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Home , Hyperbaric medicine

No. 23

Legends and Leadership in Hyperbaric at the world-renowned Karolinska University Hospital

Critical Care News The views, opinions and assertions expressed in the interviews are is published by Maquet Critical Care. strictly those of the interviewed and do not necessarily reflect or represent the views of Maquet Critical Care AB. Maquet Critical Care AB 171 54 Solna, Sweden © Maquet Critical Care AB, 2014. Phone: +46 (0)10 335 73 00 All rights reserved. No part of this publication may be reproduced, www.maquet.com stored in a retrieval system, or transmitted in any form or by any other means, electronic, mechanical, photocopying, recording, or otherwise, ©Maquet Critical Care 2014. All rights reserved. without the prior written permission of the copyright owner. Editor-in-chief: Kris Rydholm Överby Publisher: Paolo Raffaelli The following designations are registered or pending trademarks Order No. MX-5883, MCV00038812 of Maquet Critical Care AB: SERVO-i®, SERVO-U™, NAVA®. Printed in Sweden www.criticalcarenews.com [email protected] 2 | Critical Care News

Annika Ryberg, MD and Folke Lind, MD with critically ill ICU patient in the multiplace chamber

Legends and Leadership in at the world-renowned Karolinska University Hospital

Folke Lind, MD, PhD has been an important international driving in the development of Hyperbaric Medicine. In 1991 he became Director of Hyperbaric Medicine at Karolinska, and from that time on, he and his colleagues have helped hyperbaric treatment evolve into an established science. Critical Care News met with Dr Lind, and with Michael Nekludov, MD, who has been working at the institution since 1999 and is the Director of Hyperbaric Medicine and also with Peter Kronlund, Perfusionist and Technical Manager, who has contributed to the CE registration of products in hyperbaric conditions and is currently the European Chairman of the HBO Safety Committee. These pioneers have enjoyed a unique collaboration, and they share their experiences of their journey in hyperbaric medicine, their current HBO innovations and future desires for continued development in the field. Critical Care News | 3

Can you describe the current scope of your hyperbaric medicine facilities at Karolinska, and what events led to this?

Folke Lind: I became responsible for the hyperbaric chamber facilities in 1991, and I received sponsoring from Siemens Elema and AGA at that time to establish a hyperbaric chamber facility for intensive care patients. We had two SERVO 900 ventilators at our disposal, and we published our first scientific research article about the use of the SERVO 900 ventilator in HBO . All of these factors led to our starting a good HBO facility for our intensive care patients.

Michael Nekludov: Karolinska Hospital is a world-leading level 1 institution, and this benefits our HBO operations. We are located in close proximity to our central ICU department and helicopter pad, which are important factors. We have a large 4-lock rectangular multiplace Folke Lind, MD, PhD at chamber, totalling 50 square meters, Karolinska has been an in which we can treat up to four ICU important international patients simultaneously. We can take driving force in the development of care of up to 9 ventilator patients in our Hyperbaric Medicine. multiplace chamber, in the case of a catastrophic event like a large fire. The chamber was established in 2005 and is equipped with everything an intensive patient category for us. Our most leading to possible , and 5 care patient needs. We have another common acute patient indication is sickness patients. large multiplace chamber that we used necrotizing faciitis. These serious soft primarily as our research chamber; it tissue bacterial infections are the For treatments in our monoplace can be used in hyperbaric as well as largest patient category we treat with chamber last year, we treated primarily hypobaric conditions. Our department HBO, particularly in the multiplace radiation tissue damaged patients, also has 3 monoplace chambers. chamber, since most of them are deeply patients with , infected sedated, and requiring intensive care. implants and hypoxic ulcers, and , lastly decompression sickness. Which types of and numbers of and carbon-monoxide intoxication patients have you treated with HBO are other acute patient categories. over the past twelve months? What is the current staffing situation We also have elective HBO therapy within your department for supporting Michael Nekludov: During 2013 we with different patient categories, hyperbaric medical treatments? have conducted 245 HBO treatments such as patients with with SERVO-i in the multiplace intensive foot ulcers, patients with radiation Michael Nekludov: Currently we have care chamber, with 52 patients in total. damaged tissue, chronic infections, 14 doctors that work for HBO on-call. In our monoplace chambers we neurosurgical infections and Chamber operators consist of both conducted 1956 treatments last patients with infected implants. nurses and physicians, and we have 16 year in a total of 88 patients – these staff members currently, with another patients usually require much longer Michael Nekludov: If you look at our 2 in training. We have a total of 27 series of treatments per patient. statistics from last year, of the 245 intensive care nurses who are qualified treatments in the multiplace chamber; 24 to work in the HBO chamber. We have Folke Lind: Many people think of these were carbon monoxide cases, 4 permanent staff members in our that we primarily use HBO to treat were a total of 167 monoplace department consisting of 2 decompression sickness, also known treatments, 30 treatments of tissue registered nurses and 2 practical nurses. as divers’ disease, but this is a minority ischemia - for example crush injuries 4 | Critical Care News

