Med · 2023 · PMID 38055877
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...
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 the 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.
Aerobic exercise performance is reduced following prolonged cold-water immersion.
Hess HW, Schlader ZJ, Johnson BD … +2 more , Pryor RR, Hostler D
Undersea Hyperb Med · 2023 · PMID 38055876
We tested the hypotheses that self-paced aerobic exercise performance is reduced following four hours of cold-water immersion when breathing air and further reduced when breathing 100% oxygen (O2). Nine healthy adults (f...
We tested the hypotheses that self-paced aerobic exercise performance is reduced following four hours of cold-water immersion when breathing air and further reduced when breathing 100% oxygen (O2). Nine healthy adults (four women; age 24 ± 3 years; body fat 17.9 ± 6.4%; VO2max 48±9 mL • kg • minute⁻¹) completed three visits: a no-immersion control trial and two experimental trials consisting of a four-hour cold-water immersion (20.1±0.3°C) either breathing air (FIO2 = 0.21) or O2 (FIO2 = 1.0). During the no-immersion control trial and following immersion in the experimental trials, subjects first completed a 60-minute ruck-march carrying 20% of body mass in a rucksack, immediately followed by an unweighted, self-paced 5-km time trial on a motorized treadmill. Core temperature, heart rate, and rating of perceived exertion were recorded every 1,000 meters during the 5-km time trial. Data are presented mean± SD. Time trial performance was reduced following immersion in both the 100% O2 trial (32±6 minutes; p=0.01) and air trial (32±5 minutes; p=0.01) compared to the control trial (28± 4 minutes). However, there was no difference between the 100% O2 and air trials (p=0.86). Heart rate, core temperature, and rating of perceived exertion increased during the time trial (time effect: p≺0.01), but were not different between trials (trial effect: p≥0.33). These findings suggest that prolonged cold-water immersion attenuates self-paced aerobic exercise performance, but does not appear to be further affected by breathing gas type.
Buoyant ascent rate profiles for the MK10 and MK11 submarine escape and immersion equipment.
Fothergill DM, Frederick CS, Hughes LM
Undersea Hyperb Med · 2023 · PMID 38055875
INTRODUCTION: Since the U.S. Navy transitioned from the MK10 to the MK11 submarine escape and immersion equipment (SEIE), there has been an increase in the incident rate of pulmonary barotrauma during submarine escape tr...
INTRODUCTION: Since the U.S. Navy transitioned from the MK10 to the MK11 submarine escape and immersion equipment (SEIE), there has been an increase in the incident rate of pulmonary barotrauma during submarine escape training. This study compares the ascent rate profiles of the MK10 and MK11 SEIE to determine if ascent rate differences between the escape suits are associated with increased pulmonary barotraumas. METHODS: Buoyant ascent rates of the MK10 and MK11 SEIE were compared using weighted manikins equivalent to the 1st, 50th, and 99th percentile body weight of a submariner. Human ascents using the MK11 (n=126) were compared to human ascents in the same trainer wearing the MK10 (n=124). RESULTS: Manikin mean ascent times were faster for the MK10 than the MK11 (5.19 seconds vs 5.28 seconds, p ≺ 0.05). Terminal velocity (Vt) was affected by manikin weight (p ≺ 0.001). Human trials confirmed the manikin results. The average mean ascent velocity for the MK10 group was 0.155 meters/ second faster than the MK11 group's mean ascent velocity (p ≺ 0.001). Mean ascent velocity was inversely correlated with all anthropometrics for the MK10 group (p ≺ 0.01). Neither height nor body mass index showed a significant association with mean ascent velocity for the MK11 group. CONCLUSIONS: The Vt of buoyant ascents is significantly affected by body weight. As the mean ascent rate of the MK11 is slower than that of the MK10, ascent rate profile differences between the suits do not appear to explain the recent increase in pulmonary barotrauma incident rates during escape training.
A randomized trial of one versus three hyperbaric oxygen sessions for acute carbon monoxide poisoning.
