The Journal of the South Pacific Underwater Medicine Society and the European Underwater and Baromedical Society Volume 45 No. 1 March 2015 Intensive care in the hyperbaric chamber Recognising hypercapnia in a rebreather is difficult Dark chocolate before diving may be good for you Some divers ‘bubble’ when flying after diving Divers with a history of DCS are more likely to ‘bubble’ HBOT increases insulin sensitivity in obese males Print Post Approved PP 100007612 ISSN 1833-3516, ABN 29 299 823 713 Diving and Hyperbaric Medicine Volume 45 No. 1 March 2015 PURPOSES OF THE SOCIETIES To promote and facilitate the study of all aspects of underwater and hyperbaric medicine To provide information on underwater and hyperbaric medicine To publish a journal and to convene members of each Society annually at a scientific conference SOUTH PACIFIC UNDERWATER EUROPEAN UNDERWATER AND MEDICINE SOCIETY BAROMEDICAL SOCIETY OFFICE HOLDERS OFFICE HOLDERS President President David Smart <[email protected]> Costantino Balestra <[email protected]> Past President Vice President Michael Bennett <[email protected]> Jacek Kot <[email protected]> Secretary Immediate Past President Karen Richardson <[email protected]> Peter Germonpré <[email protected]> Treasurer Past President Peter Smith <[email protected]> Alf Brubakk <[email protected]> Education Officer Honorary Secretary David Wilkinson <[email protected]> Peter Germonpré <[email protected]> Chairman ANZHMG Member-at-Large 2014 John Orton <[email protected]> Robert van Hulst <[email protected]> Committee Members Member-at-Large 2013 Denise Blake <[email protected]> Pierre Lafère <[email protected]> Simon Mitchell <[email protected]> Member-at-Large 2012 Janine Gregson <[email protected]> Lesley Blogg <[email protected]> Webmaster Liaison Officer Joel Hissink <[email protected]> Phil Bryson <[email protected]> ADMINISTRATION ADMINISTRATION Membership Honorary Treasurer and Membership Secretary Steve Goble <[email protected]> Patricia Wooding <[email protected]> 16 Burselm Avenue, Hainault, Ilford MEMBERSHIP Essex, IG6 3EH, United Kingdom For further information on SPUMS and to complete a membership Phone & Fax: +44-(0)20-85001778 application, go to the Society’s website: <www.spums.org.au> The official address for SPUMS is: MEMBERSHIP c/o Australian and New Zealand College of Anaesthetists, For further information on EUBS and to complete a membership 630 St Kilda Road, Melbourne, Victoria 3004, Australia application, go to the Society’s website: <www.eubs.org> SPUMS is incoprorated in Victoria A0020660B DIVING AND HYPERBARIC MEDICINE <www.dhmjournal.com> Editor: Editorial Board: Michael Davis <[email protected]> Michael Bennett, Australia P O Box 35 Alf Brubakk, Norway Tai Tapu 7645 David Doolette, USA New Zealand Peter Germonpré, Belgium Phone: +64-(0)3-329-6857 Jane Heyworth, Australia Jacek Kot, Poland European (Deputy) Editor: Simon Mitchell, New Zealand Lesley Blogg <[email protected]> Claus-Martin Muth, Germany Editorial Assistant: Neal Pollock, USA Nicky McNeish <[email protected]> Monica Rocco, Italy Journal distribution: Martin Sayer, United Kingdom Steve Goble <[email protected]> Erika Schagatay, Sweden David Smart, Australia Journal submissions: Robert van Hulst, The Netherlands Submissions should be made at http://www.manuscriptmanager.com/dhm Diving and Hyperbaric Medicine is published jointly by the South Pacific Underwater Medicine Society and the European Underwater and Baromedical Society (ISSN 1833-3516, ABN 29 299 823 713) Diving and Hyperbaric Medicine Volume 45 No.1 March 2015 1 Editorial Hyperbaric oxygen treatment for the critically ill patient Lindell K Weaver There are pros and cons with both the monoplace and treated in multiplace chambers. multiplace chambers as used in intubated, critically ill patients.1 In the multiplace chamber, staffing is a potential The bottom line is, if the critical care centre is fully limitation because very few centres have sufficient committed to HBO2 for critically ill patients, sufficient numbers of intensive care unit (ICU) personnel and staff must be trained in HBO2 and critical care, the chamber clinicians available 24/7, especially when offering HBO2 must be in close proximity to the ICU, equipment must twice per day or more than one critically ill patient per work seamlessly with that in the ICU and there must be day. 2 The staffing demands for the treatment of critically sufficient clinical workload to maintain staff skills. If these ill patients in a monoplace chamber are less burdensome criteria are not satisfied, then monoplace chamber use for since inside attendants are not required. In addition, the critically ill patients is a reasonable alternative, but close staff in multiplace chambers incur a decompression risk, proximity to the ICU (or preferably inside the ICU) and especially when exposed to the high pressures often used a skilled staff fully aware of pitfalls and issues unique to to treat critically ill patients, often up to 304 kPa. When