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UNDERSEA & HYPERBARIC MEDICINE Controlled CMS Data Demonstrates a Cost and Clinical Advantage for Hyperbaric Oxygen for Radiation Cystitis John J. Feldmeier, DO1; John P. Kirby, MD2; Helen B. Gelly, MD3; Marc Robins, DO4; John Peters, FACHE5; Peter Gruhn, MA6; Sarmistha Pal, PhD6 1 Professor Emeritus and Past Chairman, Radiation Oncology, University of Toledo Medical Center 2 Associate Professor of Surgery, Washington University School of Medicine, St Louis, MO 3 President, Regenerative and Hyperbaric Medicine, Marietta, Georgia 4 Senior Medical Director, Intermountain Health 5 Executive Director, Undersea and Hyperbaric Medical Society 6 Dobson DaVanzo and Associates, LLC CORRESPONDING AUTHOR: John J. Feldmeier – jfeldmeier@aol.com ABSTRACT Feldmeier J, Kirby J, Gelly H, Robins M, Peters J, Gruhn P, Pal S. Controlled CMS Data Demonstrates a Cost and Clinical Advantage for Hyperbaric Oxygen for Radiation Cystitis. Undersea Hyperb Med. 2024 Second Quarter; 51(2):145-157. 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 (HBO2) 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 ..

Trends in Medicare Costs of Hyperbaric Oxygen Therapy, 2013 through 2022Helen B. Gelly, MD1; Caroline E. Fife, MD2,3; David Walker, CHT2; Kristen Allison Eckert, MPhil4 1 Regenerative and Hyperbaric Medicine, Marietta, GA 2 Intellicure, Inc., The Woodlands, TX3 Baylor College of Medicine, Houston, TX4 Strategic Solutions, Inc., Bozeman, MT CORRESPONDING AUTHOR: Helen B. Gelly – helengelly@gmail.com https://www.uhms.org/b075e18e-9d75-41f0-b7be-1897776e0d5b" alt="page1image61908832" width="74.335000" height="74.333900" /> ABSTRACT Gelly H, Fife C, Walker D, Eckert K. Trends in Medicare Costs of Hyperbaric Oxygen Therapy, 2013 through 2022. Undersea Hyperb Med. 2024 Second Quarter; 51(2):137-144. Objective: To analyze Hyperbaric Oxygen Therapy Registry (HBOTR) data to estimatethe Medicare costs of hyperbaric oxygen therapy (HBO2) 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 HBO2 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 HBO2 indications treated in the outpatient setting. Results: Generally, all costs decreased from ..

Kinjal Sethuraman, MD, MPH1; Michael Tom, MD2; Kin Wah Chew, MD1; Jonathan Romero-Casillas, MD3; Kevin Hardy, MD2 1  University of Maryland School of Medicine, Department of Emergency Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD 2  Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 3  Ponce School of Medicine, Department of Emergency Medicine, San Lucas Hospital, Ponce, Puerto Rico CORRESPONDING AUTHOR: Kinjal Sethuraman – ksethuraman@som.umaryland.edu ABSTRACT Sethuraman K, Tom M, Chew KW, Ramon Y, Romero-Casillas J, Hardy K. Quantification of referrals received at two emergency-capable hyperbaric medicine centers. Undersea Hyperb Med. 2024 Second Quarter; 51(2):97-100. Emergency hyperbaric oxygen treatment capability is limited in the United States, and there is little documentation of calls received by centers available 24 hours a day, seven days a week, 365 days a year. 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 in 2021. 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 on 180/365 (46%) days during the study ..

