DOCSLIB.ORG

Complications of Hyperbaric Oxygen Therapy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Complications of Hyperbaric Oxygen Therapy Complications of Hyperbaric Oxygen Therapy พญ. อัจฉมาพร สาลี Complications of Hyperbaric Oxygen Therapy O Related to effects of pressure on enclosed gas spaces O Related to oxygen toxicity O Psychogenic effect O Others Complications of Hyperbaric Oxygen Therapy O Related to effects of pressure on enclosed gas spaces (Barotrauma) O Ear barotrauma O Sinus barotrauma O Pulmonary barotrauma O Other barotrauma O Related to oxygen toxicity O Psychogenic effects O Others Barotrauma O Although human tissues may support great pressure, tissue injury can occur O resulting from failure of gas-filled space to equalize its internal pressure with ambient pressure changes O Boyle’s Law Barotrauma O Diving activities, compressed-air work, aviation and hyperbaric therapy O Injury is most likely when O Pressure-volume changes are great O Onset is rapid – as occurs during initial parts of pressurization or descent from atmospheric pressure Barotrauma O Two conditions must be present for barotrauma to occur O Change in ambient pressure O Transfer of pressure to a non- or partially collapsible airspace Barotrauma O In particular may affect middle ear and sinuses; lung; intestines; teeth; eye, particularly when surrounded by air space like a face mask; and other physiological or pathological gas spaces Ear barotrauma External ear barotrauma External ear barotrauma O External ear canal O 3.5 cm long and 1 cm wide O Barotrauma of canal and eardrum are possible O because ambient and outer ear pressures can not be equilibrated O Usually external ear is filled with water or air at ambient pressure O With blocked canal (e.g., by an ear plug or wax) pressure changes during descent and ascent O possible injury of epithelial lining of the external meatus and TM, with edema, hemorrhage and rarely perforation of eardrum External ear barotrauma O Other causes include external ear infection, exostoses; foreign bodies; and tight-fitting neoprene diving hoods O Pain is made worse by clearing ears O mild conductive deafness and vertigo may be present until pressure is relieved O Otoscopy reveals an ear canal that is swollen with hemorrhagic blistering; bleeding is possible Middle ear barotrauma Middle ear barotrauma O Middle ear cavity communicates with nasopharynx through Eustachian Tube (ET) – a 4 cm long tube O Under normal conditions tube is opened by chewing, swallowing or yawning due to action of controlling muscles O Allows equalization to occur between middle ear and nasopharyngeal air pressure Middle ear barotrauma O Closure of ET is passive process and it is collapsed in its natural state O Passive escape of gas occurs when middle ear pressure is around 4 cm H2O higher than ambient pressure Middle ear barotrauma O Rarely spontaneous equalization during increasing ambient pressure and this is why barotitis media may occur O Most common diving and hyperbaric medical complication Middle ear barotrauma O Otological barotrauma of descent is characterized by O initial sensation of ear blockage O followed by sharp pain O If swelling, bleeding or perforation O occurs this may be accompanied by a conducting hearing loss, mild tinnitus and vertigo Middle ear barotrauma 6 grade severity classification by Edmonds O Grade 0 - Symptoms without otoscopic signs O Grade 1 - Diffuse redness and retraction of TM O Grade 2 - Grade 1 changes plus petechial hemorrhage TM O Grade 3 - Grade 1 changes plus confluent /plaque hemorrhage in TM O Grade 4 - Dark and slightly bulging TM : free blood or fluid in middle ear O Grade 5 - TM perforation with possible blood in our outside ear canal Middle ear barotrauma O Treatment depends on degree of barotrauma O Avoided exposure to pressure O Recovery usually occurs over 3 to 14 days O Topical and systemic nasal decongestants O Pain relief O Rupture TM systemic broad spectrum antibiotic O Large perforations, especially those associated with deafness or tinnitus referred to ENT Middle ear barotrauma O Middle ear barotrauma of ascent O for ET dysfunction to cause air trapping O TM bulging outwards O May cause asymmetrical stimulation of the vestibular apparatus with alternobaric vertigo of ascent (called Lündgren Syndrome) O Self- limiting form of transient dizziness usually occurs during ascent O It is less common during descent O Although transient, vertigo, disorientation and nausea – usually lasting less than 10 minutes – may present serious problems for divers, particularly at depth Middle ear barotrauma