Hyperbaric oxygen therapy may be effective to improve hypoxemia in patients with severe COVID-2019 pneumonia: two case reports

2020 ◽  
Vol 47 (2) ◽  
pp. 181-187
Author(s):  
Dazhi Guo ◽  
◽  
Shuyi Pan ◽  
MaoMao Wang ◽  
Yufeng Guo ◽  
...  
Keyword(s):  
Hyperbaric Oxygen ◽  
Randomized Clinical Trials ◽  
Case Reports ◽  
Gas Analysis ◽  
Chest Ct ◽  
Serum Cholinesterase ◽  
Shortness Of Breath ◽  
Arterial Blood ◽  
Hbo2 Therapy ◽  
D Dimer

Objective: To determine whether hyperbaric oxygen (HBO2) therapy be effective to improve hypoxemia for severe COVID-19 pneumonia patients. Method: Two male patients ages 57 and 64 years old were treated. Each met at least one of the following criteria: shortness of breath; respiratory rate (RR) ≥30 breaths/minute; finger pulse oxygen saturation (SpO2) ≤93% at rest; and oxygen index (P/F ratio: PaO2/FiO2 ≤300 mmHg). Each case excluded any combination with pneumothorax, pulmonary bullae or other absolute contraindications to HBO2. Patients were treated with 1.5 atmospheres absolute HBO2 with an oxygen concentration of more than 95% for 60 minutes per treatment, once a day for one week. Patients’ self-reported symptoms, daily mean SpO2 (SO2), arterial blood gas analysis, d-dimer, lymphocyte, cholinesterase (che) and chest CT were conducted and measured. Results: For both patients, dyspnea and shortness of breath were immediately alleviated after the first HBO2 treatment and remarkably relieved after seven days of HBO2 therapy. The RR also decreased daily. Neither patient became critically ill. The decreasing trend of SO2 and P/F ratio was immediately reversed and increased day by day. The lymphocyte count and ratio corresponding to immune function gradually recovered. D-dimer corresponding to peripheral circulation disorders and serum cholinesterase, reflecting liver function had improved. Follow-up chest CT showed that the pulmonary inflammation had clearly subsided. Conclusions: Our preliminary uncontrolled case reports suggest that HBO2 therapy may promptly improve the progressive hypoxemia of patients with COVID-2019 pneumonia. However, the limited sample size and study design preclude a definitive statement about the potential effectiveness of HBO2 therapy to COVID-2019 pneumonia. It requires evaluation in randomized clinical trials in future.

scholarly journals Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

2017 ◽  
Vol 32 (2) ◽  
pp. 148-153
Author(s):  
Asifa Karamat ◽  
Shazia Awan ◽  
Muhammad Ghazanfar Hussain ◽  
Fahad Al Hameed ◽  
Faheem Butt ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Clinical Prediction ◽  
Prediction Rules ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
D Dimer

Hyperbaric oxygen for refractory osteomyelitis

2021 ◽  
pp. 297-321
Author(s):  
Brett B. Hart ◽  
Keyword(s):  
Clinical Trials ◽  
Hyperbaric Oxygen ◽  
Randomized Clinical Trials ◽  
Treatment Success ◽  
Management Strategies ◽  
Clinical Results ◽  
Daily Basis ◽  
Surgical Debridement ◽  
Surgical Interventions ◽  
Hbo2 Therapy

