Hyperbaric oxygen therapy for hypoxic-ischemic encephalopathy in non-fatal drowning.

Paroxysmal autonomic instability syndrome with dystonia (PAISD) is a possible complication that worsens the prognosis of hypoxic-ischemic encephalopathy related to non-fatal drowning. There are case reports of hyperbaric oxygen (HBO2) therapy enhancing recovery in such cases. We report a case of a 5-year-old boy admitted to the Pediatric Intensive Care Unit after a non-fatal drowning. He was transferred under mechanical ventilation and sedation, with hemodynamic instability and hypothermia. On admission he had a Glasgow Coma Score of 6. On the fifth day of admission he presented episodes of dystonia with decerebration posture, diaphoresis, tachycardia and hypertension, sometimes with identified triggers, suggesting PAISD. The episodes were difficult to control; multiple drugs were needed. Electroencephalography showed diffuse slow wave activity, and cranioencephalic magnetic resonance imaging showed hypoxia-related lesions, suggesting hypoxic-ischemic encephalopathy. Early after admission the patient started physiotherapy combined with normobaric oxygen therapy. Subsequently he started HBO2 therapy at 2 atmospheres, with a total of 66 sessions. Dystonia progressively subsided, with gradual discontinuation of therapy. He also showed improvement in spasticity, non-verbal communication and cephalic control. This case highlights the diagnostic and therapeutic challenges of PAISD and the potential benefit of HBO2 therapy, even in the subacute phase, in recovery of hypoxic-ischemic encephalopathy.

Seizure frequency in more than 180,000 treatment sessions with hyperbaric oxygen therapy - a single centre 20-year analysis.

INTRODUCTION: Hyperbaric oxygen therapy (HBOT) involves the risk of central nervous system oxygen toxicity (CNS-OT), including seizures in patients breathing oxygen at pressures ≥ 2 atmospheres absolute. This study aimed to determine the seizure frequency and assess the clinical benefit of a 5-minute air-break (5´-AIRBK). METHODS: Twenty-year (1999-2018) retrospective analysis of all consecutive treatments with HBOT. Medical records were reviewed to determine patient demographics, comorbidities, HBOT indications, and seizure characteristics and timing. Seizure frequency was compared before and after incorporating a 5´-AIRBK in the treatment protocol. Chi-square testing was performed using SPSS (version 24.0); P < 0.05 was accepted as statistically significant. RESULTS: We evaluated 188,335 HBOT sessions (74,255 before versus 114,080 after introducing a 5´-AIRBK). A total of 43 seizures were observed: 29 before and 14 after the 5´-AIRBK introduction (3.9 versus 1.2 per 10,000 treatments; P < 0.0001). Seizures occurred after a median of 57 (range 15-85) minutes following compression and after a median of 21 HBOT sessions (1-126). Patients experiencing seizures were undergoing treatment for: diabetic ulcer (n = 11); acute traumatic peripheral ischaemia (ATPI) (n = 6); non-diabetic ulcer (n = 5); sudden sensorineural hearing loss (n = 5); chronic refractory osteomyelitis (n = 5); radionecrosis (n = 3); necrotising fasciitis (NF) (n = 2); and haemorrhagic cystitis after allogeneic bone marrow transplantation (n = 1). ATPI and NF had a considerably higher relative frequency of seizures compared to other indications. CONCLUSIONS: A statistically significant lower seizure frequency was achieved with a 5´-AIRBK. Assessing and defining the appropriate patient/treatment profile can be useful to minimise the risk of CNS-OT.

Malignant (necrotizing) externa otitis: the experience of a single hyperbaric centre.

INTRODUCTION: Malignant otitis externa (MOE) is a potentially life-threatening infection of the soft tissues of the external ear, quickly spreading to involve the periosteum and bone of the skull base. Treatment includes antibiotics and eventually surgery. Hyperbaric oxygen treatment (HBOT) has been proposed as an adjunctive therapy. However, in the tenth consensus conference, this disease was considered as a non-indication for HBOT. The aim of this study was to evaluate the effectiveness of HBOT in MOE treatment. METHODS: Retrospective and observational study was conducted of patients with MOE treated in our centre. Staging of the disease was made according to the clinicopathological classification system. RESULTS: From March 1998 to November 2016, 16 patients were referred. 6% patients were on stage 1 of the disease at the time they were referred, 20% in stage 2, 7% in stage 3a, 13% in stage 3b and 53% in stage 4. Seven (43.75%) patients had VII nerve palsy and three (18.75%) patients had multiple nerve palsy. Average length of symptoms of disease was 5 months (maximum 11 months). Average number of sessions was 33 and the length of hospitalization prior to HBOT (median 90 days) was significantly longer than the time between beginning HBOT and cure (p = 0.028, Wilcoxon signed rank test). There were no fatalities due to MOE and all patients were considered free of disease after HBOT. CONCLUSION: HBOT was well tolerated and revealed to be a helpful adjuvant treatment in MOE. According to our data, HBOT should be considered for patients who failed conventional treatments and in severe cases.