O Alternobaric facial paralysis O transient unilateral facial paralysis in association with ipsilateral middle ear overpressure O Mechanism : facial nerve neuropraxia O Full facial nerve function usually returns to normal within 2 hours of returning to atmospheric pressure O Diving is not recommended O Myringotomy is advised Inner ear barotrauma Inner ear barotrauma O Using forceful Valsalva’s maneuvers O May elevate intracranial and inner ear hydrostatic pressure sufficiently to cause rupture of inner ear structures O Basement membrane rupture, or round and/or oval windows may be involved Inner ear barotrauma O Rupture of round window leads to a perilymph leak into middle ear perilymph fistula O Extremely rare in hyperbaric medicine practice O History of O serious vertigo O intense tinnitus O sensation of fullness in ear O sensory-neural hearing loss O nausea and vomiting O positive Romberg sign O nystagmus Inner ear barotrauma O Treatment : O Bed rest. with elevated reduce ICP O Evaluated with audiogram, electronystagmogram and be submitted to complete otorhinolaryngological and neurological evaluation O Hyperbaric exposures should be avoided until complete clinical recovery O if it is essential to continue HBO, myringotomy Sinus barotrauma Sinus barotrauma O Related to inadequate pressure equilibration in gas volumes of sinus cavities O Ostial obstruction with inadequate gas passage between nasal cavity and sinuses Sinus barotrauma O Cause of obstruction : mucus, nasal polyps, congestion of nasal mucosa, foreign bodies, nasal structural deformities or mass lesions, O sinus barotrauma of descent (sinus squeeze) or ascent (reverse sinus squeeze) O frontal and maxillary sinuses being the most commonly affected Sinus barotrauma O Hydrostatic pressure is transferred throughout body O Higher than pressure within gas space O Relative vacuum phenomenon occurs with blood vessel dilatation O Possible rupture and hemorrhage in sinus space Sinus barotrauma O Main symptom is pain, which may persist for several hours O Associated with bloody nasal discharge O Paresthesia of cheek or forehead may occur with maxillary or frontal sinus squeeze respectively O Due to compression of branches of fifth cranial nerve O Pain may be referred to occipital region with sphenoid sinus barotrauma Sinus barotrauma O Function. of pressure O Valsalva’s maneuvers,over-pressurized sinus cavity may lead to migration of air to the cranium or infra-orbital plate fractures with ophthalmic involvement and – rarely – pneumocephalus O Meningitis and blindness rare but have been reported O Again there are no known references to these severe complications during HBO therapy Pulmonary barotrauma Pulmonary barotrauma O Pulmonary barotrauma results from pulmonary overexpansion in response to a reduction in ambient pressure O Intra and extravascular intrapulmonary gas migration follow with various potential complications Pulmonary barotrauma O Pulmonary overpressure is most frequent cause of arterial gas embolism O Relatively common in diving (approximately 10% of diving accidents) O Very rare in hyperbaric medicine practice O Causes include rapid decompression and high positive pressure ventilation Pulmonary barotrauma O Arterial gas embolism O Pneumothorax O Pneumo-mediastinum O Subcutaneous emphysema Pulmonary barotrauma O Gas may exert local pressure effects or cause cerebral and coronary arterial gas embolism(AGE) O most dangerous complication Pulmonary barotrauma Risk of barotrauma O during decompression O decreased pulmonary compliance O previous spontaneous pneumothorax O acute lower respiratory infection O Atelectasis O bullous emphysema O pulmonary cysts O blunt chest trauma O sub-pleural blebs O pulmonary fibrosis O COPD with air trapping O Many of these conditions may not be adequately excluded by CXR Pulmonary barotrauma O Management, depending on severity O includes: O 100% O2 by oronasal mask O Emergency drainage of a tension pneumothorax by needdle thoracostomy O Definitive management of intrapleural gas or blood is ICD O If HBO is required, Heimlich one-way valve should be connected to drainage system O If recompression is not required regular underwater drainage is appropriate O Pericardial drainage for gas tamponade with needle pericardiocentesis Other barotrauma Other barotrauma Barodontalgia (Tooth or dental barotrauma) O characterized by pain or injury during changes in ambient pressure O mechanism involved may be related to expansion of trapped air in a cavity underneath crown of tooth with pain receptor activation O stimulation of nerve endings in chronic inflamed pulp O stimulation of maxillary sinus pain receptors. Other barotrauma Gastrointestinal Excessive swallowing of gas (i.e., aerophagia) during decompression O Rare, occur due to expansion of air in stomach and bowel, causing abdominal distension and colicky pain. Other barotrauma ocular barotrauma O Hx of ophthalmic surgical procedures O have gas in anterior chamber or vitreous cavity O This may be affected by pressure changes with resulting barotrauma including O retinal, uveal or vitreous