Busra Dilara Altun, DDS1; Selin Gamze Sümen, MD2; Melisa Öçbe, DDS, PhD1; Asim Dumlu, DDS, PhD1 1 Marmara University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Istanbul, Turkey 2 Underwater and Hyperbaric Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey CORRESPONDING AUTHOR: Busra Dilara Altun – busradkaraca@hotmail.com ABSTRACT Altun BD, Sümen SG, Öçbe M, Dumlu A. Effect of hyperbaric oxygen therapy on diabetes-related oral complications. Undersea Hyperb Med. 2024 Second Quarter; 51(2):101-106. 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 havebeen 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,and subjective symptoms such as dry mouth, halitosis, taste loss, difficulty swallowing, and clinical examination findings before HBO2 and after the 21st session. Results: Upon comparing the findings, we observed a significant decrease in dry mouth and halitosis, periodontal disease severity, and healing of candida-related stomatitis and angular cheilitis. Despite not reaching statistical significance for other saliva ..

Richard Clarke, CHT-A National Baromedical Services, Columbia, South Carolina, USA CORRESPONDING AUTHOR: Richard Clarke – dickclarke@baromedical.com ABSTRACT Clarke R. Nathanial Henshaw: Not history’s pioneering hyperbaric practitioner. Undersea Hyperb Med. 2024 Second Quarter; 51(2):107-113. 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 changes in its internal pressure and, likewise, how its door could effectivelyseal the chamber during hypo-and hyperbaric use. Henshaw would have also failed to appreciate the limitations of his two proposed measuring devices and the toxic nature of one. Neither of these would have provided any quantitative information. The impracticality of his proposed method of compressing and decompressing the chamber is readily apparent. So, too, the likely toxic accumulation of carbon ..

Christian Smolle*, MD1; Daniel Auinger*, MD2; Jörg Lindenmann, MD3;Josef Smolle, MD4; Freyja-Maria Smolle-Juettner, MD3; Lars-Peter Kamolz, MD1 1  Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria 2  Division of Anaesthesiology and Intensive Care Medicine 1, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria 3  Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Graz, Austria 4  Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria CORRESPONDING AUTHOR: Daniel Auinger – daniel.auinger@medunigraz.at *These authors contributed equally to this work. ABSTRACT Smolle C, Auinger D, Lindenmann J, Smolle J, Smolle-Juettner FM, Kamolz LP. Hyperbaric oxygen (HBO2) therapy in thermal burn injury revisited. Pressure does matter. Review. Undersea Hyperb Med. 2024 Second Quarter; 51(2):115-127. For over five decades, many experimental and clinical studies have shown predominantly positive but controversial results on the efficacy of hyperbaric oxygen (HBO2) therapy in burns. The study aimed to define a common denominator or constellations, respectively, linked to the effects of HBO2 in burns with a 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 ..

LCDR Dale Parsons, MD1; CDR (Ret) Edward Utz, MD2; CAPT Grant Kidd, DO3; CAPT Gina Virgilio, MD4 1 School of Infantry – West, Camp Pendleton, California, U.S.2 Head & Neck Surgery Department, Kaiser Permanente San Diego Medical Center, San Diego, California, U.S. 3 Navy Experimental Diving Unit, Panama City Beach, Florida, U.S.4 Explosive Ordnance Disposal Group ONE, San Diego, California, U.S. CORRESPONDING AUTHOR: Dale Parsons – dale.a.parsons7.mil@health.mil ABSTRACT Parsons D, Utz E, Kidd G, Virgilio G. Inner ear decompression sickness after a routine dive and recompression chamber drill. Undersea Hyperb Med. 2024 Second Quarter; 51(2):129-135. Inner ear decompression sickness (IEDCS) is an uncommon diving-related injury affecting the vestibulocochlear system, with symptoms typically including vertigo, tinnitus, and hearing loss, eitherin isolation or 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 a preference for lateralization to the right side. Most importantly, rapid identification and initiation of recompression treatment ..

