Renal Function in Hyperbaric Environment
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Therapeutic Hypothermia: Where Do We Stand?
5/29/2015 Therapeutic Hypothermia: Where Do We Stand? Melina Aguinaga-Meza, MD Assistant Professor of Medicine Gill Heart Institute University of Kentucky Disclosure Information Melina Aguinaga-Meza, MD “Therapeutic Hypothermia: Where Do We Stand?” • FINANCIAL DISCLOSURE: – No relevant financial relationship exists • UNLABELED/UNAPPROVED USES DISCLOSURE: – No relevant relationship exists 1 5/29/2015 The Clinical Problem • Out-of-hospital cardiac arrest (OHCA) is a leading cause of death among adults in the US • Approx. 300,000 OHCA events occur each year in the US • Resuscitation is attempted in 100,000 of these arrests • Less than 40 000 survive to hospital admission MMWR / July 29, 2011 / Vol. 60 / No. 8 2 5/29/2015 Consequences From Cardiac Arrest Myocardial Brain injury dysfunction Post-Cardiac Arrest Syndrome Systemic ischemia Disorder that + reperfusion caused the cardiac responses arrest • The effects of this syndrome are severe and pervasive MMWR / July 29, 2011 / Vol. 60 / No. 8 Survival and Neurological Outcomes after OHCA • Only one third of patients admitted to the hospital survive to hospital discharge • Approx. one out of ten people who experience OHCA survive to hospital discharge • Only 2 out of 3 of them have a good/moderate neurologic recovery MMWR / July 29, 2011 / Vol. 60 / No. 8: CARES 3 5/29/2015 “Chain of Survival” • Actions needed to improve chances of survival from out-of-hospital cardiac arrest Circulation 2010; 122:S676-84 • Try to identify and treat the precipitating causes of the arrest and prevent recurrent -
What Chamber Operators Should Know About Ear Barotrauma (And How to Prevent It) Robert Sheffield, CHT and Kevin “Kip” Posey, CHT / June 2018
LEARN.HYPERBARICMEDICINE.COM International ATMO Education What Chamber Operators Should Know About Ear Barotrauma (and How to Prevent It) Robert Sheffield, CHT and Kevin “Kip” Posey, CHT / June 2018 INTRODUCTION Ear barotrauma (i.e. “ear block”, “ear squeeze”) is the most common complication of hyperbaric treatment. It occurs when the pressure in the hyperbaric chamber is greater than the pressure in the middle ear. It is prevented by patient assessment, patient education, and the appropriate actions of the chamber operator. The chamber operator has an important role in preventing ear barotrauma in hyperbaric patients. OBJECTIVES At the conclusion of this article, the reader will be able to: Describe the anatomy of the middle ear Explain the mechanism of ear barotrauma Describe 3 techniques to equalize middle ear pressure ANATOMY OF THE MIDDLE EAR The middle ear is an air space that separates the external ear canal from the inner ear. The eardrum, called the tympanic membrane (TM), vibrates when sound enters the ear canal. The vibration is transmitted to a series of bones in the middle ear. These bones transmit vibration to another membrane (the oval window) that separates the air‐filled middle ear from the fluid‐filled inner ear, where sound is sensed in the cochlea. The nasopharynx is the area behind the nose and above the palate. The Eustachian tubes open into this area. Because of the location of the Eustachian tube openings, the same things that cause nasal congestion (e.g. allergies, upper respiratory infection) can cause swelling around the opening of the Eustachian tubes, making it more difficult to equalize pressure in the middle ear. -
Alterations in the Specific Gravity of the Blood Plasma with Onset of Diuresis in Heart Failure
MECHANISM OF DIURESIS: ALTERATIONS IN THE SPECIFIC GRAVITY OF THE BLOOD PLASMA WITH ONSET OF DIURESIS IN HEART FAILURE Harold J. Stewart J Clin Invest. 