Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.173
Filtrar
1.
Diving Hyperb Med ; 49(4): 245-252, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31828742

RESUMO

INTRODUCTION: A temporary myopic shift is a well-recognized complication of hyperbaric oxygen treatment (HBOT). Oxidation of proteins in the crystalline lens is the likely cause. Direct exposure of the eye to hyperbaric oxygen may exacerbate the effect. Our aim was to measure the magnitude of the myopic shift over a course of HBOT when using two different methods of oxygen delivery. METHODS: We conducted a randomised trial of oxygen delivery via hood versus oronasal mask during a course of 20 and 30 HBOT sessions. Subjective refraction was performed at baseline and after 20 and 30 sessions. We repeated these measurements at four and 12 weeks after completion of the course in those available for assessment. RESULTS: We enrolled 120 patients (mean age 57.6 (SD 11.2) years; 81% male). The myopic shift was significantly greater after both 20 and 30 sessions in those patients using the hood. At 20 treatments: refractory change was -0.92 D with hood versus -0.52 D with mask, difference 0.40 D (95% CI 0.22 to 0.57, P < 0.0001); at 30 treatments: -1.25 D with hood versus -0.63 with mask, difference 0.62 D (95% CI 0.39 to 0.84, P < 0.0001). Recovery was slower and less complete in the hood group at both four and 12 weeks. CONCLUSIONS: Myopic shift is common following HBOT and more pronounced using a hood system than an oronasal mask. Recovery may be slower and less complete using a hood. Our data support the use of an oronasal mask in an air environment when possible.


Assuntos
Oxigenação Hiperbárica , Miopia , Feminino , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigenação Hiperbárica/instrumentação , Oxigenação Hiperbárica/métodos , Masculino , Máscaras , Pessoa de Meia-Idade , Miopia/etiologia , Oxigênio/administração & dosagem
2.
Diving Hyperb Med ; 49(3): 154-160, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31523789

RESUMO

BACKGROUND: The risk of oxygen toxicity has become a prominent issue due to the increasingly widespread administration of hyperbaric oxygen (HBO) therapy, as well as the expansion of diving techniques to include oxygen-enriched gas mixtures and technical diving. However, current methods used to calculate the cumulative risk of oxygen toxicity during an HBO exposure i.e., the unit pulmonary toxic dose concept, and the safe boundaries for central nervous system oxygen toxicity (CNS-OT), are based on a simple linear relationship with an inspired partial pressure of oxygen (PO2) and are not supported by recent data. METHODS: The power equation: Toxicity Index = t2 × PO2c, where t represents time and c represents the power term, was derived from the chemical reactions producing reactive oxygen species or reactive nitrogen species. RESULTS: The toxicity index was shown to have a good predictive capability using PO2 with a power c of 6.8 for CNS-OT and 4.57 for pulmonary oxygen toxicity. The pulmonary oxygen toxicity index (PO2 in atmospheres absolute, time in h) should not exceed 250. The CNS-OT index (PO2 in atmospheres absolute, time in min) should not exceed 26,108 for a 1% risk. CONCLUSION: The limited use of this toxicity index in the diving community, after more than a decade since its publication in the literature, establishes the need for a handy, user-friendly implementation of the power equation.


Assuntos
Doenças do Sistema Nervoso Central/induzido quimicamente , Oxigenação Hiperbárica , Hiperóxia , Pneumopatias/induzido quimicamente , Oxigênio/toxicidade , Sistema Nervoso Central , Mergulho/fisiologia , Humanos , Oxigenação Hiperbárica/efeitos adversos , Pressão Parcial
3.
Diving Hyperb Med ; 49(3): 167-174, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31523791

RESUMO

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.


