Hyperbaric Medicine in Pediatrics — reality of a Portuguese reference center / Medicina Hiperbárica em Pediatria — realidade de um centro de referência português

ABSTRACT Objective: To identify and characterize the population of Pediatric patients referred to our hyperbaric oxygen therapy center. Methods: Retrospective and observational study, including pediatric patients treated with hyperbaric oxygen therapy, from 2006 to 2021, at the hyperbaric medicine reference center in the north of Portugal. Variables of interest were extracted from electronic medical records. Results: Our study included 134 patients. The most frequent reasons for referral were carbon monoxide poisoning (n=59) and sudden sensorineural hearing loss (n=41). In 75 cases (56%), treatment was initiated in an urgent context. Symptom presentation at Emergency Department varied among patients, the most frequent being headache and nausea/vomiting. Concerning carbon monoxide poisoning, the most common sources were water heater, fireplace/brazier, and boiler. Regarding adverse effects, it was identified one case of intoxication by oxygen and four cases of middle ear barotrauma. Conclusions: The most frequent cause for referral was carbon monoxide poisoning. All patients evolved favorably, with few side effects being reported, emphasizing the safety of this therapy. While most pediatricians may not be aware of the potential benefits arising with hyperbaric oxygen therapy, it is of upmost importance to promote them, so that this technique is increasingly implemented.

RESUMO Objetivo: Identificar e caracterizar a população de casos pediátricos encaminhados para o nosso centro de oxigenoterapia hiperbárica. Métodos: Estudo retrospetivo e observacional, que incluiu doentes pediátricos tratados com oxigenoterapia hiperbárica, de 2006 a 2021, no centro de referência de medicina hiperbárica do norte de Portugal. As variáveis de interesse foram extraídas dos processos clínicos eletrônicos. Resultados: O nosso estudo incluiu 134 casos. Os motivos de encaminhamento mais frequentes foram intoxicação por monóxido de carbono (n=59) e surdez súbita neurossensorial (n=41). Em 75 casos (56%) o tratamento foi iniciado em contexto de urgência. Os sintomas de apresentação à admissão variaram entre os diferentes casos, sendo os mais frequentes cefaleias e náuseas/vômitos. No que diz respeito à intoxicação por monóxido de carbono, as fontes mais comuns foram o aquecedor, lareira/braseiro e caldeira. Com relação aos efeitos adversos, foram identificados um caso de intoxicação por oxigênio e quatro casos de barotrauma do ouvido médio. Conclusões: A causa mais frequente de encaminhamento foi a intoxicação por monóxido de carbono. Todos os pacientes evoluíram favoravelmente e foram registrados poucos efeitos adversos, o que enfatiza a segurança desta terapia. Uma vez que a maioria dos pediatras pode não estar informada sobre os potenciais benefícios da oxigenoterapia hiperbárica, é de extrema importância promovê-los para que esta técnica seja cada vez mais implementada.

Case report: Is bilateral renal dioctophymosis and severe uremia in a dog synonymous of euthanasia? Not today.

A dog with bilateral renal dioctophymosis presented with stage 5 acute kidney injury, weight loss, vomiting, apathy, and hematuria. Laboratory tests showed creatinine of 17.2 mg/dL and Dioctophyme renale eggs in the urine. It underwent a 30-min session of hyperbaric oxygen preconditioning at a pressure of 2 ATA. Subsequently, bilateral nephroscopy was performed, without warm ischemia, using Amplatz-type renal dilators. Five parasites were removed, three females from the right kidney, one female from the left kidney, and one male from the abdominal cavity. After surgery, the patient continued doing daily hyperbaric oxygen therapy (HBOT) sessions and clinical therapy. Postoperative care consisted of analgesics, antimicrobials, antioxidants, gastric protector and fluid therapy. Ultrasound monitoring showed a reduction in the area of renal dilation and the hematological and biochemical tests showed rapid recovery from acute kidney injury. There was no bacterial growth in the urine sample collected directly from the kidneys. The patient had an excellent clinical progression and was discharged from hospital 7 days postoperatively, with creatinine values of 2.9 mg/dL. This is the first report of the use of nephroscopy in the treatment of dioctophymosis and indicates excellent chances of cure even in severe cases of bilateral parasitosis. HBOT was shown to be an ally in the clinical therapy of patients with D. renale by helping with stabilization and postoperative recovery.

The effect of hyperbaric oxygen therapy in head and neck cancer patients with radiation induced dysphagia-a systematic review.

PURPOSE: The aim of this systematic review was to assess the role of hyperbaric oxygen therapy  (HBOT) in patients with dysphagia after radiation therapy for head and neck cancer. METHOD: A systematic search was conducted in the electronic databases Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials for relevant studies until March 14, 2023. No restriction on language or publication date. The criteria for inclusion: patients with HNC who had received both radiation therapy and HBOT as 1) a preventive treatment against swallowing difficulties, 2) to preserve swallowing function, or 3) to promote swallowing difficulties. RESULTS: We identified 1396 records. After removal of 31 duplicates, 1365 records were accessible for title and abstract screening. This yielded 53 studies for full text assessment. Six studies met the eligibility criteria and were included for qualitative analysis. CONCLUSION: Evidence of HBOT benefits in patients with dysphagia after radiation therapy for head and neck cancer is inconsistent. Well-designed studies using validated outcome measures and long-term follow-up are warranted.

