2024 December;54(4)
Diving Hyperb Med. 2024 20 December;54(4):265–274. doi: 10.28920/dhm54.4.265-274. PMID: 39675733.
Economic analysis of hyperbaric oxygen therapy for the treatment of ischaemic diabetic foot ulcers
Robin J Brouwer1,2*, Nick S van Reijen3*, Marcel G Dijkgraaf4, Rigo Hoencamp2,5,6, Mark JW Koelemay3, Robert A van Hulst1, Dirk T Ubbink3
1 Department of Anaesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
2 Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
3 Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
4 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
5 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
6 Department of Surgery, Erasmus University, Rotterdam, The Netherlands
* Both authors contributed equally to this paper
Corresponding author: Dr Robin J Brouwer, Department of Anaesthesiology, Amsterdam University Medical Centers, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
Keywords
Peripheral arterial occlusive disease; Cost-effectiveness; Wound healing
Abstract
(Brouwer RJ, van Reijen NS, Dijkgraaf MG, Hoencamp R, Koelemay MJW, van Hulst RA, Ubbink DT. Economic analysis of hyperbaric oxygen therapy for the treatment of ischaemic diabetic foot ulcers. Diving and Hyperbaric Medicine. 2024 20 December;54(4):265–274. doi: 10.28920/dhm54.4.265-274. PMID: 39675733.)
Introduction: The aim was to determine the cost-effectiveness and cost-utility of additional hyperbaric oxygen therapy (HBOT) compared to standard care (SC) for ischaemic diabetic foot ulcers (DFUs) regarding limb salvage and health status.
Methods: An economic analysis was conducted, comprising cost-effectiveness and cost-utility analyses, with a 12-month time horizon, using data from the DAMO2CLES multicentre randomised clinical trial. Cost-effectiveness was defined as cost per limb saved and cost-utility as cost per quality-adjusted life year (QALY). The difference in cost effectiveness between HBOT+SC and SC alone was determined via an incremental cost-effectiveness ratio (ICER).
Results: One-hundred and twenty patients were included, with 60 allocated to HBOT+SC and 60 to SC. No significant cost difference was found in the intention-to-treat analysis: €3,791 (bias corrected and accelerated [BCA] 95% CI, €3,556-€-11,138). Cost per limb saved showed an ICER of €37,912 (BCA 95% CI €-112,188-€1,063,561) for HBOT+SC vs. SC. There was no significant difference in mean QALYs: 0.54 for HBOT+SC vs. 0.56 for SC alone (-0.02; BCA 95% CI -0.11-0.08). This resulted in a cost-utility of minus €227,035 (BCA 95% CI €-361,569,550-€-52,588) per QALY. Subgroup analysis for Wagner stages III/IV showed an ICER of €19,005 (BCA 95%CI, -€18,487-€264,334) while HBOT did not show any benefit for Wagner stage II.
Conclusions: HBOT as an adjunct to SC showed no significant differences in costs and effectiveness for patients with DFUs regarding limb salvage and health status. However, for patients with Wagner stage III/IV ischaemic DFUs there was a trend towards better effectiveness and cost-effectiveness.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Original article
Diving Hyperb Med. 2024 20 December;54(4):275−280. doi: 10.28920/dhm54.4.275-280. PMID: 39675734.
Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss: a cohort study of 10 versus more than 10 treatments
Brenda R Laupland1, Kevin B Laupland2,3, Kenneth Thistlethwaite1
1 Hyperbaric Medicine Unit, Royal Brisbane and Women’s Hospital, Brisbane, Australia
2 Department of Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia
3 Queensland University of Technology (QUT), Brisbane, Australia
Corresponding author: Dr Brenda R Laupland, Hyperbaric Medicine Unit, Ned Hanlon Building, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, QLD 4006, Brisbane, Australia
ORCiD: 0009-0005-4883-1932
Keywords
Dose; Hyperbaric research; Number of treatments; Outcomes
Abstract
(Laupland BR, Laupland KB, Thistlethwaite K. Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss: a cohort study of 10 versus more than 10 treatments. Diving and Hyperbaric Medicine. 2024 20 December;54(4):275−280. doi: 10.28920/dhm54.4.275-280. PMID: 39675734.)
Introduction: Current treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) includes a combination of corticosteroids and hyperbaric oxygen therapy (HBOT) without established dose. The objective of this study was to investigate whether > 10 HBOT treatments offers improved outcome over 10 treatments.
