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UHM Journal Ahead of Print

The UHMS now provides the Undersea and Hyperbaric Medicine Journal as an e-publication prior to print.  UHMS members and subscriber will have access to the full unedited paper once logged in. 



CMS Data Demonstrates a Cost and Clinical Advantage for Hyperbaric Oxygen for Radiation Cystitis, A Controlled Study John J. Feldmeier DO 1, John P. Kirby MD 2, Helen B. Gelly MD3 Marc Robins DO 4, John Peters FACHE 5 Peter Gruhn, MA6, Sarmistha Pal, PhD6 1. Professor Emeritus and Past Chairman, Radiation Oncology, University of Toledo Medical Center. 2. Associate Professor of Surgery, Washington University School of Medicine in St Louis, MO 3. President, Regenerative and Hyperbaric Medicine, Marietta, Georgia 4. Marc Robins, DO, MPH, FUHM, FAACP 5. John S. Peters, FACHE, ED UHMS 6. Peter Gruhn, M.A., Dobson DaVanzo and Associates, LLC 6. Sarmistha Pal, Ph.D., Dobson ..
  Hyperbaric Oxygen Therapy Regimens, Treated Conditions, and Adverse Effect Profile RUNNING TITLE:  AN UNDERSEA AND HYPERBARIC MEDICAL SOCIETY SURVEY STUDY ABSTRACT Introduction: When administering HBO2, pressures can range from 1.4 atmospheres absolute (ATA) to 3 ATA. While different treatment modalities have been proposed, there is a paucity of literature comparing the effectiveness and risk profile associated with different pressures treating the same condition. Considering the therapeutic divergence, this study aims to survey Undersea and Hyperbaric Medical Society (UHMS) members on pressure modalities and their use in different clinical conditions. Methods: The study was a voluntary cross-sectional survey administered online and open to healthcare providers ..
Cardiovascular effects of breath-hold diving at altitude RUNNING HEAD: BREATH-HOLD DIVING AT ALTITUDE   ABSTRACT Hypoxia, centralization of blood in pulmonary vessels, and increased cardiac output during physical exertion are the pathogenetic pathways of acute pulmonary edema observed during exposure to extraordinary environments. This study aimed to evaluate the effects of breath-hold diving at altitude, which exposes simultaneously to several of the stimuli mentioned above. To this aim, 11 healthy male experienced divers (age 18-52y) were evaluated (by Doppler echocardiography, lung echography to evaluate ultrasound lung B-lines (BL), hemoglobin saturation, arterial blood pressure, fractional NO (Nitrous Oxide) exhalation) in basal condition (altitude 300m asl), ..
Acute aortic dissection during scuba diving RUNNING HEAD: ACUTE AORTIC DISSECTION DURING SCUBA DIVING   ABSTRACT A 60-year-old man with hypertension and dyslipidemia complained of chest pain upon ascending from a maximum depth of 27 meters while diving.  After reaching the shore, his chest pain persisted, and he called an ambulance.  When a physician checked him on the doctor’s helicopter, his electrocardiogram (ECG) was normal, and there were no bubbles in his inferior vena cava or heart on a portable ultrasound examination.  The physician still suspected that he had acute coronary syndrome instead of decompression illness; therefore, he was transported to our hospital.  ..
Acute effects of apnea bouts on hemoglobin concentration and hematocrit: a systematic review and meta-analysis APNEA AND HEMATOLOGICAL EFFECTS ABSTRACT Objective: This study aimed to systematically analyze the existing literature and conduct a meta-analysis on the acute effects of apnea on the hematological response by assessing changes in hemoglobin (Hb) concentration and hematocrit (Hct) values. Methods: Research in Pubmed, The Cochrane Library, and Web of Science was carried out for studies in which the main intervention was voluntary hypoventilation, and Hb and Hct values were measured. Risk of bias and quality assessments were performed. Results: Nine studies with data from 160 participants were ..
Advanced high-pressure hyperbaric techniques in tunneling HIGH-PRESSURE TECHNIQUES IN TUNNELING   ABSTRACT Work in compressed air and diving are both occupational activities that have been around since the mid-19th century, and those undertaking their work under elevated pressure. Meeting the demand to go to “higher pressure for longer” in tunneling has lagged in diving, but both activities have found it necessary to adopt mixed gas breathing and saturation exposure techniques. This paper explains how work in hyperbaric conditions at high pressure is undertaken in tunneling and is illustrated by the hyperbaric activity likely to be involved in constructing a large-diameter road tunnel ..
 ABSTRACT A widely accepted belief is that Nathaniel Henshaw was the first practitioner of hyperbaric medicine. He is said to have constructed the first hyperbaric chamber where he treated several disorders and provided opportunities to prevent disease and optimize well-being. While there is little doubt Henshaw was the first to conceptualize this unique medical technology, careful analysis of his treatise has convinced this writer that his was nothing more than a proposal. Henshaw’s air chamber was never built. He would have failed to appreciate how its structural integrity could be maintained in the presence of enormous forces generated by envisioned ..
