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1.
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
2.
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
3.
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
4.
Dan Med J ; 66(2)2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30722823

RESUMO

INTRODUCTION: Patients with diabetic foot ulcers (DFU) suffer from diabetes-related complications and comor-bidities. Hyperbaric oxygen therapy (HBOT) is a treatment modality with limited capacity used in the treatment of DFUs. It is important to ensure that HBOT is offered to patients who are suitable for this treatment regarding effect, compliance and life expectancy. The objective of the present study was to describe the population of patients with DFU who were referred to HBOT in Denmark in the 1999-2016 period. METHODS: All patients with DFU who were treated at the HBOT chamber in Copenhagen during the study period were considered. Patients with an invalid social security number or an incorrect diagnosis were excluded. Data on comor-bidities, amputation and death were extracted from the Danish National patient Registry and the Danish Civil Registration System. Continuous data were described as median values and binary data were described as proportions. The probability estimate for survival and amputation was investigated by constructing Kaplan-Meier curves. RESULTS: The cohort included 148 patients. Patients were mainly referred from the Capital Region (92%) and multi-disciplinary wound care centres were the primary referring departments (67%). Comorbidity rates were high with an initial median Charlson Comorbidity Index score of five. The five-year amputation and mortality estimates after referral were 73.5% and 51.8%, respectively. CONCLUSIONS: The study showed that Danish DFU patients who are offered HBOT are in advanced stages of their disease, and the referral hinges on local factors such as geography and the referring source rather than on standardised procedures. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Pé Diabético/terapia , Oxigenação Hiperbárica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Estudos de Coortes , Comorbidade , Dinamarca , Pé Diabético/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Sistema de Registros , Resultado do Tratamento
5.
Disaster Med Public Health Prep ; 13(1): 94-96, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30012229

RESUMO

OBJECTIVE: The Florida Department of Health in Miami-Dade County (DOH-Miami-Dade) investigated 106 reported carbon monoxide (CO) exposures over a 9-day timeframe after Hurricane Irma. This report evaluates risk factors for CO poisoning and the importance of heightened surveillance following natural disasters. METHODS: Data on CO poisoning cases from September 9 to 18, 2017 were extracted from Merlin, the Florida Department of Health Surveillance System. Medical records were obtained and follow-up interviews were conducted to collect data on the confirmed CO poisoning cases. Data were analyzed using SAS v9.4. RESULTS: Ninety-one of the 106 people exposed to CO met the case definition for CO poisoning: 64 confirmed, 7 probable, and 20 suspect cases. Eighty-eight percent of the affected individuals were evaluated in emergency departments and 11.7% received hyperbaric oxygen treatment. The most frequently reported symptoms included headache (53.3%), dizziness (50.7%), and nausea (46.7%). Three patients expired due to their exposure to CO. CONCLUSIONS: Post Hurricane Irma, the DOH-Miami-Dade investigated numerous cases for CO exposure. By understanding who is most likely to be impacted by CO and the impact of generators' location on people's health, education efforts can be tailored to the population most at risk and further CO exposures and related mortalities following natural disasters can be reduced. (Disaster Med Public Health Preparedness. 2019;13:94-96).


Assuntos
Intoxicação por Monóxido de Carbono/complicações , Intoxicação por Monóxido de Carbono/terapia , Tempestades Ciclônicas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Monóxido de Carbono/efeitos adversos , Intoxicação por Monóxido de Carbono/epidemiologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Florida/epidemiologia , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Lactente , Masculino , Pessoa de Meia-Idade
7.
Rev Infirm ; 67(242): 14-15, 2018.
Artigo em Francês | MEDLINE | ID: mdl-29907169

RESUMO

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.


Assuntos
Oxigenação Hiperbárica , Doença Aguda/terapia , Doença Crônica/terapia , Serviços Médicos de Emergência/métodos , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigenação Hiperbárica/métodos , Oxigenação Hiperbárica/enfermagem , Oxigenação Hiperbárica/estatística & dados numéricos , Oxigênio/uso terapêutico
8.
Rev Infirm ; 67(242): 16-17, 2018.
Artigo em Francês | MEDLINE | ID: mdl-29907170

RESUMO

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.


