Alterações cardiorrespiratórias de pacientes submetidos à oxigenoterapia hiperbárica / Alteraciones cardiorrespiratorias de pacientes sometidos a la oxigenoterapia hiperbárica / Cardiorespiratory alterations in patients undergoing hyperbaric oxygen therapy

RESUMO Objetivo Avaliar modificações cardiorrespiratórias em decorrência de sessão única de oxigenoterapia hiperbárica. Método Estudo aleatorizado com pacientes: grupos-controle e oxigenoterapia hiperbárica. As avaliações ocorreram no início, durante e após a exposição ao oxigênio puro acima de uma atmosfera, durante 2 horas. A pressão arterial sistêmica, saturação periférica de oxigênio, frequência de pulso, volume e capacidade pulmonar, pressões inspiratória e expiratória máximas foram avaliadas. A saturação periférica de oxigênio, frequência de pulso e pressão arterial sistêmica foram avaliadas durante a pressurização na primeira hora. Os dados foram avaliados pelo teste de ANOVA, Mann-Whitney e teste t independente (p<0,05). Resultados Foram avaliados 14 pacientes adultos. No grupo sob terapia (sete sujeitos), idade: 49,57±14,59 anos houve redução da frequência de pulso de 16 batimentos por minuto após 35 minutos de terapia (análise intragrupo), e a saturação periférica de oxigênio foi maior neste mesmo período se comparado ao grupo-controle. Conclusão A oxigenoterapia hiperbárica promove alterações cardiorrespiratórias com o aumento da saturação periférica de oxigênio e redução da frequência de pulso, sem alterar os níveis pressóricos arteriais e a força, volumes e capacidades respiratórios.

RESUMEN Objetivo Evaluar modificaciones cardiorrespiratorias consecuentes de sesión única de oxigenoterapia hiperbárica. Método Estudio aleatorizado con pacientes: grupos de control y oxigenoterapia hiperbárica. Las evaluaciones ocurrieron en el inicio, durante y después de la exposición al oxígeno puro por encima de una atmósfera, durante dos horas. La presión arterial sistémica, saturación periférica de oxígeno, frecuencia de pulso, volumen y capacidad pulmonar, presiones inspiratoria y espiratoria máximas fueron evaluadas. La saturación periférica de oxígeno, frecuencia de pulso y presión arterial sistémica fueron evaluadas durante la presurización en la primera hora. Los datos fueron evaluados por el test de ANOVA, Mann Whitney y prueba t independiente (p<0,05). Resultados Fueron evaluados 14 pacientes adultos. En el grupo bajo terapia (siete sujetos), edad: 49,57±14,59 años, hubo reducción de la frecuencia de pulso de 16 latidos por minuto tras 35 minutos de terapia (análisis intragrupo), y la saturación periférica de oxígeno fue mayor en ese mismo período si comparado con el grupo de control. Conclusión La oxigenoterapia hiperbárica proporciona alteraciones cardiorrespiratorias con el aumento de la saturación periférica de oxígeno y la reducción de la frecuencia de pulso, sin alterar los niveles de presión arteriales y la fuerza, volúmenes y capacidades respiratorios.

ABSTRACT Objective To evaluate cardiorespiratory alterations due to a single session of hyperbaric oxygen therapy. Method Randomized study with patients: a control group and hyperbaric oxygen therapy. Evaluations occurred in the beginning, during, and after exposure to pure oxygen above atmosphere for 2 hours. Systemic blood pressure, peripheral oxygen saturation, pulse rate, lung volume and lung capacity, and maximal inspiratory and expiratory pressures were evaluated. Peripheral oxygen saturation, pulse rate, and systemic blood pressure were evaluated during the pressurizing in the first hour. Data were evaluated by means of ANOVA, Mann-Whitney, and independent t-test (p<0.05). Results A total of 14 adult patients were evaluated. In the group under therapy (seven subjects), aged: 49.57±14.59 years, there was a decrease in the pulse rate of 16 beats per minute after 35 minutes of therapy (intragroup analysis), and the peripheral oxygen saturation was higher within the same period compared to the control group. Conclusion The hyperbaric oxygen therapy promotes cardiorespiratory alterations with the increase of the peripheral oxygen saturation and decrease of the pulse rate, without altering blood pressure levels and the strength, volumes, and respiratory capacities.