Weaver LK, Deru K, Churchill S … +1 more , Russo A
Undersea Hyperb Med · 2023 · PMID 37708067
INTRODUCTION: Hyperbaric oxygen (HBO₂) improves outcome in patients with acute carbon monoxide (CO) poisoning, but optimal dose/timing are unknown. In this double-blind, sham-controlled randomized trial, we compared neur...
INTRODUCTION: Hyperbaric oxygen (HBO₂) improves outcome in patients with acute carbon monoxide (CO) poisoning, but optimal dose/timing are unknown. In this double-blind, sham-controlled randomized trial, we compared neuropsychological sequelae at six weeks and six months in patients receiving three HBO₂ sessions or one HBO₂ session and two sham chamber sessions after acute CO poisoning. METHODS: After completing one HBO₂ session (3.0 ATA, 60 minutes, 2.0 ATA, 65 minutes), CO-poisoned patients were randomized (1:1): two sham chamber sessions (1 ATA air, 120 minutes) or two additional HBO₂sessions (2.0 ATA, 90 minutes at pressure, 120 minutes in chamber) completed within 24 hours. Eligible patients were >24 hours from accidental poisoning, English-speaking, and not intubated. We planned 150 participants. RESULTS: The study was stopped early for enrollment futility. From 2006 to 2016, we screened 395 patients: 136 were deemed eligible to participate, and 75 signed informed consent. Two were later withdrawn for past brain injury/PTSD (one sham, one HBO₂), and one for performance validity (sham). Of the 72 analyzed, mean age was 42 ± 15 years, 40 (56%) were male, 20 (28%) had loss of consciousness, and mean initial carboxyhemoglobin was 22 ± 9%. The rate of six-week neuropsychological sequelae was 50% in the one-HBO₂ session group and 55% in the three-HBO₂ sessions group (p = 0.80), and at six months was 42% versus 46%, respectively (p = 0.76). CONCLUSIONS: There was no difference in the rate of neuropsychological sequelae in those who received three HBO₂ sessions and those who received one HBO₂ sessions and two sham sessions. The higher rate of neuropsychological sequelae compared to an earlier study may be due to neuropsychological test-retest effects or previously identified risk factors for cognitive sequelae (age, duration of poisoning, cerebellar dysfunction). This study's rates of cognitive difficulties, affective complaints, and other symptoms suggest brain injury after CO poisoning is common.
Cerebral arterial gas embolism and neurogenic stunned myocardium in a previously healthy freediver.
Baldino TJ, Goh MS
Undersea Hyperb Med · 2023 · PMID 37708066
Cardiomyopathy is a known but rare sequelae of diving-related cerebral arterial gas embolism (CAGE). In previously reported cases, patient findings have been consistent with takotsubo cardiomyopathy (TCM) per the revised...
Cardiomyopathy is a known but rare sequelae of diving-related cerebral arterial gas embolism (CAGE). In previously reported cases, patient findings have been consistent with takotsubo cardiomyopathy (TCM) per the revised Mayo Clinic's diagnostic criteria. A lesser-known variant of stress-related cardiomyopathy is neurogenic stunned myocardium (NSM), which occurs after a neurological event such as subarachnoid hemorrhage and typically presents in younger patients. Presentation tends to differ slightly to TCM with non-specific left ventricular dysfunction and T wave inversions. This case adds to the rare numbers of reported cardiomyopathy from diving and is the first reported case of suspected NSM associated with CAGE.
Does diving deteriorate hearing functions?
Canarslan-Demir KC, Ozgok-Kangal K, Kilic S … +1 more , Genc H
Undersea Hyperb Med · 2023 · PMID 37708065
Studies evaluating the hearing function of professional divers have yielded mixed results. In this study, we aimed to observe the effect of diving on hearing function by comparing the audiometry of experienced divers wit...