Assuntos
Oxigenação Hiperbárica , Convulsões/epidemiologia , Perda Auditiva Súbita , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigênio/efeitos adversos , Estudos Retrospectivos , Convulsões/etiologia
4.
Undersea Hyperb Med ; 46(4): 437-445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509900

RESUMO

Introduction: To determine if hyperbaric oxygen (HBO2) therapy has an effect on diabetic blood glucose levels (BGL) and, if so, the extent of this effect. Also, to examine factors that exacerbate any observed effect. Methods: This was a retrospective review of prospectively collected quality data on diabetics undergoing HBO2. Pre- and post-treatment BGL were recorded. Pre-treatment BGL ⟨120 mg/dL received glucose supplementation. Hypoglycemia was defined as BGL ⟨70 mg/dL. BGL ⟨90 mg/dL was included as an elevated hypoglycemia threshold. Results: 77 patients representing 1,825 treatments were included for analysis. No patient had deleterious side effects or required emergency care. BGL decreased in 75.4% of treatments in this group, with a median decrease of 25 mg/dL (IQR=54 mg/dL; range of decreased 374 mg/dL to increased 240 mg/dL). A statistically significant greater percentage of treatments of patients with type 2 diabetes resulted in a decrease in BGL (1598 or 77.5%) compared to treatments of patients with type 1 diabetes (169 or 51.5%) (χ2(1, N=1767) =55.37, p⟨0.001). 1.1% of treatments had post-HBO2 serum glucose ⟨90 mg/dL, and 0.2% of treatments had post-HBO2 serum glucose ⟨70 mg/dL. The majority (70%) of patients with post-HBO2 BGL ⟨90 mg/dL were maintained on insulin alone (χ2(2, N=20) =12.4, p=0.002). Well-controlled diabetics (i.e., those with all BGLs within 50 mg/dL over all pre-HBO2 treatments) had no post-HBO2 BGL ⟨70 mg/dL or ⟨90 mg/dL. Conclusion: Our results suggest that HBO2 does not cause a clinically significant decrease in diabetic patient BGL. No patient in our study had deleterious side effects or required emergency care. We found that glucose level of ⟨90 mg/dL occurred more often in those who use insulin. Hyperbaric patients who exhibit consistent BGL values may represent a group who could be managed similarly to the non-diabetic population.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Oxigenação Hiperbárica , Idoso , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigenação Hiperbárica/estatística & dados numéricos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Estudos Retrospectivos , Esteroides/efeitos adversos
5.
Undersea Hyperb Med ; 46(4): 467-481, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509903

RESUMO

Introduction/Background: The incidence of complications and number of critically ill patients in hyperbaric medicine is relatively low [1]. This poses a challenge to those tasked with educating trainees as well as maintaining the skills of staff. Hyperbaric medicine fellows may not be exposed to critical patient scenarios or complications of hyperbaric medicine during a one-year fellowship. Additional staff may be unfamiliar with these situations as well. The purpose of hyperbaric simulation curriculum is to train health care providers for rare situations. To our knowledge, this hyperbaric simulation curriculum is the first published use of simulation education in the specialty of undersea and hyperbaric medicine. Materials and Methods: Two simulation cases have been developed that involve a patient with oxygen toxicity during hyperbaric treatment as well as an ICU patient with mucous plugging. Results: Medical training simulations are an effective method of teaching content and training multiple roles in Undersea and Hyperbaric Medicine. Summary/Conclusions: A hyperbaric simulation curriculum is an achievable educational initiative that is able to train multiple team members simultaneously in situations that they may not encounter on a regular basis. We believe that this could be easily exported to otherinstitutions for further education.


Assuntos
Currículo , Educação Médica/métodos , Oxigenação Hiperbárica , Treinamento por Simulação/métodos , Doenças do Sistema Nervoso Central/induzido quimicamente , Doenças do Sistema Nervoso Central/terapia , Bolsas de Estudo , Humanos , Oxigenação Hiperbárica/efeitos adversos , Unidades de Terapia Intensiva , Intubação Intratraqueal , Muco , Oxigênio/envenenamento , Simulação de Paciente
7.
Undersea Hyperb Med ; 46(3): 341-352, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31394603