[Hyperbaric oxygen therapy, a little-known discipline]. / L'oxygénothérapie hyperbare, une discipline peu connue.

There are two types of indications of hyperbaric oxygen therapy: it may be used as an emergency treatment in certain acute pathologies or as a therapy for chronic long-term pathologies. The indications are regularly updated and assessed through consensus conferences.

[Hyperbaric medicine and emergency medicine, an example of decompression sickness in diving]. / Hyperbarie et médecine d'urgence, exemple de l'accident de désaturation en plongée.

One of the reasons for the emergency use of a hyperbaric chamber concerns a diving-related accident. Decompression sickness is potentially serious; it requires urgent treatment and hyperbaric recompression. It is caused by the formation of nitrogen bubbles in the organism which appear during the diver's ascent and throughout his or her decompression.

[Nursing care of a patient admitted to a hyperbaric chamber for a chronic wound]. / Prise en charge infirmière d'un patient admis au caisson hyperbare pour une plaie chronique.

The hyperbaric chamber is a particularly relevant therapy for the healing of chronic wounds such as radiation-induced wounds, ulcers, diabetic foot or osteomyelitis. This article describes the pathway of a patient with a chronic wound from the perspective of a hyperbaric medicine nurse.

[The hyperbaric chamber, a hostile working environment]. / Le caisson hyperbare, un milieu de travail plutôt hostile.

Nursing practice in the hyperbaric environment draws on very specific skills. This setting, which is presented as a therapeutic tool in a range of indications, is also a hostile care environment for health professionals. A team from Lyon reveals the characteristics of nursing practice in a hyperbaric chamber.

[Hypnoanalgesia, a complementary therapy for painful care procedures]. / L'hypno-analgésie, une offre complémentaire pour les soins douloureux.

In the framework of the management of patients receiving hyperbaric oxygen therapy, hypnoanalgesia is a complementary pain management tool, notably during the changing of dressings. Trained in this management of care-related pain, the teams of the hypebaric medicine centre in Lyon share their experience.

[Immersion in the world of hyperbaric medicine with two specialist nurses]. / Immersion dans le monde de l'hyperbarie avec deux infirmiers spécialisés.

The speciality of the hyperbaric nurse, whether practised in the civil or military setting, has a wide-reaching scope. Two teams of professionals from Lyon and Toulon share their motivations and demonstrate, through the words of two nurses, a real collective passion for this original and highly technical practice.

O enfermeiro do trabalho na identificação dos riscos ocupacionais em medicina hiperbárica / La enfermera del trabajo en la identificación de riesgos laborales en medicina hiperbárica / The nurse's work on identification of occupational risks in hyperbaric medicine

Objective: to elaborate the risk map; identify the occupational risks to workers in a clinical of hyperbaric medicine, to describe actions/ preventive measures for the nurse's work to reduce the risks. Method: This is a descriptive and an exploratory study, with a qualitative approach. The risk map was developed using the Adobe Illustrator CS3, after authorization. Results: the work of professionals in clinical of Hyperbaric Medicine is enveloped in several occupational risk factors, highlighting the probability of fire or explosion that can cause harm to workers' health and even death. The nurse's work could act guiding / educating workers about the importance of using strategies to remove / keep away from all sources of ignition in the presence of oxygen. Conclusion: The preparation of the risk map is of paramount importance for the diagnosis of occupational risks and, therefore, the planning of preventive measures aimed at promoting the health of workers in this area.

Objetivo: elaborar o mapa de risco; identificar os riscos ocupacionais ao trabalhador da clínica de medicina hiperbárica; descrever ações/ medidas preventivas do enfermeiro do trabalho para minimizar os riscos existentes. Método: estudo descritivo e exploratório com abordagem qualitativa. O mapa de riscos foi elaborado utilizando-se o programa Adobe Illustrator CS3, após autorização. Resultados: o trabalho dos profissionais nas clínicas de Medicina Hiperbárica está envolto em vários fatores de risco ocupacional, destacando-se a probabilidade de incêndio ou explosão que podem ocasionar danos à saúde dos trabalhadores e até mesmo a morte. O enfermeiro do trabalho pode atuar orientando/educando os trabalhadores quanto à importância de utilização de estratégias para eliminar/manter afastadas todas as fontes de ignição na presença de oxigênio. Conclusão: a elaboração do mapa de riscos é de primordial importância para o diagnóstico dos riscos ocupacionais e conseqüentemente para o planejamento de medidas preventivas, visando à promoção da saúde dos trabalhadores.