Studies evaluating the hearing function of professional divers have yielded mixed results. In this study, we aimed to observe the effect of diving on hearing function by comparing the audiometry of experienced divers with a non-diver control group. Secondly, we aimed to compare the hearing function among divers according to the diving years and the number of dives in terms of diving exposure. Experienced divers who applied to the University of Health Sciences Gűlhane Training and Research Hospital Underwater and Hyperbaric Medicine Department between 2017-2021 for periodic fitness to dive examinations were included in our study. The control group was randomly selected from the non-diver population with similar ages and gender. The audiometry of the control group and the study group was compared. While the control group was found to be better only at 8,000 Hz in the left ear (p = 0.03), there was no difference between the study group and the control group in other frequencies and pure-tone averages. In conclusion, we did not find any evidence regarding the worsening effect of diving on the hearing functions of experienced divers. With the increased awareness of occupational safety in recent years, modern technologies, protective measures, and more conservative diving profiles may have minimized the possible adverse effects of diving on hearing function. Longitudinal studies on hearing functions in the same occupational diver groups should be conducted while observing the effect of different diving profiles and noise exposures.
Effect of drysuit seals on intraocular pressure in non-immersed scuba divers.
Islam Y, Spears M, Brennan M … +2 more , Pitkin A, Covington D
Undersea Hyperb Med · 2023 · PMID 37708064
OBJECTIVE: This study quantifies the change in intraocular pressure (IOP) secondary to wearing neck seals in scuba diving drysuits. Previous work demonstrates significant pressures exerted by these seals; we hypothesize...
OBJECTIVE: This study quantifies the change in intraocular pressure (IOP) secondary to wearing neck seals in scuba diving drysuits. Previous work demonstrates significant pressures exerted by these seals; we hypothesize that they would. METHODS: IOP was measured in 33 divers before and while wearing a drysuit using rebound tonometry. The drysuit neck seal pressures were measured using a manometer. A paired two-sample t-test was used to compare IOP before and after drysuit donning. Pearson correlation coefficients were calculated between neck sealing pressures and IOP by side. RESULTS: The mean IOP in the right eye was similar pre- and post-drysuit donning, with baseline mean 15.9 mmHg (3.7 mmhg) versus 15.4 mmHG (4.3 mmHg) post-donning, p=0.41. Similarly, the mean IOP in the left eye was also similar, with mean pre-donning IOP 15.6 (3.8 mmHg) versus 15.4 mmHg (4.7 mmHg) post-donning, p=0.75. The mean right and left neck seal pressures were 23.66 (10.60) mmHg and 23.67 (7.87) mmHg, respectively. Only the correlation between right neck sealing pressure for silicone neck seals and right IOP, pre- and post-donning was significant (pre: 0.97, p-value 0.03, post: 0.98, p-value 0.02). CONCLUSION: No significant difference overall was detected in IOP with drysuit donning.
From UPTD to ESOT: Monitoring hyperoxic exposure in surface-oriented diving.
Risberg J, van Ooij PJ, Matity L
Undersea Hyperb Med · 2023 · PMID 37708063
A recent review suggested that the measure K = t² x pO₂ [4.57] (t is exposure time in h, pO in atm) should replace unit pulmonary toxic dose (UPTD) as an exposure index for pulmonary oxygen toxicity (POT) in surface-orie...
A recent review suggested that the measure K = t² x pO₂ [4.57] (t is exposure time in h, pO in atm) should replace unit pulmonary toxic dose (UPTD) as an exposure index for pulmonary oxygen toxicity (POT) in surface-oriented diving. K would better predict reduction in vital capacity (VC) during exposure and allow prediction of recovery. Although K is more accurate estimating VC changes than UPTD, the calculation of K is more extensive, particularly when estimating hyperoxic exposure for dives with multiple pO₂ segments. Furthermore, and in contrast with UPTD, K is difficult to interpret on its own given its non- linear dimension of time. We suggest that a new metric: ESOT (equivalent surface oxygen time) should be used to replace UPTD. ESOT = t x pO₂ [2.285] (t is exposure time in minutes, pO in atm). ESOT=1 is thus the hyperoxic exposure reached after one minute of breathing 100% O₂ at surface pressure. Hyperoxic monitoring by ESOT is more practical than K to apply in an operational environment, with no loss of accuracy in POT prediction. In addition, it intuitively allows interpreting hyperoxic exposures on its own, analogous to UPTD. The daily hyperoxic threshold limits suggested by Risberg and van Ooij for two, five and an unlimited number of successive diving days would translate to ESOTs of 650, 500 and 420 respectively.