HBO2 are very important. Certainly the financial cost of multiplace chambers are operated at increased altitude, such implementing monoplace chambers for critically ill patients as that in Salt Lake City, the decompression risk for inside is a factor worthy of consideration too, since they are less attendants can be unacceptably high, but may be lessened expensive than fully equipped multiplace chambers. The by the attendant breathing supplemental oxygen, which ECHM position paper summarises all these various issues.4 may also have adverse consequences if done repetitively over many years. References Clearly a relatively smooth transition from the ICU to the 1 Lind F. A pro/con review comparing the use of mono- and hyperbaric centre can be accomplished by using multiplace multiplace hyperbaric chambers for critical care. Diving chambers if the same IV pumps and ventilators (including Hyperb Med. 2015;45:56-60. modern-day ventilator modes) are used in the chamber as 2 Kot J. Staffing and training issues in critical care hyperbaric in the ICU.3 For monoplace chamber treatment of critically medicine. Diving Hyperb Med. 2015;45:47-50. 3 Millar IL. Hyperbaric intensive care technology and ill patients, their IVs must be changed to accommodate the equipment. Diving Hyperb Med. 2015;45:50-6. IV pass-through and IV pump, which may be different to 4 Mathieu D. Hyperbaric oxygen therapy for intensive care that of the ICU (and with different tubing), and ventilator patients: position statement by the European Committee for support is much more challenging than what is possible Hyperbaric Medicine. Diving Hyperb Med. 2015;45:42-6. in the multiplace chamber. Unfortunately, monoplace chamber ventilators are very limited in performance and Lindell K Weaver, Hyperbaric Medicine, LDS Hospital, Salt Lake features. These limitations often require the patient to be City, UT and Intermountain Medical Center, Murray, UT, USA E-mail: <[email protected]> deeply sedated for HBO2 and sometimes pharmacologically paralyzed, which can be independently risky. Nevertheless, with a skilled staff and specialized equipment, monoplace Key words chamber use for very ill patients can be accomplished Hyperbaric oxygen, hyperbaric medicine, intensive care without evidence that adverse events are any greater than if medicine, editorials The Editor’s offering Over the years, a variety of changes have been made to improve efficiency of the office and the governance of the This issue marks two important changes for Diving and journal. As of the beginning of January, DHM has moved Hyperbaric Medicine (DHM). The handling of submissions to a web-based platform called Manuscript Manager (MM) and their peer review has become increasingly challenging as (http://www.manuscriptmanager.com) for submissions and the workload has grown (the number of papers submitted to peer review. In future, all submissions must be submitted on DHM has nearly tripled in the past decade) and has resulted line through our new portal <http://www.manuscriptmanager. in mistakes and delays that are frustrating for all of us. Both com/dhm>. E-mail submissions will no longer be accepted Nicky McNeish and I work part-time to produce DHM from though we are still dealing with submissions from 2014 and home offices; there is only so much we can do in that time before in the old manner. We recommend that everyone looks and with the limited budget from subscriptions. Publishing at the instructional videos on the MM website to see how costs have steadily increased, but the ExComs have worked the office will function and, especially, authors should watch hard to minimise the financial impact of this on members. video 5 and reviewers video 9. This software package can be tailored to the specific requirements of a journal and we are 2 Diving and Hyperbaric Medicine Volume 45 No. 1 March 2015 still in the learning phase of how best to meet DHM’s needs. With Peter Müller’s recent resignation as European Editor, The active participation of authors and reviewers in this it is with considerable regret that I also have to advise of process is welcomed. However, please do not cry “wolf” too Costantino Balestra’s resignation from the Editorial Board. often, try to solve the problem yourself before contacting us Peter and Tino will be greatly missed, but I am confident at <[email protected]>; we all have the same that we will find other doctors and scientists out there who goal – to create an interesting, diverse and readable journal. will fill their shoes with honour. The second important change is in the governance of This issue will suit chocoholic divers if the findings by Sigrid the journal. Although communications between the two Theunnisen et al are confirmed.1 I know many divers who society executives has improved with time, there remain enjoy chocolate after a dive; now we have an excuse to eat some frustrations both in my dealings with them as Editor it for breakfast too, before going diving! and between the two organisations.