Hyperbaric Oxygen Therapy in Retinal Arterial Occlusion: Epidemiology, Clinical Approach, and Visual Outcomes.

PURPOSE: To evaluate the efficacy and safety of hyperbaric oxygen therapy (HBOT) in patients with acute retinal artery occlusion (RAO). Secondarily, to analyse the epidemiology and the clinical approach. METHODS: Retrospective study of 13 patients submitted to HBOT between 2013 and 2018. The analysed parameters consisted of: systemic history, time between symptoms onset and treatment, initial approach, number of HBOT sessions, complications of HBOT and best corrected visual acuity-BCVA (of the total sample, central RAO-CRAO-group, and branch RAO-BRAO group). RESULTS: Arterial hypertension was the most prevalent systemic risk factor (53.8%). Initial therapies were 100% normobaric oxygen administration, topical and oral hypotensive medication, eye massage and aspirin. CRAO was observed in 69.2% and BRAO in 30.8% of the cases, with clinically significant visual improvement (a decrease in logMAR of 0.3) in 55.5% and 75%, respectively. Time between symptoms onset and treatment had a median of 9 hours. The median number of HBOT sessions was 7, without complications. CONCLUSIONS: HBOT provide BCVA improvement in patients with RAO, when it is performed in an early time after the symptom onset. It seems to be an effective and safe therapeutic option for a pathology that still remains without approved treatment.

Stage III Kienböck's disease treated with hyperbaric oxygen: the role of an unusual approach to a rare condition.

Kienböck's disease is a rare condition characterised by avascular necrosis of the lunate bone. Its natural history and aetiopathogenesis have not yet been clarified, nor are its triggering factors identified. We present a case of a 17-year-old male gymnast, without relevant medical/family history, with stage IIIA Kienböck's disease diagnosed in 2016. Initially, submitted to conservative treatment that proved to be insufficient. Consequently, surgical treatment was proposed, but refused. The patient instead underwent experimental treatment with hyperbaric oxygen (120 sessions, 100% oxygen at 2.5 atm, for 70 min periods, once daily, five times per week). In April 2018, a favourable clinical and radiological evolution was observed, with an improvement in the patterns of pain, motion and strength and an almost complete involution of the process of aseptic necrosis of the semilunar. To the best of our knowledge, this is the first report of Kienböck's disease treated with hyperbaric oxygen.

New perspectives on the conservative management of osteoradionecrosis of the mandible: A literature review.

Over the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

Hyperbaric Oxygen Therapy for the Treatment of Fournier's Gangrene: A Review of 34 Cases.

INTRODUCTION: Fournier's gangrene is a serious necrotizing infection that can be fatal if not promptly attended. Treatment for this condition consists of a combination of surgical debridement, antibiotherapy and supportive care. Hyperbaric oxygen therapy is used as an adjuvant for the optimization of infected tissue oxygenation and for its bactericidal and bacteriostatic effects. MATERIAL AND METHODS: The data presented in this study encompass a period of 25 years of clinical records of patients with Fournier's gangrene that had been treated at our center with hyperbaric oxygen therapy. RESULTS: A total of 34 patients were treated. The vast majority of patients were males (94.1%) with a mean age of 53.7 years. Urinary tract was the most frequent source of infection and diabetes was most common comorbidity seen in patients. Mortality rate was 20.8%. DISCUSSION: The most common observed comorbidity was diabetes, suggesting diabetes as one predisposing factor. The majority of deceased patients had diabetes, although no significant correlation between diabetes and death was found. The area of residence of patients may affect patients' referral to these facilities. CONCLUSIONS: Although Fournier's gangrene is a rare condition, it is nevertheless a fatal illness, namely in patients with comorbidities like diabetes. Hyperbaric oxygen therapy is recommended as an adjuvant to conventional therapy and should be considered whenever available. To further assess the role of hyperbaric oxygen therapy, in the treatment of this condition, additional studies should be carried out.

