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I was pleased, surprised and upset that a special issue of the (UHM) Journal (Vol 43, No 5, 2016) was devoted to one study concerning the role of HBO2 in treating TBI . . . DOI: 10.22462/1.2.2017.13

I was quite entertained to read the clashing commentaries by Dr. Mike Davis [1] and Dr. Carl Edmonds [2] regarding immersion pulmonary edema (IPE). Much of their disagreement centers on nomenclature for the condition and whether IPE warrants splitting into “scuba divers pulmonary edema” (SDPE) and “swimming-induced pulmonary edema” (SIPE). DOI: 10.22462/1.2.2017.12

I do not think we will forget the joy we felt when Beatrice Bebe Vio won the Paralympic Gold in Rio in 2016 for fencing with foil. Nor can we forget the famous selfie taken by President Obama with her during his last official State Dinner in October 2016 while he entertained the Italian delegation. It is certain that Bebe will remember this year as a special time full of emotions that only very few people in the world can experience . . . DOI: 10.22462/1.2.2017.11

Arterial gas embolism (AGE) can be clinically devastating, and is most often associated with exposure to changes in ambient pressure, medical procedure or congenital malformation. Here we report a case of AGE in a 78-year-old male without these traditional risk factors. Rather, the patient’s history included chronic obstructive pulmonary disease, necrotizing pneumonia, bullous disease and coughing. He was safely treated with hyperbaric oxygen (HBO2) therapy for AGE, with initial clinical improvement, but ultimately died from his underlying condition. Pathophysiology is discussed. This case illustrates the possibility that AGE can occur due to rupture of lung tissue in the absence of traditional risk factors. HBO2 therapy should be considered in the management of such patients. DOI: 10.22462/1.2.2017.16  

Introduction: This study aims to evaluate the hearing gain efficacy from adjunctive hyperbaric oxygen (HBO2) treatment in patients with idiopathic sudden sensorineural hearing loss (ISSHL). Materials and Methods: A retrospective analysis of chart reviews was performed on patients with ISSHL between January 2013 through December 2015. All patients were referred to us from our ENT Department for adjunctive hyperbaric oxygen treatment. The results were assessed through pure-tone audiometry (PTA) data change (hearing gain), both before and after HBO2 treatment. Age, gender, affected ear side, HBO2 treatment sessions, both before and after HBO2 treatment PTA were all recorded. Results: Ninety-three (93) patients with ISSHL were included in the study. The average hearing gain in this study was 17.9 dB (p=0.001), where a total of 46 (49.46%) patients showed an improvement (hearing gain ≥10 dB) in response to HBO2 treatment (p=0.002). Patients with the poorest initial severity of hearing loss who displayed a greater degree of hearing improvement after HBO2 treatment were male and in the 40- to 59-year-old age group. Conclusion: This study found that adjunctive hyperbaric oxygen treatment was efficacious for patients with idiopathic sudden sensorineural hearing loss. The total average hearing gain was recorded to be 17.9 dB. DOI: 10.22462/1.2.2017.10

Background: Decompression sickness may involve the central nervous system. The most common site is spinal cord. This study was conducted to determine the relationship between magnetic resonance(MR) imaging findings of spinal damage and clinical findings in acute decompression sickness. Methods: We conducted a retrospective review of 12 patients (male=10, female=2) who presented with spinal cord symptoms. We investigated their clinical features, neurological findings and radiologic findings. Results: The depth and bottom time of the dive were 34.5 meters (range 22-56) and 22.7 minutes (range 10-55) respectively. Most divers ascended within appropriate time frame as shown by the decompression tables. The most frequent initial symptoms were lower limbs weakness (n=12), followed by sensory disturbances (n=10) and bladder dysfuction (n=5). The chief radiologic abnormalities were continuous (n=3), or non-continuous (n=5) high-signal intensity on T2-weighted images at posterior paramedian portion of the spinal cord, mainly thoracic level. There were no abnormal findings in the remaining four (4) patients, and they showed good prognosis. All patients were treated with hyperbaric oxygen therapy and some received high-dose dexamethasone. On discharge, five (5) patients had made a full recovery, seven (7) had some residual neurological sequelae, and all patients except one (1) regained normal bladder function. Conclusion: Spinal cord decompression ..

