2022 June;52(2) 

Diving Hyperb Med. 2022 June 30;52(2):78−84. doi: 10.28920/dhm52.2.78-84. PMID: 35732278.

Decompression illness in Finnish technical divers: a follow-up study on incidence and self-treatment

Laura J Tuominen1,2, Sofia Sokolowski3, Richard V Lundell1,4, Anne K Räisänen-Sokolowski1,4,5,6

1 Helsinki University, Helsinki, Finland
2 Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
3 University of Eastern Finland, Kuopio, Finland
4 Diving Medical Centre, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
5 Department of Pathology, HUSLAB, Helsinki University Hospital, and Helsinki University, Helsinki, Finland
6 DAN Europe Foundation, Finnish Division, Roseto, Italy

Corresponding author: Dr Laura Tuominen, Helsinki University, Yliopistonkatu 4, 00100 Helsinki, Finland
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Keywords
Cold; Decompression sickness; First aid oxygen; Epidemiology; Hyperbaric oxygen treatment; Technical diving; Trimix

Abstract
(Tuominen LJ, Sokolowski S, Lundell RV, Räisänen-Sokolowski AK. Decompression illness in Finnish technical divers: a follow-up study on incidence and self-treatment. Diving and Hyperbaric Medicine. 2022 June 30;52(2):78−84. doi: 10.28920/dhm52.2.78-84. PMID: 35732278.)
Introduction: Technical diving is increasing in popularity in Finland, and therefore the number of decompression illness (DCI) cases is also increasing among technical divers. Although hyperbaric oxygen treatment (HBOT) remains the standard of care, there are anecdotal reports of technical divers treating mild DCI symptoms themselves and not seeking a medical evaluation and possible recompression therapy. This study aimed to make an epidemiologic inventory of technical diving-related DCI symptoms, to establish the incidence of self-treatment and to determine the apparent effectiveness of different treatment methods.
Methods: A one-year prospective survey with online questionnaires was conducted. Fifty-five experienced and highly trained Finnish technical divers answered the survey and reported their diving activity, DCI symptoms, symptom treatment, and treatment outcome.
Results: Of the reported 2,983 dives, 27 resulted in symptoms of DCI, which yielded an incidence of 91 per 10,000 dives in this study. All of the reported DCI symptoms were mild, and only one diver received HBOT. The most common selftreatments were oral hydration and rest. First aid oxygen (FAO2) was used in 21% of cases. Eventually, none of the divers had residual symptoms.
Conclusions: The incidence of self-treated DCI cases was 27 times higher than that of HBO-treated DCI cases. There is a need to improve divers’ awareness of the importance of FAO2 and other recommended fi rst aid procedures and to encourage divers to seek medical attention in case of suspected DCI.

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


2022 June;52(2) 

Diving Hyperb Med. 2022 June 30;52(2):85−91. doi: 10.28920/dhm52.2.85-91. PMID: 35732279.

A prospective single-blind randomised clinical trial comparing two treatment tables for the initial management of mild decompression sickness

Neil Banham1, Philippa Hawkings2, Ian Gawthrope1

1 Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch WA, Australia
2 Medical Services, Alfred Health, Melbourne VIC, Australia

Corresponding author: Dr Neil Banham, Department of Hyperbaric Medicine, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch WA 6150, Australia
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Keywords
Decompression illness; Diving research; Hyperbaric oxygen treatment; Recompression; Recreational diving; Scuba diving; Treatment sequelae

