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Number 6

UHM Journal Number 44-6 - November-December 2017 - full issue

  11-27-2017

Review on hyperbaric oxygen treatment in femoral head necrosis

Background: Femoral head necrosis (FHN) is a common invalidating disease with an unclear etiology and pathophysiology that affects middle-aged people. FHN may lead to joint collapse and require invasive treatments. Because of its clinical and socioeconomic significance, an early diagnosis, staging and appropriate treatment are required. Unfortunately, to date a unique algorithm for the treatment of FHN has not been defined. Objective: In this report we summarize the Tenth European Consensus Conference on hyperbaric medicine (April 2016, France), during which experts from Europe revised the list of accepted indications for hyperbaric oxygen (HBO2) treatment, including FHN. Methods: In this report all aspects of osteonecrosis discussed ..

  11-27-2017

Health care worker decompression sickness: incidence, risk and mitigation

Inadvertent exposure to radiation, chemical agents and biological factors are well recognized hazards associated with the health care delivery system. Less well appreciated yet no less harmful is risk of decompression sickness in those who accompany patients as inside attendants (IAs) during provision of hyperbaric oxygen therapy. Unlike the above hazards where avoidance is practiced, IA exposure to decompression sickness risk is unavoidable. While overall incidence is low, when calculated as number of cases over number of exposures or potential for a case during any given exposure, employee cumulative risk, defined here as number of cases over number of ..

  11-27-2017

Influence of hyperoxia on diastolic myocardial and arterial endothelial function

Objective: Hyperoxia is known to influence cardiovascular and endothelial function, but it is unknown if there are differences between younger and older persons. The aim of this study was to monitor changes in myocardial diastolic function and flow-mediated dilatation (FMD) in younger and elderly volunteers, before and after exposure to relevant hyperbaric hyperoxia. Methods: 51 male patients were separated into two groups for this study. Volunteers in Group 1 (n=28, mean age 26±6, “juniors”) and Group 2 (n=23, mean age 53±9, “seniors”) received standard HBO2 protocol (240kPa oxygen). Directly before and after hyperoxic exposure in a hyperbaric chamber we took blood samples (BNP, hs-troponin-t), ..

  11-27-2017

Hyperbaric oxygen therapy as an adjuvant to source control in necrotizing soft tissue infections

Introduction: Necrotizing soft tissue infections (NSTI) are rare but potentially lethal disorders, and adequate management is time- and resource-demanding. This study aims to assess whether variations in the treatment modalities – surgery, hyperbaric oxygen (HBO2) therapy and negative pressure wound therapy – had an impact on the length to definitive source control in NSTI patients who underwent HBO2. Methods: This is a retrospective study of all NSTI patients treated with hyperbaric oxygen therapy between March 2007 and May 2015 at Unidade Local de Saúde de Matosinhos (ULSM) Hyperbaric Unit. A multiple linear regression model was used to assess the impact of different treatment ..

  11-27-2017

Hyperbaric oxygen suppresses growth of Klebsiella pneumoniae and enhances effect of tigecycline in vitro

Objectives: (1) To examine whether hyperbaric oxygen (HBO2) will inhibit growth of multidrug-resistant Klebsiella pneumoniae (MDR-K. pneumoniae) and extensively drug-resistant Klebsiella pneumoniae (XDR-K. pneumoniae); (2) To determine whether the effect of tigecycline on XDR-K. pneumoniae will be enhanced by HBO2.  Methods: The effects of 1.5 hours of treatment with normoxia (21% O2, 1 atmosphere absolute/ATA) or HBO2 (100% O2, 2 ATA) on bacterial counts of eight isolates of MDR-K. pneumoniae and eight isolates of XDRK. pneumoniae were studied. The effects of five hours of treatment with normoxia (21% O2, 1 ATA), tigecycline (21% O2, 1 ATA), HBO2 (100% O2, 3 ATA) or ..

  11-27-2017

Dried salted plum consumption ameliorates hyperbaric oxygen therapy-induced otalgia severity at the first chamber session: a prospective randomized controlled study

Purpose: One of the most common complications of hyperbaric oxygen (HBO2) therapy is middle ear barotrauma (MEB), occasionally causing otalgia. The objective of this study was to evaluate the effect of dried salted plum consumption on MEB and otalgia associated with HBO2 therapy. Materials and methods: Patients undergoing the first chamber session of HBO2 therapy were included in the present prospective randomized controlled trial. The Valsalva maneuver was administered to all patients before HBO2. The patients were randomly divided into two groups: one that ate a dried salted plum during HBO2 treatment and the other that did not. An otoscopic examination was performed ..