Load more

Recommended publications
  • Mansfield, NG18 2AD to the Editor: Dear Sir, VERTIGO in DIVERS Thank You for Asking for My Comments on Noel Roydhouse's Letter Which I Have Read with Interest
    Br J Sports Med: first published as 10.1136/bjsm.17.3.210 on 1 September 1983. Downloaded from 210 CORRESPONDENCE 14 Woodhouse Road, Mansfield, NG18 2AD To the Editor: Dear Sir, VERTIGO IN DIVERS Thank you for asking for my comments on Noel Roydhouse's letter which I have read with interest. He is technically correct in stating that vertigo is not inevitable when the tympanic membrane ruptures. Vertigo is not dependent on the size of perforation that is sustained, but is dependent on the rate of ingress of cold water into the tympanic cavity. The caloric effect produced by rapid ingress of water is entirely dependent on the temperature difference between the water that has entered the tympanic cavity and body temperature. Once the water temperature reaches approximate body temperature then the caloric effect ceases as does the vertigo. As ENT surgeons we use this caloric phenomenon for testing labyrinthine function (vestibular function); and under test conditions we use water at 300C and 440C, in ears with intact tympanic membranes, in order to induce a vertigo. If an article were to be directed at "diving doctors" I think that it would be fair comment for it to be stated that a vertigo sustained on descent should be assumed to be due to a tympanic membrane rupture with rapid ingress of water, until proven otherwise, by inspection of the ear; if the tympanic membrane is found to be intact, then a diagnosis of perilymph fistula must be made, which will only be proved or disproved by performing an exploratory tympanotomy.
    [Show full text]
  • Hyperbaric Physiology the Rouse Story Arrival at Recompression
    Hyperbaric Physiology The Rouse Story • Oct 12, 1992, off the New Jersey coast • father/son team of experienced divers • explore submarine wreck in 230 ft (70 m) • breathing compressed air • trapped in wreck & escaped with no time for decompression Chris and Chrissy Rouse Arrival at recompression Recompression efforts facility • Both divers directly ascend to dive boat • Recompression starts about 3 hrs after • Helicopter arrives at boat in 1 hr 27 min ascent • Bronx Municipal Hospital recompression facility – put on pure O2 and compressed to 60 ft – Chris (39 yrs) pronounced dead • extreme pain as circulation returned – compressed to 165 ft, then over 5.5 hrs – Chrissy (22 yrs) gradually ascended back to 30 ft., lost • coherent and talking consciousness • paralysis from chest down • no pain – back to 60 ft. Heart failure and death • blood sample contained foam • autopsy revealed that the heart contained only foam Medical Debriefing Gas Laws • Boyle’s Law • Doctors conclusions regarding their – P1V1 = P2V2 treatment • Dalton’s Law – nothing short of recompression to extreme – total pressure is the sum of the partial pressures depths - 300 to 400 ft • Henry’s Law – saturation treatment lasting several days – the amt of gas dissolved in liquid at any temp is – complete blood transfusion proportional to it’s partial pressure and solubility – deep helium recompression 1 Scuba tank ~ 64 cf of air Gas problems during diving Henry, 1 ATM=33 ft gas (10 m) dissovled = gas Pp & tissue • Rapture of the deep (Nitrogen narcosis) solubility • Oxygen
    [Show full text]
  • The Use of Heliox in Treating Decompression Illness
