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UHM Journal Ahead of Print


The UHMS now provides the Undersea and Hyperbaric Medicine Journal as an e-publication prior to print.  UHMS members and subscriber will have access to the full unedited paper once logged in. 

-THE FOLLOWING PAPERS WILL UNDERGO A FINAL EDIT PRIOR TO FINAL PUBLICATION -


 

 ABSTRACT A widely accepted belief is that Nathaniel Henshaw was the first practitioner of hyperbaric medicine. He is said to have constructed the first hyperbaric chamber where he treated several disorders and provided opportunities to prevent disease and optimize well-being. While there is little doubt Henshaw was the first to conceptualize this unique medical technology, careful analysis of his treatise has convinced this writer that his was nothing more than a proposal. Henshaw’s air chamber was never built. He would have failed to appreciate how its structural integrity could be maintained in the presence of enormous forces generated by envisioned ..
Effect of hyperbaric oxygen therapy on diabetes-related oral complications HYPERBARIC OXYGEN THERAPY IN DIABETES MELLITUS ABSTRACT Background: Diabetes Mellitus is a chronic disease characterized by uncontrolled blood sugar levels, which lead to end-organ damage. While the diagnosis and treatment of its complications have been extensively studied, the effect of Hyperbaric Oxygen Therapy (HBO2) on diabetes- related oral complications remains unexplored. Aim: This prospective clinical study aims to investigate the effect of HBO2 on diabetes-related oral complications. Methods: Twenty patients diagnosed with diabetic foot ulcers and scheduled for HBO2 were included in this study. We recorded stimulated and unstimulated saliva pH, buffering capacity, flow rate, ..
[ RESEARCH ARTICLE [ Quantification of referrals received at two emergency-capable hyperbaric medicine centers QUANTIFICATION OF HYPERBARIC REFERRALS ABSTRACT Emergency hyperbaric oxygen treatment capability is limited in the United States, and there is little documentation of calls received by 24/7/365 centers. Our study aimed to calculate the number of calls received for urgent hyperbaric oxygen (HBO2). We logged calls from two HBO2 chambers on the East Coast of the United States that serve a densely populated region. The total number of emergency calls was 187 at the University of Maryland (UMD) and 127 at the University of Pennsylvania (UPenn). There were calls ..
Objective: To analyze Hyperbaric Oxygen Therapy Registry (HBOTR) data to determine physician productivity rates and understand the frequency of simultaneous patient supervision in the United States (US). Methods: Deidentified electronic health record data from all payers were prospectively collected from the HBOTR from 2013 to 2022 and retrospectively analyzed. We estimated the mean number of yearly hyperbaric oxygen therapy (HBO2) treatments per physician per workday. We analyzed physician productivity by counting the number of physicians who administered fewer than two HBO2 treatments daily on average and the ten most productive physicians. Results: There were 262,055 HBO2 sessions provided by 333 physicians ..
Background: Hyperbaric oxygen (HBO2) therapy is an alternative method against the 5 deleterious effects of ischemic/reperfusion (I/R) injury and its inflammatory response. 6 This study assessed the effect of preoperative HBO2 on patients undergoing 7 pancreaticoduodenectomy. 8 Study design: Patients were randomized via a computer-generated algorithm. Patients 9 in the HBO2 cohort received two sessions of HBO2 the evening before and the 10 morning of surgery. Measurements of inflammatory mediators and self-assessed pain 11 scales were determined pre-and postoperatively. In addition, perioperative variables 12 and long-term survival were collected and analyzed. Data are presented as median 13 (mean ± ..
Chronic wounds have a significant impact on a patient’s quality of life. Different pathologies, such as poor blood supply and tissue breakdown, may lead to inadequate oxygenation of the wound. Hyperbaric oxygen (HBO2) is a widely used treatment for an increasing number of medical practices. A new so-called “hyperbaric treatment” trend has emerged. The use of low-pressure, soft-sided, or inflatable chambers represents a growing trend in hyperbaric medicine. Used in professional settings as well as directly marketed to individuals for home use, they are promoted as equivalent to clinical hyperbaric treatments provided in medical centers. However, these chambers are ..
In clinical management of carbon monoxide (CO) poisoning, serum cardiac enzyme biomarkers and electrocardiogram (ECG) are both highly recommended emergency check-ups to evaluate myocardial injuries. Medical imaging – including head CT or MRI – are not routine for CO poisoning emergency management. We herein report on a comatose patient who was diagnosed with cerebral infarction secondary to 24 hours previous acute CO poisoning, warned by a typical cerebral-type T waves on ECG in advance, and confirmed by a head MRI. Fortunately, the patient made a full recovery based on a timely treatment with medications and hyperbaric oxygen (HBO2) therapy. ..
In-chamber pneumothorax has complicated medically remote professional diving operations, submarine escape training, management of decompression illness and hospital-based provision of hyperbaric oxygen therapy. Attempts to avoid thoracotomy by combination high oxygen partial pressure breathing (the concept of inherent unsaturation) and greatly slowed rates of chamber decompression proved successful on several occasions. When this delicate balance designed to prevent intrapleural gas volume expanding faster than it contracts proved futile, chest drains were inserted. The presence of pneumothorax was misdiagnosed or missed altogether with disturbing frequency resulting in wide-ranging clinical consequences. One patient succumbed before the chamber had been fully decompressed. ..