Hyperbaric oxygen therapy enhances graft healing and mechanical properties after anterior cruciate ligament reconstruction: An experimental study in rabbits.

Hyperbaric oxygen therapy (HBOT) has proven successful in wound healing. However, its potential effects on anterior cruciate ligament (ACL) injuries remain uncertain. This study aimed to investigate the impact of HBOT on graft healing following ACL reconstruction in rabbits. Male New Zealand rabbits underwent ACL reconstruction and were randomly divided into two groups: the HBOT group and the ambient air group. The HBOT group received 100% oxygen at 2.5 atmospheres absolute for 2 h daily for 5 consecutive days, starting from the first day after surgery. The ambient air group was maintained in normal room air throughout the entire period. After 12 weeks following the surgery, animals were euthanized, and their knees were harvested for analysis. The HBOT group demonstrated superior graft maturation and integration in comparison to the ambient air group, as evidenced by lower graft signal intensity on magnetic resonance imaging, decreased femoral and tibial tunnel size, and higher bone mineral density values on high-resolution peripheral quantitative computed tomography scans. Additionally, biomechanical testing indicated that the HBOT group had greater load to failure and stiffness values than the ambient air group. In conclusion, the adjuvant use of HBOT improved ACL graft maturation and integration, reduced tunnel widening, and enhanced the biomechanical properties of the graft. These results may provide important insights into the potential clinical application of HBOT as a therapeutic intervention to enhance graft healing after ACL reconstruction, paving the way for further research in this area.

Evaluation of oxidative stress in an experimental model of Crohn's disease treated with hyperbaric oxygen therapy.

INTRODUCTION: Treatments of Inflammatory Bowel Disease (IBD) are able to control symptoms in most cases, however, a fraction of patients do not improve or have a loss of response to treatments, making it important to explore new therapeutic strategies. Hyperbaric oxygen therapy (HBO) may represent one of them. The aim of this study was to evaluate the effects of HBO therapy in an experimental model of IBD. METHODS: Sixty male BALBc mice were divided into six groups. Group 1 was colitis-induced with trinitrobenzene sulfonic acid (TNBS) + ethanol, group 2 received TNBS + ethanol plus HBO, group 3 received only ethanol, group 4 received ethanol plus HBO, group 5 received saline solution, and group 6 received saline solution plus HBO. HBO was performed for four days, subsequently, the mice were evaluated daily. At the end of the study, samples from the intestine were collected for histological analysis as well as for measurement of antioxidant enzymes and cytokine levels. RESULTS: HBO significantly improved the clinical and histological status of the animals. Treatment with HBO increased the activity of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) in all of the groups; moreover, the difference was only significant between the TNBS and TNBS + HBO groups and treatments promoted a reduction in the proinflammatory cytokines IFN-γ, IL-12, IL-17 and TNF-α and increased the anti-inflammatory cytokines IL-4 and IL-10, with no changes in IL-13. CONCLUSION: HBO effectively treats TNBS-induced colitis by increasing the activity of antioxidant enzymes and modulating cytokine profiles.

Advance in hyperbaric oxygen therapy in spinal cord injury.

Spinal cord injury (SCI) is a severe lesion comporting various motor, sensory and sphincter dysfunctions, abnormal muscle tone and pathological reflex, resulting in a severe and permanent lifetime disability. The primary injury is the immediate effect of trauma and includes compression, contusion, and shear injury to the spinal cord. A secondary and progressive injury usually follows, beginning within minutes and evolving over several hours after the first ones. Because ischemia is one of the most important mechanisms involved in secondary injury, a treatment to increase the oxygen tension of the injured site, such as hyperbaric oxygen therapy, should theoretically help recovery. Although a meta-analysis concluded that hyperbaric oxygen therapy might be helpful for clinical treatment as a safe, promising and effective choice to limit secondary injury when appropriately started, useful and well-defined protocols/guidelines still need to be created, and its application is influenced by local/national practice. The topic is not a secondary issue because a well-designed randomized controlled trial requires a proper sample size to demonstrate the clinical efficacy of a treatment, and the absence of a common practice guideline represents a limit for results generalization. This narrative review aims to reassemble the evidence on hyperbaric oxygen therapy to treat SCI, focusing on adopted protocols in the studies and underlining the critical issues. Furthermore, we tried to elaborate on a protocol with a flowchart for an evidence-based hyperbaric oxygen therapy treatment. In conclusion, a rationale and shared protocol to standardize as much as possible is needed for the population to be studied, the treatment to be adopted, and the outcomes to be evaluated. Further studies, above all, well-designed randomized controlled trials, are needed to clarify the role of hyperbaric oxygen therapy as a strategic tool to prevent/reduce secondary injury in SCI and evaluate its effectiveness based on an evidence-based treatment protocol. We hope that adopting the proposed protocol can reduce the risk of bias and drive future studies.