Introdução: A gangrena de Fournier é uma infecção necrotizante grave, que pode levar à morte se não for tratada rapidamente. O tratamento baseia-se na combinação do desbridamento cirúrgico, antibioterapia e terapêutica de suporte. A oxigenoterapia hiperbárica surge como adjuvante quer na optimização da oxigenação dos tecidos infetados, quer através da ação bactericida e bacteriostática. Material e Métodos: Foi feita uma revisão dos processos clínicos dos doentes com gangrena de Fournier referenciados ao Centro de Medicina Subaquática e Hiperbárica da Marinha para realizar oxigenoterapia hiperbárica num período de 25 anos. Resultados: Foram tratados 34 doentes. A maioria dos doentes era do género masculino (94,1%) com idade média de 53,7 anos. A diabetes foi a comorbilidade mais frequentemente associada. O foco de infeção mais frequente foi o trato urinário. A taxa de mortalidade foi de 20,8%. Discussão: A diabetes é a comorbilidade mais frequente, sugerindo a diabetes como factor predisponente. A maioria dos doentes falecidos tinham diabetes, todavia não se conseguiu estabelecer correlação entre diabetes e morte. A área de residência dos doentes parece limitar a referenciação ao centro. Conclusões: A gangrena de Fournier, apesar de rara, é uma doença potencialmente fatal, nomeadamente em doentes com comorbilidades como a diabetes. A oxigenoterapia hiperbárica está recomendada como adjuvante à terapêutica convencional e, quando este recurso está disponível, deve ser considerado. São necessários mais estudos para melhor aferir o papel da oxigenoterapia hiperbárica no tratamento desta entidade.

[Pneumatosis Coli Treated with Metronidazole and Hyperbaric Oxygen Therapy: A Successful Case]. / Pneumatose Cólica Tratada com Metronidazol e Oxigenoterapia Hiperbárica: Um Caso de Sucesso.

Pneumatosis intestinalis, characterized by the presence of gas within the bowel wall, is an uncommon condition with variable presentation. It may be idiopathic or secondary to other diseases. A computed tomography scan is the most sensitive method for diagnosis. In the absence of signs and symptoms of complications, such as perforation and peritonitis, pneumatosis intestinalis can be managed conservatively. We present the case of a 59-year-old woman with pneumatosis coli secondary to benign ovary teratoma. After surgery she remained symptomatic and was successfully treated with metronidazole and hyperbaric oxygen therapy.

A pneumatose intestinal, caracterizada pela presença de gás na parede do cólon, é uma condição incomum com um espectro de apresentação variável. Pode ser idiopática ou secundária a outras doenças. A tomografia computorizada é o método de diagnóstico com maior sensibilidade. Na ausência de sinais e sintomas sugestivos de complicações, como a perfuração e a peritonite, a pneumatose intestinal pode ser tratada de forma conservadora. Apresenta-se o caso de uma mulher de 59 anos com pneumatose cólica secundária a teratoma ovárico benigno. Após a cirurgia, manteve-se sintomática e foi tratada com sucesso com metronidazol e oxigenoterapia hiperbárica.

Hyperbaric oxygen therapy for refractory radiation-induced hemorrhagic cystitis.

OBJECTIVES: To analyze the efficacy of hyperbaric oxygen for the treatment of radiation-induced hemorrhagic cystitis and to identify factors associated with successful treatment. METHODS: Clinical records from 176 patients with refractory radiation-induced hemorrhagic cystitis treated at the Portuguese Navy Center for Underwater and Hyperbaric Medicine, during a 15-year period, were retrospectively analyzed. Evolution of macroscopic hematuria was used to analyze treatment efficacy and correlated with other external variables. RESULTS: From a total of 176 treated patients, 23.9% evidenced other radiation-induced soft tissue lesions. After an average on 37 sessions, 89.8% of patients showed resolution of hematuria, with only 1.7% of adverse events. In our sample, hematuria resolution after treatment with hyperbaric oxygen was statistically associated to the need for transfusion therapy (P = 0.026) and the number of sessions of hyperbaric oxygen (P = 0.042). No relationship was found with the remaining variables. CONCLUSIONS: Refractory radiation-induced hemorrhagic cystitis can be successfully and safely treated with hyperbaric oxygen. Treatment effectiveness seems to be correlated with the need for transfusion therapy and the number of sessions performed.