Methods: A retrospective chart review was performed of patients treated with HBOT for ISSNHL between 2013 and 2022 at the Royal Brisbane and Women’s Hospital. Pure tone average results from 500, 1,000, 2,000, 4,000 hertz (PTA4) were obtained pre-treatment, after treatment 10, and six weeks post-treatment.
Results: There were 479 patients treated for ISSNHL: 144 having audiograms six weeks post-treatment, 140 of whom also had an audiogram after treatment 10. At six weeks post treatment 22% (32/144) had normal hearing (PTA4 < 25 dB), and 69% (99/144) had a PTA4 gain ≥ 10 dB. At the treatment 10 audiogram, 83/140 (59%) were improved. From these, 5/21 (24%) with 10 treatments and 14/57 (25%) with > 10 treatments had a further PTA4 gain of ≥ 10 dB occurring after treatment 10. For those 57/140 (41%) not improved at treatment 10, 7/26 (27%) with 10 treatments and 12/31 (39%) with > 10 treatments were improved at six weeks post-treatment with 5/7 (71%) and 8/12 (67%) of the 10 and > 10 groups respectively having ≥ 10 dB gain in PTA4 occurring after treatment 10. Overall, there was no significant difference in mean (SD) hearing gain from treatment 10 to six weeks post treatment between the 10 treatments and > 10 treatments groups: 4.73 (8.90) versus 5.93 (11.25) dB, P = 0.53.
Conclusions: In conjunction with steroids, 10 treatments of hyperbaric oxygen therapy appear to offer equivalent benefit to > 10 treatments. Similar improvements in PTA4 and hearing recovery occur after 10 HBOT treatments independent of ongoing HBOT. A prospective trial comparing 10 versus > 10 treatments for ISSNHL with outcome measured beyond treatment completion is warranted.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Original article
Diving Hyperb Med. 2024 20 December;54(4):281−286. doi: 10.28920/dhm54.4.281-286. PMID: 39675735.
Occurrence and resolution of freediving-induced pulmonary syndrome in breath-hold divers: an online survey of lung squeeze incidents
Elaine Yu1, Grant Z Dong2, Timothy Patron2, Madeline Coombs2, Peter Lindholm1,3, Frauke Tillmans1,2,3
1 Department of Emergency Medicine, University of California, San Diego, California, USA
2 Divers Alert Network, Durham, North Carolina, USA
3 Center of Excellence in Diving, University of California, San Diego, California, USA
Corresponding author: Dr Elaine Yu, Department of Emergency Medicine, University of California, San Diego, California, USA
Keywords
Barotrauma; Pulmonary barotrauma; Pulmonary edema; Pulmonary oedema; Survey
Abstract
(Yu E, Dong GZ, Patron T, Coombs M, Lindholm P, Tillmans F. Occurrence and resolution of freediving-induced pulmonary syndrome in breath-hold divers: an online survey of lung squeeze incidents. Diving and Hyperbaric Medicine. 2024 20 December;54(4):281−286. doi: 10.28920/dhm54.4.281-286. PMID: 39675735.)
Introduction: Breath-hold divers occasionally surface with signs of fluid accumulation and/or bleeding in air-filled spaces. This constellation of symptoms, recently termed ‘freediving induced pulmonary syndrome’, is thought to come from immersion pulmonary oedema and/or barotrauma of descent and is colloquially termed a ‘squeeze’. There is limited understanding of the causes, diagnosis, management, and return to diving recommendations after a squeeze.
Methods: We developed an online survey that queried breath-hold divers on the circumstances and management of individual squeeze events.
Results: A total of 132 (94 M, 38 F) breath-hold divers filled out the survey. Most were recreational or competitive freedivers with mean age of 37 years old and nine years of experience. Of those, 129 (98%) held a certification in freediving from an accredited training agency. A total of 103 individuals reported 140 squeeze events from 2008–2023. The average depth at which a squeeze occurred was 43 m. The top contributors to lung squeezes were described as movement at depth, contractions, and inadequate warm-up. The most common symptoms of a squeeze were cough, sputum production, and fatigue. Divers were instructed to wait an average of two months before returning to diving after a squeeze. On average, divers were able to achieve the same depth of their squeeze event three months after the incident.
Conclusions: Inadequate warm-up, contractions, and abnormal movement at depth are the most reported causes for a squeeze. Most divers do not seek medical treatment after a lung squeeze event and can return to the same depth within three months.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Original article
Diving Hyperb Med. 2024 20 December;54(4):287−295. doi: 10.28920/dhm54.4.287-295. PMID: 39675736.
Modelling the risk factors for accidents in recreational divers: results from a cross-sectional evaluation in Belgium
Kurt G Tournoy1,2, Martijn Vandebotermet3, Philippe Neuville4, Peter Germonpré5
1 Ghent University, Faculty of Medicine and Life Sciences, Ghent, Belgium
2 Department of Respiratory Medicine, Onze-Lieve-Vrouw Hospital Aalst, Belgium
3 Department of Respiratory Medicine, General Hospital Groeninge, Kortrijk, Belgium
4 General Physician, Ostend, Belgium
5 Centre for Hyperbaric Oxygen Therapy, Military Hospital, Brussels, Belgium
Corresponding author: Kurt Tournoy, OLV-Aalst, Moorselbaan 164, 9300 Aalst, Belgium
ORCiD: 0000-0003-4943-3782
Keywords
Diving incidents; Diving medicine; Diving research; ENT; Epidemiology; Fitness to dive; Health surveys
Abstract
(Tournoy KG, Vandebotermet M, Neuville P, Germonpré P. Modelling the risk factors for accidents in recreational divers: results from a cross-sectional evaluation in Belgium. Diving and Hyperbaric Medicine. 2024 20 December;54(4):287−295. doi: 10.28920/dhm54.4.287-295. PMID: 39675736.)
Introduction: Characterisation of the recreational diving community could help to identify scuba divers at risk for accidents.
Methods: We performed a cross-sectional evaluation in a federation for recreational scuba divers in Belgium (Duiken.Vlaanderen). Using binary logistic regression, factors predictive for accidents leading to hospitalisation were identified.
Results: Of the 710 members, 210 (29.6%) participated in the survey, representing 140,133 dives. Age was > 50 years in 55% and the median (interquartile range [IQR]) number of dives was 380 (IQR 140–935). Cardiac (9.5%), orthopaedic (11.0%), ear-nose-throat (ENT, 10.5%) and allergic diseases (30.5%) were the top four morbidities. Twenty percent reported taking cardiovascular medication. Decompression accidents, barotrauma of the ear and musculoskeletal injuries were reported in 11.0, 11.9 and 11.0%. Fifty-five divers (26.2%) reported incidents not necessitating a medical intervention. For 36 divers (17.1%), medical interventions were necessary. Among these, 13 divers (6.2%) were hospitalised at least once and 12 (5.7%) of these needed hyperbaric oxygen therapy (HBOT). The absolute risk for hospitalisation or HBOT was 0.01% per dive. Age, advanced diving qualification, more dives annually, cardiac or ENT pathology and cardiac medication were significantly associated with an increased likelihood of hospitalisation resulting from diving accidents. In a multivariate risk model, ENT comorbidity (odds ratio [OR] 9.3; P = 0.006) and cardiac medication (OR 5.6; P = 0.05) predicted hospitalisation due to a diving accident.
Conclusions: One in six recreational scuba divers required a medical intervention at least once during their career, while 6.2% were hospitalised or received HBOT. Ear nose and throat comorbidity and cardiac medication were strong predictors for accidents. These should be given sufficient weight in dive medical examination.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Original article
Diving Hyperb Med. 2024 20 December;54(4):296−300. doi: 10.28920/dhm54.4.296-300. PMID: 39675737.
Meclizine seasickness medication and its effect on central nervous system oxygen toxicity in a murine model
Guy Wiener1, Anna Jamison1, Dror Tal1
1 Motion Sickness and Human Performance Laboratory, The Israel Naval Medical Institute, IDF Medical Corps, Haifa, Israel
Corresponding author: Guy Wiener, Motion Sickness and Human Performance Laboratory, The Israel Naval Medical Institute (INMI), Box 22, Rambam Health Care Campus, P.O. Box 9602, 3109601 Haifa, Israel
ORCiD: 0009-0007-8749-6078
Keywords
Cholinergic antagonists; Closed circuit rebreathers; Diving; Histamine antagonists; Seizures
Abstract
(Wiener G, Jamison A, Tal D. Meclizine seasickness medication and its effect on central nervous system oxygen toxicity in a murine model. Diving and Hyperbaric Medicine. 2024 20 December;54(4):296−300. doi: 10.28920/dhm54.4.296-300. PMID: 39675737.)
Introduction: Diving utilising closed circuit pure oxygen rebreather systems has become popular in professional settings. One of the hazards the oxygen diver faces is central nervous system oxygen toxicity (CNS-OT), causing potentially fatal convulsions. At the same time, divers frequently travel by boat, often suffering seasickness. The over-the-counter medication meclizine is an anticholinergic and antihistaminergic agent that has gained popularity in the treatment of seasickness. Reports have shown the inhibitory effect that acetylcholine has on glutamate, a main component in the mechanism leading to CNS-OT seizure. The goal of the present study was to test the effect of meclizine on the latency to CNS-OT seizures under hyperbaric oxygen conditions.
Methods: Twenty male mice were exposed twice to 608 kPa (6 atmospheres) absolute pressure while breathing oxygen after administration of control solution (carboxymethyl cellulose solvent) or drug solution (meclizine) in a randomised crossover design. Latency to tonic-clonic seizures was visually measured.
Results: Mean latency to seizure did not significantly differ between the control group (414 s, standard deviation
[SD] 113 s) and meclizine group (434 s, SD 174 s).
Conclusions: Based on results from this animal model, meclizine may be an appropriate option for divers suffering from seasickness, who plan on diving using pure oxygen rebreather systems.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Original article
Diving Hyperb Med. 2024 20 December;54(4):301−307. doi: 10.28920/dhm54.4.301-307. PMID: 39675738.
Trends in competitive freediving accidents
Jérémie Allinger1, Oleg Melikov2, Frédéric Lemaître1
1 CETAPS UR 3832 Faculty of Sports Sciences, University of Rouen, Rouen, France
2 Association Internationale pour le Développement de l’Apnée, AIDA International, Geneva, Switzerland
Corresponding author: Dr Oleg Melikhov, Association Internationnale pour le Développement de l’Apnée (AIDA International), Rue de l’Athénée 4, C/O Mentha Avocats, CH-1211 Genève 12, Switzerland
ORCiD: 0000-0001-9442-7707
Keywords
Barotrauma; Blackout; Breath-hold diving; Central nervous system; Hypoxia; Loss of consciousness; Safety
Abstract
(Allinger J, Melikov O, Lemaître F. Trends in competitive freediving accidents. Diving and Hyperbaric Medicine. 2024 20 December;54(4):301−307. doi: 10.28920/dhm54.4.301-307. PMID: 39675738.)
Introduction: Understanding safety issues in competitive freediving is necessary for taking preventive actions and to minimise the risk for the athletes.
Methods: We analysed occurrence of loss of consciousness (LOC) and pulmonary barotrauma (PBt) in various freediving disciplines in 988 competitions over five years (from 2019 to 2023 inclusive), with 38,789 officially registered performances (starts): 26,403 in pool disciplines and 12,386 in depth disciplines.
Results: Average incident rate in competitive freediving (all cases: LOCs plus PBt, 2019−2023) was 3.43% (1,329 incidents / 38,789 starts). The average incident rate of LOC and PBt within five years were 3.31% and 0.38% respectively for all disciplines. Two disciplines present higher risk for LOC: dynamic without fins (DNF) (mean risk ratio (RR) = 1.48, 95% CI, 1.13 to 1.96, P < 0.01) and constant weight without fins (CNF) (mean RR = 2.02, 95% CI, 1.39 to 2.94, P < 0.001). The RR for PBt was not higher in any discipline. The overall risk of all types of incidents (LOC plus PBt) was also higher for DNF (mean RR = 1.55, 95% CI, 1.18 to 2.04, P < 0.01) and CNF (mean RR = 2.80, 95% CI, 1.70 to 5.04, P < 0.001).
Conclusions: The disciplines without fins in the pool (DNF) and at depth (CNF) appear to be the most dangerous in terms of LOC. We may recommend that organisers and safety teams should pay a special attention to no-fin disciplines as most risky for possible LOC.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Original article
Diving Hyperb Med. 2024 20 December;54(4):308−319. doi: 10.28920/dhm54.4.308-319. PMID: 39675739.
Divers treated in Townsville, Australia: worse symptoms lead to poorer outcomes
Denise F Blake1,2, Melissa Crowe3, Daniel Lindsay4,5, Richard Turk6, Simon J Mitchell7,8,9, Neal W Pollock10,11
1 Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia
2 Marine Biology and Aquaculture, James Cook University, Townsville, Queensland, Australia
3 Division of Research, James Cook University, Townsville, Queensland, Australia
4 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
5 Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
6 Hyperbaric Medicine Unit, Townsville University Hospital, Townsville, Queensland, Australia
7 Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
8 Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
9 Slark Hyperbaric Unit, North Shore Hospital, Auckland, New Zealand
10 Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
11 Service de médecine hyperbare, Centre de médecine de plongée du Québec, Levis, Québec, Canada
Corresponding author: Dr Denise F Blake, IMB 23, Emergency Department, 100 Angus Smith Drive, Townsville University Hospital, Douglas, Queensland 4814, Australia
ORCiD: 0000-0002-2811-4195
Keywords
Decompression illness; Decompression sickness; Hyperbaric oxygen treatment; Oxygen; Recompression; Scuba diving
Abstract
(Blake DF, Crowe M, Lindsay D, Turk R, Mitchell SJ, Pollock NW. Divers treated in Townsville, Australia: worse symptoms lead to poorer outcomes. Diving and Hyperbaric Medicine. 2024 20 December;54(4):308−319. doi: 10.28920/dhm54.4.308-319. PMID: 39675739.)
Introduction: Hyperbaric oxygen treatment (HBOT) is considered definitive treatment for decompression illness. Delay to HBOT may be due to dive site remoteness and limited facility availability. Review of cases may help identify factors contributing to clinical outcomes.
Methods: Injured divers treated in Townsville from November 2003 through December 2018 were identified. Information on demographics, initial disease severity, time to symptom onset post-dive, time to pre-HBOT oxygen therapy (in-water recompression or normobaric), time to HBOT, and clinical outcome was reviewed. Data were reported as median (interquartile range [IQR]) with Kruskal-Wallis and chi-square tests used to evaluate group differences. Significance was accepted at P < 0.05.
Results: A total of 306 divers (184 males, 122 females) were included with a median age of 29 (IQR 24, 35) years. Most divers had mild initial disease severity (n = 216, 70%). Time to symptom onset was 60 (10, 360) min, time to pre-HBOT oxygen therapy was 4:00 (00:30, 24:27) h:min, and time to start of HBOT was 38:51 (22:11, 69:15) h:min. Most divers (93%) had a good (no residual or minor residual symptoms) outcome and no treated diver died. Higher initial disease severity was significantly associated with shorter times to symptom onset, oxygen therapy, and HBOT, and with worse outcomes. The paucity of cases receiving HBOT with minimal delay precluded meaningful evaluation of the effect of delay to HBOT.
Conclusions: Most divers had mild initial disease severity and a good outcome. Higher initial disease severity accelerated the speed of care obtained and was the only factor associated with poorer outcome.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Original article
Diving Hyperb Med. 2024 20 December;54(4):320−327. doi: 10.28920/dhm54.4.320-327. PMID: 39675740.
Dive medicine capability at Rothera Research Station (British Antarctic Survey), Adelaide Island, Antarctica
Felix N R Wood1,2, Katie Bowen1, Rosemary Hartley1, Matt Warner1, Doug Watts1,3
1 British Antarctic Survey Medical Unit, Plymouth, United Kingdom
2 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, United Kingdom
3 DDRC Healthcare, Plymouth, United Kingdom
Corresponding author: Dr Felix Wood, British Antarctic Survey Medical Unit, Science Park, Plymouth, PL6 8BU, United Kingdom
ORCiD: 0000-0002-5706-852X
Keywords
Cold; Drysuit; Diving; Diving emergencies; Recompression; Remote locations
Abstract
(Wood FNR, Bowen K, Hartley R, Warner M, Watts D. Dive medicine capability at Rothera Research Station (British Antarctic Survey), Adelaide Island, Antarctica. Diving and Hyperbaric Medicine. 2024 20 December;54(4):320−327. doi: 10.28920/dhm54.4.320-327. PMID: 39675740.)
Rothera is a British Antarctic Survey research station located on Adelaide Island adjacent, to the Antarctic Peninsula. Diving is vital to support a long-standing marine science programme but poses challenges due to the extreme and remote environment in which it is undertaken. We summarise the diving undertaken and describe the medical measures in place to mitigate the risk to divers. These include pre-deployment training in the management of emergency presentations and assessing fitness to dive, an on-site hyperbaric chamber and communication links to contact experts in the United Kingdom for remote advice. The organisation also has experience of evacuating patients, should this be required. These measures, as well as the significant infrastructure and logistical efforts to support them, enable high standards of medical care to be maintained to divers undertaking research on this most remote continent.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Technical report
Diving Hyperb Med. 2024 20 December;54(4):328−337. doi: 10.28920/dhm54.4.328-337. PMID: 39675741.
Development of myopia in scuba diving and hyperbaric oxygen treatment: a case report and systematic review
Sofia A Sokolowski1, Anne K Räisänen-Sokolowski1,2, Richard V Lundell1,3,4
1 Department of Pathology, Helsinki University, Helsinki, Finland
2 Pathology, Helsinki University Hospital, Helsinki, Finland
3 Department of Leadership and Military Pedagogy, National Defence University, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
4 Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
Corresponding author: Sofia A Sokolowski, Department of Pathology, Helsinki University, Helsinki, Finland
ORCiD: 0000-0002-7936-1436
Keywords
Myopization, Ophthalmology, Oxygen toxicity, Side effects, Recreational divers, Repetitive diving, Safety
Abstract
(Sokolowski SA, Räisänen-Sokolowski AK, Lundell RV. Development of myopia in scuba diving and hyperbaric oxygen treatment: a case report and systematic review. Diving and Hyperbaric Medicine. 2024 20 December;54(4):328−337. doi: 10.28920/dhm54.4.328-337. PMID: 39675741.)
Introduction: A 54-year-old, previously healthy Caucasian male diver was on a 22-day liveaboard diving holiday. During this time, he performed 75 open-circuit dives, of which 72 were with enriched air nitrox. All dives were within recreational length and depth. After the trip he noticed a worsening of vision and his refraction had changed from the previous -3.75/–5.75 to -5.5/–7.75 dioptres. Hyperoxic myopia is a well-known phenomenon after hyperbaric oxygen treatment (HBOT), but related literature in recreational divers is scarce.
Methods: A systematic literature review on the effect of a hyperoxic environment on the development of myopia was done according to the PRISMA guidelines. Three databases were searched: Ovid MEDLINE, Scopus, and the Cochrane Library. A risk of bias analysis was done on all articles, and the GRADE approach was used to evaluate the quality of evidence. Articles that had sufficient data were used to synthesise a visualisation of oxygen exposure and changes in refraction.
Results: Twenty-two articles were included in this review. These included five case reports, two case series, nine cohort studies, one randomised controlled trial and five reviews, of which one was systematic. Most articles described HBOT patients’ ocular complications, although four articles were diver centric. The synthesis of results suggests that divers tend to get a greater myopic shift with a smaller exposure. However, the data were too heterogeneous to perform meaningful statistical analyses. This review is the first to focus on divers instead of HBOT patients.
Conclusions: The case presented led to a systematic literature review on the effects of hyperbaric oxygen on refractive changes in both HBOT patients and divers. The data were too heterogeneous to make meaningful suggestions on a safety limit to prevent myopisation in diving.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Review article
Diving Hyperb Med. 2024 20 December;54(4):338−343. doi: 10.28920/dhm54.4.338-343. PMID: 39675742.
South Pacific Underwater Medicine Society (SPUMS) position statement regarding paediatric and adolescent diving
Elizabeth Elliott1, David Smart1, John Lippmann2,3, Neil Banham4, Matias Nochetto5, Stephan Roehr6
1 Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Australia
2 Australasian Diving Safety Foundation, Melbourne, Australia
3 Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
4 Department of Hyperbaric Medicine, Fiona Stanley Hospital, Perth, Australia
5 Divers Alert Network (DAN), Durham NC, USA
6 Department of Hyperbaric Medicine, Townsville University Hospital, Townsville, Australia
Corresponding author: Dr Elizabeth Elliott, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Liverpool St, Hobart, Tasmania 7000, Australia
ORCiD: 0009-0005-3679-621X
Keywords
Adolescents; Children; Fitness to dive; Medicals – diving; Recreational divers; Risk assessment; Scuba diving
Abstract
(Elliott E, Smart D, Lippmann J, Banham N, Nochetto M, Roehr S. South Pacific Underwater Medicine Society (SPUMS) position statement regarding paediatric and adolescent diving. Diving and Hyperbaric Medicine. 2024 20 December;54(4):338−343. doi: 10.28920/dhm54.4.338-343. PMID: 39675742.)
This paediatric diving position statement was developed from a targeted workshop at the 51st Annual Scientific Meeting of the South Pacific Underwater Medicine Society (SPUMS) on 8 June 2023. It highlights the factors that SPUMS regards as important when undertaking health risk assessments for diving by children and adolescents (defined as aged 10 to 15 years). Health risk assessments for diving should be performed by doctors who are trained in diving medicine and who are familiar with the specific risks which result from breathing compressed gas in the aquatic environment. Undertaking a diver health risk assessment of children and adolescents requires a detailed history (including medical, mental health, psychological maturity), a comprehensive diver medical physical examination and evaluation of all relevant investigations to exclude unacceptable risks. In addition, assessment of the individual’s motivation to dive and reported in-water capability should occur, whilst engaging with their parent/guardian and instructor, where appropriate, to ensure that safety for the child is optimised. The guideline applies to all compressed air diving including scuba and surface supply diving provided in open and contained bodies of water.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Guidelines
Diving Hyperb Med. 2024 20 December;54(4):344−349. doi: 10.28920/dhm54.4.344-349. PMID:.
Joint position statement on immersion pulmonary oedema and diving from the South Pacific Underwater Medicine Society (SPUMS) and the United Kingdom Diving Medical Committee (UKDMC) 2024
Neil Banham1, David Smart2, Peter Wilmshurst3, Simon J Mitchell4,5,6, Mark S Turner7, Philip Bryson8
1 Department of Hyperbaric Medicine, Fiona Stanley Hospital, Perth, Australia
2 Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Australia
3 Cardiology Department, Royal Stoke University Hospital, Stoke on Trent, United Kingdom
4 Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
5 Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
6 Slark Hyperbaric Unit, North Shore Hospital, Auckland, New Zealand
7 Bristol Heart Institute, Bristol, United Kingdom
8 TAC Healthcare Group, Wellheads Industrial Estate, Aberdeen, United Kingdom
Corresponding author: Dr Neil Banham, Department of Hyperbaric Medicine, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch WA 6150, Australia
Keywords
Fitness for diving; Guideline; Immersion pulmonary edema; Scuba; Swimming induced pulmonary edema
Abstract
(Banham N, Smart D, Wilmshurst P, Mitchell SJ, Turner MS, Bryson P. Joint position statement on immersion pulmonary oedema and diving from the South Pacific Underwater Medicine Society (SPUMS) and the United Kingdom Diving Medical Committee (UKDMC) 2024. Diving and Hyperbaric Medicine. 2024 20 December;54(4):344−349. doi: 10.28920/dhm54.4.344-349. PMID: 39675743.)
This joint position statement (JPS) on immersion pulmonary oedema (IPO) and diving is the product of a workshop held at the 52nd Annual Scientific Meeting of the South Pacific Underwater Medicine Society (SPUMS) from 12–17 May 2024, and consultation with the United Kingdom Diving Medical Committee (UKDMC), three members of which attended the meeting. The JPS is a consensus of experts with relevant evidence cited where available. The statement reviews the nomenclature, pathophysiology, risk factors, clinical features, prehospital treatment, investigation of and the fitness for future compressed gas diving following an episode of IPO. Immersion pulmonary oedema is a life-threatening illness that requires emergency management as described in this statement. A diver with previous suspected or confirmed IPO should consult a medical practitioner experienced in diving medicine. The SPUMS and the UKDMC strongly advise against further compressed gas diving if an individual has experienced an episode of IPO.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Guidelines
Diving Hyperb Med. 2024 20 December;54(4):350−353. doi: 10.28920/dhm54.4.350-353. PMID: 39675744.
Anaesthetic and surgical management of gastric perforation secondary to a diving incident: a case report
Ismaïl Ben Ayad1, Chloe Damman1, Lionel vander Essen2, Bernard Majerus2
1 Catholic University of Leuven (UCLouvain), Brussels, Belgium
2 Clinique Saint-Pierre, Ottignies, Belgium
Corresponding author: Dr Ismaïl Ben Ayad, Catholic University of Leuven (UCLouvain), Promenade de l’Alma, 1200, Woluwe-Saint-Lambert Brussels, Belgium
ORCiD: 0009-0007-0665-9294
Keywords
Hypoxia, Trauma, Surgery, Anaesthesia, Treatment, Ascent
Abstract
(Ben Ayad I, Damman C, vander Essen L, Majerus B. Anaesthetic and surgical management of gastric perforation secondary to a diving incident: a case report. Diving and Hyperbaric Medicine. 2024 20 December;54(4):350−353. doi: 10.28920/dhm54.4.350-353. PMID: 39675744.)
Gastric perforation secondary to barotrauma is a rare surgical condition which may manifest as an acute abdomen and potentially lead to complications such as pneumoperitoneum. A 50-year-old, healthy, experienced diving instructor was transported to our emergency department for an acute abdomen and severe dyspnoea after a diving incident. Clinical suspicion combined with computed tomography scanning lead to the diagnosis of linear rupture of the stomach. Exsufflation of the abdominal cavity was performed in the emergency department and then the patient was sent to the operating room for emergency laparoscopic gastric repair. Post-operative management was focused on decompressing the stomach with a nasogastric tube and abdominal radiography with barium ingestion was performed to confirm the absence of leakage. The patient was discharged at postoperative day four. We found 16 similar cases in the published literature. Gastric perforation secondary to a diving accident is rare but requires rapid diagnosis and surgical treatment.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Case report
Diving Hyperb Med. 2024 20 December;54(4):354−359. doi: 10.28920/dhm54.4.354-359. PMID: 39675745.