RESUMO

Introduction: Global outcomes can strengthen inferences from clinical trials. We evaluate global outcomes for persistent post-concussive symptoms (PCS) after mild traumatic brain injury (mTBI) in two clinical trials of hyperbaric oxygen (HBO2) in United States service members. Methods: During study design, outcomes of symptom, cognitive, and functional impairments planned for a trial of HBO2 for PCS (HOPPS) were weighted and grouped into different domains to formulate the composite outcome total score. The composite outcome was compared between the intervention groups in HOPPS and those in a subsequent HBO2 trial (BIMA) for validation. Additionally, two post hoc global outcome measures were explored, including one composed of components that demonstrated favorable characteristics in both studies and another via components used in another TBI randomized trial (COBRIT). Results: In total, 143 active-duty or veteran military personnel were randomized across the two studies. Composite total scores improved from baseline for HBO2 (mean ± SD -2.9±9.0) and sham (-2.9±6.6) groups in HOPPS but did not differ significantly between groups (p=0.33). In BIMA, 13-week changes from baseline favored the HBO2 group (-3.6±6.4) versus sham (-0.3±5.2; p=0.02). No between-group differences were found when COBRIT composite scoring was applied to BIMA. Overall, HBO2 effects were maximized when the post hoc global measure derived from both studies was applied to the data. Conclusions: Composite total scores in HOPPS and BIMA were consistent with primary study results. The global measures considered may offer utility as endpoints to achieve maximal HBO2 effect in future trials of the mTBI population. IDs: clinicaltrials.gov Identifiers NCT01611194 (BIMA) and NCT01306968 (HOPPS).


Assuntos
Oxigenação Hiperbárica , Síndrome Pós-Concussão/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Concussão Encefálica/complicações , Cognição , Feminino , Humanos , Oxigenação Hiperbárica/efeitos adversos , Masculino , Pessoa de Meia-Idade , Militares , Projetos de Pesquisa , Fatores de Tempo , Veteranos , Adulto Jovem
8.
Undersea Hyperb Med ; 46(3): 331-340, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31394602

RESUMO

Safety monitoring and successful blinding are important features of randomized, blinded clinical trials. We report chamber- and protocol-related adverse events (AEs) for participants enrolled in two randomized, double-blind clinical trials of hyperbaric oxygen (HBO2) for persistent post-concussive symptoms clinicaltrials.gov identifiers NCT01306968, HOPPS, and NCT01611194, BIMA), as well as the success of maintaining the blind with a low-pressure sham control arm. In both studies, participants were randomized to receive HBO2 (1.5 atmospheres absolute, >99% oxygen) or sham chamber sessions (1.2 atmospheres absolute, room air). In 143 participants undergoing 4,245 chamber sessions, chamber-related adverse events were rare (1.1% in the HOPPS study, 2.2% in the BIMA study). Minor, non-limiting barotrauma was the most frequently reported. Rarely, some participants experienced headache with chamber sessions. No serious adverse events were associated with chamber sessions. An allocation questionnaire completed after intervention revealed that the sham control arm adequately protected the blind in both trials. Participants based allocation assumptions on symptom improvement or lack of symptom improvement and could not discern intervention arm by pressure, smell, taste, or gas flow.


Assuntos
Oxigenação Hiperbárica/efeitos adversos , Síndrome Pós-Concussão/terapia , Adulto , Barotrauma/etiologia , Concussão Encefálica/complicações , Método Duplo-Cego , Dor de Orelha/etiologia , Feminino , Cefaleia/etiologia , Humanos , Oxigenação Hiperbárica/métodos , Masculino , Militares , Projetos Piloto , Distribuição Aleatória , Segurança
9.
Undersea Hyperb Med ; 46(1): 55-61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154685

RESUMO

Introduction: Eustachian tube dysfunction (ETD) and middle ear barotrauma (MEB) are the most common adverse effects of hyperbaric oxygen (HBO2) treatments. Patients practice equalization maneuvers to prevent ETD and MEB prior to hyperbaric exposure. Some patients are still unable to equalize middle ear pressure. This ETD results in undesirable consequences, including barotrauma, treatment with medications or surgical myringotomy with tube placement and interruption of HBO2. When additional medications and myringotomy are employed, they are associated with additional complications. Methods: A device known as the Ear Popper® has been reported to reduce complications from serous otitis media and reduce the need for surgical interventions (myringotomy). Patients unable to equalize middle ear pressure during initial compression in the hyperbaric chamber were allowed to use the device for rescue. All hyperbaric treatments were compressed using a United States Navy TT9, or a 45-fsw hyperbaric treatment schedule. Patients with persistent ETD and the inability to equalize middle ear pressure were given the Ear Popper upon consideration of terminating their treatment. Results: The Ear Popper allowed all patients to successfully equalize middle ear pressure and complete their treatments. Conclusion: This study substantiates the use of this device to assist in allowing pressurization of the middle ear space in patients otherwise unable to achieve equalization of middle ear pressure during HBO2 treatment in a multiplace chamber.