Abstract
(Banham N, Hawkings P, Gawthrope I. A prospective single-blind randomised clinical trial comparing two treatment tables for the initial management of mild decompression sickness. Diving and Hyperbaric Medicine. 2022 June 30;52(2):85−91. doi: 10.28920/dhm52.2.85-91. PMID: 35732279.)
Introduction: Limited evidence suggests that shorter recompression schedules may be as effi cacious as the US Navy Treatment Table 6 (USN TT6) for treatment of milder presentations of decompression sickness (DCS). This study aimed to determine if divers with mild DCS could be effectively treated with a shorter chamber treatment table.
Methods: All patients presenting to the Fremantle Hospital Hyperbaric Medicine Unit with suspected DCS were assessed for inclusion. Participants with mild DCS were randomly allocated to receive recompression in a monoplace chamber via
either a modifi ed USN TT6 (TT6m) or a shorter, custom treatment table (FH01). The primary outcome was the number of treatments required until resolution or no further improvement (plateau).
Results: Forty-one DCS cases were included, 21 TT6m and 20 FH01. Two patients allocated to FH01 were moved to TT6m mid-treatment due to failure to significantly improve (as per protocol), and two TT6m required extensions. The median total number of treatments till symptom resolution was 1 (IQR 1−1) for FH01 and 2 (IQR 1−2) for TT6m (P = 0.01). More patients in the FH01 arm (17/20, 85%) showed complete symptom resolution after the initial treatment, versus 8/21 (38%) for TT6m (P = 0.003). Both FH01 and TT6m had similar overall outcomes, with 19/20 and 20/21 respectively asymptomatic at the completion of their fi nal treatment (P = 0.97). In all cases where two-week follow-up contact was made, (n = 14 FH01 and n = 12 TT6m), patients reported maintaining full symptom resolution.
Conclusions: The median total number of treatments till symptom resolution was meaningfully fewer with FH01 and the shorter treatment more frequently resulted in complete symptom resolution after the initial treatment. There were similar patient outcomes at treatment completion, and at follow-up. We conclude that FH01 appears superior to TT6m for the treatment of mild decompression sickness.

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


2022 June;52(2) 

Diving Hyperb Med. 2022 June 30;52(2):92−96. doi: 10.28920/dhm52.2.92-96. PMID: 35732280.

A survey of caustic cocktail events in rebreather divers 

Peter Buzzacott1, Grant Z Dong2, Rhiannon J Brenner2, Frauke Tillmans2

1 Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Western Australia
2 Divers Alert Network, Durham, North Carolina, USA

Corresponding author: Dr Frauke Tillmans, Research Director, Divers Alert Network, 6 W Colony Place, Durham (NC) 27705, USA
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Keywords
First aid; Incidents; Injuries; Safety; Technical diving

Abstract
(Buzzacott P, Dong GZ, Brenner RJ, Tillmans F. A survey of caustic cocktail events in rebreather divers. Diving and Hyperbaric Medicine. 2022 June 30;52(2):92−96. doi: 10.28920/dhm52.2.92-96. PMID: 35732280.)
Introduction: Closed-circuit rebreathers (CCRs) are designed to be watertight. Ingressing water may react with carbondioxide absorbent in the CCR, which may produce alkaline soda with a pH of 12–14, popularly referred to by CCR divers as a ‘caustic cocktail’. This study aimed to explore divers’ responses to caustic cocktail events and to investigate if CCR diving experience is associated with experiencing a caustic cocktail.
Methods: An online survey instrument was developed and an invitation to participate was extended to certified CCR divers aged ≥ 18 years. Relationships between number of caustic cocktail events and potential risk factors: age; hours of rebreather diving experience; and number of rebreather dives were explored.
Results: Of the 413 respondents, 394 (95%) identifi ed as male, mean age was 46 years and median length of CCR certification was six years. Fifty-seven percent (n = 237) of respondents reported having experienced a caustic cocktail. The probability of self-reporting none, one, or more caustic cocktail events increased with experience. Divers reported a variety of first aid treatments for caustic cocktails, with ~80% citing their CCR instructor as a source of information.
Conclusions: The more hours or dives a CCR diver accrues, the more likely they will self-report having experienced one or more caustic cocktail events. The majority of CCR divers responded to a caustic cocktail by rinsing the oral cavity with water. A proportion of divers, however, responded by ingesting soda, dairy, juice, or a mildly acidic solution such as a mixture of vinegar and water. The recommendation to immediately flush with water needs reinforcing among rebreather divers.

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


2022 June;52(2) 

Diving Hyperb Med. 2022 June 30;52(2):97−102. doi: 10.28920/dhm52.2.97-102. PMID: 35732281.

The effect of pressure changes during simulated diving on the shear bond strength of orthodontic brackets

Meenal N Gulve1, Nitin D Gulve2

1 Department of Conservative Dentistry and Endodontics, M.G.V.’s K.B.H. Dental College and Hospital, Nashik, India
2 Department of Orthodontics and Dentofacial Orthopedics, M.G.V.’s K.B.H. Dental College and Hospital, Nashik, India

Corresponding author: Dr Meenal N Gulve, Department of Conservative Dentistry and Endodontics, M.G.V.’s K.B.H. Dental College and Hospital, Nashik, India
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Keywords
Barotrauma; Dental; Diving; Hyperbaric research; Scuba

Abstract
(Gulve MN, Gulve ND. The effect of pressure changes during simulated diving on the shear bond strength of orthodontic brackets. Diving and Hyperbaric Medicine. 2022 June 30;52(2):97−102. doi: 10.28920/dhm52.2.97-102. PMID: 35732281.)
Introduction: This study investigated the effect of pressure variations to which divers are subjected on shear bond strength of orthodontic brackets bonded to teeth with resin modifi ed glass ionomer cement (RMGIC) or composite resin.
Methods: Eighty extracted premolars were randomly divided into two groups. Group 1: orthodontic brackets were bonded with RMGIC. Group 2: orthodontic brackets were bonded with composite resin. Each group was further divided into two subgroups. Subgroup A: The samples were kept at sea level pressure (101 kPa). Subgroup B: The samples were pressurised once from 101 kPa to 405 kPa for five minutes, then depressurised to 101 kPa. Shear bond strength was then measured.
Results: Shear bond strength of brackets bonded with RMGIC in the simulated diving group was signifi cantly less than that of ambient pressure group (P = 0.019), while no significant difference was found between the simulated diving group and ambient pressure group for brackets bonded with resin cement (P = 0.935). At ambient pressure, there was no significant difference between shear bond strength of brackets bonded with RMGIC and composite resin (P = 0.83). In simulated diving conditions, there was a statistically significant difference between shear bond strength of brackets bonded with the RMGIC and composite (P = 0.009).
Conclusions: Pressure changes during scuba diving may have an adverse effect on the retention of brackets bonded with RMGIC. Using composite resin for bonding brackets appears to be good strategy for patients such as divers who will be exposed to pressurised environments.

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


2022 June;52(2) 

Diving Hyperb Med. 2022 June 30;52(2):103−107. doi: 10.28920/dhm52.2.103-107. PMID: 35732282.

Quantifying drysuit seal pressures in non-immersed scuba divers

Derek B Covington1, Matthew Spears2, Richa Wardhan2, Meghan Brennan2, Yasmin Islam3, Andrew D Pitkin2

1 Department of Anesthesiology, Center for Hyperbaric and Environmental Physiology, Duke University, Durham (NC), USA
2 Department of Anesthesiology, University of Florida College of Medicine, Gainesville (FL), USA
3 Department of Ophthalmology, University of Florida College of Medicine, Gainesville (FL), USA

Corresponding author: Dr Derek Covington, Department of Anesthesiology, Center for Hyperbaric and Environmental Physiology, Duke University, DUMC 3094, Durham, NC 27710, USA
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Keywords
Diving; Latex; Paresthesia; Silicone; Technical diving

Abstract
(Covington DB, Spears M, Wardhan R, Brennan M, Islam Y, Pitkin AD. Quantifying drysuit seal pressures in non-immersed scuba divers. Diving and Hyperbaric Medicine. 2022 June 30;52(2):103−107. doi: 10.28920/dhm52.2.103-107. PMID: 35732282.)
Introduction: Drysuits use fl exible neck and wrist seals to maintain water-tight seals. However, if the seals exert too much pressure adverse physiological effects are possible, including dizziness, lightheadedness, syncope, and paresthesias in the hands. We aimed to quantify the seal pressures of neck and wrist seals in non-immersed divers.
Methods: We recruited 33 diving volunteers at two dive facilities in High Springs, Florida. After a history and physical exam, we measured vital signs as well as wrist and neck seal pressures using a manometer system.
Results: The mean (SD) seal pressure of the right wrist seals was found to be 38.8 (14.9) mmHg, while that of the left wrist seals was 37.6 (14.9) mmHg. The average neck seal pressure was 23.7 (9.4) mmHg. Subgroup analysis of seal material demonstrated higher mean sealing pressure with latex seals compared to silicone; however, this difference was not statistically significant.
Conclusions: Drysuit seal pressures are high enough to have vascular implications and even potentially cause peripheral nerve injury at the wrist. Divers should trim their seals appropriately and be vigilant regarding symptoms of excessive seal pressures. Further research may elucidate if seal material infl uences magnitude of seal pressure.

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


2022 June;52(2) 

Diving Hyperb Med. 2022 June 30;52(2):108−118. doi: 10.28920/dhm52.2.108-118. PMID: 35732283.

A review of snorkelling and scuba diving fatalities in Queensland, Australia, 2000 to 2019

John Lippmann1,2,3

1 Australasian Diving Safety Foundation, Canterbury, Victoria, Australia
2 Department of Public Health and Preventive Medicine, Monash University, Victoria, Australia
3 The Royal Lifesaving Society – Australia, Sydney, Australia

Corresponding author: Dr John Lippmann, Australasian Diving Safety Foundation, PO Box 478 Canterbury VIC 3126, Australia
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Keywords
Age; Breath-hold diving; Cardiac; Chain of events analysis; Diving deaths; Obesity

Abstract
(Lippmann J. A review of snorkelling and scuba diving fatalities in Queensland, Australia, 2000 to 2019. Diving and Hyperbaric Medicine. 2022 June 30;52(2):108−118. doi: 10.28920/dhm52.2.108-118. PMID: 35732283.)
Introduction: This study examined all known diving-related fatalities in Queensland, Australia, from 2000 to 2019 to determine likely causes and potential countermeasures.
Methods: Data were extracted from the Australasian Diving Safety Foundation fatality database, including previously published reports. The National Coronial Information System was searched to identify diving-related deaths in Queensland for 2014–2019 and data were extracted, analysed, and combined with previously published data covering the period 2000–2013. Descriptive statistics and parametric and non-parametric tests were used to analyse these data.
Results: There were 166 snorkelling and 41 scuba victims identifi ed with median ages of 59 and 49 years respectively, and 83% of snorkel and 64% of scuba victims were males. One quarter of snorkel and 40% of scuba victims were obese. Two-thirds of the snorkellers and three quarters of scuba divers were overseas tourists. Contributory predisposing health conditions were identified in 61% of snorkel and 50% of scuba victims. Nine scuba victims died on their first dive.
Conclusions: The increase in snorkelling deaths likely reflects increased participation, higher age, and poorer health. The main disabling condition in both cohorts was cardiac-related. Pre-existing health conditions, poor skills, inexperience, poor planning, supervision shortcomings and lack of effective buddy systems featured in both cohorts, and apnoeic hypoxia in breath-hold divers. Suggested countermeasures include improved education on the importance of health and fitness for safe diving and snorkelling, increased emphasis on an honest and accurate pre-activity health declaration and subsequent implementation of appropriate risk mitigation strategies, improved supervision, better buddy pairing, and on-going education on the hazards of extended apnoea.

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


2022 June;52(2) 

Diving Hyperb Med. 2022 June 30;52(2):119−125. doi: 10.28920/dhm52.2.119-125. PMID: 35732284.

Blood pressure in rats selectively bred for their resistance to decompression sickness

Emmanuel Dugrenot1,2, Jérémy Orsat1, François Guerrero1

1 Univ Brest, ORPHY EA4324, IBSAM, 6 avenue Le Gorgeu, 29200 Brest, France
2 TEK diving SAS, F-29200, Brest, France

Corresponding author: Dr François Guerrero, EA4324 ORPHY, 6 Av. Le Gorgeu CS 93837, 29238 BREST Cedex 3, France
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Keywords
Animal model; Circulation; Decompression illness; Genetics; Scuba diving

Abstract
(Dugrenot E, Orsat J, Guerrero F. Blood pressure in rats selectively bred for their resistance to decompression sickness. Diving and Hyperbaric Medicine. 2022 June 30;52(2):119−125. doi: 10.28920/dhm52.2.119-125. PMID: 35732284.)
Introduction: Susceptibility to decompression sickness (DCS) is characterised by a wide inter-individual variability whose origins are still poorly understood. This hampers reliable prediction of DCS by decompression algorithms. We previously selectively bred rats with a 3-fold greater resistance to DCS than standard rats. Based on its previously reported relation with decompression outcomes, we assessed whether modification in vascular function is associated with resistance to DCS.
Methods: The arterial pressure response to intravenous administration of acetylcholine (ACh, 5 μg.kg-1) and adrenaline (5 and 10 μg.kg-1) was compared in anaesthetised DCS-resistant rats (seven females, seven males) and standard Wistar rats (seven females, 10 males) aged 14–15 weeks. None of these rats had previously undergone hyperbaric exposure.
Results: There was a non-significant tendency for a lower diastolic (DBP) and mean blood pressure (MBP) in DCS-resistant rats. After ACh administration, MBP was significantly lower in resistant rats, for both males (P = 0.007) and females (P = 0.034). After administration of adrenaline 10 μg.kg-1, DCS-resistant rats exhibited lower maximal DBP (P = 0.016) and MBP (P = 0.038). Systolic and pulse blood pressure changes did not differ between groups in any of the experiments.
Conclusions: Resistance to DCS in rats is associated to a trend towards a lower vascular tone but not blood pressure reactivity. Whether these differences are a component of the susceptibility to DCS remains to be confirmed.

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


2022 June;52(2) 

Diving Hyperb Med. 2022 June 30;52(2):126−135. doi: 10.28920/dhm52.2.126-135. PMID: 35732285.

Efficacy and safety of hyperbaric oxygen treatment to treat COVID-19 pneumonia: a living systematic review update

Sylvain Boet1,2,3, Cole Etherington2, Nibras Ghanmi4, Paul Ioudovski4, Andrea C Tricco5,6,7, Lindsey Sikora8, Rita Katznelson9

1 Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada
2 Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
3 Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Canada
4 Department of Public Health Sciences, Faculty of Health Sciences, Queens University, Ontario, Canada
5 Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
6 Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
7 Queen’s Collaboration for Health Care Quality: A JBI Centre of Excellence, Ontario, Canada
8 Health Sciences Library, University of Ottawa, Ottawa, Canada
9 Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada

Corresponding author: Dr Sylvain Boet, Department of Anesthesiology and Pain Medicine, Hyperbaric Medicine Unit, The Ottawa Hospital, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, K1H 8L6, Ontario, Canada
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Keywords
Hyperbaric medicine; Hypoxia; Infection; SARS-CoV-2

Abstract
(Boet S, Etherington C, Ghanmi N, Ioudovski P, Tricco AC, Sikora L, Katznelson R. Effi cacy and safety of hyperbaric oxygen treatment to treat COVID-19 pneumonia: a living systematic review update. Diving and Hyperbaric Medicine. 2022 June 30;52(2):126−135. doi: 10.28920/dhm52.2.126-135. PMID: 35732285.)
Introduction: As the COVID-19 pandemic evolves, new effective treatment options are essential for reducing morbidity and mortality as well as the strain placed on the healthcare system. Since publication of our initial review on hyperbaric oxygen treatment (HBOT) for hypoxaemic COVID-19 patients, interest in HBOT for COVID-19 has grown and additional studies have been published.
Methods: For this living systematic review update the previously published search strategy (excluding Google Scholar) was adopted with an extension from 01 February 2021 to 01 April 2022. Study inclusion criteria, data extraction, risk of bias estimation and dispute resolution methods were repeated.
Results: Two new studies enrolling 127 patients were included in this update, taking the total to eight studies with 224 patients. Both new studies were randomised controlled trials, one at moderate and one at high risk of bias. Across these eight studies, 114 patients were treated with HBOT. All reported improved clinical outcomes without observation of any serious adverse events. Meta-analysis remained unjustified given the high heterogeneity between studies and incomplete reporting.
Conclusions: This updated living systematic review provides further evidence on the safety and effectiveness of HBOT to treat acute hypoxaemic COVID-19 patients.

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: Systematic Review


2022 June;52(2) 

Diving Hyperb Med. 2022 June 30;52(2):136−148. doi: 10.28920/dhm52.2.136-148. PMID: 35732286.