Hyperbaric oxygen mitigates KIM-1 and inflammatory cytokine levels in kidney transplantation.
Bűyűk B, Öztopuz Ö
Undersea Hyperb Med · 2023 · PMID 37708062
The aim of this study was to investigate the effect of hyperbaric oxygen (HBO2) administration during cold ischemic time to organs removed from donors before kidney transplantation. A total of 24 rats were divided into t...
The aim of this study was to investigate the effect of hyperbaric oxygen (HBO2) administration during cold ischemic time to organs removed from donors before kidney transplantation. A total of 24 rats were divided into three groups: Group 1 was the control group, Group 2 received 60 minutes of HBO2 at 2.5 atmospheres absolute, and Group 3 received 120 minutes of 2.5 ATA HBO2. The renal artery was entered with a polyethylene catheter and perfused with a standard organ preservation solution. Falcon tubes containing organs obtained from rats in Groups 2 and 3 were placed in a box supported by ice blocks. The temperature was kept constant at 4°C and the box was placed in a pressure tank with 2.5 ATA HBO2. HBO2 was applied for 60 and 120 minutes, respectively. Organ samples were harvested at the end of 24 hours for histopathological evaluation, immunohistochemical analysis of TNF-α and IL-18, TUNEL analysis for apoptosis, and gene expression levels of kidney injury molecule-1 (KIM-1) and caspase-3. In histopathological examinations, hematoxylin and eosin staining was performed and samples were evaluated for tubular necrosis and vacuolization criteria. Group 2 and Group 3 had significant decreases compared to Group one in this regard. Immunohistochemical staining was performed for TNF-α, IL-18, and apoptosis levels; significant decreases were found in Groups 2 and 3. There were significant decreases in Groups 2 and 3 for KIM-1 and caspase-3 gene expression levels compared to Group 1, as well. Thus, it was demonstrated that during the cold ischemic period before kidney transplantation, HBO2 administration to organs removed from donors can reduce apoptotic cell numbers, inflammatory cytokine release, and histopathological damage to the organs as well as decreasing the expression of the KIM-1 gene, which is an indicator of kidney damage.
Hyperbaric oxygen treatment for paracentral acute middle maculopathy: a case study.
Neiberger RJ, Waters ET
Undersea Hyperb Med · 2023 · PMID 37708061
A 47-year-old active-duty Navy diver with a complicated past medical history which resulted in his designation as not physically qualified (NPQ) for diving duty in 2016 presented on 07 May 2021 complaining of left-sided...
A 47-year-old active-duty Navy diver with a complicated past medical history which resulted in his designation as not physically qualified (NPQ) for diving duty in 2016 presented on 07 May 2021 complaining of left-sided blurred vision. On exam by the attending undersea medical officer, he was found to have a left upper inner and upper outer quadrant visual field defect and a central scotoma. Urgent referral to ophthalmology ruled out retinal detachment but resulted in an initial diagnosis of a left branch retinal artery occlusion without embolus. Considering this a variant of central retinal artery occlusion, hyperbaric oxygen (HBO2) therapy was initiated approximately 12 hours after symptom onset, resulting in complete, though temporary, resolution of the visual field defect. He reported that after completion of his first HBO2 treatment, his visual field deficit began to return, but the deficit again resolved after initiating surface oxygen therapy between HBO2 treatments. After two days of continuous surface oxygen and daily HBO2 treatments, which minimized his visual field defect, his deficits changed to a persistent left lateral peripheral defect and a recurrent central nasal defect. At this time, his periodic ophthalmology evaluation revised his diagnosis to cilioretinal artery occlusion (CrAO). Further evaluation by ophthalmology revealed retinal changes consistent with a secondary diagnosis of paracentral acute middle maculopathy (PAMM), an ophthalmologic condition only recently defined in the literature (2013) [10] secondary to advances in retinal imaging technology. This case is presented to share the findings of this complicated case and to postulate a benefit from using HBO2 for cilioretinal artery occlusion with PAMM.
Case report of CT-guided lung biopsy complicated by air embolism.