Assuntos
Barotrauma/prevenção & controle , Otopatias/prevenção & controle , Tuba Auditiva , Oxigenação Hiperbárica/efeitos adversos , Estudo de Prova de Conceito , Terapia de Salvação/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Atmosférica , Deglutição , Desenho de Equipamento , Tuba Auditiva/fisiologia , Feminino , História do Século XIX , Humanos , Masculino , Pessoa de Meia-Idade , Otolaringologia/história , Terapia de Salvação/métodos
10.
Int Marit Health ; 70(2): 125-131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31237673

RESUMO

BACKGROUND: Hyperbaric oxygen therapy is one of new trends of additional treatment, especially for non-di- ving-related diseases in Thailand. Hyperbaric inside attendants have to work under hyperbaric environment to provide medical care for patients in the hyperbaric chamber. This study aims to investigate longitudinal change in lung function in hyperbaric inside attendants (HIAs) and the relationship with hyperbaric exposure. MATERIALS AND METHODS: This is a retrospective longitudinal study exploring the adverse long-term effects to the lungs in HIAs. All inside attendants (HIAs) who worked in the public hospitals or medical centres with multiplace hyperbaric chamber in Thailand were included. To be considered for inclusion in the study, inside attendants were required to have at least two follow-up lung function tests and minimum 1-year interval at baseline from annually periodic examination. Lung function of HIAs were compared against reference values of the Thai population. RESULTS: There were 51 subjects with 9.26-year mean period of follow-up. The HIAs showed a significantly decrease in measured lung function in average forced expiratory volume in 1 second (FEV1), forced expi- ratory flow at 25-75% of functional vital capacity (FEF25-75%) and FEV1/FVC ratio over time. The annual reductions in FEV1, FEF25-75% and FEV1/FVC ratio were 22.52 mL per year, 44.92 mL/s per year and 0.48% per year, respectively. The study showed significant differences in annual changes in FVC, FEF25-75% and FEV1/FVC ratio between HIAs and the lung function predicted values for the Thais. However, the results revealed no differences of annual change in FEV1 from predicted values. The average working depths, average session duration and total working hours as HIAs were related with the changes of lung function. CONCLUSIONS: Working in a hyperbaric environment does affect the lung function of HIAs. In addition to fitness to work implementation, periodic lung function evaluation should be encouraged to monitor further possible harm to the attendants.


Assuntos
Volume Expiratório Forçado , Oxigenação Hiperbárica/efeitos adversos , Exposição Ocupacional/efeitos adversos , Capacidade Vital , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Medicina Naval , Recursos Humanos em Hospital , Testes de Função Respiratória , Estudos Retrospectivos , Tailândia
11.
Undersea Hyperb Med ; 46(2): 95-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31051053

RESUMO

Introduction: Symptomatic Eustachian tube dysfunction (ETD) and middle ear barotrauma (MEB) are the most common reported complications during hyperbaric oxygen (HBO2) treatment. There is no standardized rate of compression (ROC) reported to decrease the incidence rates of ETD and MEB during hyperbaric treatments. Few studies actually demonstrate that the ROC decreases the incidence of ETD or MEB. Methods: Our study was designed to determine an optimal hyperbaric chamber compression rate that might reduce the incidence of symptomatic ETD leading to MEB during the compression phase of treatment in a multiplace hyperbaric chamber. Data was collected prospectively over 2,807 elective patient treatments compressed using a U.S. Navy Treatment Table 9 (USN TT9) with a modified ROC. ROC was assigned using two variables, time (10 vs.15 minutes) and slope (linear vs. non-linear compression). Patients were exposed to all four compression schedules in a consecutive daily fashion. We recorded any patient requiring a stop during initial compression due to ear discomfort. Anyone requiring a stop was evaluated post treatment for MEB. Findings were compared to our standard 10-minute linear ROC. Evaluation of the tympanic membrane was accomplished using video otoscopy. Barotrauma when present was classified using both the Teed and O'Neill grading systems. Data was analyzed using basic statistical methods. Results: When comparing four different rates of compression during an elective USN TT9 in a multiplace (Class A) chamber there is a decreased incidence for symptomatic ETD when using a 15-minute linear compression schedule (p-value ⟨0.05). Conclusion: Using a 15-minute linear compression schedule is associated with less symptomatic ETD and less MEB when performing an elective 45 fsw (USN TT9) hyperbaric treatment in a Class A chamber. Asymptomatic ETD and MEB were not considered in this study.


