A case of tension pneumothorax during hyperbaric oxygen therapy in an earthquake survivor with crush injury complicated by ARDS (adult respiratory distress syndrome).

Pneumothorax (PTX) is rarely reported in patients receiving hyperbaric oxygen (HBO2) therapy. Patients with air-trapping lesions in the lungs and those with a history of spontaneous PTX, lung disease, mechanical ventilation or chest trauma are at an increased risk for PTX during HBO2 therapy. A 28-year-old male earthquake survivor was referred to our center for multiple wounds 21 days after being rescued from the debris. He had been intubated and put on mechanical ventilation for three days because of adult respiratory distress syndrome (ARDS). At initial presentation, he was conscious, well-oriented and hemodynamically stable. The initial six HBO2 treatments were uneventful. On the seventh HBO2 treatment, the patient lost consciousness and developed cardiopulmonary arrest near the end of decompression. The HBO2 specialist accompanying the patient inside the chamber immediately initiated CPR. A diagnosis of tension PTX was made. After the patient was removed from the chamber, a chest tube was inserted, which improved the symptoms. Although rare, tension PTX can occur during HBO2 therapy. Early diagnosis and intervention are crucial for saving a patient's life. Increased vigilance is required during treatment of patients with risk factors for PTX.

Effect of hyperbaric oxygen on flow-mediated vasodilation: an ultrasound study.

OBJECTIVE: The purpose of this study was to investigate the effect of hyperbaric oxygen (HBO) treatment on flow-mediated vasodilation (FMD) by ultrasound examination. METHODS: We studied 14 young patients without cardiovascular problems who underwent HBO treatment. The indications for HBO treatment were osteomyelitis (n = 8), Crohn disease (n = 2), perianal abscesses (n = 2), lingual artery embolization (n = 1), and aseptic necrosis (n = 1). The ultrasound evaluation for FMD was performed before HBO treatment, after 1 session of HBO treatment, and after 10 sessions of HBO treatment. The right brachial artery FMD response was evaluated by the mean of the baseline right brachial artery diameter, absolute change in the diameter before and after cuff inflation/deflation, and percent change in the diameter. RESULTS: Statistical analysis showed a significant change in the preinflation right brachial artery diameter before (mean +/- SD, 3.6 +/- 0.54 mm) and after (3.76 +/- 0.56 mm) 10 sessions of HBO treatment (P < .05). The absolute changes in the right brachial artery diameter before and after cuff inflation/deflation (0.36 +/- 0.2 mm before HBO treatment, 0.37 +/- 0.22 mm after 1 session of HBO treatment, and 0.38 +/- 0.21 mm after 10 sessions) and percent change in FMD (10% +/- 5.8% before HBO treatment, 10.6% +/- 7.5% after 1 session of HBO treatment, and 10.6% +/- 7.7% after 10 sessions) after induction of a hyperemic response by cuff inflation were not statistically significant (P > .05). CONCLUSIONS: Hyperbaric oxygen treatment did not have an immediate effect on FMD (absolute change in the right brachial artery diameter after cuff inflation/deflation); however, the right brachial artery diameter increased after 10 sessions of HBO treatment. This may suggest chronic stress on the vascular endothelium after HBO.