  11-27-2017

Quantitative Romberg’s test in acute carbon monoxide poisoning treated by hyperbaric oxygen

Objective: The aim of this study was to evaluate whether monitoring of acute carbon monoxide-poisoned (COP) patients by means of quantitative Romberg’s test (QR-test) during a hyperbaric oxygen (HBO2) therapy regimen could be a useful supplement in the evaluation of neurological status. Method: We conducted a retrospective study (2000-2014) in which we evaluated data containing quantitative sway measurements of acute COP patients (n = 58) treated in an HBO2 regimen. Each patient was tested using QR-test before and after each HBO2 treatment. Data were analyzed using linear mixed models (LMM). In each LMM, sway prior to HBO2 therapy was set as the fixed ..

  11-27-2017

The Dewey monitor: Pulse oximetry can independently detect hypoxia in a rebreather diver

Rebreather diving has one of the highest fatality rates per man hour of any diving activity in the world. The leading cause of death is hypoxia, typically from equipment or procedural failures. Hypoxia causes very few symptoms prior to causing loss of consciousness. Additionally, since the electronics responsible for controlling oxygen levels in rebreathers often control their alarm systems, frequently divers do not receive any external warnings.  This study investigated the use of a forehead pulse oximeter as an independent warning device in the event of rebreather failure. Ten test subjects (seven male, three female, median age 29, range 26-35) exercised at a ..

  11-27-2017

Physiological responses to prolonged saturation diving: a field-based pilot study

This study aimed to assess the effect of extreme environmental exposure during an operational saturation dive on airway inflammation (exhaled nitric oxide (FeNo)), components of fitness (flexibility and aerobic capacity) and blood hematological variables. Six saturation divers, who undertook a 26 ± 0.5 day operational saturation dive were recruited to take part in this study. Participants completed a field-based repeated measure test battery on three occasions (pre-dive, post-dive and 24 hours after saturation dive). Hemoglobin concentration was significantly (P<0.001) reduced from pre- (15.3±0.8 g/dL) to post- saturation (14.25±1.2 g/dL) dive but recovered toward baseline values within 24 hours (15.13±1.03 g/dL; P=0.04).  Similarly, a reduction in ..

  11-27-2017

Effects of prolonged and repeated immersions on heart rate variability and complexity in military divers

Background: The influence of prolonged and repeated water immersions on heart rate variability (HRV) and complexity was examined in 10 U.S. Navy divers who completed six-hour resting dives on five consecutive days. Pre-dive and during-dive measures were recorded daily.  Methods: Dependent variables of interest were average heart rate (HR), time-domain measures of HRV [root mean square of successive differences of the normal RR (NN) interval (RMSSD), standard deviation of the NN interval (SDNN)], frequency-domain measures of HRV [low-frequency power spectral density (psd) (LFpsd), low-frequency normalized (LFnu), high-frequency psd (HFpsd), high-frequency normalized (HFnu), low-frequency/high-frequency ratio (LF/HF)], and non-linear dynamics of HRV  ..

  11-27-2017

Smoking cessation program among naval diver trainees in the Republic of Singapore Navy

Background: Since 2016, the Naval Diving Unit (NDU) of the Republic of Singapore Navy (RSN) has instituted a smoking cessation trial program for their trainees, instituting a blanket ban on smoking during training hours in order to promote smoking cessation and create a smoke-free culture among its servicemen. For the rest of RSN personnel, they would attend a more costly, established Health Promotion Board (HPB) smoking cessation program, which employs social support strategies, while they undergo basic training in the Navy Military Experts Institute (NMI). Methodology: We examined the outcomes and direct costs of the NDU smoking cessation trial program, compared ..

  11-27-2017

Alternobaric vertigo and facial baroparesis caused by scuba diving and relieved by chewing pineapple: a case report

Equalization of middle ear pressure is an important consideration for scuba divers. When middle ear pressure is asymmetric, a diver may experience alternobaric vertigo. Moreover, individuals with an underlying temporal bone dehiscence are predisposed to facial baroparesis. An understanding on behalf of fellow divers and emergency responders to recognize and differentiate facial baroparesis from decompression illness is critical. Misdiagnosis may lead to inappropriate treatment or unwarranted stoppage of diving. There have been a few dozen reported cases of facial baroparesis in the literature, but few have included firsthand accounts.  This report describes an incidence of unilateral facial baroparesis preceded by alternobaric ..

  11-27-2017

Letter: UHMS HBO2 COMMITTEE CHAIR QUESTIONS FDA ON INCORRECT INFO

 [ letter ] DOI: 10.22462/11.12.2017.13

  11-27-2017

POLICY: UHMS announces position statement on low-pressure, soft-sided hyperbaric chambers

 [ Position Statement ] DOI: 10.22462/11.12.2017.14

  11-27-2017

MEDAQs: Air breaks + Metered dose inhaler Q&As

  11-27-2017