Assuntos
Barotrauma/prevenção & controle , Otopatias/prevenção & controle , Tuba Auditiva/lesões , Oxigenação Hiperbárica/métodos , Suspensão de Tratamento/estatística & dados numéricos , Barotrauma/etiologia , Protocolos Clínicos , Otopatias/etiologia , Orelha Média/lesões , Humanos , Oxigenação Hiperbárica/efeitos adversos , Incidência , Otoscopia/métodos , Pressão , Estudos Prospectivos , Fatores de Tempo , Membrana Timpânica
12.
Undersea Hyperb Med ; 46(2): 101-106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31051054

RESUMO

Hyperbaric-associated middle ear barotrauma (MEB) is one of the most common side effects of the exposure to hyperbaric oxygen (HBO2) therapy. This retrospective observational study of 5,962 patients undergoing longterm therapy for chronic conditions took place at the local Diving and Hyperbaric Medicine Unit (DHMU) in Villafranca-Verona (Italy), a DHMU that administers, in multiplace chambers, more than 20,000 HBO2 treatments per year. The study was designed to weight and analyze both the incidence and severity of MEBs at the facility. Thanks to a systematic recording method over eight years, 2003-2010, we observed 549 MEBs (9.2% of all HBO2 treatments). The majority of them were female patients older than 50. MEBs observed were usually of minor complexity, with minimal otoscopic changes (69.03% of our occurrences were registered as Wallace-Teed Grade 1). MEBs were registered in 20.3% of those patients already suffering from difficulties in equalizing ear pressure, and/or presenting ear pain during the initial compression phase (descent) of the hyperbaric treatment. Inflammatory diseases of the upper respiratory tract, with special attention to rhinitis, appear to be a condition capable of predisposing patients in developing MEB. MEB did lead to the suspension of therapy for 89 patients in our case series. This was 16.2% of all the MEBs registered, or 1.49% of all patients who underwent HBO2 at the facility in the considered time lapse.


Assuntos
Barotrauma/epidemiologia , Orelha Média/lesões , Oxigenação Hiperbárica/efeitos adversos , Adulto , Distribuição por Idade , Idoso , Barotrauma/etiologia , Feminino , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rinite/complicações , Distribuição por Sexo , Suspensão de Tratamento/estatística & dados numéricos
13.
Undersea Hyperb Med ; 46(2): 107-116, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31051055

RESUMO

Middle ear barotrauma (MEB), one of the side effects of hyperbaric oxygen (HBO2) therapy, sometimes cannot be directly diagnosed during the therapy itself. Instead, its incidence and degree are judged based on subjective statements made by patients when in conversation with medical staff regarding how they feel. To prevent MEB in practice, it is proposed that the tympanic membrane evaluation system and automatic control chamber developed in a previous study be applied as part of a prevention algorithm [16]. The proposed algorithm, which determines and equalizes the unbalanced pressure of a subject based on their tympanic admittance, was evaluated in conjunction with conventional HBO2 therapy in an experiment involving 100 subjects. Among the 50 subjects in the control group who received HBO2 therapy 16 subjects experienced MEB. In contrast, the experimental group of 50 subjects were treated with a hyperbaric chamber protocol incorporating the automatic control system and proposed algorithm. At the conclusion of the treatment, no subjects exhibited middle ear barotrauma. In the case of the control group, while the target pressure was achieved, middle ear barotrauma still occurred. However, in the case of the experimental group, the pressure inside the chamber was adjusted as per the algorithm, which allowed the target pressure for every subject to be achieved without experiencing MEB. When a particular subject was unable to perform any pressure equalization method such as swallowing or the Valsalva maneuver, the chamber was not pressurized based on the tympanic admittance and thus no MEB occurred.