1941;20(1):1-6. https://doi.org/10.1172/JCI101189. Research Article Find the latest version: https://jci.me/101189/pdf MECHANISM OF DIURESIS: ALTERATIONS IN THE SPECIFIC GRAVITY OF THE BLOOD PLASMA WITH ONSET OF DIURESIS IN HEART FAILURE By HAROLD J. STEWART (From the Department of Medicine of.the New York Hospital and Cornell University Medical College and the Hospital of the Rockefeller Institute for Medical Research, New York) (Received for publication July 3, 1940) There are divergent views concerning the Moreover, its duration may be brief before res- mechanism by which diuresis is initiated. Many toration is attempted, or it may be long enough of the observations on this subject relate to mer- and of such magnitude that it can be detected. curial drugs. Crawford and McIntosh (1) con- On the other hand, if diuresis is initiated at cluded that novasurol induced primary dilution, the tissue side of the system so that fluid enters followed by concentration of the blood in edema- the blood stream first, dilution of the blood would tous patients. Bryan, Evans, Fulton, and Stead occur. Equilibrium would be disturbed until the (2) thought that salyrgan resulted in concentra- kidneys began to excrete the surplus fluid. If di- tion of the blood, since sustained rise in its spe- lution of the blood was of sufficient duration and cific gravity occurred coincident with diuresis in magnitude, it might be detected. -
Critical Care in the Monoplace Hyperbaric Chamber
Critical Care in the Monoplace Hyperbaric Critical Care - Monoplace Chamber • 30 minutes, so only key points • Highly suggest critical care medicine is involved • Pitfalls Lindell K. Weaver, MD Intermountain Medical Center Murray, Utah, and • Ventilator and IV issues LDS Hospital Salt Lake City, Utah Key points Critical Care in the Monoplace Chamber • Weaver LK. Operational Use and Patient Care in the Monoplace Chamber. In: • Staff must be certified and experienced Resp Care Clinics of N Am-Hyperbaric Medicine, Part I. Moon R, McIntyre N, eds. Philadelphia, W.B. Saunders Company, March, 1999: 51-92 in CCM • Weaver LK. The treatment of critically ill patients with hyperbaric oxygen therapy. In: Brent J, Wallace KL, Burkhart KK, Phillips SD, and Donovan JW, • Proximity to CCM services (ed). Critical care toxicology: diagnosis and management of the critically poisoned patient. Philadelphia: Elsevier Mosby; 2005:181-187. • Must have study patient in chamber • Weaver, LK. Critical care of patients needing hyperbaric oxygen. In: Thom SR and Neuman T, (ed). The physiology and medicine of hyperbaric oxygen therapy. quickly Philadelphia: Saunders/Elsevier, 2008:117-129. • Weaver LK. Management of critically ill patients in the monoplace hyperbaric chamber. In: Whelan HT, Kindwall E., Hyperbaric Medicine Practice, 4th ed.. • CCM equipment North Palm Beach, Florida: Best, Inc. 2017; 65-95. • Without certain modifications, treating • Gossett WA, Rockswold GL, Rockswold SB, Adkinson CD, Bergman TA, Quickel RR. The safe treatment, monitoring and management -
Consensus Conference, the ECHM
24 Diving and Hyperbaric Medicine Volume 47 No. 1 March 2017 Consensus Conference Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment Daniel Mathieu, Alessandro Marroni and Jacek Kot Abstract (Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving and Hyperbaric Medicine. 2017 March;47(1):24-32.) The tenth European Consensus Conference on Hyperbaric Medicine took place in April 2016, attended by a large delegation of experts from Europe and elsewhere. The focus of the meeting was the revision of the European Committee on Hyperbaric Medicine (ECHM) list of accepted indications for hyperbaric oxygen treatment (HBOT), based on a thorough review of the best available research and evidence-based medicine (EBM). For this scope, the modified GRADE system for evidence analysis, together with the DELPHI system for consensus evaluation, were adopted. The indications for HBOT, including those promulgated by the ECHM previously, were analysed by selected experts, based on an extensive review of the literature and of the available EBM studies. The indications were divided as follows: Type 1, where HBOT is strongly indicated as a primary treatment method, as it is supported by sufficiently strong evidence; Type 2, where HBOT is suggested as it is supported by acceptable levels of evidence; Type 3, where HBOT can be considered as a possible/optional measure, but it is not yet supported by sufficiently strong evidence. For each type, three levels of evidence were considered: A, when the number of randomised controlled trials (RCTs) is considered sufficient; B, when there are some RCTs in favour of the indication and there is ample expert consensus; C, when the conditions do not allow for proper RCTs but there is ample and international expert consensus. -