Refractory osteomyelitis is defined as a chronic osteomyelitis that persists or recurs after appropriate interventions have been performed or where acute osteomyelitis has not responded to accepted management techniques [1]. To date, no randomized clinical trials examining the effects of hyperbaric oxygen (HBO2) therapy on refractory osteomyelitis exist, and the number of new osteomyelitis clinical trials conducted over the past decade has been limited. However, based on a comprehensive review of the scientific literature, the addition of HBO2 therapy to routine surgical and antibiotic treatment of previously refractory osteomyelitis appears to be both safe and ultimately improves infection resolution rates. In most cases, the best clinical results are obtained when HBO2 treatment is administered in conjunction with culture-directed antibiotics and initiated soon after clinically indicated surgical debridement. Where extensive surgical debridement or removal of fixation hardware is relatively contraindicated (e.g., cranial, spinal, sternal, or pediatric osteomyelitis), a trial of culture-directed antibiotics and HBO2 therapy prior to undertaking more than limited surgical interventions provides a reasonable prospect for osteomyelitis cure. HBO2 therapy is ordinarily delivered on a once daily basis, five-seven days per week, for 90–120 minutes using 2.0–3.0 atmospheres absolute (ATA) pressure. Where prompt clinical improvement is seen, the existing regimen of antibiotics and HBO2 therapy should be continued for approximately four to six weeks. Typically, 20–40 HBO2 sessions are required to achieve sustained therapeutic benefit. In contrast, if prompt clinical response is not noted or osteomyelitis recurs after this initial treatment period, then continuation of the current antibiotic and HBO2 treatment regimen is unlikely to be effective. Instead, clinical management strategies should be reassessed and additional surgical debridement and/or modification of antibiotic therapy considered. Subsequent reinstitution of HBO2 therapy will again help maximize the overall chances for treatment success in these persistently refractory patients.

scholarly journals Incidental Aluminum Phosphide Poisoning: Case Report and Current Management

Folia Medica ◽  
2018 ◽  
Vol 60 (3) ◽  
pp. 464-467
Author(s):  
Özlem Çakın ◽  
Gokhan Tazegul ◽  
Ayça Gümüş ◽  
Melike Cengiz ◽  
Atilla Ramazanoğlu
Keyword(s):  
Case Report ◽  
Metabolic Acidosis ◽  
Supportive Care ◽  
Case Reports ◽  
Gas Analysis ◽  
Aluminum Phosphide ◽  
Storage Unit ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Local Case

Abstract Aluminum phosphide (AlP) is a commonly used cheap rodenticide, insecticide, and fumigant. Most intoxications in the literature are suicidal ingestions, however, AlP may cause incidental inhalational toxicities as well. After ingestion or inhalation, nausea, vomiting, dyspnea and abdominal pain develops within minutes. Hallmark of toxicity is refractory hypotension, cardiac failure and severe metabolic acidosis developing within a matter of hours are the major cause of mortality. In Turkey, AlP tablets are widely accessible and are sold without any restrictions. However, there are few local case reports in the literature. Additionally, incidental AlP intoxications are rarely reported. Herein, we present a 25-year-old male patient incidentally poisoned with AlP. He was found unconscious in a grain storage unit protected by aluminum phosphide tablets. He had hypotension and tachycardia. Arterial blood gas analysis did not reveal metabolic acidosis. He was quickly intubated and admitted to Intensive Care Unit (ICU). Supportive care crystalloid solution, n-acetyl cysteine and norepinephrine infusion was administered. After 36 hours, he was extubated and discharged without any complications. There is no specific antidote or treatment for AlP toxicity. Literature is controversial regarding treatment approach. Inhalational toxicity may occur under extreme conditions, as presented in this case report. Preventive strategies should be considered to reduce incidents. Clinicians should also be aware that AlP is a widely available and highly toxic compound that has no specific antidote and toxicity needs to be urgently treated with best supportive care.

scholarly journals N-terminal pro-B-type natriuretic peptide levels increases after hyperbaric oxygen therapy in diabetic patients

2008 ◽  
Vol 31 (5) ◽  
pp. 231 ◽  
Author(s):  
Senol Yildiz ◽  
Gunalp Uzun ◽  
Omer Uz ◽  
Osman Metin Ipcioglu ◽  
Ejder Kardesoglu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Lower Extremity ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Diabetic Patients ◽  
Arterial Blood ◽  
Cardiovascular Functions ◽  
Hbo2 Therapy