Guo D, Li D, Xue R … +2 more , Lv Y, Pan S
Undersea Hyperb Med · 2023 · PMID 37708060
RATIONALE: Cerebral arterial air embolism is a rare but potentially fatal complication of computed tomography (CT) guided lung biopsy. Hyperbaric oxygen (HBO2) is the first line of treatment for arterial gas embolism and...
RATIONALE: Cerebral arterial air embolism is a rare but potentially fatal complication of computed tomography (CT) guided lung biopsy. Hyperbaric oxygen (HBO2) is the first line of treatment for arterial gas embolism and needs to be administered immediately after the event. Early HBO2 can reduce the mortality rate of cerebrovascular air embolism. PATIENT CONCERNS: A 65-year-old woman was diagnosed with a pulmonary nodule with a diameter of approximately 0.8 cm in the right lower lung. The patient developed consciousness, convulsions, and arrhythmia after CT-guided lung biopsy. DIAGNOSIS: Cranial CT revealed arborizing/linearly distributed gas in the right temporal, parietal, and occipital lobes and left frontal and parietal lobes. Chest CT showed a small amount of pneumothorax. Interventions: The patient was administered HBO2 twice and received other medical treatments and bone flap decompressive craniectomy. OUTCOMES: The patient developed multiple acute cerebral infarctions and even brain herniation complicated with acute myocardial infarction. Three months after the event, the patient's consciousness was still "open eyes coma" and GCS score was 8t points (E4VtM4). Head CT showed multiple cerebral infarctions and softening lesions. ECG showed sinus rhythm, normal range of the electrocardiogram axis, T wave change, and low voltage on the limb leads. LESSONS: Cerebral arterial air embolism is a serious complication of CT-guided lung biopsy. The recommended standard HBO2 should be used as early as possible. However, too severe an injury caused by severe arterial air embolism may not be significantly improved by one to two sessions of HBO2.
Wireless point-of-care ultrasound in a multiplace hyperbaric chamber.
Tanaka HL, Medak AJ, Duchnick J … +1 more , Lindholm P
Undersea Hyperb Med · 2023 · PMID 37708059
BACKGROUND: Electronic devices remain highly restricted from use during hyperbaric oxygen (HBO2) treatment due to risk of fire in a pressurized, oxygen-rich environment. Over recent decades, point-of- care ultrasound (PO...
BACKGROUND: Electronic devices remain highly restricted from use during hyperbaric oxygen (HBO2) treatment due to risk of fire in a pressurized, oxygen-rich environment. Over recent decades, point-of- care ultrasound (POCUS) has established utility in most clinical environments except hyperbaric chambers, where only heavily modified POCUS devices have been used. This study evaluated proof of concept, safety, and performance of a wireless off-the-shelf handheld POCUS device in the hyperbaric environment. MATERIALS AND METHODS: The GE Vscan Air was initially tested in a Class C chamber with 100% nitrogen up to 4.0 ATA and monitored. Second, the Vscan Air was paired with an encased Apple iPad, tested previously for hyperbaric use, and both were pressurized to 2.4 ATA in a Class A chamber (21% oxygen) and evaluated. Similarly, it was then tested at 2.8 ATA and also paired wirelessly with an iPad outside the chamber. Device temperature, image quality, functionality, and wireless connection were tested continuously. RESULTS: The GE Vscan Air automatically shut off due to power button depression during initial compression; thus the power button was punctured with an 18-gauge needle to equalize gas pressure. Thereafter, the system performed well throughout all tests without degradation in function or image quality. The device did not overheat nor reach temperatures concerning for fire hazard. Further, wireless connection to out-of-chamber devices was maintained. CONCLUSIONS: Our results suggest that the GE Vscan Air can be used with minor modification in a multi- place hyperbaric chamber. Wireless functionality allows for pairing with a screen and device outside the chamber.
Hyperbaric oxygen therapy for central retinal artery occlusion: Visual acuity and time to treatment.