Assuntos
Doença da Descompressão/terapia , Medicina de Emergência , Oxigenação Hiperbárica , Mergulho/efeitos adversos , Medicina de Emergência/métodos , Enfermagem em Emergência/métodos , Humanos , Oxigenação Hiperbárica/enfermagem , Oxigenação Hiperbárica/estatística & dados numéricos , Recursos Humanos
9.
Rev Infirm ; 67(242): 18-20, 2018.
Artigo em Francês | MEDLINE | ID: mdl-29907171

RESUMO

Colourless and odourless, each year carbon monoxide is responsible for several thousand cases of poisoning. Often collective, their symptoms are non specific and can result in serious neurological sequelae or even death, if they are not detected in time. The (pre-) hospital emergency nurse plays an important role in the management of these patients, in terms of assessment, treatment and monitoring as well as the organisation of the admittance of victims, categorisation and medical triage. As part of a team, the nurse ensures that the patient enters an adapted, regulated pathway, with the most serious cases being directed towards a hospital equipped with a hyperbaric medicine facility.


Assuntos
Intoxicação por Monóxido de Carbono , Triagem , Intoxicação por Monóxido de Carbono/diagnóstico , Intoxicação por Monóxido de Carbono/enfermagem , Intoxicação por Monóxido de Carbono/terapia , Emergências/enfermagem , Enfermagem em Emergência/métodos , Enfermagem em Emergência/organização & administração , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Triagem/organização & administração , Recursos Humanos
10.
Rev Infirm ; 67(242): 27-28, 2018.
Artigo em Francês | MEDLINE | ID: mdl-29907175

RESUMO

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.


Assuntos
Analgesia , Dor Crônica/terapia , Oxigenação Hiperbárica/estatística & dados numéricos , Analgesia/métodos , Analgesia/enfermagem , Dor Crônica/enfermagem , Terapia Combinada/enfermagem , Humanos , Oxigenação Hiperbárica/enfermagem , Manejo da Dor/métodos , Manejo da Dor/enfermagem
11.
Respir Investig ; 56(3): 249-257, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29773297

RESUMO

BACKGROUND: High-flow nasal cannula oxygen therapy (HFNC) is widely used mainly in the acute care setting, but limited data are available on real-world practice in adults. The objective of this study was to describe HFNC practices in Japanese adults. METHODS: A retrospective cross-sectional multicenter survey of adult patients receiving HFNC from January through March 2015 was conducted in 33 participating hospitals in Japan. RESULTS: We obtained information on 321 patients (median age, 76; 218 men, 103 women; median estimated PaO2/FIO2, 178 mm Hg) from 22 hospitals. Do-not-intubate status was determined in 37.4% of patients. Prior to HFNC, 57.9% of patients received conventional oxygen therapy; 25.9%, noninvasive ventilation; and 15.0%, invasive mechanical ventilation. The common indications for HFNC were acute hypoxemic respiratory failure (ARF) (65.4%), postoperative respiratory support (15.9%), and post-extubation respiratory support (11.2%). The underlying etiology of ARF included interstitial lung disease, pneumonia, and cardiogenic pulmonary edema. HFNC was administered mostly in intensive care units or intermittent care units (60.7%) and general wards (36.1%). Median duration of HFNC was 4 days; median total flow rate, 40 L/min; and median FIO2, 50%. HFNC significantly improved PaO2, PaCO2, SpO2 and respiratory rate from baseline. Two-thirds of patients finally survived to be discharged or transferred. CONCLUSIONS: We documented patient demographics, clinical indications, and settings of HFNC use in the real world. We also demonstrated positive effects of HFNC on respiratory parameters. Further studies are urgently needed regarding the efficacy and safety of HFNC in populations outside of previous clinical trials.


Assuntos
Oxigenação Hiperbárica/métodos , Insuficiência Respiratória/terapia , Doença Aguda , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Japão , Masculino , Estudos Multicêntricos como Assunto , Cuidados Pós-Operatórios , Testes de Função Respiratória , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
12.
Undersea Hyperb Med ; 45(2): 129-156, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29734566