Objetivo: elaborar el mapa de riesgos; identificar los riesgos laborales a los trabajadores en una clínica de Medicina Hiperbárica; describir las acciones y medidas preventivas para el trabajo de la enfermera para reducir los riesgos. Método: estudio descriptivo y exploratorio con un enfoque cualitativo. El mapa de riesgo fue desarrollado usando el Adobe Illustrator CS3, con previa autorización. Resultados: el trabajo de los profesionales en las clínicas de Medicina Hiperbárica está envuelto en varios factores de riesgo laboral, destacando la probabilidad de incendio o explosión que puede causar daño a la salud de los trabajadores e incluso la muerte. La enfermera debe educar a los trabajadores sobre la importancia de la utilización de estrategias para eliminar toda fuente de ignición en presencia de oxígeno. Conclusión: La preparación del mapa de riesgos es de suma importancia para el diagnóstico de riesgos laborales y por lo tanto la planificación de medidas preventivas encaminadas a la promoción de la salud de los trabajadores.

Hyperbaric nursing.

The varied clinical applications for hyperbaric oxygen therapy have led to the development of a unique, highly skilled nursing specialty of hyperbaric nursing. The ever-increasing availability of hyperbaric medicine and the broadening scope of clinical indications have fueled the need for highly skilled hyperbaric nurses.

The use of deep tables in the treatment of decompression illness: the Hyperbaric Technicians and Nurses Association 2011 Workshop.

In August 2011, a one-day workshop was convened by the South Pacific Underwater Medicine Society and the Hyperbaric Technicians and Nurses Association to examine the use of deep recompression treatment tables for the treatment of decompression illness in Australia and New Zealand. The aim of the workshop was to develop a series of consensus statements to guide practice around the region. The workshop chose to focus the discussion on the use of 405 kPa (30 msw) maximum depth tables using helium-oxygen breathing periods, and covered indications, staffing and technical requirements. This report outlines the evidence basis for these discussions and summarises the series of consensus statements generated. These statements should assist hyperbaric facilities to develop and maintain appropriate policies and procedures for the use of such tables. We anticipate this work will lead to the formulation of a standard schedule for deep recompression to be developed at a future workshop.

Cuidado enfermero en hiperoxigenoterapia hiperbárica / Nursing care in hyperbaric oxygen therapy

Surgida dentro del ámbito del buceo para tratar casos de descompresión, la medicina hiperbárica se utiliza cada vez más por sus excelentes efectos terapéuticos en enfermedades refractarias a los tratamientos médicos y quirúrgicos habituales. La oxigenoterapia hiperbárica (OHB), como se denomina comúnmente, se aplica en el interior de una cámara que permite la administración de oxígeno en ambiente presurizado. Las patologías tratadas en cámara hiperbárica tienen como común denominador algún grado de hipoxia y el oxígeno presurizado actúa como un auténtico fármaco produciendo diferentes respuestas en función de las dosis y los tiempos de administración y garantizando unos niveles de oxigenación imposibles de conseguir por otros métodos. Este servicio requiere personal especialmente cualificado para su correcto funcionamiento. El propósito de este trabajo es dar a conocer el papel que desempeña una enfermera en este servicio y la especificidad del cuidado enfermero de pacientes con este tratamiento (AU)

Hyperbaric medicine emerged from diving to treat decompression, and is being used more and more frequently due to its excellent therapeutic effects in treatments that do not respond to the usual medical and surgical treatments.Hyperbaric oxygen therapy (HBOT), as it is commonly called, is applied inside a chamber that makes it possible to administer oxygen in a pressurised environment. The pathologies treated in a hyperbaric chamber share some degree of hypoxia and the pressurised oxygen acts as a true drug, producing different responses depending on the dose and administration times, and ensuring oxygen levels that are impossible to obtain using other methods. This service requires highly qualified personnel for its proper functioning. The aim of this project is to shed light on the nurse’s role in this service and the specificity of nursing care of patients undergoing this treatment (AU)

[Legal issues of Brazilian hyperbaric nursing: why regulate?]. / Aspectos legais da enfermagem hiperbárica brasileira: por que regulamentar?