As the population gets older, coupled with increased awareness of good health practices and the recognition that fitness contributes to participation in activities generally appropriate for younger individuals, decisions need to be made about what are appropriate activities for the older-aged scuba (self-contained underwater breathing apparatus) diver. It is essential to appreciate the distinction between chronological and physiological age. Three factors, namely fitness, comorbidities, and mobility and strength are fundamental when making decisions about participation in activities in general as well as in scuba diving for older adults. There is almost always a time to “call it quits” for everything. DOI: 10.22462/1.2.2017.8

Current study findings concerning changes in the renin-angiotensin system (RAS) in cases of hyperoxic acute lung injury (HALI) have shown conflicting results. This study aimed to detect the angiotensin II (Ang II) and angiotensin-converting enzyme (ACE) in a rat HALI model. Healthy male Sprague-Dawley rats were randomly assigned into three groups: the control group, HALI group and hyperbaric oxygen preconditioning (HBO2-PC) group. HALI was induced by exposure to pure oxygen at 250 kPa for six hours. In the HBO2-PC group, rats were exposed to oxygen at 250 kPa for 60 minutes twice daily for two consecutive days; HALI was induced at 24 hours after the last oxygen exposure. After HALI, the lung, spleen and liver were harvested for HE staining and pathological examination. At one hour and 18 hours after HALI, the blood, liver, lung and spleen were collected for the detection of Ang II and ACE contents by enzyme-linked immunosorbent assay. Pathological examination showed the lung was significantly damaged and characteristics of HALI were observed, but there were no significant pathological changes in the liver and spleen. After HALI, Ang II and ACE contents of different tissues increased progressively over time, but HBO2-PC group showed reductions in the Ang II and ..

Hyperoxic acute lung injury (HALI) is caused by prolonged exposure to high oxygen partial pressure. This study was undertaken to investigate the protective effects of oridonin on HALI in a mouse model. Mice were randomly divided into three groups: the control group, HALI group and oridonin (ORI) group. HALI was induced by exposing mice to pure oxygen at 2.5 atmospheres absolute (ATA) for six hours in the HALI and ORI groups. In the ORI group, mice were intraperitoneally injected with ORI at 10 mg/kg twice daily after hyperoxic exposure. Animals were sacrificed 24 hours after the hyperoxia exposure, followed by bronchoalveolar lavage fluid (BALF). Lungs were then collected. Each lung was processed for HE staining and detection of wet-to-dry weight ratio. The lactate dehydrogenase (LDH) activity and protein content of BALF were determined, and the contents of malonaldehyde (MDA), glutathione (GSH), tumor necrosis factor alpha (TNF-α) and interleukin-10 (IL-10) in the lung were measured. Our results showed prolonged exposure to hyperoxia significantly damaged the lung, caused lung edema, increased MDA and TNF-α, and reduced GSH and IL-10 in the lung. However, post-exposure treatment with oridonin was able to improve lung pathology, attenuate lung edema, reduce MDA and TNF-α, and increase GSH and ..

This study aimed to evaluate a recently developed equipment test method by assessing the safe and accurate functioning of the Abbott Optium FreeStyle H portable blood glucose monitor for use in the Alfred Hospital’s hyperbaric chamber. The results of this study indicate that the test method can be used successfully to evaluate instruments and/or devices for use in the hyperbaric environment. The evaluation initially found that this particular glucose monitor contained a lithium battery that can be hazardous when used in the hyperbaric environment. However, upon further inspection it was determined the battery posed minimal risk for fire and explosion due to its small capacity and design application. The results indicate that the Abbott Optium FreeStyle H blood glucose monitor operated normally when used in the hyperbaric chamber. This glucometer was found to perform within the calibration specification requirements for accuracy at all stages of a typical hyperbaric treatment and as such the Abbott Optium FreeStyle H blood glucose monitor was deemed safe for use in the hyperbaric chamber at the Alfred Hospital. DOI: 10.22462/1.2.2017.5