Clinical and biochemical short-term effects of hyperbaric oxygen therapy on SARS-Cov-2+ hospitalized patients with hypoxemic respiratory failure.

BACKGROUND: Hyperbaric oxygen therapy (HBOT) has been proposed to address COVID-19- associated respiratory failure. However, its biochemical effects are poorly known. METHOD: 50 patients with hypoxemic COVID-19 pneumonia were divided into C group (standard care) and H group (standard care plus HBOT). Blood was obtained at t = 0 and t = 5 days. Oxygen saturation (O2 Sat) was followed up. White blood cell (WC) count, lymphocytes (L) and platelets (P) and serum analysis (glucose, urea, creatinine, sodium, potassium, ferritin, D dimer, LDH and CRP) were carried out. Plasma levels of sVCAM, sICAM, sPselectin, SAA and MPO, and of cytokines (IL-1ß, IL-1RA, IL-6, TNFα, IFNα, IFNγ, IL-15, VEGF, MIP1α, IL-12p70, IL-2 and IP-10) were measured by multiplex assays. Angiotensin Converting Enzyme 2 (ACE-2) levels were determined by ELISA. RESULTS: The average basal O2 Sat was 85 ± 3%. The days needed to reach O2 Sat >90% were: H: 3 ± 1 and C: 5 ± 1 (P < 0,01). At term, H increased WC, L and P counts (all, H vs C: P < 0,01). Also, H diminished D dimer levels (H vs C, P < 0,001) and LDH concentration (H vs C, P < 0.01]. At term, H showed lower levels of sVCAM, sPselectin and SAA than C with respect to basal values (H vs C: ΔsVCAM: P < 0,01; ΔsPselectin: P < 0,05; ΔSAA: P < 0,01). Similarly, H showed diminished levels of TNFα (ΔTNFα: P < 0,05) and increased levels of IL-1RA and VEGF than C respect to basal values (H vs C: ΔIL-1RA and ΔVEGF: P < 0,05). CONCLUSION: Patients underwent HBOT improved O2 Sat with lower levels of severity markers (WC and platelets count, D dimer, LDH, SAA). Moreover, HBOT reduced proinflammatory agents (sVCAM, sPselectin, TNFα) and increased anti-inflammatory and pro-angiogenic ones (IL-1RA and VEGF).

Revisiting the role of hyperbaric oxygen therapy in knee injuries: Potential benefits and mechanisms.

Knee injury negatively impacts routine activities and quality of life of millions of people every year. Disruption of tendons, ligaments, and articular cartilage are major causes of knee lesions, leading to social and economic losses. Besides the attempts for an optimal recovery of knee function after surgery, the joint healing process is not always adequate given the nature of intra-articular environment. Based on that, different therapeutic methods attempt to improve healing capacity. Hyperbaric oxygen therapy (HBOT) is an innovative biophysical approach that can be used as an adjuvant treatment post-knee surgery, to potentially prevent chronic disorders that commonly follows knee injuries. Given the well-recognized role of HBOT in improving wound healing, further research is necessary to clarify the benefits of HBOT in damaged musculoskeletal tissues, especially knee disorders. Here, we review important mechanisms of action for HBOT-induced healing including the induction of angiogenesis, modulation of inflammation and extracellular matrix components, and activation of parenchyma cells-key events to restore knee function after injury. This review discusses the basic science of the healing process in knee injuries, the role of oxygen during cicatrization, and shed light on the promising actions of HBOT in treating knee disorders, such as tendon, ligament, and cartilage injuries.

Evaluation of oxidative stress in an experimental model of Crohn's disease treated with hyperbaric oxygen therapy

Abstract Introduction: Treatments of Inflammatory Bowel Disease (IBD) are able to control symptoms in most cases, however, a fraction of patients do not improve or have a loss of response to treatments, making it important to explore new therapeutic strategies. Hyperbaric oxygen therapy (HBO) may represent one of them. The aim of this study was to evaluate the effects of HBO therapy in an experimental model of IBD. Methods: Sixty male BALBc mice were divided into six groups. Group 1 was colitis-induced with trinitrobenzene sulfonic acid (TNBS) + ethanol, group 2 received TNBS + ethanol plus HBO, group 3 received only ethanol, group 4 received ethanol plus HBO, group 5 received saline solution, and group 6 received saline solution plus HBO. HBO was performed for four days, subsequently, the mice were evaluated daily. At the end of the study, samples from the intestine were collected for histological analysis as well as for measurement of antioxidant enzymes and cytokine levels. Results: HBO significantly improved the clinical and histological status of the animals. Treatment with HBO increased the activity of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) in all of the groups; moreover, the difference was only significant between the TNBS and TNBS + HBO groups and treatments promoted a reduction in the proinflammatory cytokines IFN-γ, IL-12, IL-17 and TNF-α and increased the anti-inflammatory cytokines IL-4 and IL-10, with no changes in IL-13. Conclusion: HBO effectively treats TNBS-induced colitis by increasing the activity of antioxidant enzymes and modulating cytokine profiles.