This study aimed to show the needs to standardize nursing care related to hyperbaric oxygenation and regulate working conditions for nursing staff that works on this area. They approach the legislation at the Brazilian Society of Hyperbaric Medicine, on Brazilian Chapter of the Undersea and Hyperbaric Medical Society, on Regulating Rules of the Ministry of Labor and on the Code of Ethics of Nursing Professionals, as instruments still insufficient to legalize the Hyperbaric Nurse, its procedures in hyperbaric conditions and pressurized environments. It allowed pondering on the disclosure of the state of art of hyperbaric nursing, as well as the incorporation of this activity in relation to the specialties on the COFEN Resolution 290/2004 and postgraduate courses in Nursing.

Aspectos legais da enfermagem hiperbárica brasileira: por que regulamentar? / Aspectos legales de la enfermería hiperbárica brasileña: ¿por que reglamentar? / Legal issues of Brazilian hyperbaric nursing: why regulate?

Este estudo objetivou apontar as necessidades de normatizar a assistência de enfermagem relacionada à oxigenação hiperbárica e regulamentar as condições de trabalho para a equipe de enfermagem que atua nessa área. Aborda-se a legislação existente na Sociedade Brasileira de Medicina Hiperbárica, no Capítulo Brasileiro da Undersea Hyperbaric Medical Society, nas Normas Reguladoras do Ministério do Trabalho e no Código de Ética dos Profissionais de Enfermagem, como instrumentos ainda insuficientes para legalização do Enfermeiro Hiperbárico e de seus procedimentos nas condições hiperbáricas e ambientes pressurizados. Permitiu refletir quanto a divulgação do estado da arte da enfermagem hiperbárica, bem como a incorporação dessa atividade na relação de especialidades constantes da Resolução COFEN 290/2004 e de cursos de pós-graduação em Enfermagem.

This study aimed to show the needs to standardize nursing care related to hyperbaric oxygenation and regulate working conditions for nursing staff that works on this area. They approach the legislation at the Brazilian Society of Hyperbaric Medicine, on Brazilian Chapter of the Undersea and Hyperbaric Medical Society, on Regulating Rules of the Ministry of Labor and on the Code of Ethics of Nursing Professionals, as instruments still insufficient to legalize the Hyperbaric Nurse, its procedures in hyperbaric conditions and pressurized environments. It allowed pondering on the disclosure of the state of art of hyperbaric nursing, as well as the incorporation of this activity in relation to the specialties on the COFEN Resolution 290/2004 and postgraduate courses in Nursing.

Este estudio objetivó apuntar necesidades de normalizar la atención de enfermería relacionada con la oxigenación hiperbárica y regular condiciones de trabajo para el equipo de enfermería de esta área. Se abarca la legislación existente en la Sociedad Brasileña de Medicina Hiperbárica, capitulo Brasileño de la Undersea Hyperbaric Medical Society, en las Normas Reguladoras del Ministerio del Trabajo y en el Código de Ética de los Profesionales de Enfermería, como instrumentos aún insuficientes para legalizar el enfermero Hiperbárico, sus procedimientos en condiciones hiperbáricas y ambientes presurizados. Permitió reflejar sobre la difusión del estado del arte de la enfermería hiperbárica, así como incorporación de esta actividad en la relación de las especialidades que están en la Resolución COFEN 290/2004 y cursos de postgrado en enfermería.

Produção do conhecimento na área hiperbárica: principais doenças associadas ao mergulho profissional / Producción del conocimiento en el área hyperbaric: asociados principales de las enfermedades al buceo profesional / Production of the knowledge in the hyperbaric area: main illnesses associates to the professional diving

Descrever as principais doenças descompressivas e barotraumas que acometem mergulhadores profissionais e seus respectivos tratamentos. Método: Pesquisa bibliográfica, com características descritivoanalíticas. A seleção de textos se deu a partir da leitura dos resumos encontrados, tendo como critérios à relevância e adequação do estudo em questão. Resultados: As patologias mais comumente relacionadas ao mergulho são a doença da descompressão e o barotrauma. A oxigenação hiperbárica é utilizada como tratamento para cura e reparação do dano produzido pela pressão aumentada. Conclusão: A importância da produção do conhecimento científico das doenças relacionadas ao mergulho se deve a sua letalidade e crescente incidência, visto que os acidentes marinhos oriundos do trabalho subaquático acontecem com frequência. Apontamos como relevância para as práticas de enfermagem o saber em áreas ainda pouco exploradas, para que possa aprimorar sua assistência no que diz respeito à prevenção de acidentes e a uma assistência qualificada em seu grau de complexidade, em caso de ocorrência.