Symptomatic Middle Ear and Cranial Sinus Barotraumas As a Complication of Hyperbaric Oxygen Treatment
İst Tıp Fak Derg 2016; 79: 4 KLİNİK ARAŞTIRMA / CLINICAL RESEARCH J Ist Faculty Med 2016; 79: 4 http://dergipark.ulakbim.gov.tr/iuitfd http://www.journals.istanbul.edu.tr/iuitfd SYMPTOMATIC MIDDLE EAR AND CRANIAL SINUS BAROTRAUMAS AS A COMPLICATION OF HYPERBARIC OXYGEN TREATMENT HİPERBARİK OKSİJEN TEDAVİSİ KOMPLİKASYONU: SEMPTOMATİK ORTA KULAK VE KRANYAL SİNUS BAROTRAVMASI Bengüsu MİRASOĞLU*, Aslıcan ÇAKKALKURT*, Maide ÇİMŞİT* ABSTRACT Objective: Hyperbaric oxygen therapy (HBOT) is applied for various diseases. It is generally considered safe but has some benign complications and adverse effects. The most common complication is middle ear barotrauma. The aim of this study was to collect data about middle ear and cranial sinus barotraumas in our department and to evaluate factors affecting the occurrence of barotrauma. Material and methods: Files of patients who had undergone hyperbaric oxygen therapy between June 1st, 2004, and April 30th, 2012, and HBOT log books for the same period were searched for barotraumas. Patients who were intubated and unconscious were excluded. Data about demographics and medical history of conscious patients with barotrauma (BT) were collected and evaluated retrospectively. Results: It was found that over eight years and 23,645 sessions, 39 of a total 896 patients had BT; thus, the general BT incidence of our department was 4.4%. The barotrauma incidence was significantly less in the multiplace chamber (3.1% vs. 8.7%) where a health professional attended the therapies. Most barotraumas were seen during early sessions and were generally mild. A significant accumulation according to treatment indications was not determined. Conclusion: It was thought that the low barotrauma incidence was related to the slow compression rate as well as training patients thoroughly and monitoring them carefully. -
Hyperbaric Oxygen Therapy (HBOT) Final Evidence Report
20, 2012 Health Technology Assessment Hyperbaric Oxygen Therapy (HBOT) for Tissue Damage, Including Wound Care and Treatment of Central Nervous System (CNS) Conditions Final Evidence Report February 15, 2013 Health Technology Assessment Program (HTA) Washington State Health Care Authority PO Box 42712 Olympia, WA 98504-2712 (360) 725-5126 hta.hca.wa.gov [email protected] Hyperbaric Oxygen Therapy (HBOT) for Tissue Damage, Including Wound Care and Treatment of Central Nervous System (CNS) Conditions A Health Technology Assessment Prepared for Washington State Health Care Authority FINAL REPORT – February 15, 2013 Acknowledgement This report was prepared by: Hayes, Inc. 157 S. Broad Street Suite 200 Lansdale, PA 19446 P: 215.855.0615 F: 215.855.5218 This report is intended to provide research assistance and general information only. It is not intended to be used as the sole basis for determining coverage policy or defining treatment protocols or medical modalities, nor should it be construed as providing medical advice regarding treatment of an individual’s specific case. Any decision regarding claims eligibility or benefits, or acquisition or use of a health technology is solely within the discretion of your organization. Hayes, Inc. assumes no responsibility or liability for such decisions. Hayes employees and contractors do not have material, professional, familial, or financial affiliations that create actual or potential conflicts of interest related to the preparation of this report. Prepared by Winifred Hayes, Inc. Page i February -
Contraindications and Relative Contraindications, and Complications That May Occur with And/Or During HBOT