Usos de cámara hiperbárica en otorrinolaringología / Uses for hyperbaric chambers in otolaryngology

Resumen En la terapia con oxígeno hiperbárico (HBO) se utiliza oxígeno al 100% de concentración en una cámara presurizada con presiones supraatmosféricas, que corresponden de 2 a 3 atmósferas. Los mecanismos por los cuales funciona esta terapia se relacionan con propiedades físicas de los gases y su comportamiento fisiológico en el organismo, lo que lleva finalmente a la hiperoxia, evento fisiológico que permite la obtención de diversos efectos beneficiosos. La evidencia en medicina ha demostrado su utilidad mayormente en la enfermedad por descompresión, infecciones cutáneas graves e intoxicación por monóxido de carbono. En el ámbito de la otorrinolaringología ha probado ser útil en algunas enfermedades como la hipoacusia súbita idiopática, tanto como terapia única como asociada al uso de corticosteroides, como en la osteomielitis refractaria del oído externo, la que en conjunto con antibioticoterapia y manejo quirúrgico presenta un evidente aumento en la tasa de mejoría. Cabe mencionar que la terapia con HBO ha demostrado también beneficios en los tratamientos y complicaciones posteriores a la radiación en pacientes con cáncer de cabeza y cuello. Es importante mencionar que la terapia con HBO no está exenta de riesgos y requiere que los pacientes cumplan con características específicas para su utilización, por lo que su indicación debe ser juiciosa y en casos seleccionados.

Abstract In hyperbaric oxygen therapy, 100% pure oxygen is used in a pressurized chamber with super atmospheric pressures which correspond to 2-3 atmospheres. The mechanism by which this treatment works is related to the physical properties of gases and their physiological behavior in the body, which leads to hyperoxia, the physiological event which allows for diverse beneficial health effects. The evidence in medicine has proven its utility mainly in decompression sickness, severe skin infections and carbon monoxide poisoning. In the otolaryngology field it has been proven useful in diseases like idiopathic sudden sensorineural hearing loss, both as the only treatment and as a concurrent treatment along with corticosteroids, in malignant otitis externa which in conjunction with antibiotic treatment and a surgical approach presents a clear increase in improvement rates. It must be mentioned that hyperbaric chamber treatment has also shown benefits in radiation treatment and post radiation complications in head and neck cancer patients. It is important to note that hyperbaric oxygen therapy is not without risks and patients must meet specific criteria for it to be applied, therefore it must be indicated using careful judgement and only in necessary cases.

The role of hyperbaric oxygen therapy in the treatment of radiation lesions.

INTRODUCTION: Cancer remains one of the leading causes of death worldwide, with 50-60% of patients requiring radiotherapy during the course of treatment. Patients' survival rate has increased significantly, with an inevitable increase in the number of patients experiencing side effects from cancer therapy. One such effect is late radiation injuries in which hyperbaric oxygen therapy appears as complementary treatment. With this work we intend to divulge the results of applying hyperbaric oxygen therapy among patients presenting radiation lesions in our Hyperbaric Medicine Unit. MATERIALS AND METHODS: Retrospective analysis of clinical records of patients with radiation lesions treated at the Hyperbaric Medicine Unit assessed by the scale Late Effects of Normal Tissues-Subjective, Objective, Management, Analytical (LENT-SOMA) before and after treatment, between October 2014 and September 2019 were included. Demographic characteristics, primary tumor site, subjective assessment of the LENT-SOMA scale before and after treatment were collected and a comparative analysis (Students t test) was done. RESULTS: 88 patients included: 33 with radiation cystitis, 20 with radiation proctitis, 13 with osteoradionecrosis of the mandible and 22 with radiation enteritis. In all groups, there was a significant decrease (p < 0.005) in the subjective parameter of the LENT-SOMA scale. DISCUSSION: Late radiation lesions have a major influence on patients' quality of life. In our study hyperbaric oxygen therapy presents as an effective therapy after the failure of conventional treatments. CONCLUSION: Hyperbaric oxygen therapy is an effective complementary therapy in the treatment of refractory radiation lesions.

Medium-pressure hyperbaric oxygen therapy for livedoid vasculopathy.

Livedoid vasculopathy (LV) is a cutaneous manifestation of several diseases that lead to noninflammatory thrombosis of dermal vessels. We report the case of a 26-year-old female with a 4 years and 8 months-old history of diagnosis of LV and a non-healing ulcer of more than a year of evolution. Because of refractory response to standard care, low-pressure hyperbaric oxygen (LPHBOT) was added to the therapeutic scheme (azathiopine 2.5 mg/kg, folic acid and acetylsalicylic acid). After 12 sessions of LHBOT (60 min, 1.45 ATA ≈ 100% O2), ulcers achieved complete healing with significant pain relief and no recurrence was present over 6 months. More studies are necessary to determine the effectiveness of HBOT for LV treatment.