Describe the main descompression illnesses and barotraumas that involve professional divers and their respective treatments. Method: Bibliographical research, with analytical descriptive characteristics. The selection of the texts came from the reading of some published abstract, taking account for the relevance and adequacy of the study in question. Results: The most common pathology related to the diving is the decompression illness and the barotrauma. The hyperbaric oxygenation is used as treatment to cure the damage caused by the increased pressure. Conclusion: The importance of the scientific knowledge production related to the diving illness occurs because of its lethality and increasing incidence, since marine accidents have happened frequently. To the practice of nursery, we can say that it’s really relevant the knowledge in fields which have not been studied deeply in order to improve its care so that accidents can be avoided and also a qualified care in a high complexity degree, if it happens (occurs).

Describir las principales enfermedades descompresión y barotraumas que afectan a los buzos profesionales y sus tratamientos. Métodos: Investigación bibliográfica, con características descripciónanalíticas. La selección de textos fue para empezar a leer los resúmenes encontrados, teniendo como criterios la pertinencia y adecuación del estudio en cuestión. Resultados: Las enfermedades más comunes relacionados con el buceo es la enfermedad de descompresión y barotrauma. La oxigenación hyperbaric se utiliza como tratamiento para la curación y la reparación de los daños causados por el aumento de la presión. Conclusión: La importancia de la producción de conocimiento científico de las enfermedades relacionadas con el buceo debido a su creciente incidencia y mortalidad, mientras que los accidentes marítimos que surgen del trabajo subacuático ocurren con frecuencia. Señalamos la importancia de la práctica de los conocimientos de enfermería en las zonas aún no exploradas, para que pueda mejorar su asistencia en relación con la prevención de accidentes y de asistencia calificada en su grado de complejidad, en caso de la ocurrencia.

Oxygen: the two-faced elixir of life.

Take a moment and consider our planet without oxygen. Imagine the earth some 2.5 billion years ago when oxygen first appeared as a waste product of early anaerobes. Oxygen, as we know it today, is essential for life. Abundant and relatively inexpensive to manufacture, oxygen has widespread use in industry and healthcare. Anesthesia providers routinely administer oxygen in concentrations exceeding that in ambient air to ensure clinical safety and to offset the predictable sequelae associated with patient, drug-related, and procedural factors. Understanding the history of this unique element is critical in evaluating the often contentious body of contemporary research that has illuminated its efficacy (as elixir) and its attendant complications (its "two-faced" nature). Of particular interest is its role in free radical formation as etiogenic in developing complications. Oxygen is a mainstay in the perioperative management of patients, but its administration should be guided by thoughtful and rational goal-directed outcomes to maximize efficacy and minimize complications associated with its use.

An exploration of patients' memories and experiences of hyperbaric oxygen therapy in a multiplace chamber.

AIMS AND OBJECTIVES: To examine patients' memories and experiences of hyperbaric oxygen therapy in a multiplace chamber of a hyperbaric medicine unit in Australia. BACKGROUND: There is minimal literature available documenting patients' feelings and memories of hyperbaric oxygen therapy, particularly in a multiplace chamber. DESIGN: Exploratory. METHODS: A convenience sample of seven non-emergency patients was interviewed separately at the conclusion of their multi-session therapy. A semi-structured approach elicited in-depth information regarding their experiences and memories of the hyperbaric oxygen therapy. Interviews were 30-45 minutes long and audiotaped for transcription and analysis. Field notes were also used to note non-verbal cues and other observations not evident from the audio material. Data collection ceased when data saturation was evident from the interviews. Interview transcripts were examined using a content analysis approach, with textual coding and thematic development. RESULTS: Issues derived from the data included: the uncertainty of the treatment; the noise and cold of the chamber; the discomfort of the mask or hood; and the boredom. Participant responses to the therapy related to previous noxious experiences and the individual's personality. CONCLUSIONS: This information was used to examine ways of reducing any negative feelings and experiences associated with hyperbaric oxygen therapy, thus improving the service provided to patients. RELEVANCE TO CLINICAL PRACTICE: Identification of these stressors and related issues may also enable subsequent development of a risk-stratification instrument to predict patients who do not complete treatment.