    The Diving Medical Advisory Committee DMAC, Eighth Floor, 52 Grosvenor Gardens, London SW1W 0AU, UK www.dmac-diving.org Tel: +44 (0) 20 7824 5520 [email protected] The Use of Heliox in Treating Decompression Illness DMAC 23 Rev. 1 – June 2014 Supersedes DMAC 23, which is now withdrawn There are many ways of treating decompression illness (DCI) at increased pressure. In the past 20 years, much has been published on the use of oxygen and helium/oxygen mixtures at different depths. There is, however, a paucity of carefully designed scientific studies. Most information is available from mathematical models, animal experiments and case reports. During a therapeutic compression, the use of a different inert gas from that breathed during the dive may facilitate bubble resolution. Gas diffusivity and solubility in blood and tissue is expected to play a complex role in bubble growth and shrinkage. Mathematical models, supported by some animal studies, suggest that breathing a heliox gas mixture during recompression could be beneficial for nitrogen elimination after air dives. In humans, diving to 50 msw, with air or nitrox, almost all cases of DCI can be adequately treated at 2.8 bar (18 msw), where 100% oxygen is both safe and effective. Serious neurological and vestibular DCI with only partial improvements during initial compression at 18 msw on oxygen may benefit from further recompression to 30 msw with heliox 50:50 (Comex therapeutic table 30 – CX30). There have been cases successfully treated on 50:50 heliox (CX30), on the US Navy recompression tables with 80:20 and 60:40 heliox (USN treatment table 6A) instead of air and in heliox saturation.
    [Show full text]
  • Chapter 23 ENVIRONMENTAL EXTREMES: ALTERNOBARIC
    Environmental Extremes: Alternobaric Chapter 23 ENVIRONMENTAL EXTREMES: ALTERNOBARIC RICHARD A. SCHEURING, DO, MS*; WILLIAM RAINEY JOHNSON, MD†; GEOFFREY E. CIARLONE, PhD‡; DAVID KEYSER, PhD§; NAILI CHEN, DO, MPH, MASc¥; and FRANCIS G. O’CONNOR, MD, MPH¶ INTRODUCTION DEFINITIONS MILITARY HISTORY AND EPIDEMIOLOGY Altitude Aviation Undersea Operations MILITARY APPLIED PHYSIOLOGY Altitude Aviation Undersea Operations HUMAN PERFORMANCE OPTIMIZATION STRATEGIES FOR EXTREME ENVIRONMENTS Altitude Aviation Undersea Operations ONLINE RESOURCES FOR ALTERNOBARIC ENVIRONMENTS SUMMARY *Colonel, Medical Corps, US Army Reserve; Associate Professor, Military and Emergency Medicine, Uniformed Services University of the Health Sci- ences, Bethesda, Maryland †Lieutenant, Medical Corps, US Navy; Undersea Medical Officer, Undersea Medicine Department, Naval Medical Research Center, Silver Spring, Maryland ‡Lieutenant, Medical Service Corps, US Navy; Research Physiologist, Undersea Medicine Department, Naval Medical Research Center, Silver Spring, Maryland §Program Director, Traumatic Injury Research Program; Assistant Professor, Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland ¥Colonel, Medical Corps, US Air Force; Assistant Professor, Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland ¶Colonel (Retired), Medical Corps, US Army; Professor and former Department Chair, Military and Emergency Medicine, Uniformed Services University of the Health Sciences,
    [Show full text]
  • Clinical Management of Severe Acute Respiratory Infections When Novel Coronavirus Is Suspected: What to Do and What Not to Do
    INTERIM GUIDANCE DOCUMENT Clinical management of severe acute respiratory infections when novel coronavirus is suspected: What to do and what not to do Introduction 2 Section 1. Early recognition and management 3 Section 2. Management of severe respiratory distress, hypoxemia and ARDS 6 Section 3. Management of septic shock 8 Section 4. Prevention of complications 9 References 10 Acknowledgements 12 Introduction The emergence of novel coronavirus in 2012 (see http://www.who.int/csr/disease/coronavirus_infections/en/index. html for the latest updates) has presented challenges for clinical management. Pneumonia has been the most common clinical presentation; five patients developed Acute Respira- tory Distress Syndrome (ARDS). Renal failure, pericarditis and disseminated intravascular coagulation (DIC) have also occurred. Our knowledge of the clinical features of coronavirus infection is limited and no virus-specific preven- tion or treatment (e.g. vaccine or antiviral drugs) is available. Thus, this interim guidance document aims to help clinicians with supportive management of patients who have acute respiratory failure and septic shock as a consequence of severe infection. Because other complications have been seen (renal failure, pericarditis, DIC, as above) clinicians should monitor for the development of these and other complications of severe infection and treat them according to local management guidelines. As all confirmed cases reported to date have occurred in adults, this document focuses on the care of adolescents and adults. Paediatric considerations will be added later. This document will be updated as more information becomes available and after the revised Surviving Sepsis Campaign Guidelines are published later this year (1). This document is for clinicians taking care of critically ill patients with severe acute respiratory infec- tion (SARI).
