2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):2–9. doi: 10.28920/dhm51.1.2-9. PMID: 33761535.

Hyperbaric oxygen treatment for mastectomy flap ischaemia: A case series of 50 breasts

Nicole E Spruijt1, Lisette T Hoekstra1,2, Johan Wilmink3, Maarten M Hoogbergen1,4

1 Da Vinci Clinic, Geldrop, the Netherlands
2 Department of Plastic, Reconstructive and Hand Surgery, Maastricht UMC+, the Netherlands
3 Department of Plastic, Reconstructive and Hand Surgery, Maxima Medical Center Eindhoven, the Netherlands
4 Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, the Netherlands

Corresponding author: Dr Nicole E Spruijt, Da Vinci Clinic, Nieuwendijk 49, 5664HB Geldrop, the Netherlands
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Key words
Necrosis; Nipple; Outcome; Radiotherapy; Skin; Surgery

Abstract
(Spruijt NE, Hoekstra LT, Wilmink J, Hoogbergen MH. Hyperbaric oxygen treatment for mastectomy flap ischaemia: a case series of 50 breasts. Diving and Hyperbaric Medicine. 2021 March 31;51(1):2–9. doi: 10.28920/dhm51.1.2-9. PMID: 33761535.)
Introduction: Hyperbaric oxygen treatment (HBOT) has been suggested as an effective intervention to limit necrosis of ischaemic skin flaps after mastectomy. The purpose of this study was to evaluate outcomes of HBOT in the largest series of patients to date with mastectomy flap ischaemia.
Methods: A retrospective analysis was performed of 50 breasts requiring HBOT for mastectomy flap ischaemia. The severity of the ischaemia or necrosis was evaluated by four independent observers using the skin ischaemia necrosis (SKIN) score. Multivariate logistic regression analyses were used to assess associations between risk factors and re-operation.
Results: HBOT was started a median of 3 days (range 1–23) after surgery and continued for a median of 12 sessions (range 6–22). The breast SKIN surface area scores (n = 175 observations by the independent observers) improved in 34% (of observations) and the depth scores deteriorated in 42% (both P < 0.01). Both the surface area and depth scores were associated with the need for re-operation: higher scores, reflecting more severe necrosis of the mastectomy flap, were associated with increased need for re-operation. Twenty-nine breasts (58%) recovered without additional operation. Pre-operative radiotherapy (OR 7.2, 95% CI 1.4–37.3) and postoperative infection (OR 15.4, 95% CI 2.6–89.7) were risk factors for re-operation in multivariate analyses.
Conclusions: In this case series, the surface area of the breast affected by ischaemia decreased during HBOT, and most breasts (58%) did not undergo an additional operation. A randomised control trial is needed to confirm or refute the possibility that HBOT improves outcome in patients with mastectomy flap ischaemia.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):10–17. doi: 10.28920/dhm51.1.10-17. PMID: 33761536.

An insight to tympanic membrane perforation pressure through morphometry: A cadaver study

Derya Ümit Talas1, Orhan Beger2, Ülkü Çömelekoğlu3, Salim Çakır4, Pourya Taghipour4, Yusuf Vayisoğlu1

1 Mersin University Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
2 Mersin University Faculty of Medicine, Department of Anatomy, Mersin, Turkey
3 Mersin University Faculty of Medicine, Department of Biophysics, Mersin, Turkey
4 Mersin University Faculty of Medicine, Mersin, Turkey

Corresponding author: Orhan Beger, Mersin University Faculty of Medicine, Department of Anatomy, Ciftlikkoy Campus, 33343, Mersin, Turkey
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Key words
Bursting pressure, Cadaver, Ear barotrauma; Eardrum; Diving; Transducer

Abstract
(Talas DÜ, Beger O, Çömelekoğlu Ü, Çakır S, Taghipour P, Vayisoğlu Y. An insight to tympanic membrane perforation pressure through morphometry: A cadaver study. Diving and Hyperbaric Medicine. 2021 March 31;51(1):10–17. doi: 10.28920/dhm51.1.10-17. PMID: 33761536.)
Introduction: A cadaveric experimental investigation aimed to show the rupture pressure of the tympanic membrane (TM) for otologists to evaluate its tensile strength.
Methods: Twenty adult ears in 10 fresh frozen whole cadaveric heads (four males, six females) mean age 72.8 (SD 13.8) years (range 40–86) were studied. The tensile strength of the TM was evaluated with bursting pressure of the membrane. The dimensions of the membranes and perforations were measured with digital imaging software.
Results: The mean bursting pressure of the TM was 97.71 (SD 36.20) kPa. The mean area, vertical and horizontal diameters of the TM were 57.46 (16.23) mm2, 9.54 (1.27) mm, 7.99 (1.08) mm respectively. The mean area, length and width of the perforations were 0.55 (0.25) mm2, 1.37 (0.50) mm, and 0.52 (0.22) mm, respectively. Comparisons of TM dimension, bursting pressure, and perforation size by laterality and gender showed no significant differences. The bursting pressure did not correlate (positively or negatively) with the TM or perforation sizes.
Conclusions: The TM can rupture during activities such as freediving or scuba diving, potentially leading to serious problems including brain injuries. Studying such events via cadaveric studies and data from case studies is of fundamental importance. The minimum experimental bursting pressures might better be taken into consideration rather than average values as the danger threshold for prevention of TM damage (and complications thereof) by barotrauma.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):18–24. doi: 10.28920/dhm51.1.18-24. PMID: 33761537.

A survey on the health status of Dutch scuba diving instructors

Prashant Komdeur1, Thijs T Wingelaar2,3, Rob A van Hulst3

1 Sports Medical Center Papendal, Hengstdal 3, 6574 NA Ubbergen, the Netherlands
2 Diving Medical Center, Royal Netherlands Navy, Den Helder, the Netherlands
3 Department of Anaesthesiology, University Medical Center, Amsterdam, the Netherlands

Corresponding author: Dr Prashant Komdeur, Sports Medical Center Papendal, Hengstdal 3, 6574 NA Ubbergen, the Netherlands
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Key words
Age; Drugs; Fitness to dive; Health surveys; Medications; Medical conditions and problems; Risk factors

Abstract
(Komdeur P, Wingelaar TT, van Hulst RA. A survey on the health status of Dutch scuba diving instructors. Diving and Hyperbaric Medicine. 2021 March 31;51(1):18–24. doi: 10.28920/dhm51.1.18-24. PMID: 33761537.)
Introduction: As the diving population is ageing, so are the diving instructors. Health issues and the use of prescribed medications are more common when ageing. The death of two diving instructors during one weekend in 2017 in the Netherlands, most likely due to cardiovascular disease, motivated investigation of the prevalence of relevant comorbidities in Dutch diving instructors.
Methods: All Dutch Underwater Federation diving instructors were invited to complete an online questionnaire. Questions addressed diving experience and current and past medical history including the use of medications.
Results: A response rate of 27% yielded 497 questionnaires (87% male, average age 57.3 years [SD 8.5]). Older instructors were over-represented among responders (82% of males and 75% of females > 50 years versus 66% of males and 51% of females among the invited cohort). Forty-six percent of respondents reported no current medical condition. Hypertension was the most commonly reported condition followed by hay fever and problems equalising ears and sinuses. Thirty-two percent reported no past medical condition. Problems of equalising ears and sinuses was the most common past medical condition, followed by hypertension, joint problems or surgery, and hay fever. Fifty-nine percent used non-prescription medication; predominantly analgesics and nose or ear drops. Forty-nine percent used prescription medicine, mostly cardiovascular and respiratory drugs. Body mass index (BMI) was > 25 kg·m-2 in 66% of males and 38% of females. All instructors with any type of cardiovascular disease were overweight.
Conclusions: Nineteen percent of responding diving instructors suffered from cardiovascular disease with above-normal BMI and almost 60% used prescribed or non-prescribed medication. Some dived while suffering from medical issues or taking medications, which could lead to medical problems during emergency situations with their students.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):25–33. doi: 10.28920/dhm51.1.25-33. PMID: 33761538.

Snorkelling and breath-hold diving fatalities in New Zealand, 2007 to 2016

John Lippmann1,2, Chris Lawrence3,4, Michael Davis5

1 Australasian Diving Safety Foundation, Ashburton, Victoria, Australia
2 Department of Public Health and Preventive Medicine, Monash University, Victoria, Australia
3 Department of Pathology, Christchurch Hospital, Christchurch, New Zealand
4 Statewide Forensic Medical Services, Royal Hobart Hospital, Tasmania, Australia
5 Honorary Senior Lecturer, Department of Anaesthesiology, School of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand

Corresponding author: Dr John Lippmann, Australasian Diving Safety Foundation, PO Box 478, Canterbury, VIC 3126, Australia
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Key words
Apnoeic hypoxia; Cardiovascular; Diving deaths; Diving incidents; Drowning; Obesity; Pulmonary oedema

Abstract
(Lippmann J, Lawrence C, Davis M. Snorkelling and breath-hold diving fatalities in New Zealand, 2007 to 2016. Diving and Hyperbaric Medicine. 2021 March 31;51(1):25–33. doi: 10.28920/dhm51.1.25-33. PMID: 33761538.)
Introduction: New Zealand’s (NZ) long coastline offers a diverse underwater environment with abundant opportunities for harvesting seafood and for recreation. Fatalities from snorkelling/breath-hold diving have been reported from the 1960s through to 2006. Those from 2007 to 2016 are reported here.
Methods: The National Coronial Information System, the Australasian Diving Safety Foundation diving fatality database, and the Water Safety NZ “Drownbase” were searched and additional coronial data provided by the NZ Ministry of Justice. An anonymised database was created and analysed for multiple factors. A chain of events analysis was performed for each case.
Results: There were 38 snorkelling or breath-hold-related deaths in NZ, 33 men and five women. Twenty-nine were breath-hold divers involved in gathering seafood, and six ‘surface snorkellers’, predominantly sightseeing. Two-thirds were diving alone and/or were not being observed by anyone out of the water. Twenty-eight victims were classified as overweight or obese and 19/38 were Māori. Pre-existing health factors that may have or definitely contributed to the fatality were present in 30 cases. The most common of these were cardiac (18/38). Two divers had insulin-dependent diabetes mellitus, one each epilepsy and asthma whilst cannabis and/or alcohol were possible factors in seven deaths. Five (possibly six) deaths resulted from apnoeic hypoxia.
Conclusions: Overall, death from snorkelling/breath-hold diving was an uncommon event (38 in 10 years). Poor judgement was a common feature. Middle-aged Māori men with pre-existing disease feature strongly. This suggests an on-going need for appropriate water safety education within and beyond the Māori community.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):34–43. doi: 10.28920/dhm51.1.34-43. PMID: 33761539.

Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A systematic review and meta-analysis

Morten Hedetoft1,2, Michael H Bennett2, Ole Hyldegaard1

1 Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark
2 Department of Anaesthesia and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, Australia

Corresponding author: Dr Morten Hedetoft, Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Blegdamsvej 8, 2100 Copenhagen, Denmark
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Key words
Evidence; Necrotizing infections; Systematic review

Abstract
(Hedetoft M, Bennett MH, Hyldegaard O. Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A systematic review and meta-analysis. Diving and Hyperbaric Medicine. 2021 March 31;51(1):34–43. doi: 10.28920/dhm51.1.34-43. PMID: 33761539.)
Introduction: Surgical intervention, broad-spectrum antibiotics and intensive care support are the standard of care in the treatment of necrotising soft-tissue infections (NSTI). Hyperbaric oxygen treatment (HBOT) may be a useful adjunctive treatment and has been used for almost 60 years, but its efficacy remains unknown and has not been systematically appraised. The aim was to systematically review and synthesise the highest level of clinical evidence available to support or refute the use of HBOT in the treatment of NSTI.
Methods: The review was prospectively registered (PROSPERO; CRD42020148706). MEDLINE, EMBASE, CENTRAL and CINAHL were searched for eligible studies that reported outcomes in both HBOT treated and non-HBOT treated individuals with NSTI. In-hospital mortality was the primary outcome. Odds ratio (ORs) were pooled using random-effects models.
Results: The search identified 486 papers of which 31 were included in the qualitative synthesis and 21 in the meta-analyses. Meta-analysis on 48,744 patients with NSTI (1,237 (2.5%) HBOT versus 47,507 (97.5%) non-HBOT) showed in-hospital mortality was 4,770 of 48,744 patients overall (9.8%) and the pooled OR was 0.44 (95% CI 0.33–0.58) in favour of HBOT. For major amputation the pooled OR was 0.60 (95% CI 0.28–1.28) in favour of HBOT. The dose of oxygen in these studies was incompletely reported.
Conclusions: Meta-analysis of the non-random comparative data indicates patients with NSTI treated with HBOT have reduced odds of dying during the sentinel event and may be less likely to require a major amputation. The most effective dose of oxygen remains unclear.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):44–52. doi: 10.28920/dhm51.1.44-52. PMID: 33761540.

Middle ear barotrauma in diving

Oskari H Lindfors1, Anne K Räisänen-Sokolowski2,3, Jari Suvilehto4, Saku T Sinkkonen1

1 Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
2 Department of Pathology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
3 Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
4 Mehiläinen Oy, Helsinki, Finland

Corresponding author: Oskari H Lindfors, Department of Otorhinolaryngology – Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital, P.O. Box 263, FI-00029 HUH, Helsinki, Finland
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Key words
ENT; Epidemiology; Eustachian tube; Eustachian tube dysfunction; Health surveys; Survey; Valsalva manoeuvre

Abstract
(Lindfors OH, Räisänen-Sokolowski AK, Suvilehto J, Sinkkonen ST. Middle ear barotraumas in diving. Diving and Hyperbaric Medicine. 2021 March 31;51(1):44–52. doi: 10.28920/dhm51.1.44-52. PMID: 33761540.)
Introduction: Middle ear barotrauma (MEBt) is the most common medical complication in diving, posing a serious risk to dive safety. Given this prevalence and the continuing growth of the diving industry, a comprehensive overview of the condition is warranted.
Methods: This was a survey study. An anonymous, electronic questionnaire was distributed to 7,060 recipients: professional divers of the Finnish Border Guard, the Finnish Rescue Services, and the Finnish Heritage agency; and recreational divers registered as members of the Finnish Divers’ Association reachable by e-mail (roughly two-thirds of all members and recreational divers in Finland). Primary outcomes were self-reported prevalence, clinical characteristics, and health effects of MEBt while diving. Secondary outcomes were adjusted odds ratios (OR) for frequency of MEBt with respect to possible risk factors.
Results: A total of 1,881 respondents participated in the study (response rate 27%). In total, 81% of the respondents had experienced MEBt while diving. Of those affected, 38% had used medications and 1% had undergone otorhinolaryngology-related surgical procedures due to MEBt. Factors most associated with MEBt were poor subjective success in Valsalva (‘occasionally’ versus ‘always’ successful: OR 11.56; 95% CI 7.24–18.47) and Toynbee (‘occasionally’ versus ‘always’ successful: OR 3.51; 95% CI 1.95–6.30) manoeuvres.
Conclusions: MEBt is common in both recreational and professional divers, having affected 81% of the respondents. The main possible risk factors include poor success in pressure equalisation manoeuvres.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):53–62. doi: 10.28920/dhm51.1.53-62. PMID: 33761541.

Fatalities involving divers using surface-supplied breathing apparatus in Australia, 1965 to 2019

John Lippmann1,2

1 Australasian Diving Safety Foundation, Canterbury, Victoria, Australia
2 Department of Public Health and Preventive Medicine, Monash University, Victoria, Australia

Corresponding author: Dr John Lippmann, Australasian Diving Safety Foundation, P.O. Box 478 Canterbury, VIC 3126, Australia
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Key words
Carbon monoxide; Chain of events analysis; Diving compressors; Diving deaths; Fitness to dive; Occupational diving

Abstract
(Lippmann J. Fatalities involving divers using surface-supplied breathing apparatus in Australia, 1965 to 2019. Diving and Hyperbaric Medicine. 2021 March 31;51(1):53–62. doi: 10.28920/dhm51.1.53-62. PMID: 33761541.)
Introduction: This study identified characteristics and diving practices of victims of fatal surface supplied breathing apparatus (SSBA) incidents in Australia from 1965–2019 to determine underlying factors and risks associated with these activities, better educate the diving community and prevent such deaths.
Methods: A hand search was made of ‘Project Stickybeak’ reports from 1965–2000 and SSBA fatality data were compared to the Australasian Diving Safety Foundation fatality database. The National Coronial Information System was searched to identify SSBA diving deaths for 2001–2019. Extracted data were collated and analysed using descriptive statistics and Poisson Regression. A chain of events analysis was used to determine the likely sequence of events.
Results: There were 84 identified SSBA-related deaths during the study period. Most victims were relatively young, healthy males (median age 33 years). At least 50% of victims were undertaking work-related diving, and 37% were recreational diving. Equipment issues, mainly compressor-related, were the main contributor, identified as a predisposing factor in 48% of incidents and as triggers in 24%.
Conclusions: Preventable surface-supplied diving deaths still occur in both occupational and recreational diving, often from poor equipment maintenance and oversight. Incorrect configuration of the SSBA and lack of training remain on-going problems in recreational users. These could be addressed by improved education, and, failing this, regulatory oversight. The increase in health-related incidents in older participants may be controlled to some extent by greater medical oversight, especially in recreational and non-certified occupational divers who should be encouraged to undergo regular diving medical assessments.

Copyright: This article is the copyright of the author who grants Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):63–67. doi: 10.28920/dhm51.1.63-67. PMID: 33761542.

Does persistent (patent) foramen ovale closure reduce the risk of recurrent decompression sickness in scuba divers?

Björn Edvinsson1, Ulf Thilén1, Niels Erik Nielsen2, Christina Christersson3, Mikael Dellborg4, Peter Eriksson4, Joanna Hlebowicz1

1 Department of Cardiology, Department of Clinical Science, Skåne University Hospital, Lund University, Lund, Sweden
2 Department of Cardiology, Department of Clinical Science, University Hospital Linköping, Linköping University, Linköping, Sweden
3 Department of Medical Sciences, Cardiology Uppsala University, Uppsala, Sweden
4 Department of Cardiology, Department of Clinical Science, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden

Corresponding author: Dr Joanna Hlebowicz, Department of Cardiology, Skåne University Hospital, Lund University, SE-221, 85 Lund, Sweden
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Key words
Decompression illness; Right-to-left shunt; Risk; Scuba diving; Trimix;Venous gas embolism

Abstract
(Edvinsson B, Thilén U, Nielsen NE, Christersson C, Dellborg M, Eriksson P, Hlebowicz J. Does patent foramen ovale closure reduce the risk of recurrent decompression sickness in scuba divers? Diving and Hyperbaric Medicine. 2021 March 31;51(1):63–67. doi: 10.28920/dhm51.1.63-67. PMID: 33761542.)
Introduction: Interatrial communication is associated with an increased risk of decompression sickness (DCS) in scuba diving. It has been proposed that there would be a decreased risk of DCS after closure of the interatrial communication, i.e., persistent (patent) foramen ovale (PFO). However, the clinical evidence supporting this is limited.
Methods: Medical records were reviewed to identify Swedish scuba divers with a history of DCS and catheter closure of an interatrial communication. Thereafter, phone interviews were conducted with questions regarding diving and DCS. All Swedish divers who had had catheter-based PFO-closure because of DCS were followed up, assessing post-closure diving habits and recurrent DCS.
Results: Nine divers, all with a PFO, were included. Eight were diving post-closure. These divers had performed 6,835 dives (median 410, range 140–2,200) before closure, and 4,708 dives (median 413, range 11–2,000) after closure. Seven cases with mild and 10 with serious DCS symptoms were reported before the PFO closure. One diver with a small residual shunt suffered serious DCS post-closure; however, that dive was performed with a provocative diving profile.
Conclusion: Divers with PFO and DCS continue to dive after PFO closure and this seems to be fairly safe. Our study suggests a conservative diving profile when there is a residual shunt after PFO closure, to prevent recurrent DCS events.

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


 

2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):68–71. doi: 10.28920/dhm51.1.68-71. PMID: 33761543.

Hyperbaric oxygen for sudden hearing loss: Influence of international guidelines on practice in Australia and New Zealand

Susannah Sherlock1,2, Sharon Kelly3, Michael H Bennett4,5

1 Hyperbaric Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia
2 Senior Clinical Lecturer, University of Queensland, Brisbane, Australia
3 Department of Ear Nose and Throat Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Australia
4 Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney Australia
5 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia

Corresponding author: Dr Susannah Sherlock, Royal Brisbane and Women’s Hospital, Butterfield St, Herston QLD 4029, Brisbane, Australia
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Key words
ENT; General interest; Hearing loss, sudden; Hyperbaric facilities; Hyperbaric oxygen therapy; Medical society

Abstract
(Sherlock S, Kelly S, Bennett MH. Hyperbaric oxygen for sudden hearing loss: Influence of international guidelines on practice in Australia and New Zealand. Diving and Hyperbaric Medicine. 2021 March 31;51(1):68–71. doi: 10.28920/dhm51.1.68-71. PMID: 33761543.)
Introduction: Idiopathic sudden sensorineural hearing loss (ISSHL) is an otolaryngologic emergency. The Undersea and Hyperbaric Medicine Society (UHMS) revised practice guidelines in 2014 adding ISSHL to approved indications. This study investigated whether the UHMS guidelines influenced referral and practice in Australia and New Zealand.
Methods: Retrospective review of 319 patient referrals in two time periods (five years prior to addition of ISSHL to indications (T-PRE) and three years post (T-POST)).
Results: Seven of eight participating hyperbaric facilities provided data down to the level of the indication for HBOT for analysis. In T-PRE 136 patients were treated with HBOT for ISSHL, representing between 0% and 18% of the total cases to each facility. In the T-POST period 183 patients were treated for ISSHL, representing from 0.35% to 24.8% of the total patients in each facility. Comparison between the two periods shows the proportion of patients treated with ISSHL among all indications increased from 3.2% to 12.1% (P < 0.0009). One facility accounted for 74% (101/136) of ISSHL patients receiving HBOT in T-PRE and 63% (116/183) in T-POST. ISSHL case load at that facility increased from 18% to 24.8% (P = 0.009) after the UHMS guideline publication. Three of the seven units had a significant increase in referrals after the guideline change.
Conclusion: There remains equipoise regarding HBOT in the management of ISSHL. Only three out of seven units had a significant increase in ISSHL patients after the UHMS guidelines publication. Without well controlled RCTs to develop guidelines based on good evidence this is unlikely to change and practice variation will continue.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):72–77. doi: 10.28920/dhm51.1.72-77. PMID: 33761544.

Patient knowledge and experience of hyperbaric oxygen treatment

Louise MacInnes1, Carol Baines1, Alexandra Bishop2, Karen Ford3

1 Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
2 DDRC Healthcare, Hyperbaric Medical Centre, Plymouth, Devon, UK
3 Tasmanian Health Service South, Tasmania and University of Tasmania, Hobart, Tasmania, Australia

Corresponding author: Dr Carol Baines, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Tasmania 7000, Australia
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Key words
Communication; Panic; Patient monitoring; Questionnaire; Stress

Abstract
(MacInnes L, Baines C, Bishop A, Ford K. Patient knowledge and experience of hyperbaric oxygen treatment. Diving and Hyperbaric Medicine. 2021 March 31;51(1):72–77. doi: 10.28920/dhm51.1.72-77. PMID: 33761544.)
Introduction: This paper presents a quantitative and qualitative study exploring patients’ knowledge and experience of hyperbaric oxygen treatment (HBOT).
Methods: Participants included 29 patients with appropriate indications who were undertaking HBOT at facilities in two different locations: Hobart, Australia, and Plymouth, United Kingdom. Participants completed surveys prior to commencing HBOT, after five sessions, and on completion of HBOT. Semi-structured one-to-one interviews were conducted with each individual on conclusion of their course. Data were analysed using descriptive statistics and interpretive description.
Results: Prior to referral, 15/29 (52%) of participants knew HBOT was used to treat divers, and of these, 9/15 (60%) were familiar with its use for non-divers. Only one third sought additional information about the process between referral for HBOT and attending their medical assessment. Anxiety was a pre-treatment concern amongst participants. However, when re-measured after five sessions and upon completion of the HBOT course, anxiety was reduced. The interview data revealed themes based around the physical, emotional and social aspects of HBOT: (1) anxiety within self; (2) naivety to normalisation; (3) enjoyment being a ‘diver’; and (4) burdens of HBOT.
Conclusions: Many patients experienced anxiety prior to commencing HBOT but, with support, quickly adjusted to treatment, transitioning from a state of naivety to normalisation in their experience of the hyperbaric chamber. They enjoyed feeling like a ‘diver’ and considered aspects of the burdens of treatment, such as finances or logistics, a minor inconvenience. These results highlight the need for psychosocial support during treatment by identifying gaps in patient preparation for HBOT.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):78–81. doi: 10.28920/dhm51.1.78-81. PMID: 33761545.

Provision of emergency hyperbaric oxygen treatment for a patient during the COVID-19 pandemic

Michelle L Lim1, Soo J Kim2, Meng K Tan2, Kim H Lim2, Hooi G See2

1 Department of Surgical Intensive Care, Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore
2 Hyperbaric and Diving Medicine Centre, Singapore General Hospital, Singapore

Corresponding author: Dr Michelle Lim, Department of Surgical Intensive Care, Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, 1 Outram Road Singapore 169608, Singapore
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Key words
Carbon monoxide; Infectious diseases; Intensive care medicine; Logistics

Abstract

(Lim ML, Kim SJ, Tan MK, Lim KH, See HG. Provision of emergency hyperbaric oxygen treatment for a patient during the COVID-19 pandemic. Diving and Hyperbaric Medicine. 2021 March 31;51(1):78–81. doi: 10.28920/dhm51.1.78-81. PMID: 33761545.)
The experience of managing a critically ill severe carbon monoxide poisoning patient suspected of possibly also suffering COVID-19 and requiring emergency hyperbaric oxygen treatment is described. Strategies used to minimise infection risk, modifications to practice and lessons learnt are described. All aerosol generating procedures such as endotracheal tube manipulation and suctioning should be undertaken in a negative pressure room. In the absence of in-chamber aerosol generating procedures, an intubated patient presents less risk than that of a non-intubated, symptomatically coughing patient. Strict infection control practices, contact precautions, hospital workflows and teamwork are required for the successful HBOT administration to an intubated COVID-19 suspect patient.

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: Short communication


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):82–85. doi: 10.28920/dhm51.1.82-85. PMID: 33761546.

Investigation of a cluster of decompression sickness cases following a high-altitude chamber flight

Nazim Ata1, Erkan Karaca1

1 Aeromedical Research and Training Center, Eskisehir, Turkey

Corresponding author: Dr Nazim Ata, Ucucu Sagliği Arastirma ve Egitim Merkezi, Eski Hava Hastanesi, Eskisehir, Turkey 26010
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Key words
Ascent; Aviation; Barometric pressure; Case reports; Hyperbaric oxygen; Hypoxia training

Abstract

(Ata N, Karaca E. Investigation of a cluster of decompression sickness cases following a high-altitude chamber flight. Diving and Hyperbaric Medicine. 2021 March 31;51(1):82–85. doi: 10.28920/dhm51.1.82-85. PMID: 33761546.)
Although relatively safe, hypoxia exposure is a mandatory training requirement for aircrew that carries the risk of decompression sickness (DCS). Usually DCS affects only one individual at a time. Here, a cluster of three simultaneous cases is reported. Since these numbers were well in excess of the usually encountered incidence rate, the purpose of this work was to identify the most likely reasons using the epidemic DCS investigation framework which involves four main considerations: time; place; population; and environment. Based on time and place observations, this cluster clearly falls into the individual-based classification, where the environment is a primary concern. Indeed, equipment analysis allowed us to identify the most likely reason for two out of three cases (perforations in the oro-nasal oxygen masks worn during training). It led to replacement of damaged equipment and modification of teaching to prevent such damage. It is recommended that this investigative template may be used for any future occurrences of DCS in clusters.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):86–93. doi: 10.28920/dhm51.1.86-93. PMID: 33761547.

Hyperbaric oxygen treatment: Results in seven patients with severe bacterial postoperative central nervous system infections and refractory mucormycosis

Pedro Valente Aguiar1,2, Bruno Carvalho1,2, Pedro Monteiro1,2, Paulo Linhares1,2,3, Óscar Camacho4, Rui Vaz1,2,3

1 Neurosurgery Department, Centro Hospitalar Universitário São João, Oporto, Portugal
2 Faculty of Medicine, Oporto University, Oporto, Portugal
3 Neurosciences Centre, Hospital CUF, Oporto, Portugal
4 Hyperbaric Medical Unit, Unidade Local de Saúde de Matosinhos, Portugal

Corresponding author: Dr Pedro D Valente Aguiar, Department of Neurosurgery, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
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Key words
Brain; Mucormycosis; Neurosurgery; Refractory infections; Spine

Abstract
(Valente Aguiar P, Carvalho B, Monteiro P, Linhares P, Camacho Ó, Vaz R. Hyperbaric oxygen treatment: Results in seven patients with refractory central nervous system infections. Diving and Hyperbaric Medicine. 2021 March 31;51(1):86–93. doi: 10.28920/dhm51.1.86-93. PMID: 33761547.)
Introduction: Resistant bacterial infections following brain and spine surgery and spontaneous mucormycosis with central nervous system (CNS) involvement represent a serious treatment challenge and more efficient therapeutic approaches ought to be considered. Hyperbaric oxygen treatment (HBOT) has shown promise as a complementary therapy. This case series evaluated whether HBOT contributed to infection resolution in seven patients with refractory CNS infectious conditions.
Methods: Clinical results for seven patients referred for HBOT between 2010 to 2018 to treat refractory postoperative brain and spine infections or spontaneously developing mucormycosis were retrospectively analysed. The patients’ clinical files and follow-up consultations were reviewed to assess evolution and outcome.
Results: Seven patients were referred with a median age of 56 years. The median follow-up was 20 months. Four patients had postoperative infections and three had rhino-orbital-cerebral mucormycosis (ROCM). HBOT was used as an adjunctive treatment to antimicrobial therapy in all patients. Prior to HBOT, all patients had undergone an average of four operations due to infection refractoriness and had completed an average of five months of antimicrobial therapy. After HBOT, infection resolution was obtained in six patients without additional operations, while one patient with ROCM stopped HBOT after the third session due to intolerance. Three patients stopped antimicrobial therapy while four were maintained on prophylactic treatment.
Conclusions: Infection resolution was reached in the six patients that completed HBOT as prescribed. HBOT may serve as an effective complementary treatment in CNS refractory postoperative and spontaneous infections.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):94–97. doi: 10.28920/dhm51.1.94-97. PMID: 33761548.

Saturation diver fatality due to hydrogen sulphide while working on a subsea pipe line

Ajit C Kulkarni1

1 Hyperbaric Solutions, Mumbai, India

Corresponding author: Dr Ajit C Kulkarni, Hyperbaric Solutions, 3 A, Siddhivinayak Chambers, Bandra East, Mumbai 400051, India
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Key words
Gas solubility; Hydrogen sulphide; Hyperbaric oxygen; Pulmonary oedema; Saturation diving

Abstract

(Kulkarni AC. Saturation diver fatality due to hydrogen sulphide while working on a subsea pipe line. Diving and Hyperbaric Medicine. 2021 March 31;51(1):94–97. doi: 10.28920/dhm51.1.94-97. PMID: 33761548.)
In the offshore oil industry, Multipurpose Support Vessels with extensive diving capability are used for inspection, maintenance and repair of subsea pipelines. The diving industry has developed systemic safety checks and strict regulatory control after a number of fatal accidents in early years. However, accidents do continue to occur and, when involving divers in the water, are often fatal. Hydrogen sulphide (H2S), called ‘sour gas’ in an oil field, is produced by the action of anaerobic bacteria on sulphate containing organic matter. A highly toxic gas, it remains a constant danger for offshore oil industry workers who must remain vigilant. Crude oil and gas produced in these oilfields is called ‘sour crude’ and pipelines carry this crude with varying content of dissolved H2S to shore for processing. Divers are routinely called to attend to leaking pipelines and come in contact with this crude. Their hot water suits and umbilical lines are often covered with crude containing dissolved H2S. There is always a possibility that these may enter and contaminate the bell environment. Such a case leading to fatality is reported here.

Copyright: This article is the copyright of the author who grants Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Case report


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):98–102. doi: 10.28920/dhm51.1.98-102. PMID: 33761549.

Echocardiography – techniques and pitfalls whilst diagnosing persistent (patent) foramen ovale as a risk factor in divers with a history of decompression sickness

Charles P Azzopardi1, Kurt Magri1, Alex Borg2, Jake Schembri3, Jonathan Sammut3

1 Baromedicine Department, Hyperbaric Unit, Mater Dei Hospital, Malta
2 Cardiology Department, Mater Dei Hospital, Malta
3 Mater Dei Hospital, Malta

Corresponding author: Dr Charles P Azzopardi, Baromedicine Department, Hyperbaric Unit, Mater Dei Hospital, Triq id-Donaturi tad-Demm, Tal-Qroqq, Msida, Malta
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Key words
Bubbles; Decompression illness; Right-to-left shunt

Abstract

(Azzopardi CP, Magri K, Borg A, Schembri J, Sammut J. Echocardiography – techniques and pitfalls whilst diagnosing persistent (patent) foramen ovale as a risk factor in divers with a history of decompression sickness. Diving and Hyperbaric Medicine. 2021 March 31;51(1):98–102. doi: 10.28920/dhm51.1.98-102. PMID: 33761549.)
The case of a diver with a history of decompression sickness (DCS) after recreational scuba diving is presented. Cutis marmorata, a subtype of cutaneous DCS, has been consistently associated with the presence of a persistent (patent) foramen ovale (PFO) as a risk factor. Diagnostic uncertainty arose when transthoracic echocardiography with antecubital injection of agitated saline bubbles (ASBs) did not show any significant shunt, but the presence of a large Eustachian valve was counteracted by intra-femoral injection of ASBs, showing a large PFO with spontaneous shunting. The importance of proper echocardiography techniques prior to resorting to intra-femoral injection of ASBs to counteract the haemodynamic effects of the Eustachian valve is emphasised.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):103–106. doi: 10.28920/dhm51.1.103-106. PMID: 33761550.

Spinal cord decompression sickness in an inside attendant after a standard hyperbaric oxygen treatment session

Jacek Kot1,2, Ewa Lenkiewicz2, Edward Lizak2, Piotr Góralczyk2, Urszula Chreptowicz2

1 National Centre for Hyperbaric Medicine, Institute of Maritime and Tropical Medicine in Gdynia, Medical University of Gdansk, Poland
2 Department of Hyperbaric Medicine and Sea Rescue, University Centre for Maritime and Tropical Medicine in Gdynia, Poland

Corresponding author: Associate Professor Jacek Kot, National Centre for Hyperbaric Medicine , Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Powstania Styczniowego 9B, 81-519 Gdynia, Poland
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Key words
Decompression illness; Hyperbaric facilities; Occupational health; Working in compressed air

Abstract

(Kot J, Lenkiewicz E, Lizak E, Góralczyk P, Chreptowicz U. Spinal cord decompression sickness in an inside attendant after a standard hyperbaric oxygen treatment session. Diving and Hyperbaric Medicine. 2021 March 31;51(1):103–106. doi: 10.28920/dhm51.1.103-106. PMID: 33761550.)
Medical personnel in hyperbaric treatment centres are at occupational risk for decompression sickness (DCS) while attending patients inside the multiplace hyperbaric chamber (MHC). A 51-year-old male hyperbaric physician, also an experienced diver, was working as an inside attendant during a standard hyperbaric oxygen therapy (HBOT) session (70 minutes at 253.3 kPa [2.5 atmospheres absolute, 15 metres’ seawater equivalent]) in a large walk-in MHC. Within 10 minutes after the end of the session, symptoms of spinal DCS occurred. Recompression started within 90 minutes with an infusion of lignocaine and hydration. All neurological symptoms resolved within 10 minutes breathing 100% oxygen at 283.6 kPa (2.8 atmospheres absolute) and a standard US Navy Treatment Table 6 was completed. He returned to regular hyperbaric work after four weeks of avoiding hyperbaric exposures. Transoesophageal echocardiography with a bubble study was performed 18 months after the event without any sign of a persistent (patent) foramen ovale. Any hyperbaric exposure, even within no-decompression limits, is an essential occupational risk for decompression sickness in internal hyperbaric attendants, especially considering the additional risk factors typical for medical personnel (age, dehydration, tiredness, non-optimal physical capabilities and frequent problems with the lower back).

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):107–110. doi: 10.28920/dhm51.1.107-110. PMID: 33761551.

Hyperbaric oxygen treatment in recurrent development of complex regional pain syndrome: A case report

Michal Hájek1,2, Dittmar Chmelař2,3, Jakub Tlapák4,5, František Novomeský6, Veronika Rybárová6, Miloslav Klugar7

1 Centre of Hyperbaric Medicine, Ostrava City Hospital, Ostrava, Czech Republic
2 Department of Biomedical Sciences, Institute of Microbiology and Immunology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
3 Czech Anaerobic Bacteria Reference Laboratory, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
4 The Institute of Aviation Medicine, Prague, Czech Republic
5 Department of Military Surgery, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
6 Department of Forensic Medicine and Medicolegal Expertises, Jessenius Faculty of Medicine, Comenius University, University Hospital, Martin, Slovak Republic
7 Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC; JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic

Corresponding author: Dr Michal Hajek, Center of Hyperbaric Medicine, Ostrava City Hospital, Nemocnicni 20, 728 80 Ostrava, Czech Republic
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Key words
Case reports; CRPS; Hyperbaric oxygen therapy; Pain; Risk factors

Abstract

(Hájek M, Chmelař D, Tlapák J, Novomeský F, Rybárová V, Klugar M. Hyperbaric oxygen treatment in recurrent development of complex regional pain syndrome: A case report. Diving and Hyperbaric Medicine. 2021 March 31;51(1):107–110. doi: 10.28920/dhm51.1.107-110. PMID: 33761551.)
A broad spectrum of conditions including neuropathic pain, complex regional pain syndrome (CRPS) and fibromyalgia, have been implicated as causes of chronic pain. There is a need for new and effective treatments that patients can tolerate without significant adverse effects. One potential intervention is hyperbaric oxygen treatment (HBOT). The case reported here is unique in describing repeated HBOT in a patient who developed recurrent post-traumatic CRPS of the lower as well as the upper limbs. In the first event, two months after distortion and abruption of the external right ankle, the patient suffered leg pain, oedema formation, mild hyperaemia, limited mobility of the ankle and CRPS Type 1. In the second event, the same patient suffered fracture-dislocation of the distal radius 1.5 years after the first injury. After the plaster cast was removed the patient developed pain, warmth, colour changes, oedema formation and limited wrist mobility with CRPS Type 1. Pharmacological treatment as well as HBOT were used with significant improvement of functional outcome in both cases. Some studies suggest that patients with a history of CRPS are more likely to develop secondary CRPS compared to the rates reported in the literature among the general population. Patients with a history of CRPS should be counselled that they may be at risk for developing secondary CRPS if they undergo surgery or sustain trauma to another extremity.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):111–115. doi: 10.28920/dhm51.1.111-115. PMID: 33761552.

Decompression sickness after a highly conservative dive in a diver with known persistent foramen ovale: Case report

William Brampton1, Martin DJ Sayer2,3

1 Hyperbaric Medicine Unit. Aberdeen Royal Infirmary, Aberdeen, Scotland
2 Tritonia Scientific Ltd., Oban, Scotland
3 West Scotland Centre for Diving and Hyperbaric Medicine, Oban, Scotland

Corresponding author: Dr William Brampton, Hyperbaric Medical Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, Scotland, UK
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Key words
Decompression illness; Diving; Patent foramen ovale; SPUMS; UKSDMC

Abstract

(Brampton W, Sayer MDJ. Decompression sickness after a highly conservative dive in a diver with known persistent foramen ovale: Case report. Diving and Hyperbaric Medicine. 2021 March 31;51(1):111–115. doi: 10.28920/dhm51.1.111-115. PMID: 33761552.)
A diver returned to diving, 15 months after an episode of neuro-spinal decompression sickness (DCS) with relapse, after which she had been found to have a moderate to large provoked shunt across a persistent (patent) foramen ovale (PFO), which was not closed. She performed a single highly conservative dive in line with the recommendations contained in the 2015 position statement on PFO and diving published jointly by the South Pacific Underwater Medicine Society and the United Kingdom Sports Diving Medical Committee. An accidental Valsalva manoeuvre shortly after surfacing may have provoked initial symptoms which later progressed to DCS. Her symptoms and signs were milder but closely mirrored her previous episode of DCS and she required multiple hyperbaric oxygen treatments over several days, with residua on discharge. Although guidance in the joint statement was mostly followed, the outcome from this case indicates that there may be a subgroup of divers with an unclosed PFO, who have had a previous episode of serious DCS, who may not be safe to dive, even within conservative limits.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):116–118. doi: 10.28920/dhm51.1.116-118. PMID: 33761553.

Hyperbaric oxygen treatment for late low colorectal anastomosis ischaemia: Case report

Marcello Sanzi1, Alberto Aiolfi1, Jacopo Nicolò Marin1, Abd El Hakim Darawsh2, Davide Bona1

1 Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant’Ambrogio, Milan, Italy
2 Istituto Lombardo di Medicina Iperbarica, Milan, Italy

Corresponding author: Dr Marcello Sanzi, Istituto Clinico Sant’Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149 Milan, Italy
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Key words
Gastro-intestinal tract; Surgery; Anastomosis; Wounds

Abstract
Sanzi M, Aiolfi A, Marin JN, Darawsh AEH, Bona D. Hyperbaric oxygen treatment for late low colorectal anastomosis ischaemia: Case report. Diving and Hyperbaric Medicine. 2021 March 31;51(1):116–118. doi: 10.28920/dhm51.1.116-118. PMID: 33761553.)
Introduction: This report describes the use of hyperbaric oxygen treatment (HBOT) to treat a case of colorectal anastomosis ischaemia following colorectal surgery.
Case report: A 47-year-old man developed post-operative colorectal anastomosis ischaemia with leak after laparoscopic low anterior resection for T3N0 adenocarcinoma of the rectum. The leak with concomitant ischaemia presented 17 days after surgery. HBOT was administrated in 11 sessions over three weeks and the patient followed endoscopically and radiologically for two months. At two months the anastomosis showed both endoscopic and radiological healing; therefore the ileostomy was closed. Anal function was satisfactory with no incontinence or evidence of sepsis.
Conclusions: Intra-operative or late leak with concomitant ischaemia of a colorectal anastomosis is a challenging event in colorectal surgery. HBOT may be beneficial in promoting healing in selected patients. Further studies are needed to evaluate conservative treatments and the role of HBOT.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):119–123. doi: 10.28920/dhm51.1.119-123. PMID: 33761554.

Pneumomediastinum and the use of hyperbaric oxygen treatment

Stephanie M Price1,2, Will D Price1,3, Mickaila J Johnston1,2,4

1 Naval Hospital Guam, Agana Heights, Guam
2 USS FRANK CABLE, Santa Rita, Guam
3 USS EMORY S LAND, Santa Rita, Guam
4 Naval Medical Readiness Training Unit, Silverdale, WA, USA

Corresponding author: Dr Stephanie M Price, LT, MC, USN – USS FRANK CABLE, Unit 100105 Box 211, FPO, AP 96657, USA
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Key words
Pulmonary barotrauma; Pulmonary overinflation syndrome; Diving barotrauma

Abstract

(Price SM, Price WD, Johnston MJ. Pneumomediastinum and the use of hyperbaric oxygen treatment. Diving and Hyperbaric Medicine. 2021 March 31;51(1):119–123. doi: 10.28920/dhm51.1.119-123. PMID: 33761554.)
Pulmonary barotrauma may occur in diving and can result in a spectrum of injuries referred to as pulmonary over-inflation syndrome (POIS). Pneumomediastinum is a part of the POIS spectrum and only rarely results in respiratory symptoms. We present a case of a civilian diver who developed pneumomediastinum with respiratory symptoms which did not respond to normobaric 100% oxygen. After investigation for pneumothorax, he underwent hyperbaric oxygen treatment which resulted in significant alleviation of his symptoms. This is a novel case example of this treatment algorithm.

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


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):124. doi: 10.28920/dhm51.1.124. PMID: 33761555.

Commentary on “Fatal air embolism in a breath-hold diver” and the implied dangers of technical freediving

Derek Covington, Chris Giordano

Address for correspondence: Department of Anesthesiology, University of Florida College of Medicine, Gainesville FL, USA
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Key words
Barotrauma; Breath-hold diving; Cerebral arterial gas embolism; Diving deaths; Sputum

 

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: Letter to the Editor


2021 March;51(1)

Diving Hyperb Med. 2021 March 31;51(1):125. doi: 10.28920/dhm51.1.125. PMID: 33761556.

Acute central nervous system oxygen toxicity at normobaric pressure

F Michael Davis

Address for correspondence: Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Key words
Oxygen; Toxicity; Central nervous system; Pressure; Case reports

Copyright: This article is the copyright of the author who grants Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Letter to the Editor

Diving and Hyperbaric Medicine is indexed on MEDLINE, Science Citation Index Expanded (SciSearch®) and Embase/Scopus and complies with the International Committee of Medical Journal Editors (ICMJE) Recommendation for the Conduct, Report, Editing and Publication of Scholarly Work in Medical Journals.
Articles from 2017 are deposited in PubMed Central