Effect of hyperbaric oxygen therapy on diabetes-related oral complications HYPERBARIC OXYGEN THERAPY IN DIABETES MELLITUS ABSTRACT Background: Diabetes Mellitus is a chronic disease characterized by uncontrolled blood sugar levels, which lead to end-organ damage. While the diagnosis and treatment of its complications have been extensively studied, the effect of Hyperbaric Oxygen Therapy (HBO2) on diabetes- related oral complications remains unexplored. Aim: This prospective clinical study aims to investigate the effect of HBO2 on diabetes-related oral complications. Methods: Twenty patients diagnosed with diabetic foot ulcers and scheduled for HBO2 were included in this study. We recorded stimulated and unstimulated saliva pH, buffering capacity, flow rate, ..
[ RESEARCH ARTICLE [ Quantification of referrals received at two emergency-capable hyperbaric medicine centers QUANTIFICATION OF HYPERBARIC REFERRALS ABSTRACT Emergency hyperbaric oxygen treatment capability is limited in the United States, and there is little documentation of calls received by 24/7/365 centers. Our study aimed to calculate the number of calls received for urgent hyperbaric oxygen (HBO2). We logged calls from two HBO2 chambers on the East Coast of the United States that serve a densely populated region. The total number of emergency calls was 187 at the University of Maryland (UMD) and 127 at the University of Pennsylvania (UPenn). There were calls ..
Objective: To analyze Hyperbaric Oxygen Therapy Registry (HBOTR) data to determine physician productivity rates and understand the frequency of simultaneous patient supervision in the United States (US). Methods: Deidentified electronic health record data from all payers were prospectively collected from the HBOTR from 2013 to 2022 and retrospectively analyzed. We estimated the mean number of yearly hyperbaric oxygen therapy (HBO2) treatments per physician per workday. We analyzed physician productivity by counting the number of physicians who administered fewer than two HBO2 treatments daily on average and the ten most productive physicians. Results: There were 262,055 HBO2 sessions provided by 333 physicians ..
In clinical management of carbon monoxide (CO) poisoning, serum cardiac enzyme biomarkers and electrocardiogram (ECG) are both highly recommended emergency check-ups to evaluate myocardial injuries. Medical imaging – including head CT or MRI – are not routine for CO poisoning emergency management. We herein report on a comatose patient who was diagnosed with cerebral infarction secondary to 24 hours previous acute CO poisoning, warned by a typical cerebral-type T waves on ECG in advance, and confirmed by a head MRI. Fortunately, the patient made a full recovery based on a timely treatment with medications and hyperbaric oxygen (HBO2) therapy. ..
Throughout more than five decades a multitude of experimental and clinical studies has shown predominantly positive, but also controversial results on the efficacy of hyperbaric oxygen (HBO2) therapy in burns. Aim of the study was to define a common denominator or constellations, respectively, linked to the effects of HBO2 in burns with special focus on dosage parameters. Based on original work since 1965, species, number of individuals, type of study, percentage of total body surface area (TBSA), region, depth of burn, causative agent, interval between burn and first HBO2 session, pressure, duration of individual session, number of HBO2 sessions per ..
The hip is the most common location for avascular necrosis of the femoral head (AVN), with an estimated incidence in the United States of 10,000 to 20,000 new cases per year. The current standard of care for early disease is core decompression, with bone marrow injections becoming more commonplace. Hyperbaric oxygen enhances oxygen delivery to tissue, promotes an anti-inflammatory and pro-healing environment, and helps initiate angiogenesis. We believe that these properties of HBO2 make it a unique tool for AVN and applied it in conjunction with standard of care for our patient.   DOI: 10.22462/644
Inner ear decompression sickness (IEDCS) is an uncommon diving-related injury affecting the vestibulocochlear system, with symptoms typically including vertigo, tinnitus and hearing loss, either in isolation or in combination. Classically associated with deep, mixed-gas diving, more recent case series have shown that IEDCS is indeed possible after seemingly innocuous recreational dives, and there has been one previous report of IEDCS following routine hyperbaric chamber operations. The presence of right-to-left shunt (RLS), dehydration and increases in intrathoracic pressure have been identified as risk factors for IEDCS, and previous studies have shown a predominance of vestibular rather than cochlear symptoms, with ..
We present two cases of cricoid chondronecrosis treated with hyperbaric oxygen (HBO2) therapy. Both patients presented with biphasic stridor and dyspnea several weeks after an intubation event. Tracheostomy was ultimately performed for airway protection, followed by antibiotic treatment and outpatient HBO2 therapy. Both patients were decannulated within 6 months of presentation and after at least 20 HBO2 therapy sessions. Despite a small sample size, our findings are consistent with data supporting HBO2 therapy’s effects on tissue edema and neovascularization as well as HBO2 potentiation of antibiotic treatment and leukocyte function. We suggest HBO2 therapy may have accelerated airway decannulation ..
Renal abscess (RA) is a collection of infective fluid in or around the renal parenchyma. It typically occurs in immunocompromised patients including those with diabetes mellitus (DM), poor nutritional status, or steroid administration. We herein report a case of RA associated with DM in which hyperbaric oxygen (HBO2) therapy greatly contributed to the resolution of this disease. The patient was an 85-year-old man with poorly controlled type 2 DM. Contrast-enhanced computed tomography for postoperative follow-up of appendiceal cancer showed a mass lesion with poor contrast enhancement extending from the upper pole of the left kidney to the dorsal side. Therefore, a diagnosis ..