We present a standardized test methodology and results for our evaluation of the Carefusion Alaris PC infusion pump, comprising the model 8015 PC Unit and the model 8100 Large Volume Pump (LVP) module. The evaluation consisted of basic suitability testing, internal component inspection, surface temperature measurement of selected internal components, and critical performance testing (infusion rate accuracy and occlusion alarm pressure) during conditions of typical hyperbaric oxygen (HBO2) treatment in our facility’s class A multiplace chamber. We have found that the pumps pose no enhanced risk as an ignition source, and that the pumps operate within manufacturer’s specifications for flow rate and occlusion alarms at all stages of HBO2 treatments, up to 4.0 ATA and pressurization and depressurization rates up to 180 kPa/minute. The pumps do not require purging with air or nitrogen and can be used unmodified, subject to the following conditions: pumps are undamaged, clean, fully charged, and absent from alcohol cleaning residue; pumps are powered from the internal NiMH battery only; maximum pressure exposure 4.0 ATA; maximum pressurization and depressurization rate of 180 kPa/minute; LVP modules locked in place with retaining screws. DOI: 10.22462/1.2.2017.4

Background: The incidence of intentional carbon monoxide (CO) poisoning is believed to have declined due to strict federal CO emissions standards for motor vehicles and the uniform application of catalytic converters (CC). We sought to compare ambient CO levels produced by automobiles with and without catalytic converters in a residential garage, as well as from other CO sources commonly used for intentional poisoning. Methods: CO levels were measured inside a free-standing 73 m3 one-car garage. CO sources included a 1971 automobile without CC, 2003 automobile with CC, charcoal grill, electrical generator, lawn mower and leaf blower. Results: After 20 minutes of operation, the CO level in the garage was 253 PPM for the car without a catalytic converter and 30 PPM for the car equipped with one. CO levels after operating or burning the other sources were: charcoal 200 PPM; generator >999 PPM; lawn mower 198 PPM; and leaf blower 580 PPM. Conclusions: While emissions controls on automobiles have reduced intentional CO poisonings, alternate sources may produce CO at levels of the same magnitude as vehicles manufactured prior to the use of catalytic converters. Those involved in the care of potentially suicidal individuals should be aware of this. DOI: 10.22462/1.2.2017.3

As the title implies, much appears amiss with hyperbaric medicine. Long recognized for its life-saving, CNS-sparing, infection fighting and tissue-salving attributes, its current application has been rightly called into question by a broad cross-section of health care delivery system stakeholders [1, 2, 3, 4, 5]. This paper will examine what lies behind the stunning loss of availability for a majority of the Federal Drug Administration-approved uses, arguably those for which patients have the most to gain. It will address overutilization in the context of an erosion of practice standards and widespread manipulation of the reimbursement process. It will make suggestions aimed at restoring its broader availability across the full extent of FDA-approved uses. Finally, it offers guidance to ensure that HBO2 therapy is employed only when medically necessary by adoption of the drug administration “rights” principle, namely the right indication for the right patient at the right time and only for the right amount of time. DOI: 10.22462/1.2.2017.2

The field of undersea and hyperbaric medicine has changed since the day six Naval officers established the Undersea Medical Society in 1967. At that time, the focus of the field primarily involved the treatment of emergencies, but over the next 50 years, the UHMS has promulgated the use of hyperbaric oxygen (HBO2) therapy for many additional indications. The field of hyperbaric medicine has grown to include more than the treatment of emergent indications, and as the interest in using HBO2 for non-healing wounds increased, the number of facilities available for emergency and critical care hyperbaric oxygen therapy has dropped. There are numerous reasons for this. DOI: 10.22462/1.2.2017.1