    [Show full text]
  • Dive Medicine Aide-Memoire Lt(N) K Brett Reviewed by Lcol a Grodecki Diving Physics Physics
    Dive Medicine Aide-Memoire Lt(N) K Brett Reviewed by LCol A Grodecki Diving Physics Physics • Air ~78% N2, ~21% O2, ~0.03% CO2 Atmospheric pressure Atmospheric Pressure Absolute Pressure Hydrostatic/ gauge Pressure Hydrostatic/ Gauge Pressure Conversions • Hydrostatic/ gauge pressure (P) = • 1 bar = 101 KPa = 0.987 atm = ~1 atm for every 10 msw/33fsw ~14.5 psi • Modification needed if diving at • 10 msw = 1 bar = 0.987 atm altitude • 33.07 fsw = 1 atm = 1.013 bar • Atmospheric P (1 atm at 0msw) • Absolute P (ata)= gauge P +1 atm • Absolute P = gauge P + • °F = (9/5 x °C) +32 atmospheric P • °C= 5/9 (°F – 32) • Water virtually incompressible – density remains ~same regardless • °R (rankine) = °F + 460 **absolute depth/pressure • K (Kelvin) = °C + 273 **absolute • Density salt water 1027 kg/m3 • Density fresh water 1000kg/m3 • Calculate depth from gauge pressure you divide press by 0.1027 (salt water) or 0.10000 (fresh water) Laws & Principles • All calculations require absolute units • Henry’s Law: (K, °R, ATA) • The amount of gas that will dissolve in a liquid is almost directly proportional to • Charles’ Law V1/T1 = V2/T2 the partial press of that gas, & inversely proportional to absolute temp • Guy-Lussac’s Law P1/T1 = P2/T2 • Partial Pressure (pp) – pressure • Boyle’s Law P1V1= P2V2 contributed by a single gas in a mix • General Gas Law (P1V1)/ T1 = (P2V2)/ T2 • To determine the partial pressure of a gas at any depth, we multiply the press (ata) • Archimedes' Principle x %of that gas Henry’s Law • Any object immersed in liquid is buoyed
    [Show full text]
  • 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.
    [Show full text]
  • Eustachian Tube Catheterization. J Otolaryngol ENT Res
    Journal of Otolaryngology-ENT Research Editorial Open Access Eustachian tube catheterization Volume 3 Issue 2 - 2015 Hee-Young Kim Introduction Otorhinolaryngology, Kim ENT clinic, Republic of Korea Although Eustachian tube obstruction (ETO) as one of the principal Correspondence: Hee-Young Kim, Otorhinolaryngology, Kim causes of ‘hearing loss’, and/or ‘ear fullness’, and/or ‘tinnitus’, and/ ENT Clinic, 2nd fl. 119, Jangseungbaegi-ro, Dongjak-gu, Seoul, 06935, Republic of Korea, Tel +82-02-855-7541, or ‘headache (including otalgia)’, and/or ‘vertigo’, has already been Email recognized by many well-respected senior doctors for a long time, it has still received only scant attention both in the literature and in Received: September 02, 2015 | Published: September 14, practice.1,2 2015 Pressure differences between the middle ear and the atmosphere cause temporary conductive hearing loss by decreased motion of the tympanic membrane and ossicles of the ear.3 This point includes clue for explaining the mechanism of tinnitus due to Eustachian tube obstruction.1 Improvement of tinnitus after Eustachian tube catheterization, can mean that the tinnitus is from the hypersensitivity of cochlear nucleus following decrease of afferent nerve stimuli owing to air-bone gap.1,4 The middle ear is very much like a specialized paranasal sinus, with normal balance as maintained by the labyrinthine mechanism.7 called the tympanic cavity; it, like the paranasal sinuses, is a hollow There are many other conditions which may cause vertigo, but since mucosa-lined cavity in the skull that is ventilated through the nose.5 Eustachian tube obstruction is one of the most obvious, and also the Tympanic cavity and mastoid cavity are named on the basis of most easily corrected, every patient with symptoms of vertigo, and/or anatomy.