Perspective on ultrasound bioeffects and possible implications for continuous post-dive monitoring safety

Erica P McCune1, David Q Le1, Peter Lindholm2, Kathryn R Nightingale3, Paul A Dayton1, Virginie Papadopoulou1

1 Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
2 Department of Emergency Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
3 Department of Biomedical Engineering, Duke University, Durham, NC, USA

Corresponding author: Dr Virginie Papadopolou, 9004 Mary Ellen Jones Building, 116 Manning Drive, Chapel Hill, NC 27599-7575, USA
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Keywords
Bubbles; Cavitation; Decompression; Decompression research; Venous gas emboli

Abstract

(McCune EP, Le DQ, Lindholm P, Nightingale KR, Dayton PA, Papadopoulou V. Perspective on ultrasound bioeffects and possible implications for continuous post-dive monitoring safety. Diving and Hyperbaric Medicine. 2022 June
30;52(2):136−148. doi: 10.28920/dhm52.2.136-148. PMID: 35732286.)
Ultrasound monitoring, both in the form of Doppler and 2D echocardiography, has been used post-dive to detect decompression bubbles circulating in the bloodstream. With large variability in both bubble time course and loads, it has been hypothesised that shorter periods between imaging, or even continuous imaging, could provide more accurate post-dive assessments. However, while considering applications of ultrasound imaging post-decompression, it may also be prudent to consider the possibility of ultrasound-induced bioeffects. Clinical ultrasound studies using microbubble contrast agents have shown bioeffect generation with acoustic powers much lower than those used in post-dive monitoring. However, to date no studies have specifically investigated potential bioeffect generation from continuous post-dive echocardiography. This review discusses what can be drawn from the current ultrasound and diving literature on the safety of bubble sonication and highlights areas where more studies are needed. An overview of the ultrasound-bubble mechanisms that lead to bioeffects and analyses of ultrasound contrast agent studies on bioeffect generation in the pulmonary and cardiovascular systems are provided to illustrate how bubbles under ultrasound can cause damage within the body. Along with clinical ultrasound
studies, studies investigating the effects of decompression bubbles under ultrasound are analysed and open questions regarding continuous post-dive monitoring safety are discussed.

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


2022 June;52(2) 

Diving Hyperb Med. 2022 June 30;52(2):149−153. doi: 10.28920/dhm52.2.149-153. PMID: 35732287.

Hyperbaric oxygen treatment in a rare complication of intramuscular injection: four cases of Nicolau syndrome

Sefika Korpinar1

1 Department of Underwater and Hyperbaric Medicine, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey

Corresponding author: Dr Sefika Korpinar, Department of Underwater and Hyperbaric Medicine, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
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Keywords
Case reports; Embolia cutis medicamentosa; Nicolau syndrome; Non-steroidal anti-inflammatories; Wounds

Abstract

(Korpinar S. Hyperbaric oxygen treatment in a rare complication of intramuscular injection: four cases of Nicolau syndrome. Diving and Hyperbaric Medicine. 2022 June 30;52(2):149−153. doi: 10.28920/dhm52.2.149-153. PMID: 35732287.)
Intramuscular injections are one of the most common clinical procedures. The objectives of this case series are to analyse the role, timing and effi cacy of hyperbaric oxygen treatment (HBOT) in the management of Nicolau syndrome (NS), an extremely rare complication of this common intervention. Clinical, demographic, laboratory and microbiological data extraction were performed through retrospective analysis of the medical records of all patients with NS who were referred for HBOT over a 10-year period with wounds, ischaemia, infection or necrosis at the injection site following drug injection; four patients with NS were included. All injections were made via the intramuscular route; three adult cases followed a non-steroidal anti-inflammatory drug, diclofenac sodium and one in a child followed penicillin injection. The time between diagnosis/injection and HBOT ranged from five to 33 days. NS can develop despite all preventive measures based on injection technique guidelines. HBOT appeared beneficial to healing of NS when administered with other therapeutic approaches. Due to the missing pieces of the puzzle in pathogenesis, NS is rarely completely reversible; keeping the awareness high for undesirable complications stands out as the most effective approach.

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


 

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