Recurrent cutaneous decompression sickness in a hyperbaric chamber attendant with a large persistent foramen ovale
Peter T Wilmshurst1, Christopher J Edge2
1 Royal Stoke University Hospital, Newcastle Road, Stoke on Trent, United Kingdom
2 Department of Life Sciences, Imperial College, London, United Kingdom
Corresponding author: Dr Peter T Wilmshurst, Royal Stoke University Hospital, Newcastle Road, Stoke on Trent, ST4 6QG, United Kingdom
Keywords
Bubbles; Echocardiography; Hyperbaric oxygen treatment; Migraine with aura; Oxygen; Working in compressed air
Abstract
(Wilmshurst PT, Edge CJ. Recurrent cutaneous decompression sickness in a hyperbaric chamber attendant with a large persistent foramen ovale. Diving and Hyperbaric Medicine. 2024 20 December;54(4):354−359. doi: 10.28920/dhm54.4.354-359. PMID: 39675745.)
A 41-year-old female nurse had cutaneous decompression sickness on two occasions after acting as an inside chamber attendant for patients receiving hyperbaric oxygen. She breathed air during the treatments at pressures equivalent to 14 and 18 metres of seawater, but each time she decompressed whilst breathing oxygen. Latency was 2.5 hours and one hour. She was found to have an 11 mm diameter persistent foramen ovale. It was closed and she returned to work without recurrence of decompression sickness. Review of the literature suggests that shunt mediated decompression sickness is an important occupational risk for individuals with a large right-to-left shunt when working in hyperbaric air, but the manifestations of decompression sickness differ in those who decompress whilst breathing oxygen compared with those who decompress whilst breathing air.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Case report
Diving Hyperb Med. 2024 20 December;54(4):360−367. doi: 10.28920/dhm54.4.360-367. PMID: 39675746.
Five consecutive cases of sensorineural hearing loss associated with inner ear barotrauma due to diving, successfully treated with hyperbaric oxygen
David Smart1
1 Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
Corresponding author: Clinical Professor David Smart, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Liverpool St, Hobart, Tasmania 7000, Australia
ORCiD: 0000-0001-6769-2791
Keywords
Barotrauma; Case reports; Cochlea; Hearing loss, sudden; Hyperbaric oxygen treatment; Inner ear
Abstract
(Smart D. Five consecutive cases of sensorineural hearing loss associated with inner ear barotrauma due to diving, successfully treated with hyperbaric oxygen. Diving and Hyperbaric Medicine. 2024 20 December;54(4):360−367. doi: 10.28920/dhm54.4.360-367. PMID: 39675746.)
Introduction: This report describes the outcomes of sensorineural hearing loss (SNHL) due to cochlear inner ear barotrauma (IEBt) in five divers treated with hyperbaric oxygen (HBOT).
Methods: The case histories of five consecutive divers presenting with SNHL from IEBt due to diving, were reviewed. All divers provided written consent for their data to be included in the study. All had reference pre-injury audiograms. All noted ear problems during or post-dive. Independent audiologists confirmed SNHL in all divers prior to HBOT, then assessed outcomes after HBOT.
Results: Three divers breathed compressed air on low risk dives, and two were breath-hold. None had symptoms or signs other than hearing loss, and none had vestibular symptoms. All could equalise their middle ears. Inner ear decompression sickness was considered unlikely for all cases. All were treated with HBOT 24 hours to 12 days after diving. Two divers received no steroid treatment, one was treated with HBOT after an unsuccessful 10-day course of steroids, and two divers received steroids two days after commencing HBOT. All divers responded positively to HBOT with substantial improvements in hearing across multiple frequencies and PTA4 measurements. Median improvement across all frequencies (for all divers) was 28 dB, and for PTA4 it was 38 dB.
Conclusions: This is the first case series describing use of HBOT for IEBt-induced SNHL. The variable treatment latency and use/timing of steroids affects data quality, but also reflects pragmatic reality, where steroids have minimal evidence of benefit for IEBt. HBOT may benefit diving related SNHL from IEBt with no evidence of perilymph fistula, and provided the divers can clear their ears effectively. A plausible mechanism is via correction of ischaemia within the cochlear apparatus. More study is required including data collection via national or international datasets, due to the rarity of IEBt.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Publication Type: Case report