Purpose: Diabetic patients receive hyperbaric oxygen therapy for non-healing lower extremity ulcers. Exposure to hyperbaric hyperoxia during hyperbaric oxygen therapy may affect cardiovascular functions by different mechanisms. Patients may experience serious problems such as pulmonary edema and death during hyperbaric oxygen therapy. The effect of hyperbaric oxygen therapy on cardiovascular functions in diabetic patients is not well documented. N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been suggested as powerful biochemical marker of cardiac function. The aim of this study was to investigate the effect of hyperbaric oxygen therapy on NT-proBNP levels in diabetic patients. Methods: Twenty-five diabetic patients (19 male and 6 female, 64.7 ± 10.2 yr), who were planning to undergo hyperbaric oxygen therapy for non-healing lower extremity ulcers, were prospectively enrolled into the study. All patients were evaluated with echocardiography before the study. Heart rate and arterial blood pressure of patients were measured, and venous blood samples were drawn from each patient for NT-proBNP analysis before and immediately after the hyperbaric oxygen therapy. Results: NT-proBNP levels increased from 815 ± 1096 pg/ml to 915 ± 1191 pg/ml after HBO2 therapy (P < 0.05). Heart rate and arterial blood pressure did not change with HBO2 therapy (P > 0.05). Conclusion: Hyperbaric oxygen therapy induces considerable ventricular wall stress in diabetic patients. Care should be taken when a diabetic patient with cardiovascular disease is treated with hyperbaric oxygen therapy.

scholarly journals Eucalyptus oil poisoning: two case reports

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Abraham M. Ittyachen ◽  
Georgie Rajan George ◽  
Meera Radhakrishnan ◽  
Yetin Joy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Supportive Care ◽  
Emergency Room ◽  
Case Reports ◽  
Gas Analysis ◽  
Arterial Blood Gas ◽  
Eucalyptus Oil ◽  
Arterial Blood

Abstract Background Eucalyptus oil poisoning is rare in adults but is not that uncommon in children. The common side effects in children include depression in the level of consciousness, ataxia, seizures, and vomiting. Unlike in children, seizures are unusual in adult patients with eucalyptus oil poisoning. We report the cases of two patients with eucalyptus oil poisoning, both adults who unintentionally took eucalyptus oil and presented to the emergency room of our institution with seizures. Case presentation Two adult Indian men who unintentionally consumed eucalyptus oil presented to the emergency room of our institution with seizures. In both patients, arterial blood gas analysis showed the presence of severe metabolic acidosis. Both the patients were managed in the intensive care unit and received standard supportive care. Metabolic acidosis was corrected with intravenous bicarbonate infusion. They were successfully discharged on the fourth day. Conclusions All physicians should be aware of the toxic effects of eucalyptus oil, which is used often in daily life in India. Supportive care in an intensive care unit, including rapid correction of metabolic acidosis and adequate maintenance of hemodynamic parameters, will lead to a rapid recovery. Warning labels should be made mandatory on all products that contain eucalyptus oil.

scholarly journals Equine multinodular pulmonary fibrosis (EMPF): Five case reports

2013 ◽  
Vol 61 (3) ◽  
pp. 319-332 ◽  
Author(s):  
Bianca Schwarz ◽  
Andrea Klang ◽  
Barbora Bezdekova ◽  
Sára Sárdi ◽  
Orsolya Kutasi ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
Bronchoalveolar Lavage ◽  
Case Reports ◽  
Clinical Signs ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Endoscopic Examination ◽  
Gas Analysis ◽  
Arterial Blood Gas ◽  
Arterial Blood

Equine multinodular pulmonary fibrosis (EMPF), a progressive fibrosing interstitial lung disease has been associated with gammaherpesviruses. This case series describes five horses with EMPF. Three of the horses (two in Hungary, one in the Czech Republic) were diagnosed with EMPF ante mortem. They presented with typical clinical signs of EMPF including dyspnoea and weight loss. Arterial blood gas analysis revealed hypoxaemia. Blood work showed signs of inflammation like neutrophilia and hyperfibrinogenaemia. An endoscopic examination of the respiratory tract including cytology and culture of tracheobronchial secretion and bronchoalveolar lavage were performed, revealing secondary bacterial infection in one case. A suspected diagnosis of EMPF was made on the basis of a positive EHV-5 PCR from bronchoalveolar lavage and the findings of thoracic radiographs and ultrasound examination. In one case the diagnosis was confirmed by lung biopsy. All horses died or had to be euthanised despite treatment. Two horses (from Austria) were diagnosed with EMPF post mortem. They not only had EMPF but also concurrent other diseases which seemed to be associated with immunosuppression. Three horses showed the discrete form and two horses the diffuse form of EMPF. EHV-5 DNA was identified in lung tissue of all horses by PCR.

