Health effects of hyperbaric exposure on chamber attendants: a literature review.

BACKGROUND: Inside attendants working in hyperbaric chambers are exposed to risks related to the hyperbaric environment, handling and care. The aim of this study is to review the literature focusing on the impact of this activity on health. MATERIALS AND METHODS: This is a literature review using the Medline database. RESULTS: Eight articles studied decompression illness (DCI). The incidence of DCI ranged from 0 to 37 per 100,000 sessions in hyperbaric chambers (SHC). The incidence of injuries ranged from 0 to 412 per 100,000 SHC. The most prevalent cause of accidental death was fire: 77 deaths (patients and attendants) between 1923 and 1996. Dysbaric osteonecrosis has been reported in one study only. CONCLUSIONS: Inside attendants face risks in the chamber, even if serious health effects seems rare compared to the total number of SHC.

Occupational accidents among attendants inside hyperbaric chambers in France.

INTRODUCTION: The purpose of the study was to assess the number of accidents among staff employed in the operation of hyperbaric chambers in France. MATERIALS AND METHODS: A retrospective study using a questionnaire was carried out on occupational accidents in France between 2005 and 2011. RESULTS: 12 (46%) centres participated in the study, representing 73 subjects. The mean age was 43.5 years (SD=9.73). They had worked in hyperbaric chambers for 9.8 years on average (SD=7.7). The average number of hyperbaric sessions was 198.3 per subject (SD=174.25), for a total of 8.072 hyperbaric sessions; 27% of the subjects reported that they had at least one accident during the study period. In all, 30 accidents were reported: 3 blood exposures, 4 accidents related to patient handling, 20 hyperbaric accidents; 3 other accidents. Of the hyperbaric accidents, 2 (10%) involved decompression sicknesses with cutaneous symptoms, 3 (15%) decompression illness (DCI), 14 (70%) ear traumatisms, 1 (5%) dental accident. The incidences were 372 per 100,000 sessions in hyperbaric chambers (SHC) for all accidents, 248 per 100,000 SHC for hyperbaric accidents and 173 per 100,000 SHC for ENT barotraumas. CONCLUSION: The accidents involving staff operating hyperbaric chambers were mainly ear traumatisms..

Intracerebral hemorrhage related to systemic gas embolism during hysteroscopy.

Iatrogenic gas embolism is a rare but serious problem that has been documented in almost all medical specialties including gynecology. We present a 49-year-old woman undergoing operative hysteroscopy and myomectomy, who sustained sudden hypotension and decrease in the end-tidal carbon dioxid levels during the procedure. Systemic gas embolism was confirmed by echocardiographic evidence of bubbles in both right and left cardiac cavities and a rise of troponin. Hyperbaric oxygen was rapidly administered in addition to maintenance of vital functions and anti-thrombotic prevention with calciparin. A right hemiparesis was apparent after recovery from general anesthesia. Brain-computed tomography and magnetic resonnance imaging, performed on Days 3 and 2 respectively, showed a left fronto-parietal hematoma surrounded by edema. Having ruled out risk factors for a primary ischemic or hemorrhagic stroke, we concluded that hemorragic transformation of the ischemic cerebral lesion caused by gas embolism was responsible for the observed intraparenchymal hematoma. As far as we know, this is the first report relating cerebral gas embolism with an intracerebral hemorrhage. It provides an argument against anticoagulant therapy during the early stages of gas embolism care.