La vasculopatía livedoide (VL) es una manifestación cutánea de varias enfermedades que conducen a una trombosis no inflamatoria de los vasos dérmicos. Se presenta el caso de una mujer de 26 años con antecedente de diagnóstico de vasculopatía livedoide de 4 años y 8 meses, además de una úlcera no cicatrizante de más de un año de evolución. Debido a la respuesta refractaria a la atención estándar, se añadió oxígeno hiperbárico a baja presión (LPHBOT) al esquema terapéutico (azatriopina 2.5 mg/kg, ácido fólico y ácido acetilsalicílico). Después de 12 sesiones de LHBOT (60 min, 1,45 ATA ≈ 100% O2), las úlceras tuvieron una curación completa con un alivio significativo del dolor y no hubo recurrencia durante 16 meses. Se necesitan más estudios para determinar la eficacia de TOHB para el tratamiento del VL.

Medium-pressure hyperbaric oxygen therapy for livedoid vasculopathy / Terapia de oxigenación hiperbárica de media presión en vasculopatía livedoide

Abstract Livedoid vasculopathy (LV) is a cutaneous manifestation of several diseases that lead to non-inflammatory thrombosis of dermal vessels. We report the case of a 26-year-old female with a 4 years and 8 months-old history of diagnosis of LV and a non-healing ulcer of more than a year of evolution. Because of refractory response to standard care, low-pressure hyperbaric oxygen (LPHBOT) was added to the therapeutic scheme (azathiopine 2.5 mg/kg, folic acid and acetylsalicylic acid). After 12 sessions of LHBOT (60 min, 1.45 ATA ≈100% O2), ulcers achieved complete healing with significant pain relief and no recurrence was present over 6 months. More studies are necessary to determine the effectiveness of HBOT for LV treatment.

Resumen La vasculopatía livedoide (VL) es una manifestación cutánea de varias enfermedades que conducen a una trom bosis no inflamatoria de los vasos dérmicos. Se presenta el caso de una mujer de 26 años con antecedente de diagnóstico de vasculopatía livedoide de 4 años y 8 meses, además de una úlcera no cicatrizante de más de un año de evolución. Debido a la respuesta refractaria a la atención estándar, se añadió oxígeno hiperbárico a baja presión (LPHBOT) al esquema terapéutico (azatriopina 2.5 mg/kg, ácido fólico y ácido acetilsalicílico). Después de 12 sesiones de LHBOT (60 min, 1,45 ATA ≈100% O2), las úlceras tuvieron una curación completa con un alivio significativo del dolor y no hubo recurrencia durante 16 meses. Se necesitan más estudios para determinar la eficacia de TOHB para el tratamiento del VL.

Common femoral artery doppler findings pre and post hyperbaric oxygen therapy for leg ulceration / Achados de doppler da artéria femoral comum antes e depois da oxigenoterapia hiperbárica para úlcera de perna / Hallazgos de doppler de la arteria femoral común antes y después de la terapia con oxígeno hiperbárico para la ulceración de la pierna

Hyperbaric Oxygen Therapy (HBOT) assumes that high pressure hyperoxygenation causes faster tissue recovery and wound healing. Lower extremity flow rates are affected by leg ulcers that change vasodilation, microcirculation resistance, and local tissue demands; how blood hyper oxygenation influences these factors is still unclear. Peripheral arterial occlusive disease (PAOD) has been mostly associated with HBOT results in the femoral artery than in other arteries. Common femoral artery (CFA) peak systolic velocities (PSV), measured pre and post HBOT, were analyzed to research HBOT hemodynamics. Sixteen patients with leg ulcers who were 65 ± 11 (SD) (38-87) years-old, had HBOT of 90 minutes at 2.6 ATA. Bilateral CFA Doppler velocity waveforms were recorded immediately pre and post HBOT. Ulcerated vs non-ulcerated peak systolic velocity (PSV) data were compared using paired t-test. CFA PSV were significantly equal in the ulcerated and non-ulcerated extremities before HBOT: 114 ± 35 (SD) cm/s vs 116 ± 41 cm/s (p = 0.87 by paired t-test). CFA PSV in the ulcerated extremity increased to 122 ± 35 cm/s after HBOT but were statistically insignificant (p =.19 by one-tailed paired t-test). On the other hand, CFA PSV decreased to 103 ± 28 cm/s (p =.049 by one-tailed paired t-test) in the non-ulcerated extremity and were significantly lower after HBOT, with 103 ± 28 cm/s vs 122 ± 35 cm/s for the ulcerated limb (p =.02 by paired t-test). Blood velocity responses post HBOT showed differences between ulcerated vs non-ulcerated extremities. The non-ulcerated extremity apparently responded to oxygenation more than the ulcerated extremity. Such observation suggests further research on hemodynamic reactions caused by HBOT.