    [Show full text]
  • Oxygen Toxicity in Neonatal Rats: the Effect of Endotoxin Treatment on Survival During and Post-02 Exposure
    0031-3998/87/2102-0 I 09$02.00/0 PEDIATRIC RESEARCH Vol. 21. No.2, 1987 Copyright© 1987 International Pediatric Research Foundation, Inc. Printed in U.S.A. Oxygen Toxicity in Neonatal Rats: The Effect of Endotoxin Treatment on Survival during and post-02 Exposure LEE FRANK Department ofMedicine, Pulmonary Research Labora10ry, University of Miami School of Medicine, Miami, Florida 33136 ABSTRACT. Neonatal rats were treated with low doses of monary 0 2 toxicity (I, 2). However, there are unique pulmonary bacterial lipopolysaccharide (endotoxin) to test for a pro­ complications associated with prolonged hyperoxic exposure in tective effect of endotoxin against 02 toxicity and the the neonatal animal which could importantly influence both severe inhibition of normal lung development which occurs short and long-term survival post-02 exposure. These complica­ during prolonged exposure to hyperoxia. The rationale for tions relate to the known inhibitory action of hyperoxia on lung the prophylactic use of endotoxin included its marked biosynthetic processes (1, 3, 4), and the morphological conse­ protective effect against pulmonary 0 2 toxicity in adult quences this inhibitory action has on the rapidly growing and rats and its lung growth-promoting effect in experimental differentiating newborn (animal) lung. Several studies have now pulmonary stress models. Neonatal rats (4-5 days old) demonstrated that early postnatal exposure to hyperoxia is as­ survived a 14-day exposure to >95% 0 2 equally well sociated with marked inhibition of the normal septation process whether treated with saline (39/51 = 76%) or with endo­ by which the large saccular airspaces characteristic of the new­ toxin (41/51 = 80%).
    [Show full text]
  • Download Our Hyperbaric Oxygen Therapy Brochure
    Hyperbaric Oxygen THERAPY HYPERBARIC MEDICINE 987561 Nebraska Medical Center Omaha, Nebraska 68198-7561 402.552.2490 This brochure has been designed to provide you with basic information about hyperbaric oxygen therapy. After reading this brochure, please contact your doctor or the Hyperbaric Medicine staff at 402.552.2490 if you have any questions. What is Hyperbaric Oxygen Therapy? Hyperbaric oxygen therapy (HBOT) is a medical treatment used for specific medical conditions. It may be the primary treatment for some disorders, but is often used as part of a combined program involving nursing care, dressing changes, surgical debridement, medications and nutrition. During hyperbaric oxygen therapy, the patient is placed in a clear plastic chamber which is pressurized with pure oxygen up to three times normal air pressure. This increases the oxygen level in the blood and ultimately in the body tissues. How Does Hyperbaric Oxygen Therapy Work? Oxygen that is delivered to a patient in a hyperbaric chamber greatly increases the amount that can be delivered to body tissues by the blood. The benefits of hyperbaric oxygen are not from oxygen in contact with the surface of the body, but from breathing it and getting more into the blood stream. Jeffrey S. Cooper, MD, Medical Director, Hyperbaric Oxygen Therapy Hyperbaric oxygen therapy may be used to treat several medical conditions including: as the eardrum responds to changes in pressure. As part of • Severe anemia the introduction to treatment, patients are taught several easy • Brain abscess methods to avoid ear discomfort. • Bubbles of air in blood vessels (arterial gas embolism) • Burn Is Hyperbaric Oxygen Therapy Safe? • Decompression sickness Hyperbaric oxygen therapy is prescribed by a physician and • Carbon monoxide poisoning performed under medical supervision.
