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CT scout view showing pneumothorax on the right hemithorax before chest tube insertion. Figure 2: CT scout view showing recovery from pneumothorax after chest tube insertion.
Source publication
Pneumothorax (PTX) is rarely reported in patients receiving hyperbaric oxygen (HBO2) therapy. Patients with air-trapping lesions in the lungs and those with a history of spontaneous PTX, lung disease, mechanical ventilation or chest trauma are at an increased risk for PTX during HBO2 therapy. A 28-year-old male earthquake survivor was referred to o...
Context in source publication
Context 1
... diagnosis was confirmed with a CT scan showing complete collapse of the right lung and mediastinal shift to the left (Figure 1). A chest tube, attached to an underwater seal below the level of the chest, was in- serted. The patient's vital signs improved dramatically. A control CT revealed inflation of the lungs ( Figure 2). The patient regained spontaneous breathing and consciousness. Subsequent HBo 2 treatments were can- celled. The patient did not develop any neurological sequelae, but he required above-the-knee amputation of his right ...
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Importance
The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain.
Objective
To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day morta...
Citations
... Pulmonary barotrauma is also a feared complication of mechanical ventilation, particularly in patients with severe underlying lung disease (54). Cakmak et al. (55) reported tension pneumothorax in an intubated and mechanically ventilated earthquake survivor during the decompression phase of the seventh HBOT session. The patient was successfully treated with a chest tube. ...
... The rarely reported complications of HBOT are barosinusitis (1 per 10,000 treatments) [78], barodontalgia/ odontocrexis (9.2-21.6% among American and Australian civilian divers) [89], pulmonary barotrauma [90,91], arterial gas embolism [91,92], oxygen-dependent rigid tonic-clonic seizures (1 per 2000 to 3000 treatments) [93][94][95][96], progressive myopia [97], cataracts [97], and retrolental fibroplasia [98,99]. The complications with multiple sittings of HBOT were not reported in the literature, but they were rare. ...
Introduction:
Hyperbaric oxygen therapy (HBOT) has emerged as an adjunct treatment modality in various orthopedic and rheumatological conditions. Undersea and Hyperbaric Medical Society (UHMS) defined the minimum number of HBOT cycles, dose, and frequency for various diseases. UHMS laid the 14 absolute indications for HBOT. This article deals with the mechanism of actions of HBOT and evidence of various musculoskeletal disorders where HBOT was utilized to accelerate the healing process of the diseases.
Materials and methods:
The review literature search was conducted by using PubMed, SCOPUS, and other database of medical journals for identifying, reviewing, and evaluating the published clinical trial data, research study, and review articles for the use of HBOT in musculoskeletal disorders.
Results:
Various clinical researchers documented cellular and biochemical advantages of HBOT which possess allodynic effects, anti-inflammatory, and prooxygenatory effects in patients with musculoskeletal conditions. Studies on the usage of HBOT in avascular necrosis and wound healing provide a platform for exploring the plausible uses of HBOT in other musculoskeletal conditions. Literature evidence states the complications associated with HBOT therapy.
Conclusion:
The existing HBOT protocols have to be optimized for various musculoskeletal disorders. Large scale blinded RCTs have to be performed for demonstrating the level of evidence in the usage of HBOT in various musculoskeletal clinical scenarios.
... For those reports where the patients were receiving HBOT, one detailed 126 patients undergoing mechanical ventilation and concurrent HBOT (for a variety of indications), of whom six experienced patient-ventilator asynchrony while in the hyperbaric chamber. 7 An additional six single-case studies documented a heterogeneous group of patients aged 5-80 (one female and five males) for whom HBOT was complicated by tension PTX, 6,8 pulmonary oedema, 9 pneumomediastinum, 10 acute pulmonary embolism, 11 and AGE. 12 A final report described a survey of 98 HBOT centres, reporting a combined incidence of PBt of 0.00045%. 13 For those cases that involved hyperbaric air exposure (e.g., pressure tolerance testing), one case series described two otherwise healthy individuals who sustained AGE while undertaking routine pressure tolerance testing in a hyperbaric chamber, 14 while another report described a single case of AGE during decompression from a 'dry dive' in a patient with previously undiagnosed pulmonary sarcoidosis. ...
... 39,40 Certain centres also pursue additional investigations, such as CT imaging or spirometry, to characterise the nature of pre-existing respiratory disease and assess the risk of injury, while others routinely use CT chest imaging before HBOT. 8 Other investigations which may be available to providers evaluating patients for the presence of absence of gas trapping include whole body plethysmography 41 and ventilation scans using xenon, 42 nitrogen, or helium, 43 although these tests may not be available in all centres and the evidence supporting their use in pre-HBOT screening is currently limited. Despite the common practice of obtaining CXR or CT imaging as a screening tool prior to HBOT, the basis for this approach remains unclear. ...