St Peter D, Na D, Sethuraman K … +2 more , Mathews MK, Li AS
Undersea Hyperb Med · 2023 · PMID 37708058
PURPOSE: To evaluate the effectiveness of hyperbaric oxygen (HBO2) therapy as a treatment for central retinal artery occlusion (CRAO). METHODS: A total of 38 patients who underwent HBO2 for non-arteritic CRAO were identi...
PURPOSE: To evaluate the effectiveness of hyperbaric oxygen (HBO2) therapy as a treatment for central retinal artery occlusion (CRAO). METHODS: A total of 38 patients who underwent HBO2 for non-arteritic CRAO were identified. Patients with arteritic CRAO, branch retinal artery occlusion, ophthalmic artery occlusion, and other diagnoses were excluded from the analysis. The main outcome measured was the change in visual acuity at the most recent follow-up exam compared to the visual acuity at presentation before the initiation of HBO2 therapy. RESULTS: The overall visual acuity after HBO2 compared with the visual acuity at presentation showed a mean improvement of 0.5 logMAR from 2.2 to 1.7 logMAR (p=0.0003). Patients who presented with hand motion and light perception vision had a mean improvement of 0.4 logMAR (p=0.06) and 0.8 logMAR (p=0.004) after HBO2, respectively. An average visual acuity improvement of 0.5 logMAR (p=0.01) was observed when patients underwent HBO2 earlier than 24 hours of symptom onset. This mean improvement increased to 0.9 logMAR (p=0.009) if HBO2 was initiated within eight hours. CONCLUSIONS: HBO2 may be an effective treatment for non-arteritic CRAO, especially if patients are treated early and present with salvageable vision. The time to treatment and the presenting visual acuity may be predictive factors on the visual prognosis following HBO2. Further studies with a prospective design and more patients are necessary to determine the long-term outcomes and the optimal protocol for HBO2 in CRAO patients.
Undersea and Hyperbaric Medical Society Annual Scientific Meeting. June 16-18, 2023. San Diego, California: Abstracts.
Undersea Hyperb Med · 2023 · PMID 37302079
Abstract loading — click title to view on PubMed.
Hyperbaric oxygen combined with hydrogen-rich saline protects against acute lung injury.
Chang Y, Han Q, Bao X … +6 more , Wang M, Jin Y, Zhang S, Zhao X, Fang Y, Xue L
Undersea Hyperb Med · 2023 · PMID 37302078 · Publisher ↗
BACKGROUND: This study sought to investigate therapeutic effects of hydrogen-rich saline (HRS) combined with hyperbaric oxygen (HBO2) in an experimental rat model of acute lung injury (ALI). METHOD: Forty male Sprague-Da...
BACKGROUND: This study sought to investigate therapeutic effects of hydrogen-rich saline (HRS) combined with hyperbaric oxygen (HBO2) in an experimental rat model of acute lung injury (ALI). METHOD: Forty male Sprague-Dawley rats were randomly divided into sham, LPS, LPS + HBO2, LPS + HRS, and LPS + HBO2 + HRS groups. After an intratracheal injection of LPS-induced ALI, the rats were given a single-agent HBO2 or HRS or HBO2 + HRS treatment. The treatments were continued for three days in this experimental rat model of ALI. At the end of experiment, the lung pathological, inflammatory factors, and cell apoptosis in the pulmonary tissue were detected by Tunel method and cell apoptosis rate was calculated accordingly. RESULTS: In the groups treated with HBO2 + HRS, pulmonary pathological data, wet-dry weight ratio, and inflammatory factors of pulmonary tissues and alveolar lavage fluid were significantly superior to those of the sham group (p≺0.05). Cell apoptosis detection revealed that no single agent treatment of HRS or HBO2, or combination treatment, could alleviate all cell apoptosis. HRS combined with HBO2 treatment was superior to single treatment (p≺0.05). CONCLUSION: HRS or HBO2 single treatment could decrease inflammatory cytokines release in lung tissue, reduce the accumulation of oxidative products and alleviate apoptosis of pulmonary cells, then lead to positive therapeutic effects on ALI induced by LPS. Furthermore, HBO2 combined with HRS treatment presented a synergy effect on cell apoptosis decrease and a decline in inflammatory cytokine release and related inflammatory product generation, compared with a single treatment.
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