RESUMO

Background: In prior military randomized trials, participants with persistent symptoms after mild traumatic brain injury (TBI) reported improvement regardless of receiving hyperbaric oxygen (HBO2) or sham intervention. This study's objectives were to identify outcomes for future efficacy trials and describe changes by intervention. Methods: This Phase II, randomized, double-blind, sham-controlled trial enrolled military personnel with mild TBI and persistent post-concussive symptoms. Participants were randomized to receive 40 HBO2 (1.5 atmospheres absolute (ATA), ⟩99% oxygen, 60 minutes) or sham chamber sessions (1.2 ATA, room air, 60 minutes) over 12 weeks. Participants and evaluators were blinded to allocation. Outcomes assessed at baseline, 13 weeks and six months included symptoms, quality of life, neuropsychological, neurological, electroencephalography, sleep, auditory, vestibular, autonomic, visual, neuroimaging, and laboratory testing. Participants completed 12-month questionnaires. Intention-to-treat results are reported. Results: From 9/11/2012 to 5/19/2014, 71 randomized participants received HBO2 (n=36) or sham (n=35). At baseline, 35 participants (49%) met post-traumatic stress disorder (PTSD) criteria. By the Neurobehavioral Symptom Inventory, the HBO2 group had improved 13-week scores (mean change -3.6 points, P=0.03) compared to sham (+3.9 points). In participants with PTSD, change with HBO2 was more pronounced (-8.6 vs. +4.8 points with sham, P=0.02). PTSD symptoms also improved in the HBO2 group, and more so in the subgroup with PTSD. Improvements regressed at six and 12 months. Hyperbaric oxygen improved some cognitive processing speed and sleep measures. Participants with PTSD receiving HBO2 had improved functional balance and reduced vestibular complaints at 13 weeks. Conclusions: By 13 weeks, HBO2 improved post-concussive and PTSD symptoms, cognitive processing speed, sleep quality, and balance function, most dramatically in those with PTSD. Changes did not persist beyond six months. Several outcomes appeared sensitive to change; additional studies are warranted.


Assuntos
Concussão Encefálica/complicações , Oxigenação Hiperbárica/métodos , Militares , Síndrome Pós-Concussão/terapia , Adulto , Método Duplo-Cego , Feminino , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Análise de Intenção de Tratamento , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Síndrome Pós-Concussão/etiologia , Qualidade de Vida , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Avaliação de Sintomas , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Teste de Caminhada , Adulto Jovem
13.
Undersea Hyperb Med ; 45(2): 183-189, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29734570

RESUMO

On the island Nation of Guam, the United States Department of Defense has stationed military personnel from every service branch. Guam is utilized as a strategic waypoint for the U.S. military in the Pacific theater. As the largest service branch in the region, the Navy has placed a few Diving Medical Officers in Guam to collectively manage and treat patients with recompression therapy. Guam is also a popular tourist destination, with multiple recreational diving companies certifying individuals who are looking to take advantage of the beautiful warm water and exotic marine life. Unfortunately, with an increase in training and certifying inexperienced divers, came an increase in the operational tempo of the U.S. Navy's recompression chamber on Guam. The recompression chamber on Naval Base Guam (NBG) has been treating patients since 1971. With the only multiplace chamber in the Mariana Islands, Diving Medical Officers, with the accompanying chamber staff, treat military personnel, active-duty sponsored patients and civilian patients. Treating civilian patients by military providers through military treatment facilities presents multiple issues that must be addressed in an effort to provide efficient quality medical care. This article reviews the records, documents, and activity of the NBG chamber over the last four decades. Through the obtained data the information provides projected financial reimbursement from civilian patients. The article also sheds light on areas of needed improvement with regard to data collection, third-party financial collection efforts and the necessity of an inclusive electronic health record (EHR) for military and civilian patients.


Assuntos
Doença da Descompressão/terapia , Mergulho/efeitos adversos , Oxigenação Hiperbárica/estatística & dados numéricos , Militares , Medicina Naval/estatística & dados numéricos , Acidentes/economia , Acidentes/estatística & dados numéricos , Coleta de Dados , Doença da Descompressão/epidemiologia , Doença da Descompressão/etiologia , Mergulho/estatística & dados numéricos , Registros Eletrônicos de Saúde , Guam , História do Século XX , História do Século XXI , Humanos , Oxigenação Hiperbárica/economia , Oxigenação Hiperbárica/história , Medicare/economia , Militares/estatística & dados numéricos , Medicina Naval/economia , Medicina Naval/história , Crédito e Cobrança de Pacientes , Recreação/economia , Mecanismo de Reembolso , Fatores de Tempo , Estados Unidos
14.
Monaldi Arch Chest Dis ; 88(1): 882, 2018 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-29557574