Donald Lamont, PhD1; Andrew Colvin, MSc2; Adrian Heili3; Tony Ridley, MSc4; Roy Slocombe5; Jurg Wendling, MD6 1 Hyperbaric and Tunnel Safety Ltd, Wirral, UK2 Tunnelmed Services Ltd, Dunblane, UK3 Hyperbaric Tunnelling and Medical Services Ltd, Brentford, UK 4 Tony Ridley Hyperbaric Associates, Norwich, UK5 Herrenknecht International Ltd, Sunderland, UK6 Biel, Switzerland CORRESPONDING AUTHOR: Donald Lamont – donald@hyperbaricandtunnelsafety.co.uk ABSTRACT Lamont D, Colvin A, Heili A, Ridley T, Slocombe R, Wendling J. Advanced high pressure hyperbaric techniques in tunnelling. Undersea Hyperb Med. 2024 Second Quarter; 51(2):159-171. 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. Keywords: hyperbaric, decompression, tunneling, transfer under pressure, mixed gas, saturation. DOI:10.22462/640

Omar López-Rebenaque, PT, MSc1; Luis Solís-Ferrer, PT, MSc1; José Fierro-Marrero, PT, MSc1,2; Francisco de Asís-Fernández, PT, PhD1,3 1  Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain 2  Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain. 3  Breatherapy Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain. CORRESPONDING AUTHOR: José Fierro-Marrero – jose.fierromarrero@yahoo.com ABSTRACT López-Rebenaque O, Solís-Ferrer, Fierro-Marrero J, Asís-Fernández F. Acute effects of apnea bouts on hemoglobin concentration and hematocrit: a systematic review and meta-analysis. Undersea Hyperb Med. 2024 Second Quarter; 51(2):173-184. 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 ..

Youichi Yanagawa MD, PhD; Hiromichi Ohsaka MD, PhD; Shoichiro Yatsu MD, PhD; Satoru Suwa MD, PhD Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University Department of Cardiology, Shizuoka Hospital, Juntendo University CORRESPONDING AUTHOR: Youichi Yanagawa – yyanaga@juntendo.ac.jp ABSTRACT Yanagawa Y, Ohsaka H, Yatsu S, Suwa, S. Acute aortic dissection during scuba diving. Undersea Hyperb Med. 2024 Second Quarter; 51(2):185-187. 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 ..

Claudio Marabotti, MD1; Marco Laurino, PhD2; Mirko Passera2; Danilo Cialoni, MD3; Enrico Franzino, MD4; Chiara Benvenuti, MA2; Alessandro Pingitore, MD2 1 Master in Underwater and Hyperbaric Medicine, Sant’Anna School of Advanced Studies, Pisa – Italy 2 CNR Institute of Clinical Physiology, Pisa – Italy3 DAN Europe Research Division, Roseto degli Abruzzi – Italy4 Diving Doctors Italy, Ravenna - Italy CORRESPONDING AUTHOR: Claudio Marabotti – c.marabotti@gmail.com ABSTRACT Marabotti C, Laurino M, Passera M, Cialoni D, Franzino E, Benvenuti C, Pingitore A. Cardiovascular effects of breath-hold diving at altitude. Undersea Hyperb Med. 2024 Second Quarter; 51(2):189- 196. 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, ..

UHMS Position Statement + Physician’s Duties in Hyperbaric Medicine - 99183 https://www.uhms.org/62aa2e82-6e1a-40d3-8a95-9f53fd93374c" alt="page1image23190432" width="421.740000" height="0.500000" /> Date created: January 4, 2024 Edited: April 22, 2024 Date of the following review: 2029 Authorship: Dr. Matthew Kelly, Dr. Helen Gelly, Dr Owen O’Neill, Dr. Dag Shapshak Reviewed/Approved by: UHMS Board of Directors, January 27, 2024 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 hy- perbaric oxygen treatment (HBO2) cannot be over- stated. This position statement aims to underscore the significance of physician involvement in deliv- ering HBO2 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 meticu- lous approach to patient management. As the com- plexity 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 HBO2, ad- dressing the technical intricacies of the treatment and the broader spectrum of patient care. RATIONALE Physician oversight for hyperbaric oxygen treat- ment is rooted in the technical complexities of the ..