Delayed hyperbaric oxygen therapy for severe arterial gas embolism following scuba diving: a case report

2019 ◽  
pp. 197-202
Author(s):  
Charlotte Sadler ◽  
◽  
Emi Latham ◽  
Melanie Hollidge ◽  
Benjamin Boni ◽  
...  
Keyword(s):  
Critically Ill ◽  
Hyperbaric Oxygen ◽  
Shortness Of Breath ◽  
Gas Embolism ◽  
Significant Delay ◽  
Pulmonary Barotrauma ◽  
Arterial Gas Embolism ◽  
History Of ◽  
Rapid Ascent ◽  
Hbo2 Therapy

We present the case of a 42-year-old female who was critically ill due to an arterial gas embolism (AGE) she experienced while diving in Maui, Hawaii. She presented with shortness of breath and dizziness shortly after surfacing from a scuba dive and then rapidly lost consciousness. The diver then had a complicated hospital course: persistent hypoxemia (likely secondary to aspiration) requiring intubation; markedly elevated creatine kinase; atrial fibrillation requiring cardioversion; and slow neurologic improvement. She had encountered significant delay in treatment due to lack of availability of local hyperbaric oxygen (HBO2) therapy. Our case illustrates many of the complications that can occur when a patient suffers a severe AGE. These cases may occur even without a history of rapid ascent or risk factors for pulmonary barotrauma, and it is imperative that they be recognized and treated as quickly as possible with HBO2. Unfortunately, our case also highlights the challenges in treating critically ill divers, particularly with the growing shortage of 24/7 hyperbaric chambers able to treat these ICU-level patients.

Hyperbaric oxygen therapy for hypoxic-ischemic encephalopathy in non-fatal drowning

2021 ◽  
pp. 53-56
Author(s):  
Andreia Fiúza Ribeiro ◽  
◽  
Joana Gomes Vieira ◽  
Marta Moniz ◽  
Carlos Escobar ◽  
...  
Keyword(s):  
Hyperbaric Oxygen ◽  
Oxygen Therapy ◽  
Case Reports ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Hypoxic Ischemic Encephalopathy ◽  
Normobaric Oxygen ◽  
Multiple Drugs ◽  
Ischemic Encephalopathy ◽  
Hbo2 Therapy

Paroxysmal autonomic instability syndrome with dystonia (PAISD) is a possible complication that worsens the prognosis of hypoxic-ischemic encephalopathy related to non-fatal drowning. There are case reports of hyperbaric oxygen (HBO2) therapy enhancing recovery in such cases. We report a case of a 5-year-old boy admitted to the Pediatric Intensive Care Unit after a non-fatal drowning. He was transferred under mechanical ventilation and sedation, with hemodynamic instability and hypothermia. On admission he had a Glasgow Coma Score of 6. On the fifth day of admission he presented episodes of dystonia with decerebration posture, diaphoresis, tachycardia and hypertension, sometimes with identified triggers, suggesting PAISD. The episodes were difficult to control; multiple drugs were needed. Electroencephalography showed diffuse slow wave activity, and cranioencephalic magnetic resonance imaging showed hypoxia-related lesions, suggesting hypoxic-ischemic encephalopathy. Early after admission the patient started physiotherapy combined with normobaric oxygen therapy. Subsequently he started HBO2 therapy at 2 atmospheres, with a total of 66 sessions. Dystonia progressively subsided, with gradual discontinuation of therapy. He also showed improvement in spasticity, non-verbal communication and cephalic control. This case highlights the diagnostic and therapeutic challenges of PAISD and the potential benefit of HBO2 therapy, even in the subacute phase, in recovery of hypoxic-ischemic encephalopathy.