RESUMO

Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV) in Italy. We aimed to investigate the prevalence and prescription variability of HMV as well as of long-term oxygen therapy (LTOT) and continuous positive airway pressure (CPAP), in the Lombardy Region. Prescribing rates of HMV (both noninvasive and tracheostomies), CPAP (auto-CPAP, CPAP/other sleep machines) and LTOT (liquid-O2, O2-gas, concentrators) in the 15 Local Healthcare districts of Lombardy were gathered from billing data for 2012 and compared. Crude rates (per 100,000 population) and rates for the different healthcare districts were calculated. In 2012, 6325 patients were on HMV (crude prescription rate: 63/100,000) with a high variation across districts (8/100,000 in Milano 1 vs 150/100,000 in Pavia). There were 14,237 patients on CPAP (crude prescription rate: 142/100,000; CPAP/other sleep machines 95.3% vs auto-CPAP 4.7%) with also high intra-regional variation (56/100,000 in Mantova vs. 260/100,000 in Pavia). There were 21,826 patients on LTOT (prescription rate: 217/100,000 rate; liquid-O2 94%, O2-gas 2.08%, O2-concentrators 3.8%), with again high intra-regional variation (100/100,000 in Bergamo vs 410/100,000 in Valle Camonica). The crude rate of HMV prescriptions in Lombardy is very high, with a high intra-regional variability in prescribing HMV, LTOT and CPAP which is partly explainable by the accessibility to specialist centers with HMV/sleep-study facilities. Analysis of administrative data and variability mapping can help identify areas of reduced access for an improved standardization of services. An audit among Health Payer and prescribers to interpret the described huge variability could be welcomed.


Assuntos
Acesso aos Serviços de Saúde/normas , Respiração Artificial/estatística & dados numéricos , Ventiladores Mecânicos/provisão & distribução , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Humanos , Oxigenação Hiperbárica/instrumentação , Oxigenação Hiperbárica/estatística & dados numéricos , Itália/epidemiologia , Estudos Observacionais como Assunto , Assistência Centrada no Paciente , Prevalência , Respiração Artificial/instrumentação , Respiração Artificial/tendências
15.
Undersea Hyperb Med ; 45(1): 1-8, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29571226

RESUMO

Objective: To provide an update on the status of provider participation in the US Wound Registry (USWR) and its specialty registry the Hyperbaric Oxygen Therapy Registry (HBOTR), which provide much-needed national benchmarking and quality measurement services for hyperbaric medicine. Methods: Providers can meet many requirements of the Merit-Based Incentive Payment System (MIPS) and simultaneously participate in the HBOTR by transmitting Continuity of Care Documents (CCDs) directly from their certified electronic health record (EHR) or by reporting hyperbaric quality measures, the specifications for which are available free of charge for download from the registry website as electronic clinical quality measures for installation into any certified EHR. Computerized systems parse the structured data transmitted to the USWR. Patients undergoing hyperbaric oxygen (HBO2) therapy are allocated to the HBOTR and stored in that specialty registry database. The data can be queried for benchmarking, quality reporting, public policy, or specialized data projects. Results: Since January 2012, 917,758 clinic visits have captured the data of 199,158 patients in the USWR, 3,697 of whom underwent HBO2 therapy. Among 27,404 patients with 62,843 diabetic foot ulcers (DFUs) captured, 9,908 DFUs (15.7%) were treated with HBO2 therapy. Between January 2016 and September 2018, the benchmark rate for the 1,000 DFUs treated with HBO2 was 7.3%, with an average of 28 treatments per patient. There are 2,100 providers who report data to the USWR by transmitting CCDs from their EHR and 688 who submit quality measure data, 300 (43.6%) of whom transmit HBO2 quality data.


Assuntos
Benchmarking , Pé Diabético/terapia , Fidelidade a Diretrizes , Oxigenação Hiperbárica/estatística & dados numéricos , Oxigenação Hiperbárica/normas , Sistema de Registros/estatística & dados numéricos , American Recovery and Reinvestment Act , Amputação , Benchmarking/economia , Glicemia/análise , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Pé Diabético/sangue , Registros Eletrônicos de Saúde/estatística & dados numéricos , Humanos , Avaliação Nutricional , Osteomielite/terapia , Osteorradionecrose/terapia , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Sistema de Registros/normas , Mecanismo de Reembolso , Resultado do Tratamento , Estados Unidos , Procedimentos Desnecessários/estatística & dados numéricos , Cicatrização
16.
Undersea Hyperb Med ; 45(1): 83-87, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29571236

