Hyperbaric Oxygen as an Adjunctive Therapy Postfasciotomy for Unilateral Supraspinatus Rhabdomyolysis and Compartment Syndrome.

We present a case of severe supraspinatus muscle rhabdomyolysis following overexertion in a young male. Preexisting risk factors included illicit drug use. Even single muscle rhabdomyolysis can cause significant renal failure, and in our case the use of intravenous flushing was used in conjunction with hyperbaric oxygen after muscle compartment fasciotomy to maximize muscle recovery and renal protection in a manual worker (musician). Clinicians should be alert to severe muscle pain requiring narcotics after strenuous use.

The performance and safety of a pleural drainage unit under hyperbaric conditions.

The performance of a proprietary dry suction pleural drainage unit was measured under hyperbaric oxygenation conditions. The test pleural drainage unit was connected to pressure gauges that allowed the pressures created in the suction and collection chambers to be measured as well as the pleural drainage catheter pressures under varied suction regulator settings during compression, hyperbaric steady states and decompression. The maximum flow capacity of the unit was also measured under varying hyperbaric conditions. TheAtrium Oasis Dry Suction 3600 Chest Drain brand was dramatically affected by pressure change. Nevertheless, based upon our testing, we believe it can be used safely in a hyperbaric environment provided that the following precautions are taken. Suction should not be applied during pressurization. Pressurization needs to be slow, 10 kpa/min or less. Suction is needed for air leaks of 4/min or more at pressure. At stable hyperbaric pressure, the level of suction delivered can be set by adjusting the suction regulator with reference to the conversion table we have determined. Suction must be applied during depressurization if there is an air leak of 5/min or greater coming from the patient, otherwise suction is not essential. As the features of many brands and models of proprietary drains are similar, we would expect other types could be hyperbaric compatible, but individual testing should be performed before acceptance.

Cyclic variation pattern of cerebral blood flow velocity and postconceptional age.

In preterm neonates, the risk for intracerebral haemorrhage is linked to immaturity of cerebral autoregulation. The preterm's 2-5/min cyclic variation pattern of cerebral blood flow velocity is thought to reflect the degree of immaturity of autoregulation--a speculation to be tested. In a cross-sectional study 15 infants (gestational age 26-40 weeks, postconceptional age (PCA) 26-42 weeks, age 1-99 days were investigated. We performed a 10 min pulsed Doppler tracing on an internal carotid artery by means of a computer controlled 5 MHz Duplex device. Systolic velocity (Vs) was recorded pulse by pulse. After appropriate data transformation, in all infants the Fast Fourier Transform of the time course of Vs revealed the presence of a 2-5/min cyclic variation pattern (one sample z-test, P < 0.0001). There was no significant correlation between proportionate spectral power of the 2-5/min frequency band and either PCA (r = 0.23, P = 0.42) or age (r = 0.41, P = 0.13). Between 26 and 42 weeks PCA, the cycling phenomenon is constant thus not reflecting cerebral maturation, and its presence does not mean immaturity of cerebral autoregulation.