Assuntos
Algoritmos , Barotrauma/prevenção & controle , Orelha Média/lesões , Oxigenação Hiperbárica/métodos , Terapia Assistida por Computador/métodos , Testes de Impedância Acústica/métodos , Adulto , Barotrauma/etiologia , Estudos de Casos e Controles , Deglutição , Humanos , Oxigenação Hiperbárica/efeitos adversos , Incidência , Pressão/efeitos adversos , Membrana Timpânica , Manobra de Valsalva , Adulto Jovem
14.
Undersea Hyperb Med ; 46(2): 135-143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31051058

RESUMO

Purpose: Hyperbaric medicine is nascent in Korea when compared to other developed countries, such as the United States and Japan. Our facility has been managed by physicians with certifications from the Undersea and Hyperbaric Medical Society (UHMS) and National Oceanic and Atmospheric Administration in diving and clinical diseases since October 2016. This study was conducted to share similar issues that are encountered during the establishment of a program in a new area through our experiences in the operation of a hyperbaric oxygen (HBO2) therapy center. Methods: In this retrospective observational study we collected data on HBO2 patients treated at our center between October 2016 and June 2018 after HBO2 was conducted by HBO2-certified physicians. We then compared demographic data of patients with data from January 2011 to September 2015 - before HBO2 operations were conducted by HBO2-certified physicians. Result: A total of 692 patients received 5,130 treatments. Twelve indicated diseases were treated using HBO2 therapy. Fifty-six critically ill patients with intubation received HBO2. Although two patients experienced seizure due to oxygen toxicity during the study period, certified physicians and inside attendant took immediate corrective action. Conclusion: After the establishment of the HBO2 center operated by physicians with certification, more patients, including critically ill patients, received HBO2 safely for various diseases. In order to improve the practice of hyperbaric medicine in Korea, the Korean Academy of Undersea and Hyperbaric Medicine (KAUHM), an advanced and well-organized academic society, should communicate often with HBO2 centers, with the aim to set Korean education programs at UHMS course levels and increase reimbursement for HBO2 therapy.


Assuntos
Hospitais Especializados/estatística & dados numéricos , Oxigenação Hiperbárica/estatística & dados numéricos , Desenvolvimento de Programas , Idoso , Intoxicação por Monóxido de Carbono/terapia , Certificação , Estado Terminal/terapia , Doença da Descompressão/terapia , Feminino , Perda Auditiva Neurossensorial/terapia , Perda Auditiva Súbita/terapia , Hospitais Especializados/organização & administração , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigenação Hiperbárica/instrumentação , Masculino , Pessoa de Meia-Idade , Objetivos Organizacionais , Oxigênio/efeitos adversos , República da Coreia , Estudos Retrospectivos , Suspensão de Tratamento/estatística & dados numéricos
15.
Undersea Hyperb Med ; 46(2): 185-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31051063

RESUMO

Objective: An analysis of factors that may indicate both the type and degree of dehydration of a diver's body following a dry chamber hyperbaric exposure. Methods: The study was participated by 63 men - professional divers, with extensive diving experience, aged 24-51 years (average age 32.6). The subjects underwent two hyperbaric exposures, one to a pressure of 0.3 MPa and one to a pressure of 0.6 MPa, with oxygen decompression. The exposures were carried out in a hyperbaric chamber pursuant to the decompression tables of the Polish Navy, with the observance of a 24-hour interval between exposures. Blood samples were collected from the participants in order to perform a blood morphology test. Body weight was measured with the bioelectrical impedance method using the Maltron BioScan 920 device.The results were subjected to statistical analysis. The following blood morphology parameters were analyzed: hematocrit (Ht), erythrocyte size (MCV), color index (MCHC) and body weight composition: total water (TBW), extracellular water (ECW), intracellular water (ICW). Results: The studies have shown that during a hyperbaric exposure in the chamber the diver's body becomes dehydrated, with observable loss of both intracellular water as evidenced by the reduction of hematocrit content and erythrocyte size, as well as extracellular water, with the accompanying increase in the color index. Conclusions: Hyperbaric conditions are conducive to the dehydration of the diver's body, however to a degree which does not lead to an occurrence of health hazards. Good care for one's health through proper nutrition and hydration are sufficient preventive and protective measures.