A oxigenoterapia hiperbárica (HbOT) assume que a oxigenação de alta pressão resulta em mais celeridade na recuperação do tecido e na cicatrização de feridas. As taxas de fluxo nas extremidades inferiores são afetadas por úlceras nas pernas que alteram a vasodilatação, a resistência da microcirculação e as demandas locais de tecido; esses fatores podem ser influenciados pela hiperoxigenação sanguínea de maneiras ainda não claramente compreendidas. A doença arterial oclusiva periférica femoral (DAOP) tem sido associada a melhores resultados de HBOT quando comparada a outras artérias. As velocidades sistólicas de pico (PSV) da artéria femoral comum (CFA) medidas antes e depois da HBOT foram analisadas como parte de um projeto de pesquisa da hemodinâmica da HBOT. Dezesseis pacientes com úlceras de perna, com idade 65 ± 11 (DP), 38-87 anos, realizaram HBOT com duração de 90 minutos a 2,6 ATA. As formas de onda de velocidade do Doppler CFA bilateral foram registradas imediatamente antes e depois da HBOT. Os dados de PSV ulcerado vs. não ulcerado foram comparados usando o teste t pareado. Pre HBOT CFA PSV não foi significativamente diferente nas extremidades ulceradas e não ulceradas: 114 ± 35 (DP) cm/s vs 116 ± 41 cm/s (p = 0,87 pelo teste t pareado). O PSV pós HbOT CFA na extremidade ulcerada aumentou para 122 ± 35 cm/s, mas não atingiu significância estatística (p = 0,19 pelo teste t pareado unicaudal). Em contraste, CFA PSV na extremidade não ulcerada diminuiu para 103 ± 28 cm/s (p = 0,049 pelo teste t pareado unicaudal). O pós-HbOT CFA PSV foi significativamente menor no membro não ulcerado, 103 ± 28 cm/s vs 122 ± 35 cm/s para o membro ulcerado (p = 0,02 pelo teste t pareado). As respostas da velocidade do sangue após HbOT mostraram diferenças entre as extremidades ulceradas e não ulceradas. Aparentemente, a extremidade não ulcerada respondeu mais significativamente à oxigenação do que a extremidade ulcerada. Tal observação sugere pesquisas adicionais sobre as reações hemodinâmicas decorrentes da HbOT.

La terapia de oxígeno hiperbárico (HbOT) asume que la hiperoxigenación a alta presión da como resultado una recuperación más rápida de los tejidos y una cicatrización de heridas. Las tasas de flujo de las extremidades inferiores se ven afectadas por úlceras en las piernas que alteran la vasodilatación, la resistencia de la microcirculación y las demandas de los tejidos locales; estos factores pueden verse influenciados por la hiperoxigenación de la sangre, de formas que aún no se han entendido con claridad. La enfermedad oclusiva arterial periférica femoral (PAOD) se ha relacionado con los mejores resultados de HbOT que otras arterias. Las velocidades sistólicas máximas (PSV) de la arteria femoral común (CFA) medidas antes y después de la HbOT se analizaron como parte de un proyecto para investigar la hemodinámica de la HbOT. Dieciséis pacientes con úlceras en pierna, 65 ± 11 (DE) (38-87) años, 12 hombres, 11 diabéticos, tenían HbOT de 90 minutos a 2,6 ATA. Se registraron formas de onda de velocidad de CFA Doppler bilaterales inmediatamente antes y después de la HbOT. Se compararon los datos de la velocidad sistólica máxima (PSV) ulcerada frente a la no ulcerada mediante la prueba t pareada. Pre HbOT CFA PSV no fue significativamente diferente en las extremidades ulceradas y no ulceradas: 114 ± 35 (DE) cm/s vs 116 ± 41 cm/s (p = 0,87 por prueba t pareada). Post HbOT CFA PSV en la extremidad ulcerada aumentó a 122 ± 35 cm/s pero no alcanzó significación estadística (p =.19 por prueba t unilateral pareada). En contraste, CFA PSV en la extremidad no ulcerada disminuyó a 103 ± 28 cm/s (p =.049 por prueba t unilateral pareada). El PSV después de la HbOT CFA fue significativamente menor en la extremidad no ulcerada, 103 ± 28 cm/s frente a 122 ± 35 cm/s para la extremidad ulcerada (p = 0,02 según la prueba t pareada). Las respuestas de velocidad sanguínea post HbOT mostraron diferencias entre las extremidades ulceradas y no ulceradas. Aparentemente, la extremidad no ulcerada respondió más significativamente a la oxigenación que la extremidad ulcerada. Tal observación sugiere una mayor investigación sobre las reacciones hemodinámicas debidas a la HbOT.

Photographic tissue characterization applied to relative quantification related to hyperbaric oxygenation of diabetic foot ulceration: technical note / Caracterização tecidual de imagem fotográfica aplicada à quantificação relativa à oxigenação hiperbárica de úlcera de pé diabético: nota técnica / Caracterización de los tejidos de la imagen fotográfica aplicada a la cuantificación relacionada con la oxigenación hiperbárica de la úlcera del pie diabético: nota técnica

Hyperbaric oxygenation (HBO2) is a successful treatment of diabetic foot ulcerations. Research on the characterization of tissue by ultrasonography (CATUS) or by imaging (CATIM) has grown. We investigated the photographic pCATIM feasibility to quantitate HBO2 effects. Besides, we analyzed pre and post HBO2 treatment photographs quantitatively based on pixel brightnesses of gray-scale imaging versions. Grayscale Medians (GSM) for (1) entire ulceration, (2) inner core, (3) ulceration border, and (4) adjacent skin decreased from 92 to 77, 60 to 56, 105 to 101, and 105 to 90. Entire ulceration post-HBO2 pixel percentages were lower in the 112-153 intervals, 11% vs 29% (p = .0013 by Chi-square), and higher in the 41-111 brightness range, 87% vs 68% (p = .0008). A case report showed quantifiable relative changes detected by pCATIM post HBO2 treatment of diabetic foot ulceration. Further investigation may quantify brightness variabilities and/or specific GSM for ulceration and skin regions.