RESUMO

Neuropsychiatric sequelae have been reported in 15%-45% of survivors of carbon monoxide (CO) poisoning. Hyperbaric oxygen (HBO2) therapy reduces the incidence of cognitive and neurological a dysfunction. The efficacy of providing HBO2 beyond the first one to two days after initial insult is unknown. However, some evidence exists for the benefit of this treatment. We report on treating a patient 14 months after CO injury, who responded with markedly improved neurologic status. A 27-year-old scholar was found comatose due to CO poisoning (carboxyhemoglobin = 31.7%). He received five acute HBO2 treatments. After discharge, he developed chorea, Parkinsonism, dystonia, memory loss, slowed processing speed and verbal fluency, leaving him disabled. After the patient reached a clinical plateau, HBO2 was tried again at 90 minutes at 2.4 ATA plus air breaks. Neuropsychological testing was performed at baseline and after each 20 HBO2 cycles, five of which were performed during the period from 14-22 months after CO exposure. After the first 20 treatments, Parkinsonism and dystonia improved. After 40 sessions, further improvements were seen on mental speed, verbal fluency, and fine motor movements. The outcome following 100 treatments was that the patient regained independence, including the ability to drive and to become gainfully employed. Our case calls into question the concept that HBO2 therapy has no role during the chronic phase of CO brain injury. Randomized clinical trials should be considered to evaluate the therapeutic efficacy of HBO2 in patients with neurological sequelae following CO injury.


Assuntos
Intoxicação por Monóxido de Carbono/complicações , Oxigenação Hiperbárica/métodos , Transtornos Neurocognitivos/terapia , Recuperação de Função Fisiológica , Adulto , Distonia/etiologia , Distonia/terapia , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Vida Independente , Masculino , Transtornos Neurocognitivos/etiologia , Testes Neuropsicológicos , Transtornos Parkinsonianos/etiologia , Transtornos Parkinsonianos/terapia , Retratamento/métodos , Retratamento/estatística & dados numéricos , Tentativa de Suicídio , Fatores de Tempo , Resultado do Tratamento
17.
Undersea Hyperb Med ; 45(1): 89-93, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29571237

RESUMO

Introduction: Left-ventricular assist devices (LVAD) are becoming a common therapy for end-stage heart failure. These devicesare not tested for pressurization in a hyperbaricchamber by the manufacturer. In this article, we present an approach to modify the power supply in order to safely treat a patient with an LVAD. Materials and Methods: Our patient had a HeartMateII™ LVAD and presented for hyperbaric oxygen treatments for severe radiation cystitis. In order to modify this patient's equipment to be compliant with NFPA6 safety standards we made several modifications. In brief, this included eliminating the usage of lithium-ion batteries, modifying the cord to be compatible with Fink chamber outlets, and enclosing the power module in a nitrogen purge. We then used a mock circulatory system to test our modifications and make sure the LVAD continued to have appropriate flow rates. We then conducted training for staff and developed a disaster plan should the LVAD fail at any point. Results: Once we felt comfortable with the modifications and had a plan developed should any problems arise, we then proceeded to treat our patient in the hyperbaric chamber. He successfully underwent 44 hyperbaric treatments for radiation cystitis without complications. Conclusion: This case is the second reported patient in the literature with an LVAD that was successfully treated in a multiplace hyperbaric chamber. As LVADs become increasingly popular to manage heart failure, more patients with these devices will present for hyperbaric treatments. With a few modifications, an LVAD patient can be safely and successfully treated in a hyperbaric chamber.


Assuntos
Cistite/terapia , Fontes de Energia Elétrica , Desenho de Equipamento , Segurança de Equipamentos , Coração Auxiliar , Oxigenação Hiperbárica/métodos , Lesões por Radiação/terapia , Idoso de 80 Anos ou mais , Cistite/etiologia , Insuficiência Cardíaca/terapia , Ventrículos do Coração , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Lítio , Masculino , Isquemia Miocárdica/terapia , Lesões por Radiação/complicações
18.
Disaster Med Public Health Prep ; 12(3): 373-378, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28994363

RESUMO

ABSTRACTCarbon monoxide (CO) can cause mass intoxication, but no standard triage algorithm specifically addresses CO poisoning. The roles of some recent diagnostic tools in triage as well as treatment with hyperbaric oxygen are controversial. We describe a mass casualty case of CO poisoning involving 77 patients, with a focus on the triage and treatment options decided on-site. The reasons for choosing these options are reviewed, and the pitfalls that occurred and the lessons learned from this major incident are described. We discuss the potential to improve the management of such an event and strategies to accomplish this, including simplifying triage and administering oxygen to all exposed persons for 6 h. (Disaster Med Public Health Preparedness. 2018; 12: 373-378).