Assuntos
Descompressão/efeitos adversos , Desidratação/etiologia , Mergulho , Oxigenação Hiperbárica/efeitos adversos , Oxigênio , Adulto , Composição Corporal , Água Corporal , Peso Corporal , Descompressão/métodos , Desidratação/sangue , Desidratação/diagnóstico , Impedância Elétrica , Índices de Eritrócitos , Líquido Extracelular , Hematócrito , Humanos , Líquido Intracelular , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Clin Exp Rheumatol ; 37 Suppl 116(1): 63-69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30747099

RESUMO

OBJECTIVES: Fibromyalgia (FM) is a syndrome of unknown aetiology that is characterised by widespread musculoskeletal pain, fatigue and disordered sleep, and often associated with neuropsychiatric and cognitive symptoms. Current treatment options are only partially effective, but hyperbaric oxygen therapy (HBOT) seems to be capable of relieving some of the symptoms. The aim of this study was to evaluate the efficacy and safety of HBOT after fewer sessions than generally used, chosen on the basis of pre-clinical and clinical data showing its rapid and sustained antinociceptive effect. METHODS: Patients with FM underwent HBOT (100% oxygen at 2.5 ata with air breaks) administered on three days per week for a total of twenty 90-minute sessions. Pain, fatigue, the quality of sleep, symptoms of anxiety and depression, and the patients' health-related quality of life were prospectively assessed before and after ten and twenty sessions. RESULTS: Twenty-eight of the 32 study patients completed the 20 HBOT sessions. Pain scores and the symptoms of anxiety (but not those of depression) significantly improved after both 10 and 20 sessions, whereas fatigue and FM symptom severity scores significantly improved only after 20 sessions. There was no significant change in the quality of sleep. The adverse effects were limited. CONCLUSIONS: These findings support the view that HBOT is an effective, rapid and safe means of treating various symptoms of FM.


Assuntos
Fibromialgia/terapia , Oxigenação Hiperbárica , Qualidade de Vida , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigênio , Estudos Prospectivos , Resultado do Tratamento
17.
J Hosp Infect ; 101(1): 84-87, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30336170

RESUMO

Whereas high-flow nasal cannula use is gaining prevalence, its high gas flow raises concerns about aerosolization of infectious particles and spread of infection. This randomized controlled crossover non-inferiority trial (N = 20) evaluated the degree of environmental contamination by viable bacteria associated with the use of high-flow nasal cannula compared with conventional oxygen mask for critically ill patients with Gram-negative pneumonia. The results show that high-flow nasal cannula use was not associated with increased air or contact surface contamination by either Gram-negative bacteria or total bacteria, suggesting that additional infection control measures are not required.


Assuntos
Cânula/efeitos adversos , Estado Terminal , Poluição Ambiental , Oxigenação Hiperbárica/efeitos adversos , Oxigenação Hiperbárica/métodos , Máscaras/efeitos adversos , Pneumonia Bacteriana/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
18.
Diving Hyperb Med ; 48(4): 235-240, 2018 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-30517956

RESUMO

BACKGROUND: Recent studies indicated that ketone ester R,S-1,3-butanediol acetoacetate diester (BD-AcAc2) may be effective in preventing central nervous system oxygen toxicity (CNS-OT) and concomitant acute lung injury, a serious medical problem to be faced when breathing hyperbaric oxygen (HBO). This study aimed to further investigate the protective effects of BD-AcAc2 against CNS-OT and concomitant acute lung injury (ALI) in mice. METHODS: Mice were treated with BD-AcAc2 in peanut oil vehicle (2.5, 5.0 or 10.0 g·kg⁻² body weight) by gavage 20 minutes before 600 kPa HBO exposure. Control mice received the vehicle only. Seizure latency was recorded. Malondialdehyde content in brain and lung tissues, total protein level in bronchoalveolar lavage fluid (BLF) and lung water content were measured 60 minutes after the hyperbaric exposure. Histopathology of lung tissue was undertaken. RESULTS: Compared with the vehicle alone, BD-AcAc2 prolonged seizure latency in a dose-dependent manner (P < 0.01). The HBO-induced increase in brain malondialdehyde, BLF protein and lung water were significantly reduced by BD-AcAc2 (P < 0.01). CONCLUSION: Oral administration of the ketone ester BD-AcAc2 significantly protected against CNS-OT and concomitant ALI. Alleviation of oxidative stress may be one underlying mechanism providing this effect.