HYPERBARIC OXYGEN THERAPY INDICATIONS, CONTRAINDICTIONS AND COMPLICATIONS Policy: This policy lists accepted conditions or indications for insurance reimbursement for Hyperbaric oxygen therapy (HBOT), contraindications and relative contraindications, and complications that may occur with and/or during HBOT. Additional information is provided regarding drug therapy with HBOT. 1.0 HYPERBARIC OXYGEN THERAPY (HBOT) ACCEPTED CONDITIONS FOR INSURANCE REIMBURSEMENT: 1.1 The following list includes the currently accepted conditions: A. Air or gas embolism B. Carbon monoxide/cyanide poisoning and smoke inhalation C. Crush injury/traumatic ischemia D. Decompression sickness E. Enhancement in healing in selected problem wounds F. Exceptional anemia resulting for blood loss G. Gas Gangrene(clostridial) H. Necrotizing soft tissue infections I. Refractory osteomyelitis J. Comprised skin grafts/flaps K. Radiation tissue damage L. Thermal burns 2.0 ABSOLUTE CONTRAINDICATIONS 2.1 Untreated pneumothorax A. Surgical relief of the pneumothorax before the HBOT treatment, if possible, removes the obstacle to treatment. 3.0 RELATIVE CONTRAINDICATIONS-- “Conditions in which caution must sometimes be observed but which are not necessarily a contraindication to HBOT.” (Kindwall, 1995) 3.1 History of spontaneous pneumothorax 3.2 Severe sinus infection 3.3 Upper respiratory infection 3.4 Asymptomatic pulmonary lesions on chest x-ray 3.5 Uncontrollable high fever (greater than 39C) 3.6 History of chest or ear surgery 3.7 Congenital spherocytosis 3.8 Any anemia or -
A Rare Complication of Carbon Monoxide Poisoning
International Clinical Pathology Journal Case Report Open Access Compartment syndrome of the lower limb: a rare complication of carbon monoxide poisoning Abstract Volume 6 Issue 5 - 2018 Carbon monoxide poisoning (CO) nicknamed “Silent killer” remains the leading cause Ghassen Drissi, Mohamed Khaled, Houssem of poisoning deaths in most countries. In Tunisia, an estimated number of 2000 to 4000 cases of poisoning was noted per a year with an estimated percentage of death up Kraiem, Khaled Zitouna, Mohamed lassed to 90% at the site of intoxication. This intoxication is very exceptionally complicated kanoun by a compartment syndrome that can aggravate the functional and vital prognosis Department of Orthopaedics and Traumatology, La Rabta Hospital of Tunis, Tunisia when it is dominated by other symptoms, particularly neurological ones. We report the case of a patient who presented a compartment syndrome during CO intoxication Correspondence: Ghassen Drissi, Department of that evolved favorably. Orthopaedics and Traumatology, La Rabta Hospital of Tunis, Tunisia, Email Received: October 08, 2018 | Published: November 15, 2018 Introduction an inhalation syndrome causing acute respiratory failure associated with a compartmental syndrome of the left lower limb syndrome Carbon monoxide is a colorless, odourless, non-irritating gas. It is causing acute kidney failure (tubular necrosis) with rhabdomyolysis particularly toxic to mammals but undetectable by them giving it an requiring intubation associated to mechanical ventilation with insidious “Silent killer” character. In humans, it is the cause of much emergency hemodialysis sessions. With regard to the compartmental domestic intoxication, often fatal. Its causes are most often accidental, syndrome, two fasciotomies in emergency were made in our service. -
THE EFFECT of CONTINUOUS NEGATIVE PRESSURE BREATH- ING on WATER and ELECTROLYTE EXCRETION by the HUMAN KIDNEY by HERBERT 0
THE EFFECT OF CONTINUOUS NEGATIVE PRESSURE BREATH- ING ON WATER AND ELECTROLYTE EXCRETION BY THE HUMAN KIDNEY By HERBERT 0. SIEKER,1 OTTO H. GAUER,2 AND JAMES P. HENRY (From the Aero-Medical Laboratory, Wright-Patterson Air Force Base, Ohio) (Submitted for publication September 4, 1953; accepted December 30, 1953) The effects of decreased intrathoracic pressure ment. Negative pressure breathing during both inspiration on arterial blood pressure (1), venous pressure and expiration was applied through a standard U. S. Air (2, 3), cardiac output (4), and pres- Force pressure breathing oxygen mask attached by a pulmonary short tubing to a 40 liter cylinder. This cylinder was sure and volume (5) have been investigated in the ventilated by a suction pump with fresh air at the rate of past. The present study was prompted by the as- 100 to 160 liters per minute and rebreathing was pre- sociation of marked diuresis with continuous nega- vented by means of a two-way valve in the face mask. tive pressure breathing in anesthetized animals (6) The desired negative pressure, which in these experiments and the observation that in unanesthetized man was a mean pressure of 15 to 18 centimeters of water, was obtained by varying the air inlet to the container. continuous positive pressure breathing leads to an Control studies duplicated the procedure exactly except oliguria (7). The purpose of this investigation that the negative pressure breathing was omitted. Re- was to demonstrate that human subjects like an- peat studies were done in all but two subjects. esthetized animals have an increased urine flow in The urine volume for each 15-minute interval was noted response to continuous negative pressure breathing. -