What are the requirements for in the chamber a connection to the resources are needed. MAQUET and a ventilator used for HBO? ventilator is a must to generate proper the former SERVO owner Siemens- documentation of the procedure. Elema have always worked closely Folke Lind: It must be safe from together with the Karolinska Institute. an electrical standpoint as fire is a devastating occurrence in the chamber. What were the primary factors leading When it came to SERVO-i, our For the SERVO-i we have the possibility to the decision to initiate and test the collaboration started one evening in to use the ventilator in the ICU and SERVO-i ventilator for HBO treatment? 2006, when Folke, I and members of use batteries during transport to the MAQUET development department the hyperbaric chamber. We run on Folke Lind: I think our longstanding started to look at prototypes which batteries until we enter the chamber, collaboration with SERVO ventilator subsequently lead to the final approved where we connect to external 12V developers, first with Siemens and later HBO application in SERVO-i. We worked power and remove the batteries, with MAQUET, as well as our history together in the evenings after our thus ensuring a smooth process of use of the SERVO 900 ventilator in normal daytime HBO operations were without interruption of ventilation. the HBO environment made it quite finished, and on weekends as well Besides the pure safety aspects natural for us to want to help develop with evaluation of the new application. of operation, the ventilator must and upgrade to HBO with SERVO-i . Evaluation is a continuing process: compensate for the hyperbaric what works, what doesn’t work, and environment and of course deliver Peter Kronlund: To enable collaboration back to the developers to redefine, what is set, and report monitored and development, you need a partner modify, return and validate again. values correctly. EtCO2 is mandatory company with enough curiosity and and the SERVO-i curves are efficient power to drive these types of large scale Michael Nekludov: It is also important in detecting problems like increasing development projects. By power, I mean to note that with SERVO-i we have an intrinsic PEEP. As we have PDMS system that powerful financial and technical intensive care ventilator that works in the HBO environment. This is valuable to us as we place continuing requirements in regard to our standard ICU equipment and treatment performance wherever we are with the patient – either in the intensive care unit or in the HBO chamber. We need to guarantee the same quality of ventilation treatment performance in both settings. No matter where you are with the intensive care patient, you want to have access to and adjust the same respiratory parameters on the ventilator in the same manner. We want to provide a modern intensive care without any interruptions in ventilatory treatment.

With SERVO-i we also have the benefit of standardizing so that all ICU staff members can be educated and trained on the same ventilator platform.

What work and processes were requirements to receive hospital approval for use of the SERVO-i ventilator in the chambers?

Peter Kronlund: In very simple practical terms, what we do is take one medical device such as SERVO-i, and connect another medical device to it – the HBO module. It is the original device Michael Nekludov, MD, is the current Director of Hyperbaric Mediciine at Karolinska which regulates how to go forward with requirements and approval for the Critical Care News | 5

development and approval process but very valuable for everyone that was involved during each step of the way.

How often and for how long are the patients on in the chamber?

Folke Lind: The patient should be prepared before going to the chamber with appropriate ventilator, syringe pumps, and intensive care monitoring for the hyperbaric chamber. We use the SERVO-i and if the patient is given multiple treatments he can use the same ventilator in the ICU and in the chamber. In patients who need repeated HBO treatment, this allows easier and more practical handling of the routine in the ICU and chamber, as well as Technical manager Peter Kronlund has contributed to the CE approvals of several devices transport to and from the chamber. in the HBO environment We have the philosophy of slowly increasing and decreasing in the chamber. Hence, pressure is ramped connecting device. The manufacturer ”Enclosures for electrical devices in up in a curvilinear fashion during 11-13 of the HBO multiplace chamber, Haux hyperbaric facilities”, which gives an minutes until the therapeutic target Life Support in Germany, together with understanding of the requirements pressure level, 2,8 ATA corresponding an independent institution that certifies before the risk analysis is made and to18 meters below water surface, is their products called Germanischer the devices are being developed. I am obtained. After 70 minutes, during Lloyd, who in turn is an expert on currently Chairman of the European which time we provide two 5 minute HBO chambers and different types Safety Committee, so I know there is an periods of air in order to of underwater installations. They ongoing dialogue between organizations. avoid toxicity, we begin a have collaborated on a guide called For SERVO-i and HBO, it was a long slow decompression. Pressure is

Birgitta Johansson, LPN and Carola Lenbäck, LPN (chatting with a patient in a monoplace chamber). 6 | Critical Care News

just a reflection of the flow resistance in the tube as can be seen by the lower plateau pressure. If we cannot achieve normoventilation, we increase pressure and the inspiratory time thus decreasing the impact of the increased resistance. We also try to avoid ventilation as much as possible.

Can you share some of your patient experiences during the past year for the use of SERVO-i ventilator to provide HBO treatment?

Folke Lind: We calculate that we have The technical control center outside of the multiplace chamber conducted 105 patient treatments with SERVO-i with HBO in 2012, and over 200 patient treatments with SERVO-i then gradually stepped down until a environment is the increase in the and HBO in 2013, so we are well over threshold of 1.9 ATA were we remain respiratory time constant, increasing the 300 patient treatments in total for the stationary for 10 minutes, then continue tendency for auto PEEP. The situation product by now. We have treated a the decrement in pressure down to 1.3 is easily detectable as flow does not full range of patient categories, from ATA where another 10 minutes pause is return to zero during expiration. an infant of 2.5 kilos up to patients administered. Pressure is then tapered weighing 130 kilograms. The 2.5 kilo off to sea level. The total time for a baby was a difficult to ventilate patient, session is set to 113 minutes. We expand and we were happy to have SERVO-i the time to 3 hours or more if we treat to help us with this particular case. severe cases, divers or gas embolism. We have treated a The child had undergone abdominal and fasciitis had developed full range of patient in the surgical incision area. How do you monitor mechanical ventilation in the chamber? categories, from Michael Nekludov: A wide range of patients, and as we mentioned earlier, Folke Lind: We have a long tradition an infant of 2.5 very critically ill patients and patients with sepsis and multi-organ failure. Again, it of using etCO2 monitoring in the kilos up to patients chamber. This started as a collaborative is an advantage to have a standardized project with Siemens Elema using weighing 130 kilos ventilator in all the intensive care the SERVO 900 C and accompanying units, including the neonatal and pediatric

CO2 analyzer 930. We found that by patients. Introducing the SERVO-i with using compensation factors for the HBO went very smoothly, almost without hyperbaric environment we could achieve any problems at all. I am impressed breath-by-breath control of ventilation. with the product development process

By comparing the Arterial CO2 level The density of Oxygen increases at MAQUET. With many other types of to the end tidal, assuming parallel linearly with increasing barometric medical devices, we sometimes get development, we have found that etCO2 pressure. How does this affect the the impression that a device has been monitoring has been our most important gradient between Peak Inspiratory generated in product development for source to guarantee proper ventilation Pressure and Plateau Pressure? direct sales, with no understanding of and bringing immediate attention to the customer need or requirement. mechanical problems like endotracheal Folke Lind: We have used pressure Those types of companies have a tube patency. We routinely obtain a controlled ventilation routinely for several difficult time making innovative products gas 20 minutes after reaching years and flow resistance increases without understanding the true need of target pressure and then adjust the with the square root out of the density the customer. In the case of SERVO-i ventilator according to the arterial PCO2. increase. At 18 meters corresponding with HBO, MAQUET as a manufacturer With the SERVO-i we are able to control to 2,8 ATA and 2,8 times increased gas responded to customer needs and pressure and volumes both delivered density there is therefore a 1,7 times requirements, a tradition that has always and exhaled routinely and we use the increased flow resistance. Since the been associated with development of flow curve to detect intrinsic PEEP. endotracheal tube gives the highest flow the SERVO ventilator product line. An important effect of the hyperbaric resistance most of the peak pressure is Critical Care News | 7

Teamwork in the multiplace chamber with intensive care staff members Folke Lind, MD, Annika Rydberg, MD and Karin Andersson, critical care nurse

What are some of the primary When I took over the responsibility ill intensive care patients. When we differences in providing ventilation for the HBO facilities in 1991, we had bring the patient to the HBO chamber to HBO patients with the a hyperbaric Dräger Oxylog, and we we frequently see that O2 saturation SERVO-i ventilator, compared have had transport ventilators in the deteriorates a little after HBO therapy. to the SERVO 900 ventilator? early years, but these disappeared We usually increase the oxygen fairly quickly in time. We also did hand a bit and recruit the . Folke Lind: The SERVO 900 ventilator ventilation in the very beginning. If you are at a level of 70-80% prior was a valuable cornerstone here to HBO, it may be a bit problematic for more than two decades. The Peter Kronlund: It is important to note afterwards. For example, in septic SERVO-i provides us with flow and that we were unwilling to introduce other patients or patients with severe fasciitis pressure curves, in order to see how from other manufacturers in it is very important to avoid atelectasis the lungs are functioning and how the Karolinska Hospital. There has been by means of maintaining PEEP and the body is responding to expiration a focus on standardizing whenever avoiding breaking the patient circuit. and inspiration. This is especially possible to reduce the numbers of important with very critically ill patients, devices from different manufacturers, as The patient being treated in the chamber who are difficult to ventilate. part of our safety and security processes. today is a female that has a severe Michael Nekludov: We also have an fasciitis that generated in her throat unbroken chain of care for the patient, after an infection, and has spread from as they are being treated with SERVO-i The SERVO-i ventilator with HBO the throat to the . She has in the central ICU departments. may also be used in the general had complex infection processes which ICU. Can you describe the patient or have been treated with ORN-surgery clinical advantages in this respect? and thorax surgery. There are open What are some of the primary drains in her throat and thorax and her differences compared to Michael Nekludov: It is important current oxygen requirement is 60%. other HBO ventilators? to maintain continuity in the patient This type of critically ill patient is not treatment, and avoiding breaking the one that you want to expose to further Folke Lind: We have not had so ventilatory circuit with disconnecting potential risks, such as atelectasis. many other solutions to compare to. and re-connection in these severely 8 | Critical Care News

Action at 11,52 m depth in the multiplace chamber

This is about the most severe patient You are currently involved in a range We also have an ongoing Scandinavian category to be found in the ICU, of ongoing HBO studies in different randomized controlled trial to where we need to optimize ventilation areas: assessing symptom relief in investigate treating radiation induced during a number of other ongoing radiation induced cystitis with HBO, cystitis with hyperbaric oxygen. treatments and interventions. HBO in lower leg trauma, HBO as a Sahlgrenska University Hospital in treatment component in necrotizing Göteborg is sponsoring this study, Folke Lind: It is also important to note soft tissue infections, and HBO to and we are participating together with that SERVO-i HBO ventilator is connected reduce post-op complications in Rigshospitalet in Copenhagen and to the PDMS system for continuous diabetic patients. Although these the Haukeland University Hospital in data collection in the central ICU are all significant areas for research, Bergen, Norway. We have very good departments, so there is no interruption can you share which area you feel research collaboration in Scandinavia in data collection for HBO treatments. has the biggest priority at present? in the area of hyperbaric medicine. This is just one more detail that makes HBO therapy an integral portion of Folke Lind: The European research Michael Nekludov: We are also the entire intensive care treatment. project where we are participating with conducting research in the area of the largest 5 year financing is both post-operative hyperbaric oxygen pre-clinical and clinical, and the project treatments to reduce complications What do you see as development is called Infect. The purpose is to learn for diabetics undergoing vascular areas for hyperbaric treatments more about these flesh-eating bacteria. surgery. Another interesting potential and technology in the future? HBO is a small part of this project. But in research area is within neuro ICU. Scandinavia, we see several hundred of There are a few publications about Michael Nekludov: Perhaps an even these patients with these conditions and skull injuries and HBO therapy broader scale of pressure tolerances treat them with HBO in several centers in future. Right now we are currently in Sweden, Denmark and Norway. Folke Lind: For example, there are head treating at a maximum of 18-19 meters injuries too severe to operate, and there depth. But we do have types of Another international research study is aren’t many other alternative treatments treatment we would like to conduct at the Hyperbaric Oxygen in Lower Leg available. There is a theory that it might 30 meters depth with the ventilator. Trauma, or HOLLT study, which we be beneficial to give HBO intermittently are about to summarize after almost with to these patients. If we are really visionary, in future we 10 years of faithful study and research. There have been some results in this would like to deliver dialysis during the We have studied 107 patients so far, area in a randomized study in the US. course of HBO treatment. Quite recently, so we are near our objective of 120 we have conducted a technical test of a patients. About one patient every second dialysis system in the HBO chamber, but month may appear in Stockholm or we have not tested with patients yet. Melbourne, or the Czech Republic. Critical Care News | 9

At Karolinska you have become as a speaker. Sydney is the site of such as lectures, presentations pioneers as well as ambassadors or another investment in a multi-place and meetings with different groups missionaries for HBO throughout chamber, where Karolinska has been such as technicians, nurses and the world. What types of educational a forerunner. We are definitely at the physicians from different countries. activities do you conduct here? forefront in driving development in HBO. Folke Lind: That is why we have been Folke Lind: Yes, this spring we have Michael Nekludov: The US has doing this, ever since 1977 when planned visits from Moscow and historically used monoplace chambers we began our research. At my first intensivists from St Petersburg for more frequently, and there have congress in 1980, we were already whom we will hold some training been attempts there to install all pioneers for other sites who were courses. We will also conduct a equipment in a monoplace chamber, interested in starting up HBO. There study visit for 2 intensivists from the but the disadvantage to this is that the is a university hospital in Okinawa Netherlands in the next few weeks. We physician has no access to the patient in Japan that has been here for an have conducted several international during treatment, a clear limitation educational visit. They have copied our meetings in Stockholm and we offer a during a long treatment process as we HBO facilities and treatment methods, free educational website with lectures see it. We believe that the best way as has a center in Singapore. But with from meetings and symposiums, which to treat intensive care patients with reference to Asia, China is the land is located at www.hyperbaricoxygen.se. hyperbaric medicine is to incorporate with the most HBO chambers per We have a well-established collaboration all aspects of intensive care, including capita in the world! They are treating with the Mayo Clinic in the US, and caregivers, within the HBO chamber. more indications with hyperbaric they will be visiting us next year. They medicine than any of us are today. will be conducting a symposium on Peter Kronlund: We share our various HBO in 2015, where I’ve been invited experiences in different forums,

Michael Nekludov monitors and helps to prepare another patient for treatment in the hyperbaric multiplace chamber 10 | Critical Care News

Biography

Folke Lind, MD PhD has been Michael Nekludov, MD, studied Peter Kronlund, RN, Perfusionist an important driving force for the medicine at Saratov University, CCP received his initial nursing development of Hyperbaric medicine. in the Russian Federation, degree in Sweden in 1974, and With a life-long interest in diving, where he graduated in 1990. qualified as specialty nurse in 1981 it was a natural development to He received his Swedish MD diploma and as a military ICU nurse in 1984. become involved in baromedical in 1993 from the Karolinska Institute, He was a team member of the research even before his MD in followed by internship during the years Karolinska Heart Transplant and Total 1980. Baromedicine was at this time of 1995-1997 at Danderyds Hospital Artificial Heart Project for the years a part of the physiology institution in Stockholm. He also practiced in of 1985-1987, with team members at the Karolinska institute and Dr. several other Scandinavian hospitals Professor B Semb, Dr B Koul, Dr J Linds Ph.D thesis on “Respiratory such as in Göteborg, Motala, Västerås, Liska and perfusionist J Svensson. drive and breathing pattern during Gällivare and Tromsö in Norway. Peter Kronlund obtained his degree exercise in man” in many ways as Perfusionist CCP in 1988, with reflected the ground breaking In 1997, Michael Nekludov pursued special projects in Hypthermia work on respiratory physiology of his studies and work within the survival in cold water and ECMO the institution at the time. During area of anesthesiology, obtaining with heparin-coated blood circuitry his residency for specialization in a specialist degree in 2002. under Professor B Olsson. Anesthesia and Intensive Care he continued his postdoctoral research Michael Nekludov has been Peter Kronlund started working at the Karolinska Institute with more employed at the Anesthesiology in the Karolinska Hyperbaric emphasis on Hyperbaric Medicine. Department of Karolinska University Medicine Department in 2005, with In 1991 Dr. Lind became Director of Hospital since 1998, and has been the assignment to develop work Hyperbaric Medicine, a position he active as an HBO on-call physician with intensive care applications held for 17 years. During these years since 1999. He has experience in hyperbaric environment in Hyperbaric medicine and treatment within general anesthesiology and collaboration with the biomedical has evolved into an established intensive care, as well as HBO and engineering team at Karolinska. science, with proven effects of neurosurgical intensive care. beneficial actions on host infectious Peter Kronlund acted as Chairman defense systems, antibiotic Michael Nekludov, MD is currently and General Secretary of the Swedish potency, and wound involved in several ongoing and Scandinavian Perfusionist healing. During Dr. Linds leadership, research projects in the areas of Organisations 2001-2003. He has the Institution for Hyperbaric Medicine HBO and neurotrauma. He has presented numerous scientific has become leading in the world. The been Medical Director for the abstracts, oral presentations and functionality of the current multiplace HBO operations at Karolinska published articles from 1990 to the chamber is very much due to the University Hospital since 2013. present time. He is currently Technical work by Dr. Lind, first during the Manager of the Hyperbaric Medicine planning phase by providing a detailed Department at Karolinska Institute, specification of the unit and secondly and is Board Member and Chairman of by his long time collaboration with the Safety Committee of the European the industry, resulting in registration Baromedical Association for Chamber of infusion pumps, monitors, data Operators, Nurses and Technicians. collections systems, defibrillators and the SERVO ventilators for hyperbaric conditions. Dr. Lind is currently dividing his clinical obligations with research efforts associated with clinical aspects of hyperbaric therapy. He is an avid lecturer on the many different aspects of Hyperbaric medicine from chamber construction to cell-mediated patient responses. He is currently involved in several multi center trials concerned with effects of Hyperbaric therapy. Critical Care News | 11

References

1 Hesser CM, Lind F. Ventilatory 13. Handell S, Ansjön R, Castor R, Lind 24. Neovius E, Lind M, Lind F. Hyperbaric and occlusion-pressure responses F. Respiratory CO2 monitoring of the oxygen therapy for wound complications to incremental-load exercise. critically ill patient in the multiplace after surgery in the irradiated head and Respir Physiol 1983;51:391-401 chamber. Proc of the 18th Annual neck: a review of the literature and Meeting of the EUBS, 1992;59-61 a report of 15 consecutive patients. 2 Lind F. Respiratory drive and breathing Head&Neck 1997;19:315-322 pattern during exercise in man. Thesis. 14. Östlund A, Sporrong A, Linnarsson Acta Physiol Scand Suppl. 1984;533:1-47 D, Lind F. Effects of sulphur hexafluoride 25. Lind F. How do tissue cells on psychomotor performance. react to varying O2 tensions? In: 3 Lind FG, Truve AB, Lindborg Clin Physiol Lond: 1992;12;409-418 Bakker DJ, Le Péchon JC, Marroni BP. Microcomputer-assisted on- A (Eds) Hyperbaric oxygen, Best line measurement of breathing 15. Westman L, Lind F, Söderman Publishing Company 1998;55-62 pattern and occlusion pressure. M, Ericsson K, Ingvar M, Hannertz J. J Appl Physiol 1984 ;56:235-9 CT and MRI of the brain in severely 26. Pagani M, Ansjön R, Lind F, Jonsson CO-intoxicated patients treated with C, Uusijärvi J, Sumen G, Jacobsson 4 Lind F, Hesser CM. Breathing pattern hyperbaric oxygen. Undersea & H, Larsson SA. Comparison between and volumes during exercise. Hyperbaric Medicine 1993;20:15-16 near-infrared oximetry and 99mTc- Acta Physiol Scand. 1984 ;120:123-9 HMPAO uptake in the resting peripheral 16. Lind F. Clinical Hyperbaric Medicine: muscle under normobaric normoxia 5. Hesser CM, Lind F. Role of an introductory review. Proc of 19th and hypobaric . 1998; Proc. airway resistance in the control of Annual Meeting of EUBS on diving and SPIE 3194, Photon Propagation in ventilation during exercise. Acta hyperbaric medicine, 1993;110-120 Tissues III, 151;doi:10.1117/12.301047; Physiol Scand. 1984 ;120:557-65 http://dx.doi.org/10.1117/12.301047. 17. Lind F, Westman L, Handell S, 6. Lind F, Hesser CM. Breathing Söderman M, Ericson K. Middle , 27. Linnarsson D, Östlund A, Lind F, pattern and occlusion pressure during mastoid and paranasal sinus affections in Hesser CM. Hyperbaric bradycardia and moderate and heavy exercise. Acta HBO treated unconscious CO victims; a hypoventilation in exercising men: Effects Physiol Scand 1984;122:61-9 common incidental finding on MRI of the of hydrostatic pressure and breathing brain. Proc of International Congress on gas. J Appl Physiol. 1999;87:1428-32 7. Eiken O, Lind F, Bjurstedt H. Effects of Hyperbaric Medicine, Fuzhou, Kina, 1993 blood volume distribution on ventilatory 28. Pagani M, Ansjön R, Lind F, Uusijärvi variables at rest and during exercise. 18. Östlund A, Linnarsson D, Lind J, Sümen G, Jonsson C, Salmaso D, Acta Physiol Scand. 1986;127:507-12 F, Sporrong A. Relative narcotic Jacobsson H, Larsson SA. Effects of potency and mode of action of sulphur acute hypobaric hypoxia on regional 8. Eiken O, Hesser CM, Lind F, Thorsson hexafluoride and nitrogen in man. cerebral blood flow distribution: A, Tesch PA. Human skeletal muscle J Appl Physiol. 1994;76:439-444 A single photon emission computed function and during intense tomography study in humans. Acta exercise at high O2 and N2 19. Lind, F. HBO in Physiol Scand 2002;168:377-383 J Appl Physiol. 1987;63:571-5 and . Proc of 20th Annual Meeting of the EUBS, Istanbul, 234-238, 1994 29. Kalani M, Jörneskog G, Naderi 9. Lind F. Carbon monoxide. Monografi. N, Lind F, Brismar K. Hyperbaric Giftinformationscentralen 1990, 26 sidor. 20. Lind F. HBO in thermal burns. In: oxygen (HBO) therapy in treatment (Wattel F, Mathieu D (eds), First European of ulcers. Long- 10. Hesser, CM, Lind F, Linnarsson Consensus Conference on Hyperbaric term follow-up. J Diabetes and its D. Significance of airway resistance Medicine, Lille, France 1994;116-130 complications 2002;16:153-158 for the pattern of breathing and lung volumes in exercising humans. 21. Lind F. Managing the critically 30. Larsson A, Engström M, Uusijärvi J Appl Physiol 1990;68: 1875-1882 ill diver. Proc of First International J, Kihlström L, Lind F, Mathiesen Congress on Hyperbaric and Diving T. Hyperbaric oxygen treatment of 11. Lind F, Linnarsson D, Hesser CM. Medicine, Napoli, Italy 1994;113-114 postoperative neurosurgical infections. Increased end-expiratory lung volumes Neurosurgery 2002,50:287-296 during strenuous exercise in hyperbaric 22. Lind F. HBO therapy in burns and air environ-ments. Proc of the 16th smoke inhalation injury. In: Oriani G, 31. Nilsson Remahl AIM, Ansjön R, Lind Annual Meeting of the EUBS, 1990:69-73 Marroni A, Wattel F (eds.), Textbook F, Waldenlind, E. Hyperbaric oxygen on hyperbaric oxygen therapy, treatment of active cluster headache; 12. Lind F, Westman L, Söderman Springer Verlag, 1996;509-530 a double-blind placebo-controlled cross- M, Ericsson K, Ingvar M, Hannertz J. over study. Cephalgia 2002;22:730-739 Prognostic value of brain CT, MRI and 23. Hehenberger K, Brismar K, PET in severely CO-intoxicated patients Lind F, Kratz G. Dose-dependent 32. Elmqvist Stenberg A, Larsson treated with repeated hyperbaric hyperbaric oxygen stimulation of A, Gustavsson M, Gårdlund B, oxygenation. Acta Anaesthesiologica human fibroblast proliferation. Kumlien J, Lind F, Nordlander B. Italica 1991;42:172-174 Wound Rep Reg 1997;5:147-50 Cervikala nekrotiserande fasciiter- behandlingsstrategi. Läkartidningen, 2004;28-28; 2336-2341 References