    [Show full text]
  • Chronic Lung Disease (Bronchopulmonary Dysplasia)
    Intensive Care Nursery House Staff Manual Chronic Lung Disease (Bronchopulmonary Dysplasia) was first described in 1967 as severe chronic lung disease (CLD) in preterm infants with severe Respiratory Distress Syndrome (RDS) who received treatment with 100% O2, high inspiratory ventilator pressures and no PEEP. With antenatal glucocorticoids, surfactant treatment and improved ventilatory techniques, CLD has almost disappeared in larger preterm infants and now affects very preterm infants with or without antecedent RDS. DEFINITION: CLD is defined as a need for increased oxygen: • Infants <32 weeks gestation: oxygen requirement at 36 weeks gestational age (GA) or at discharge (whichever comes first) • Infants ≥32 weeks GA: oxygen requirement at age >28 d or at discharge (whichever comes first) INCIDENCE of CLD is inversely related to birth weight and GA: Birth weight (g) Incidence of CLD* 501-750 34% *UCSF 1998-2002 751-1,000 20% 1,001-1,250 5% 1,251-1,500 3% PATHOLOGY includes areas of atelectasis and emphysema, hyperplasia of airway epithelium and interstitial edema. Late changes include interstitial fibrosis and hypertrophy of airway smooth muscle and pulmonary arteriolar musculature. ETIOLOGICAL FACTORS include: • Lung immaturity with (a) ↑ susceptibility to damage from oxygen, barotrauma and volutrauma, (b) surfactant deficiency and (c) immature antioxidant defenses. • Oxygen toxicity • Barotrauma and volutrauma • Pulmonary edema (excessive fluid administration, patent ductus arteriosus) • Inflammation (multiple associated biochemical
    [Show full text]
  • Middle Ear Barotrauma After Hyperbaric Oxygen Therapy - the Role of Insuflation Maneuvers
    DOI: 10.5935/0946-5448.20120032 ORIGINAL ARTICLE International Tinnitus Journal. 2012;17(2):180-5. Middle ear barotrauma after hyperbaric oxygen therapy - the role of insuflation maneuvers Marco Antônio Rios Lima1 Luciano Farage2 Maria Cristina Lancia Cury3 Fayez Bahmad Jr.4 Abstract Objective: To analyze the association of insuflation maneuvers status before hyperbaric oxygen therapy with middle ear barotrauma. Materials and Methods: Fouty-one patients (82 ears) admitted to the Department of Hyperbaric Medicine from May 2011 to July 2012. Assessments occurred: before and after the first session, after sessions with symptoms. During the evaluations were performed: otoscopy with Valsalva and Toynbee maneuvers, video otoscopy and specific questionnaire. Middle ear barotrauma was graduated by the modified Edmond’s scale. Tubal insuflation was classified in Good, Median and Bad according to combined results of Valsalva and Toynbee maneuvers. Inclusion criteria: patients evaluated by an otolaryngologist before and after the first session, with no history of ear disease, who agreed to participate in the research (convenience sample). Results: Of the 82 ears included in the study, 32 (39%) had barotrauma after the first session. The rate of middle ear barotrauma according to tubal insuflation was: 17.9% (Good insuflation) 44.4% (Median insuflation) and 55.6% (Bad insuflation)P ( = 0.013). Conclusion: Positive Valsalva and Toynbee maneuvers before the first session, alone or associated were protective factors for middle ear barotrauma by ear after the first session. Keywords: barotrauma, hyperbaric oxygenation, middle ear ventilation. 1 Health Science School - University of Brasília - Brasília - DF - Brasil. E-mail: [email protected] 2 Health Science School - University of Brasília - Brasília - DF - Brasil.
    [Show full text]