Subacute Normobaric Oxygen and Hyperbaric Oxygen Therapy in Drowning, Reversal of Brain Volume Loss: a Case Report
[Downloaded free from http://www.medgasres.com on Monday, July 3, 2017, IP: 12.22.86.35] CASE REPORT Subacute normobaric oxygen and hyperbaric oxygen therapy in drowning, reversal of brain volume loss: a case report Paul G. Harch1, *, Edward F. Fogarty2 1 Department of Medicine, Section of Emergency Medicine, University Medical Center, Louisiana State University School of Medicine, New Orleans, LA, USA 2 Department of Radiology, University of North Dakota School of Medicine, Bismarck, ND, USA *Correspondence to: Paul G. Harch, M.D., [email protected] or [email protected]. orcid: 0000-0001-7329-0078 (Paul G. Harch) Abstract A 2-year-old girl experienced cardiac arrest after cold water drowning. Magnetic resonance imaging (MRI) showed deep gray mat- ter injury on day 4 and cerebral atrophy with gray and white matter loss on day 32. Patient had no speech, gait, or responsiveness to commands on day 48 at hospital discharge. She received normobaric 100% oxygen treatment (2 L/minute for 45 minutes by nasal cannula, twice/day) since day 56 and then hyperbaric oxygen treatment (HBOT) at 1.3 atmosphere absolute (131.7 kPa) air/45 minutes, 5 days/week for 40 sessions since day 79; visually apparent and/or physical examination-documented neurological improvement oc- curred upon initiating each therapy. After HBOT, the patient had normal speech and cognition, assisted gait, residual fine motor and temperament deficits. MRI at 5 months after injury and 27 days after HBOT showed near-normalization of ventricles and reversal of atrophy. Subacute normobaric oxygen and HBOT were able to restore drowning-induced cortical gray matter and white matter loss, as documented by sequential MRI, and simultaneous neurological function, as documented by video and physical examinations. -
Hyperbaric Oxygen Therapy Effectively Treats Long-Term Damage from Radiation Therapy
Hyperbaric oxygen therapy effectively treats long-term damage from radiation therapy HBOT is last hope for many patients “For the subset of patients who suffer from late effects of radiation exposure, hyperbaric oxygen therapy is often the only treatment than can prevent irreversible bone or tissue loss or enable them to undergo life-improving reconstructive procedures such as breast or facial surgeries,” explains Susan Sprau, M.D., Medical Director of UCLA Hyperbaric Medicine. “By offering this therapy, we are able to provide a better quality of life to patients who have already survived devastating illnesses.” Late side effects from More than 11 million people living in the U.S. today have been diagnosed with radiotherapy result from scarring cancer, and about half of them have received radiation therapy (radiotherapy). and narrowing of the blood While improved radiotherapy techniques have increased treatment precision and vessels within the treatment area, reduced side effects caused by radiotherapy, the high doses of radiation used to which may lead to inadequate kill cancer cells may still cause long-term damage to nearby healthy cells in some blood supply and cause necrosis of normal tissues and bones. patients. By helping the blood carry more oxygen to affected areas, hyperbaric Hyperbaric oxygen therapy oxygen therapy (HBOT) has been proven effective for these patients. (HBOT) helps blood carry more oxygen to affected areas and Long-term side effects stimulates growth of new blood vessels by exposing patients to For most cancer patients who experience negative effects from radiotherapy, the pure oxygen within a sealed side effects are short-term and appear within six months of their last exposure chamber set at greater than the to radiation.