Assuntos
Intoxicação por Monóxido de Carbono/diagnóstico , Incidentes com Feridos em Massa/estatística & dados numéricos , Triagem/métodos , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Testes Respiratórios/instrumentação , Testes Respiratórios/métodos , Monóxido de Carbono/análise , Intoxicação por Monóxido de Carbono/terapia , Criança , Expiração/fisiologia , Feminino , Humanos , Oxigenação Hiperbárica/métodos , Oxigenação Hiperbárica/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Triagem/tendências
19.
Undersea Hyperb Med ; 44(6): 535-542, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29281190

RESUMO

INTRODUCTION: Necrotizing soft tissue infections (NSTI) are rare but potentially lethal disorders, and adequate management is time- and resource-demanding. This study aims to assess whether variations in the treatment modalities - surgery, hyperbaric oxygen (HBO2) therapy and negative pressure wound therapy - had an impact on the length to definitive source control in NSTI patients who underwent HBO2. METHODS: This is a retrospective study of all NSTI patients treated with hyperbaric oxygen therapy between March 2007 and May 2015 at Unidade Local de Saúde de Matosinhos (ULSM) Hyperbaric Unit. A multiple linear regression model was used to assess the impact of different treatment modalities in the posdiagnosis time until source control. RESULTS: 58 patients were included; overall mortality was 13.8%. Mean time until source control was 10.4 days (±5.4). All patients were under empiric and broad-spectrum antibiotics on the day of diagnosis. Patients underwent an average of 0.62 (±0.29) surgical interventions and 1.06 (±0.52) HBO2 sessions per day. The regression model (R2=0.86) showed that after adjusting for other covariates, doubling the number of HBO2 sessions per day shortened source control by five days (? ß = -5.25; 95% CI -6.49 to 4.01), and for each day that HBO2 was delayed, source control was achieved one day later (ß = 1.03; 95% CI 0.82 to 1.24). CONCLUSIONS: More intensive HBO2 protocols with earlier and more frequent sessions shorten the time until definitive source control in necrotizing soft tissue infections, potentially lowering the impact of systemic effects of infection and complications associated with organ dysfunction.


Assuntos
Oxigenação Hiperbárica/métodos , Infecções dos Tecidos Moles/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Terapia Combinada , Desbridamento , Feminino , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Necrose , Portugal/epidemiologia , Estudos Retrospectivos , Infecções dos Tecidos Moles/mortalidade , Resultado do Tratamento , Adulto Jovem
20.
Diving Hyperb Med ; 47(4): 233-238, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29241233

RESUMO

INTRODUCTION: Acute retinal artery occlusion (ARAO) is a major cause of sudden, painless visual loss, often leaving no useful vision in the affected eye. Its incidence is cited at 0.85 per 100,000 persons per year but may be higher because of under-reporting. The natural history is difficult to study, but a spontaneous resolution rate of < 1-8% for acute, non-arteritic ARAO has been cited. Occurrence in an only eye is devastating for the patient. There is currently no consensus regarding management of ARAO and little evidence to support any treatment modality. Despite only limited case series, hyperbaric oxygen treatment (HBOT) is recommended for ARAO by the Undersea and Hyperbaric Medical Society (UHMS) and by the European Committee for Hyperbaric Medicine. METHODS: Between early 2003 and December 2012, all ARAO patients presenting to Christchurch Hospital were referred for consideration of HBOT. These 31 consecutive patients' medical records were reviewed retrospectively. The time delay from onset of visual loss to commencing HBOT; the presenting visual acuity; various demographic data; the HBOT administered and the outcome visual acuity were documented. RESULTS: All 31 patients underwent at least one HBOT (median 4, range 1-7) at a pressure of 203-284 kPa for 1.5 to 2.0 h. One patient's treatment was terminated after 60 min at their request; another declined further HBOT and one suffered middle ear barotrauma. Thirteen patients also received anticoagulants at the discretion of the referring ophthalmologist. Twenty three patients had temporarily improved vision with the first HBOT. Seven patients had permanent, good visual recovery (6/18 or better; Snellen chart); and two only modest improvement (6/60). All nine patients who improved permanently were treated within 10 hours of symptom onset. CONCLUSIONS: Where available, HBOT is indicated for ARAO. Our protocol may not have been aggressive enough and the UHMS protocol is recommended. A multi-centre, randomised controlled trial is feasible, but would be logistically difficult and expensive and may be ethically unsupportable given the lack of alternative, effective treatments.


Assuntos
Oxigenação Hiperbárica/métodos , Oclusão da Artéria Retiniana/terapia , Transtornos da Visão/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/terapia , Oclusão da Artéria Retiniana/complicações , Estudos Retrospectivos , Resultado do Tratamento , Transtornos da Visão/etiologia
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