... 44 High-resolution CT has been proposed as a substitute for CXR in pre-HBOT screening, particularly in subjects with clinical indications. 8,12,14,48 The radiation exposure associated with high-resolution CT varies dramatically based on imaging parameters but, if performed conservatively, is comparable to a CXR. 49 While CT is a superior diagnostic tool for airway abnormalities such as pulmonary cysts, 21 it frequently identifies findings of unknown medical significance. ...
Respiratory injury during or following hyperbaric oxygen treatment (HBOT) is rare, but associated pressure changes can cause iatrogenic pulmonary barotrauma with potentially severe sequelae such as pneumothoraces. Pulmonary blebs, bullae, and other emphysematous airspace abnormalities increase the risk of respiratory complications and are prevalent in otherwise healthy adults. HBOT providers may elect to use chest X-ray routinely as a pre-treatment screening tool to identify these anomalies, particularly if a history of preceding pulmonary disease is identified, but this approach has a low sensitivity and frequently provides false negative results. Computed tomography scans offer greater sensitivity for airspace lesions, but given the high prevalence of incidental and insignificant pulmonary findings among healthy individuals, would lead to a high false positive rate because most lesions are unlikely to pose a hazard during HBOT. Post-mortem and imaging studies of airspace lesion prevalence show that a significant proportion of patients who undergo HBOT likely have pulmonary abnormalities such as blebs and bullae. Nevertheless, pulmonary barotrauma is rare, and occurs mainly in those with known underlying lung pathology. Consequently, routinely using chest X-ray or computed tomography scans as screening tools prior to HBOT for low-risk patients without a pertinent medical history or lack of clinical symptoms of cardiorespiratory disease is of low value. This review outlines published cases of patients experiencing pulmonary barotrauma while undergoing pressurised treatment/testing in a hyperbaric chamber and analyses the relationship between barotrauma and pulmonary findings on imaging prior to or following exposure. A checklist and clinical decision-making tool based on suggested low-risk and high-risk features are offered to guide the use of targeted baseline thoracic imaging prior to HBOT.
... A spontaneous pneumothorax (PNX) due to air trapping can, however, develop typically during the ascent in predisposed subjects, such as those suffering from acute respiratory distress syndrome (Kot et al., 2008), obstructive pulmonary diseases (e.g., asthma, chronic obstructive pulmonary disease), or asymptomatic carriers of bullae. Overall, the incidence of PNX during HBOT is not clearly established (Cakmak et al., 2015). Symptoms and clinical features of PNX vary based on the severity of the manifestation, ranging from sudden-onset pleuritic chest pain to mild or moderate dyspnea. ...
Introduction
Hyperbaric chambers and underwater environments are challenging and at risk of serious accidents. Personnel aiming to assist patients and subjects should be appropriately trained, and several courses have been established all over the world. In healthcare, simulation is an effective learning technique. However, there have been few peer-reviewed articles published in the medical literature describing its use in diving and hyperbaric medicine.
Methods
We implemented the curriculum of the Master’s degree in hyperbaric and diving medicine held at the University of Padova with emergency medicine seminars created by the faculty and validated by external experts. These seminars integrated traditional lectures and eight in situ simulation scenarios.
Results
For the hyperbaric medicine seminar, simulations were carried out inside a real hyperbaric chamber at the ATIP Hyperbaric Treatment Centre, only using air and reproducing compression noise without pressurization to avoid damages to the manikins. The four scenarios consisted of hyperoxic seizures, pneumothorax, hypoglycemia, and sudden cardiac arrest. Furthermore, we added a hands-on session to instruct participants to prepare an intubated patient undergoing hyperbaric oxygen treatment with a checklist and simulating the patient transfer inside and outside the hyperbaric chamber. The diving medicine seminar was held at the Y-40 The Deep Joy pool in Montegrotto Terme (Italy), also involving SCUBA/breath-hold diving (BHD) instructors to rescue subjects from the water. These diving medicine scenarios consisted of neurologic syndrome (“taravana/samba”) in BHD, drowning of a breath-hold diver, pulmonary barotrauma in BHD, and decompression illness in a SCUBA diver.
Conclusion
With this experience, we report the integration of simulation in the curriculum of a teaching course in diving and hyperbaric medicine. Future studies should be performed to investigate learning advantages, concept retention, and satisfaction of participants.
... Les modifications physiopathologiques au cours et au décours des séances d'OHB sont des arguments importants dans la prise en charge des patients brûlés. En effet, la vasoconstriction et le maintien de la perméabilité capillaire permettent une réduction de la perte liquidienne et une réduction de l'oedème tissulaire [63][64][65][66] . Ces séances permettent également une préservation tissulaire par diminution du risque infectieux (bactériostase, amélioration de la fonction leucocytaire et de l'efficacité des antibiotiques), par réduction de la progression en profondeur de la brûlure, par prévention des lésions d'ischémie-reperfusion et permettent une réduction de la mortalité [67] . ...
Resumen
La oxigenoterapia hiperbárica (OHB) se define como un método de administración de oxígeno (O2) inhalado con fines terapéuticos a una presión superior a la presión atmosférica. Los beneficios terapéuticos de la OHB resultan, por una parte, de los efectos físicos debidos al aumento de la presión barométrica y la presión parcial de O2 en los tejidos y, por otra parte, de los efectos biológicos debidos a la producción de especies reactivas del O2 y el nitrógeno. Éstas son susceptibles de interactuar con numerosos procesos moleculares responsables de los principales efectos antiisquémicos, procicatrizantes y antiinfecciosos. Sus indicaciones se evalúan regularmente en el marco de conferencias de consenso internacionales. Las referencias en materia de indicaciones de la OHB son, por una parte, el consenso norteamericano de la Undersea and Hyperbaric Medical Society (UHMS) y, por otra parte, el consenso europeo del European Committee of Hyperbaric Medecine (ECHM). En Francia, la Haute Autorité de Santé analizó en 2007 el servicio médico esperado de la OHB en las diferentes indicaciones. Las principales recomendaciones del último consenso europeo que tuvo lugar el Lille en 2016 se registran en este documento. La OHB se aplica por medio de una cámara hiperbárica, comúnmente llamada «caja». Es una técnica compleja, que requiere una fuerte inversión humana y material. Tiene algunas contraindicaciones que deben respetarse y riesgos bien identificados que deben tenerse en cuenta.
... В клинической практике нормобарическая оксигенация (НБО) применяется при лечении дыхательной недостаточности [4], для повышения когнитивных способностей, для лечения подводников, баротравм и многих других патологических состояний. Вместе с тем дыхание смесями с высокими концентрациями О 2 сопряжено с локальными и системными физиологическими эффектами [5,17]. ...
Objective: Traumatic brain injury (TBI) is a global public health problem. Hyperbaric oxygen (HBO) therapy may be beneficial for TBI because it improves cerebral blood flow into tissues exhibiting low blood flow. This was done to observe the clinical therapeutic effect of different intensities of rehabilitation training and HBO therapy in early stages of TBI.
Approach: In this multicenter, randomized, stratified case-controlled prospective clinical trial, we selected 158 patients with moderate-severe TBI and assigned them into (1) a control group receiving routine once-daily (1/d) rehabilitation training without HBO, (2) study group A receiving routine 1/d rehabilitation training with HBO, (3) study group B receiving twice-daily (2/d) intensified rehabilitation training with HBO, and (4) study group C receiving 2/d intensified rehabilitation training without HBO, all for 3 months. The cognitive ability, activities of daily life (ADL), and movement ability were assessed before and after training with the Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), Modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE).
Results: FIM, FMA, MBI, and MMSE scores were improved significantly after 1-, 2-, and 3-month rehabilitation training in all TBI patients (p < 0.01), and this improvement was especially remarkable in patients who received 2/d intensified rehabilitation training with HBO (p < 0.01).
Innovation: With extensive and intensive research on TBI rehabilitation, it was proved that TBI rehabilitation intervention should be initiated as early as possible.
Conclusion: Early intensified rehabilitation training in combination with HBO is more beneficial to the recovery of cognitive, ADL, and movement abilities of TBI patients.
Significance: Hyperbaric oxygen therapy (HBOT) is an important advanced therapy in the treatment of problem wounds, including diabetic foot ulcers and late effect radiation injury. HBOT remains among the safest therapies used today. Nonetheless, there are side effects associated with HBOT. It is important for providers to be able to identify, understand, and quantify these side effects for prevention, management, and informed consent.
Recent Advances: The past two decades have seen significant advancements in our understanding of the underlying mechanisms of HBOT. This has led to a better understanding of the underlying reason for clinical benefit. It has also led to a better understanding of its side effects. Moreover, more recent literature allows for better quantification of these side effects. This review will highlight these side effects.
Critical Issues: Wound healing in the case of problem nonhealing wounds requires the use of various advanced treatment modalities, including HBOT. HBOT has been shown to significantly improve healing rates in certain problem wounds, including advanced diabetic foot ulcers and late effect radiation injury. It is provided in a variety of clinical settings by providers with varying levels of expertise. It is important for those providing this therapy to understand the potential side effects.
Future Directions: Research in HBOT has led to significant advancements in the area of wound healing. At the same time, there remains a variety of treatment protocols used at different institutions. It is important to quantify risk and benefit at different treatment pressures and times to better standardize treatment and improve patient care.
This chapter reviews the modest number of applications in the area of pulmonary disorders as normobaric oxygen is more frequently used for most indications in this area. Effects of HBO on lungs include a discussion of pulmonary arterial hemodynamics as well as lung mechanics and pulmonary gas exchange. Pulmonary oxygen toxicity is also discussed although normal therapeutic uses at most pressures of HBO do not adversely affect the lungs. Clinical applications include respiratory insufficiency, bronchial asthma, bronchitis, inflammatory processes of the lungs, and pulmonary embolism. Contraindications include nitrogen dioxide poisoning, emphysema, shock lung, and pneumothorax.