Assuntos
Acetoacetatos/uso terapêutico , Lesão Pulmonar Aguda , Encéfalo/efeitos dos fármacos , Butileno Glicóis/uso terapêutico , Oxigenação Hiperbárica , Acetoacetatos/farmacologia , Lesão Pulmonar Aguda/tratamento farmacológico , Animais , Oxigenação Hiperbárica/efeitos adversos , Camundongos , Oxigênio , Ratos Sprague-Dawley , Convulsões/tratamento farmacológico
19.
Medicine (Baltimore) ; 97(39): e12456, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278526

RESUMO

BACKGROUND: Carbon monoxide (CO) poisoning may result in acute neurological sequelae, cognitive sequelae, and delay neurological sequelae. The administration of hyperbaric oxygen (HBO) to prevent the development of delayed neurological sequelae in CO poisoning have extensively investigated but conflicting results have been reported. We performed a systematic literature review and meta-analysis of randomized controlled trials (RCTs) evaluating HBO treatment and its effect on neuropsychometric dysfunction after CO poisoning. METHODS: We searched Medline, Embase, Pubmed, and the Cochrane Register of Controlled Trials from inception to December 2017. Eligible studies compared HBO therapy with normobaric oxygen (NBO) in patients with CO poisoning. RESULTS: Six studies compared HBO with NBO in CO poisoning patients. Compared with patients treated with NBO, a lower percentage of patients treated with HBO reported headache (16.2% vs 16.5%, relative risk [RR] = 0.83, 95% CI = 0.38-1.80), memory impairment (18.2% vs 23.8%, RR = 0.80, 95% CI = 0.43-1.49), difficulty concentrating (15.0% vs 18.4%, RR = 0.86, 95% CI = 0.55-1.34), and disturbed sleep (14.7% vs 16.2%, RR = 0.91, 95% CI = 0.59-1.39). Two sessions of HBO treatment exhibited no advantage over one session. CONCLUSIONS: The meta-analysis indicated that compared with CO poisoning patients treated with NBO, HBO treated patients have a lower incidence of neuropsychological sequelae, including headache, memory impairment, difficulty concentrating, disturbed sleep, and delayed neurological sequelae. Taking into consideration the cost-effectiveness of one session of HBO, one session of HBO treatment could be an economical option for patients with CO poisoning with high severity.


Assuntos
Intoxicação por Monóxido de Carbono/complicações , Oxigenação Hiperbárica/efeitos adversos , Transtornos da Memória/prevenção & controle , Doenças do Sistema Nervoso/prevenção & controle , Transtornos do Sono-Vigília/prevenção & controle , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina/metabolismo , Progressão da Doença , Humanos , Oxigenação Hiperbárica/economia , Oxigenação Hiperbárica/métodos , Transtornos da Memória/etiologia , Transtornos da Memória/terapia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/terapia , Oxigenoterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/terapia , Resultado do Tratamento
20.
J Med Invest ; 65(3.4): 286-288, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30282875

RESUMO

Hyperbaric oxygen therapy (HBOT) for carbon monoxide (CO) poisoning is widely performed to prevent delayed neuropsychiatric syndrome. Although HBOT can generally be performed with safety, the appropriate management of HBOT still remains unestablished. A 31-year-old man was transferred to our facility to undergo HBOT in a multiplace chamber with a diagnosis of CO poisoning. The first HBOT session ended uneventfully. During the second HBOT session, the patient suddenly experienced convulsive seizures. The accompanying doctor administered intravenous propofol to stop the convulsion and terminated the HBOT. Soon after the convulsion, the patient developed frothy secretions through the endotracheal-tube with impaired oxygenation. Head computed tomography scan showed no abnormalities, suggesting the seizure was associated with complications of HBOT. A chest X-ray revealed bilateral pulmonary edema, and echocardiography revealed normal cardiac function, indicating that the pulmonary edema resulted from HBOT or neurogenic mechanism secondary to the seizure. The patient's respiratory status improved without recurrence of the seizure and no delayed neurological sequelae was seen afterwards. Here we report unexpected rare adverse events during HBOT. Hyperbaric oxygen therapy for acute indications should be performed in multiplace chambers, with appropriate preparation and medical equipment. J. Med. Invest. 65:286-288, August, 2018.


Assuntos
Oxigenação Hiperbárica/efeitos adversos , Edema Pulmonar/etiologia , Convulsões/etiologia , Adulto , Intoxicação por Monóxido de Carbono/terapia , Humanos , Oxigenação Hiperbárica/instrumentação , Japão , Masculino , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/fisiopatologia , Convulsões/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA