RESUMO
Acute pulmonary edema is a rare but severe complication of hyperbaric oxygen therapy. While patients with known cardiovascular problems may be able to withstand this therapy, rapid decompensation can still occur. Here, we present a case of a patient with known low ejection fraction and severe mitral regurgitation who developed acute pulmonary edema during the first hyperbaric treatment for a foot ulcer. This case highlights the importance of identifying patients that are high risk, such as those with moderate-to-severe cardiac disease, and pursuing other treatment options to avoid this complication.
RESUMO
During tourniquet application, blood flow is restricted to a limb to stop excessive limb hemorrhage in a trauma setting and to create a bloodless operating field in the surgical setting. During tourniquet-related ischemia, aerobic respiration stops, and ATP is depleted, and during subsequent reperfusion, there is an increase in reactive oxygen species (ROS) production and other endogenous substances, which leads to acute ischemia-reperfusion (IR) injuries, including tissue necrosis and skeletal muscle contractile dysfunction. Hyperbaric oxygen (HBO) therapy can increase the arterial oxygen tension in the tissues of patients with general hypoxia/anoxia, including carbon monoxide poisoning, circulatory arrest, and cerebral and myocardial ischemia. Here, we studied the protective effects of HBO pretreatment with 100% oxygen at 2.5 ATA against tourniquet/IR injury in mice. After one hour of HBO therapy with 100% oxygen at 2.5 ATA was administered to C57/BL6 mice, a rubber band was placed at the hip joint of the unilateral hindlimb to induce 3 h of ischemia and then released for 48 h of reperfusion. We analyzed gastrocnemius muscle morphology and contractile function and measured the levels of ATP and ROS accumulation in the muscles. HBO pretreatment did not improve tourniquet/IR-injured gastrocnemius muscle morphology and muscle contraction. Tourniquet/IR mice with HBO pretreatment showed no increase in ATP levels in IR tissues, but they did have a decreased amount of ROS accumulation in the muscles, compared to IR mice with no HBO pretreatment. These data suggest that one hour of HBO pretreatment with 100% oxygen at 2.5 ATA increases the antioxidant response to lower ROS accumulation but does not increase ATP levels in IR muscles and improve tourniquet/IR-injured muscle morphology and contractile function.
Assuntos
Oxigenoterapia Hiperbárica , Traumatismo por Reperfusão , Animais , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Músculo Esquelético , Traumatismo por Reperfusão/prevenção & controle , TorniquetesRESUMO
Carbon monoxide (CO) poisoning presents with many different cardiac effects, but one important presentation is its effect as a CO stress test to reveal underlying coronary artery disease (CAD). There are a limited number of publications detailing this phenomenon, but after CO intoxication it is important to suspect CAD in association with mild troponin leak or non-ST segment elevation myocardial infarction (NSTEMI) shown on electrocardiogram (EKG). We recently treated three patients with CO poisoning who had underlying CAD. In the first case a man presented to the emergency department with CO toxicity and an ST segment elevation myocardial infarction (STEMI), resulting in emergent angioplasty and the discovery of severe CAD. The second case involved an individual who presented with CO poisoning with rising troponin levels. An angioplasty discovered a stable 90% occlusion. The third case was a patient with CO poisoning and transient inferior T wave inversion EKG with borderline troponin elevation. Angioplasty showed only 30% occlusion, so the patient's presentation was likely due to direct CO cardiac toxicity. These cases demonstrate the varied presentations that CO poisoning can have on patients with underlying heart disease.
Assuntos
Intoxicação por Monóxido de Carbono , Doença da Artéria Coronariana/diagnóstico , Teste de Esforço , Troponina/sangue , Idoso , Angioplastia Coronária com Balão , Intoxicação por Monóxido de Carbono/sangue , Intoxicação por Monóxido de Carbono/terapia , Doença da Artéria Coronariana/sangue , Eletrocardiografia , Humanos , Oxigenoterapia Hiperbárica , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Stents , Trombose/diagnóstico , Trombose/terapiaRESUMO
Neuropsychiatric sequelae have been reported in 15%-45% of survivors of carbon monoxide (CO) poisoning. Hyperbaric oxygen (HBO2) therapy reduces the incidence of cognitive and neurological a dysfunction. The efficacy of providing HBO2 beyond the first one to two days after initial insult is unknown. However, some evidence exists for the benefit of this treatment. We report on treating a patient 14 months after CO injury, who responded with markedly improved neurologic status. A 27-year-old scholar was found comatose due to CO poisoning (carboxyhemoglobin = 31.7%). He received five acute HBO2 treatments. After discharge, he developed chorea, Parkinsonism, dystonia, memory loss, slowed processing speed and verbal fluency, leaving him disabled. After the patient reached a clinical plateau, HBO2 was tried again at 90 minutes at 2.4 ATA plus air breaks. Neuropsychological testing was performed at baseline and after each 20 HBO2 cycles, five of which were performed during the period from 14-22 months after CO exposure. After the first 20 treatments, Parkinsonism and dystonia improved. After 40 sessions, further improvements were seen on mental speed, verbal fluency, and fine motor movements. The outcome following 100 treatments was that the patient regained independence, including the ability to drive and to become gainfully employed. Our case calls into question the concept that HBO2 therapy has no role during the chronic phase of CO brain injury. Randomized clinical trials should be considered to evaluate the therapeutic efficacy of HBO2 in patients with neurological sequelae following CO injury.
Assuntos
Intoxicação por Monóxido de Carbono/complicações , Oxigenoterapia Hiperbárica/métodos , Transtornos Neurocognitivos/terapia , Recuperação de Função Fisiológica , Adulto , Distonia/etiologia , Distonia/terapia , Humanos , Oxigenoterapia Hiperbárica/estatística & dados numéricos , Vida Independente , Masculino , Transtornos Neurocognitivos/etiologia , Testes Neuropsicológicos , Transtornos Parkinsonianos/etiologia , Transtornos Parkinsonianos/terapia , Retratamento/métodos , Retratamento/estatística & dados numéricos , Tentativa de Suicídio , Fatores de Tempo , Resultado do TratamentoRESUMO
We previously published our method of performing continuous bladder irrigation (CBI) in a monoplace hyperbaric chamber [1]. This method entailed the use of an IV pump to infuse saline into the monoplace chamber. The specter of causing iatrogenic rupture of the bladder was raised following such a case, reported herein, of a woman with hemorrhagic radiation cystitis leading to cystectomy. Due to the danger of bladder rupture while providing CBI with a pump, we retract ourpreviously reported method and encourage the use of either a gravity-fed system or delay in hyperbaric oxygen therapy treatment until CBI is no longer necessary.
Assuntos
Cistite/terapia , Oxigenoterapia Hiperbárica/efeitos adversos , Lesões por Radiação/terapia , Bexiga Urinária/lesões , Administração Intravesical , Idoso de 80 Anos ou mais , Compostos de Alúmen/administração & dosagem , Compostos de Alúmen/efeitos adversos , Cistite/etiologia , Feminino , Hemorragia/etiologia , Humanos , Oxigenoterapia Hiperbárica/normas , Pressão , Lesões por Radiação/complicações , Padrões de Referência , Ruptura/etiologia , Irrigação Terapêutica/efeitos adversos , Irrigação Terapêutica/métodosRESUMO
Oxygen toxicity seizures are a well-known complication of hyperbaric oxygen treatment (HBOT). Until now, there have not been any reported cases of an acute ischaemic event (stroke) as the result of a HBOT-associated oxygen toxicity seizure. We report an event in which a seizure and stroke occurred together and consider that the stroke may have been caused by seizure-induced demand ischaemia. This challenges the generally held view that oxygen toxicity seizures in the clinical hyperbaric setting are benign. A discussion of the literature on the subject of seizure-induced brain injury is included. Risk factors for cerebrovascular disease should be taken into consideration in determining treatment pressures for HBOT, as reducing pressure reduces seizure risk.
Assuntos
Oxigenoterapia Hiperbárica/efeitos adversos , Convulsões/etiologia , Acidente Vascular Cerebral/etiologia , Idoso de 80 Anos ou mais , Humanos , Úlcera da Perna/terapia , Masculino , Exame Neurológico , Fatores de RiscoRESUMO
Gas embolism is a rare but potentially devastating complication of endoscopic procedures. We describe 3 cases of gas embolism which were associated with endoscopic procedures (esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography). We treated these at our hyperbaric medicine center with 3 different outcomes: complete resolution, death, and disability. We review the literature regarding this unusual complication of endoscopy and discuss the need for prompt identification and referral for hyperbaric oxygen therapy. Additional adjunctive therapies are also discussed.
Assuntos
Embolia Aérea/terapia , Oxigenoterapia Hiperbárica/métodos , Embolia Intracraniana/terapia , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Embolia Aérea/etiologia , Endoscopia do Sistema Digestório/efeitos adversos , Humanos , Embolia Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
INTRODUCTION: Radiation-induced hemorrhagic cystitis is a serious side effect of radiation therapy. Anemia requiring transfusion can ensue. Treatment methods include bladder irrigation, fulguration, and hyperbaric oxygen (HBO2) therapy. Failure of treatment leads to cystectomy associated with a high risk of severe complications (42%) and mortality (16%). Continuous bladder irrigation (CBI) is often required to prevent further clot formation. HBO2 supports the healing process of radiation cystitis. In patients requiring CBI, the time in HBO2 can help cause clot accumulation and obstruction. We describe a method of providing CBI in a monoplace hyperbaric chamber. MATERIALS AND METHODS: An IV to catheter adapter is used, allowing an IV pump to control CBI flow into the chamber. Drainage is collected in an extra-large (2- to 5-liter) bag. The rate is set so the volume does not exceed the bag's capacity. The bag is placed in a manner that precludes spilling and allows monitoring of outflow. RESULTS: CBI was successfully maintained. Brief cases are presented and issues discussed. SUMMARY/CONCLUSIONS: CBI is easily maintained in a monoplace hyperbaric chamber, with readily available equipment allowing for uninterrupted CBI of hemorrhagic cystitis. HBO2 helps mitigate the potential side effects of other interventions in a previously irradiated area.
Assuntos
Cistite/terapia , Hemorragia/terapia , Oxigenoterapia Hiperbárica/métodos , Lesões por Radiação/terapia , Bexiga Urinária , Idoso de 80 Anos ou mais , Cistite/etiologia , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/complicações , Radioterapia/efeitos adversos , Irrigação Terapêutica/métodos , Trombose/prevenção & controleRESUMO
INTRODUCTION: We report a case of a previously healthy adult with flulike symptoms who precipitously declined due to pneumococcal sepsis complicated by disseminated intravascular coagulation (DIC) and purpura fulminans (PF). After one week of care, including ventilation support and hemodialysis, the patient was stable enough for hyperbaric oxygen (HBO2) in an attempt to salvage his threatened extremities. HBO2 resulted in reduction of ischemic tissue and demarcation of blackened tissue to the distal digits. We feel that much at-risk tissue has been spared by HBO2 as an adjunctive therapy. METHODS: Literature on the use of hyperbaric oxygen for purpura fulminans was reviewed for precipitating issues, time to treatment, protocol, other adjuncts and outcomes. RESULTS: Fifteen papers were identified representing 19 cases of PF treated with HBO2. No controlled studies exist. HBO2 was believed to be of value in most cases; the improvement was associated with timeliness and aggressiveness of initiating HBO2. CONCLUSIONS: PF is a fulminant disorder with high mortality and morbidity. Hyperbaric oxygen appears to be useful for the management of PF complications, imposing minimal side effects or complications. Aggressive therapy should be started as soon as it is safe to transfer the patient to a facility for HBO2 treatments.