A oxigenioterapia hiperbárica (HBO2) tem sido um tratamento de sucesso para úlceras do pé diabético, enquanto cresce o número de pesquisas caracterizando o tecido por meio de ultrassonografia (Catus) ou imagem (Catim) ­ sendo que a pCatim torna viável quantificar os efeitos da oxigenioterapia hiperbárica. Fotografias do pré e pós tratamento foram analisadas quantitativamente com base em brilhos de pixel de versões de imagens em escala de cinza. Houve redução das medianas da escala de cinza (gray scale medians ­ GSM) para (1) ulceração inteira, de 92 para 77; (2) núcleo interno, de 60 para 56; (3) borda da ulceração, de 105 para 101; e (4) pele adjacente, de 105 para 90. Na úlcera completa, após a HBO2, as porcentagens de pixels foram menores nos intervalos 112-153 (11% contra 29%, p = 0,0013 por qui-quadrado) e maiores na faixa de brilho 41-111 (87% contra 68%, p = 0,0008). Um relato de caso demonstrou mudanças relativas quantificáveis detectadas por pCatim após o tratamento com HBO2 de uma úlcera do pé diabético, e investigações mais aprofundadas podem quantificar as variabilidades de brilho e/ou GSM específicas para cada ulceração e regiões da pele.

La oxigenación hiperbárica (HBO2) ha sido un tratamiento exitoso de las ulceraciones del pie diabético. Ha crecido la investigación sobre la caracterización de tejidos por ecografía (CATUS) o por imágenes (CATIM). Se investigó la viabilidad fotográfica de pCATIM para cuantificar los efectos de HBO2. Las fotografías anteriores y posteriores al tratamiento con HBO2 se analizaron cuantitativamente en función del brillo de los píxeles de las versiones de imágenes en escala de grises. Medianas de escala de grises (GSM) para (1) ulceración completa, (2) núcleo interno, (3) borde de ulceración y (4) piel adyacente disminuyeron de 92 a 77, 60 a 56, 105 a 101 y 105 a 90, respectivamente. En la ulceración completa, después de HBO2, los porcentajes de píxeles fueron más bajos en los intervalos 112-153, 11% vs 29% (p = .0013 por Chi-cuadrado) y más altos en el rango de brillo 41-111, 87% vs 68% (p = .0008). Un informe de caso demostró cambios relativos cuantificables detectados por pCATIM después del tratamiento con HBO2 de una ulceración del pie diabético. Una investigación adicional puede cuantificar las variaciones de brillo y o GSM específico para ulceraciones y regiones de la piel.

Hyperbaric oxygen therapy in the adjuvant treatment of cutaneous manifestations in dermatomyositis: a case report / Oxigenioterapia hiperbárica adjuvante ao tratamento da manifestação cutânea da dermatomiosite: relato de caso / La oxigenoterapia hiperbárica en el tratamiento adyuvante de las manifestaciones cutáneas en la dermatomiositis: reporte de un caso

Cutaneous manifestations of dermatomyositis are unusual and difficult to treat. This study aimed to report a case of cutaneous manifestations of dermatomyositis treated with hyperbaric oxygen. We present a case of dermatomyositis in a 44-year-old female with pain ulcers in her left leg for 17 months, refractory to an exclusive clinical treatment, who underwent a hyperbaric oxygen therapy (HBOT) breathing O2 100%, 90 minute sessions, six days a week, at 2.4 ATA. HBOT therapy proved to be highly efficacious in wound healing in this case and HBOT should be considered as a treatment in the assistance given to such patients.

Manifestações cutâneas da dermatomiosite são raras e difíceis de ser tratadas. O objetivo deste estudo é relatar um caso de manifestações cutâneas da dermatomiosite tratadas com oxigenioterapia hiperbárica, ocorrido em uma paciente de 44 anos, sexo feminino, com úlceras dolorosas em seu membro inferior esquerdo por 17 meses. O caso foi refratário ao tratamento clínico exclusivo e a paciente submetida a tratamento de oxigenioterapia hiperbárica (HBOT), respirando oxigênio a 100%, em sessões de noventa minutos, seis dias por semana, a 2,4 ATA. O HBOT mostrou ser altamente eficaz na cicatrização da lesão neste caso e deve ser um tratamento considerado no cuidado desses pacientes.

Las manifestaciones cutáneas de la dermatomiositis son inusuales y difíciles de tratar. El objetivo de este estudio fue reportar un caso de manifestaciones cutáneas de dermatomiositis tratadas con oxigenoterapia hiperbárica. Presentamos un caso de dermatomiositis en una mujer de 44 años con úlceras dolorosas en su pierna izquierda durante 17 meses, refractaria a un tratamiento clínico exclusivo, que se sometió a oxigenoterapia hiperbárica (HBOT) respirando O2 100%, sesiones de 90 minutos, seis días a la semana, a 2,4 ATA. La terapia con HBOT demostró ser muy eficaz en la cicatrización de heridas en este caso y la HBOT debe considerarse como un tratamiento en la asistencia brindada a estos pacientes.