33. Schnittger V, Rosendahl K, Lind F, 38. Larsson A, Engström M, Uusijärvi 43. Larsson A, Uusijärvi J, Gustavsson Palmblad J. Effects of carbon monoxide J, Kihlström L, Lind F, Mathiesen B, Lind F, Saraste H. Hyperbaric Oxygen poisoning on neutrophil responses in T. Hyperbaric oxygen treatment of (HBO) in the treatment of postoperative patients treated with hyperbaric oxygen. postoperative neurosurgical infections. infections in paediatric patients with J Investigative Medicine 2004;52:523-530 Neurosurgery 2008, Suppl 2:652-71 neuromuscular spine deformity. European Spine Journal, 2011;20:2217-22 34. Lind F et al 2004. Requirement 39. Flam F, Boijsen M, Lind F. Necrotizing Specification for New Intensive fasciitis following transorburator tape 44. Kronlund P, Olsson D, Lind F. Care Hyperbaric Chamber System treated by extensive surgery and Hyperbaric critical care patient at Karolinska University Hospital hyperbaric oxygen. Int Urogynecol J data management system. Solna, Sweden, 29pp. Pelvic Floor Dysfunct. 2009;113-115 Technical report. Diving and Hyperbaric Med 2012;42;85-87 35. Lind F, Arnell P, Douglas J, 40. Pagani M, Salmaso D, Sidiras GG, Hammarlund C, Spetz L, Wilhelmsson Jonsson C, Jacobsson H, Larsson 45. Sunkari VG, Lind F, Botusan IR, Kashif J. Hyperbar Oxygenbehandling. SFAI:s SA, Lind F. Impact of acute hypobaric A, Liu Z-J, Brismar K, Velazquez O, Riktlinjer för anestesi, intensivvård hypoxia on blood flow distribution in Catrina S-B. Hyperbaric Oxygen Therapy & smärtbehandling, 116-125, 2005 brain. Acta Physiol 2011;202:203-209 (HBOT) activates hypoxia-inducible factor 1 (HIF-1), which contributes to improved 36. Uusijärvi J, Larsson A, Gullberg 41. Lind F, Öhlén G, Lindén V, wound healing in diabetic mice. Manus N, Rutqvist J, Svensson PJ, Lind F. Eriksson B, Frostell C, et al HBO Hyperbaric oxygen (HBO) treatment reference group. ’FOCUS’ report of severe intra-abdominal infections to Stockholm County Council on and complications in children. Abstract Hyperbaric Medicine; Treatment with 5:106, ICSI, International Conference Hyperbaric Oxygen (HBO) at the on Surgical Infections, 6-8 September Karolinska University Hospital. 2011 2006, Stockholm, Sweden 42. Lind F, Eriksson B, Frostell C, Arnell 37. Niinikoski J, Bakker D, Cronjé, Lind P, Lycke H, Oscarsson N, Spetz L, F, Mathieu D, Schmutz J, Hunt T, Mani Hammarlund C, Benoni D, Douglas J. R, Romanelli M, Téot L, Wild T, Marroni How we work with hyperbaric oxygen A. ECHM-ETRS joint conference on therapy. Lakartidningen. 2011;108:1914-5 oxygen and tissue repair, Ravenna, Italy, October 27-28, 2006: recommendations by the international jury. Int J Low Extrem Wounds 2007;6:139-42

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