scholarly journals Role of markers of inflammation, severity and infusion therapy in COVID-19-defined pneumonia

2020 ◽  
pp. 80-82
Author(s):  
E.M. Khodosh
Keyword(s):  
Respiratory Failure ◽  
Clinical Manifestations ◽  
Lung Parenchyma ◽  
Diagnostic Process ◽  
Infusion Therapy ◽  
Shortness Of Breath ◽  
X Ray ◽  
Markers Of Inflammation ◽  
Arterial Blood ◽  
D Dimer

Background. Coronavirus disease (COVID-19) is likely to remain an important differential diagnosis in the next 2 years for anyone seeing a doctor with a flu-like condition, lymphopenia and/or a change in smell (anosmia) or taste. Objective. To consider by what markers of inflammation it is possible to diagnose the severity of COVID-19-defined pneumonia with the possibility of its infusion correction. Materials and methods. The clinical manifestations of the disease by severity can be classified into five forms: asymptomatic, but rather presymptomatic, according to clinical manifestations, infectious process can be attributed to persons with a positive PCR-test result for SARS-CoV-2 and normal C-reactive protein (CRP), interleukin-6 (IL-6) and ferritin. Lymphopenia is a negative prognostic factor. A mild course of the disease is characterized by any of the different signs and symptoms (eg, fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath or with shortness of breath, or with atypical images on chest radiographs and within 10-15 % lesion and still normal CRP, IL-6 and ferritin (~70-80 %). Moderate disease occurs in patients who have evidence of lower respiratory disease on clinical assessment or imaging, oxygen saturation (SpO2) ≥94 % and an increase in CRP, IL-6, ferritin, and D-dimer less than 50 % of normal. The severe course of the disease includes patients with a respiratory rate >30 per minute, SpO2 <94 %, the ratio of the partial pressure of oxygen in arterial blood to the fraction of inhaled oxygen (PaO2/FiO2) <300 mm Hg, infiltrates affecting >50 % of the lung parenchyma and a possible increase in CRP, ferritin, IL-6 and D-dimer more than 2-3 times (~20 %). The critical course of the disease is respiratory failure, septic shock and/or multiple organ failure, subtotal lesions of the parenchyma of both lungs (1-5 %). Because the disease manifests itself as pneumonia, radiological imaging plays a fundamental role in the diagnostic process, treatment, and follow-up. Standard X-ray examination of chest has low sensitivity in detecting early changes in the lungs and in the initial stages of the disease. At this stage, it can be completely negative. In later stages of infection, chest X-ray usually reveals bilateral multifocal alveolar opacities, which tend to coalesce until the lung is completely opaque. Pleural effusion may occur. Given the high sensitivity of the method, computed tomography (CT) of the chest, in particular high-resolution CT, is the method of choice in the study of COVID-19 pneumonia, even in the initial stages. There is no specific antiviral treatment recommended for COVID-19, and there is currently no vaccine. Treatment is symptomatic, and oxygen and fluid therapy represent the first step towards resolving respiratory distress and intoxication. Non-invasive and invasive mechanical ventilation may be required in cases of respiratory failure that is resistant to oxygen therapy. For the treatment of severe forms of the disease (>50 % of the lesion of the lung parenchyma), antioxidant therapy is necessary. The key requirement is to influence mitochondrial permeability, that is, to pass through the membrane of cells and mitochondria and accumulate in mitochondria (inactivation of ROS), as well as block the signals of pathways that transmit instructions from the surface to the nucleus to start inflammation (IL-1, -6, -18) in order to ensure the survival of cells as long as possible. With this pathogenetic purpose, to stop the “cytokine shtrom” we use edaravon (Xavron) 30 mg and Tivorel 100.0 ml. Conclusions. We have shown that in patients with moderate, severe and critical COVID-19-defined pneumonia (CRP ≥100 mg/l, ferritin ≥900 ng/ml, IL-6 >202.3 pg/ml) Xavron and Tivorel as an intravenous infusion caused clinical improvement in 71 % of patients.

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