The presence of a pneumothorax within a pressurized chamber represents unique diagnostic and management challenges. This is particularly the case in the medical and geographic remoteness of many chamber locations. Upon commencing chamber decompression unvented intrapleural air expands. If its initial volume and/or degree of chamber pressure reduction is significant enough a tension pneumothorax will result. Numerous reports chronicle failure to diagnose and manage in-chamber pneumothorax with resultant morbidity and one fatal outcome. Such cases have occurred in both medically remote and clinically based settings. This paper reviews pneumothorax and tension pneumothorax risk factors and clinical characteristics. It suggests ..
Throughout more than five decades a multitude of experimental and clinical studies has shown predominantly positive, but also controversial results on the efficacy of hyperbaric oxygen (HBO2) therapy in burns. Aim of the study was to define a common denominator or constellations, respectively, linked to the effects of HBO2 in burns with special focus on dosage parameters. Based on original work since 1965, species, number of individuals, type of study, percentage of total body surface area (TBSA), region, depth of burn, causative agent, interval between burn and first HBO2 session, pressure, duration of individual session, number of HBO2 sessions per ..
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 HBO2 make it a unique tool for AVN and applied it in conjunction with standard of care for our patient.   DOI: 10.22462/644
Inner ear decompression sickness (IEDCS) is an uncommon diving-related injury affecting the vestibulocochlear system, with symptoms typically including vertigo, tinnitus and hearing loss, either in isolation or in combination. Classically associated with deep, mixed-gas diving, more recent case series have shown that IEDCS is indeed possible after seemingly innocuous recreational dives, and there has been one previous report of IEDCS following routine hyperbaric chamber operations. The presence of right-to-left shunt (RLS), dehydration and increases in intrathoracic pressure have been identified as risk factors for IEDCS, and previous studies have shown a predominance of vestibular rather than cochlear symptoms, with ..
An arterial gas embolism (AGE) is a potentially fatal complication of scuba diving that is related to insufficient exhalation during ascent. During breath-hold diving, an arterial gas embolism is unlikely because the volume of gas in the lungs generally cannot exceed the volume at the beginning of the dive. However, if a diver breathes from a gas source at any time during the dive, they are at risk for an AGE or other pulmonary overinflation syndromes (POIS). In this case report, a breath-hold diver suffered a suspected AGE due to rapidly ascending without exhalation following breathing from an air ..
We present two cases of cricoid chondronecrosis treated with hyperbaric oxygen (HBO2) therapy. Both patients presented with biphasic stridor and dyspnea several weeks after an intubation event. Tracheostomy was ultimately performed for airway protection, followed by antibiotic treatment and outpatient HBO2 therapy. Both patients were decannulated within 6 months of presentation and after at least 20 HBO2 therapy sessions. Despite a small sample size, our findings are consistent with data supporting HBO2 therapy’s effects on tissue edema and neovascularization as well as HBO2 potentiation of antibiotic treatment and leukocyte function. We suggest HBO2 therapy may have accelerated airway decannulation ..
Barodontalgia, barometric pressure-induced dental pain, may occur during hyperbaric oxygen therapy due to pressure changes. This case report presents an 8-year-old male patient with barodontalgia. The patient declared a severe toothache during hyperbaric therapy. The diving medicine specialist referred the patient to the dental clinician immediately. On clinical examination, the pain was thought to be caused by caries lesions of the deciduous teeth in the left maxillary molar region. Tooth extraction was suggested. After extraction, patient continued hyperbaric oxygen therapy sessions without any pain. Patient was recommended for a session to intraoral and radiographic examination one week after the ..
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 (HBO2) 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 ..
Inner ear decompression sickness (IEDCS) is an uncommon diving-related injury affecting the vestibulocochlear system, with symptoms typically including vertigo, tinnitus and hearing loss, either in isolation or in combination. Classically associated with deep, mixed-gas diving, more recent case series have shown that IEDCS is indeed possible after seemingly innocuous recreational dives, and there has been one previous report of IEDCS following routine hyperbaric chamber operations. The presence of right-to-left shunt (RLS), dehydration and increases in intrathoracic pressure have been identified as risk factors for IEDCS, and previous studies have shown a predominance of vestibular rather than cochlear symptoms, with ..
THIS PAPER WILL UNDERGO A FINAL EDIT PRIOR TO FINAL PUBLICATION Decompression sickness (DCS) is a disease caused by abrupt change of extracorporeal pressure, with varying severity. Symptoms range from mild musculoskeletal pain to severe organ dysfunction and death, especially among patients with chronic underlying disease. Here, we report an unusual case of a 49-year-old man who experienced DCS after a dive to a depth of 38 meters. The patient’s symptoms progressed, starting with mild physical discomfort that progressed to disturbance of consciousness on the second morning. During hospitalization, we identified that in addition to DCS he had also developed diabetic ..
THIS PAPER WILL UNDERGO A FINAL EDIT PRIOR TO FINAL PUBLICATION   Carbon monoxide and cyanide poisoning are frequent causes of morbidity and mortality in cases of house and industrial fires. The 14th edition of guidelines from the Undersea Hyperbaric and Medical Society do not recommend HBO treatment in those patients who have suffered a cardiac arrest and had to receive CPR. In this paper we describe a case of a 31-year-old patient who received HBO treatment despite these recommendations and who had a partial recovery after the treatments. DOI: 10.22462/01.01.2023.8