Therapeutic approach to electric burn with platelet rich plasma, grafts and hyperbaric oxygenation / Enfoque terapéutico de quemadura eléctrica con plasma rico en plaquetas, injertos y oxigenación hiperbárica

Abstract Contact electrical burns are more severe than other forms of contact burn injury. Moreover, treatment of hand burns is an important therapeutic challenge. We present a 17 year-old female of low voltage electric hand injury, admitted 5 days after injury. The patient was treated with autologous platelet rich plasma, porcine dermis heterograft and partial autologous skin graft, all of them with hyperbaric oxygen therapy (HBOT) at 1.45 ATA ≈100% O2 like adjuvant therapy. Good evolution and acceptable aesthetic results were reported. Although more studies are required, we suggest that multi-therapeutic approach could be effective in treatment for electric burns in hands.

Resumen Las quemaduras eléctricas por contacto son más graves que otras formas de quemaduras. Además, el tratamiento de las mismas en las manos es un importante desafío terapéutico. Presentamos el caso de una mujer de 17 años de edad con lesión en la mano por quemadura por electricidad de baja tensión. Fue ingresada 5 días después de la lesión y tratada con plasma rico en plaquetas autólogo, heteroinjerto de dermis porcina e injerto de piel autólogo parcial, todo con oxigenoterapia hiperbárica (TOHB) a 1.45 ATA ≈100% O2 como terapia adyuvante. Tuvo buena evolución y resultados estéticos aceptables. Aunque se requieren más estudios, sugerimos que el enfoque multi-terapéutico podría ser eficaz en el tratamiento de las quemaduras eléctricas en las manos.

Hyperbaric oxygen therapy in the treatment of pneumocephalus associated with epidural block: case report.

INTRODUCTION: Pneumocephalus is a rare neuraxial blockade complication, which can be associated with severe neurologic changes. CLINICAL CASE: A 51-year-old patient was submitted to left total knee arthroplasty. Postoperatively, a pneumocephalus associated with decreased consciousness was diagnosed as a complication of the epidural analgesia. The treatment used was Hyperbaric Oxygen Therapy (HBOT) due to the severity of symptoms. Just after one session of HBOT, there was nearly full pneumocephalus resorption and significant clinical recovery. CONCLUSION: This case report enables anesthesiologists to recognize HBOT as a therapeutic option to be considered when treating severe cases of pneumocephalus.

Therapeutic approach to electric burn with platelet rich plasma, grafts and hyperbaric oxygenation.

Contact electrical burns are more severe than other forms of contact burn injury. Moreover, treatment of hand burns is an important therapeutic challenge. We present a 17 year-old female of low voltage electric hand injury, admitted 5 days after injury. The patient was treated with autologous platelet rich plasma, porcine dermis heterograft and partial autologous skin graft, all of them with hyperbaric oxygen therapy (HBOT) at 1.45 ATA "100% O2 like adjuvant therapy. Good evolution and acceptable aesthetic results were reported. Although more studies are required, we suggest that multi-therapeutic approach could be effective in treatment for electric burns in hands.

Las quemaduras eléctricas por contacto son más graves que otras formas de quemaduras. Además, el tratamiento de las mismas en las manos es un importante desafío terapéutico. Presentamos el caso de una mujer de 17 años de edad con lesión en la mano por quemadura por electricidad de baja tensión. Fue ingresada 5 días después de la lesión y tratada con plasma rico en plaquetas autólogo, heteroinjerto de dermis porcina e injerto de piel autólogo parcial, todo con oxigenoterapia hiperbárica (TOHB) a 1.45 ATA "100% O2 como terapia adyuvante. Tuvo buena evolución y resultados estéticos aceptables. Aunque se requieren más estudios, sugerimos que el enfoque multi-terapéutico podría ser eficaz en el tratamiento de las quemaduras eléctricas en las manos.

Tratamiento de Oxigenación Hiperbárica en Heridas Complejas / Hyperbaric Oxygen Therapy for Complex Wounds

RESUMEN El tratamiento de oxigenación hiperbárica (TOHB) a presiones de tratamiento mayores a 2 ATA (respirando concentraciones cercanas al 100% O2) se encuentra ampliamente descripto para el tratamiento de heridas. Se presentan 6 casos de heridas no cicatrizantes tratadas con TOHB a 1,45 ATA como tratamiento coadyuvante. Estudios observacionales y ensayos clínicos aleatorizados son necesarios para confirmar la eficacia e instaurar esta modalidad de oxigenación hiperbárica en las diferentes heridas crónicas.

ABSTRACT Hyperbaric Oxygen Therapy (HBOT) at pressures above 2 ATA (breathing near 100% O2) is widely described for wounds treatment. We present 6 cases of non-healing wounds treated with HBOT at 1.45 ATA, treatment as coadjutant treatment. Observational studies and randomized clinical trials are necessary to confirm the efficacy and establish this hyperbaric oxygenation modality in chronic wounds treatment.