Evaluation of pressure in water-filled endotracheal tube cuffs in intubated patients undergoing hyperbaric oxygen treatment

Introduction: Inflating endotracheal tube cuffs using water instead of air before hyperbaric oxygen treatment (HBOT) is common. The objective of this study was to assess cuff pressure (Pcuff), when the cuff was inflated using water, in normobaric conditions and during HBOT. Methods: This was a prospective, observational study taking place in hyperbaric centre and intensive care unit of the University Hospital of Lille. Every patient who required tracheal intubation and HBOT at 253.3 kPa (2.5 atmospheres absolute [atm abs]) was included. Pcuff was measured using a pressure transductor connected to the cuff inflating port. Measurements were performed at 'normobaria' (1 atm abs) and during HBOT at 2.5 atm abs. Results: Thirty patients were included between February and April 2016. Recordings were analysable in 27 patients. Mean Pcuff at normobaria was 60.8 (SD 42) cmH2O. Nineteen (70%) of patients had an excessive Pcuff (higher than 30 cmH2O). Coefficient of variation was 69%. Mean Pcuff at 2.5 atm abs was 51.6 (40.7) cmH2O, significantly lower than at normobaria (P < 0.0001). Coefficient of variation was 79%. In only five (18%) patients was Pcuff < 20 cmH2O at 2.5 atm abs. Conclusions: In normobaric conditions, when the cuff was inflated using water and not specifically controlled Pcuff was not predictable. The cuff was typically over-inflated exceeding safe pressure. During HBOT Pcuff decreased slightly.

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

Diving and Hyperbaric Medicine Journal ◽

10.28920/dhm51.1.78-81 ◽

2021 ◽

Vol 51 (1) ◽

pp. 78-81

Author(s):

Michelle L Lim ◽

◽

Soo J Kim ◽

Meng K Tan ◽

Kim H Lim ◽

...

Keyword(s):

Carbon Monoxide ◽

Infection Control ◽

Endotracheal Tube ◽

Hyperbaric Oxygen ◽

Negative Pressure ◽

Carbon Monoxide Poisoning ◽

Infection Risk ◽

Hyperbaric Oxygen Treatment ◽

Contact Precautions ◽

Oxygen Treatment

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.

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Hyperbaric oxygen treatment in three cases of necrotizing infection of the neck

Infectious Disease Reports ◽

10.4081/idr.2012.e21 ◽

2012 ◽

Vol 4 (1) ◽

pp. 21 ◽

Cited By ~ 1

Author(s):

Torbjørn Nedrebø ◽

Trond Bruun ◽

Rune Skjåstad ◽

Gunhild Holmaas ◽

Steinar Skrede

Keyword(s):

Hyperbaric Oxygen ◽

University Hospital ◽

Adjunctive Treatment ◽

Hyperbaric Oxygen Treatment ◽

Culture Techniques ◽

Conventional Culture ◽

Oxygen Treatment ◽

Microbiological Characteristics ◽

Care Facilities ◽

Significant Clinical Improvement

Necrotizing infections of the head and neck are rare conditions in our hospital. Clinical and microbiological characteristics of three consecutive cases treated in Haukeland University Hospital in western Norway in the year 2010 are described. Two cases of Lemierre’s syndrome and one case with a descending necrotizing mediastinitis (DNM) were diagnosed. All three cases were treated with broad spectrum antibiotics and in two cases surgery was possible. Hyperbaric oxygen treatment (HBOT) with intensive care facilities became recently available at our hospital, and this treatment was used in all these patients regardless of surgery. In one case we describe the use of HBOT on the basis of strong clinical suspicion of anaerobic infection only. Bacterial identification by partial sequencing of the 16SrDNA gene proved to be a useful supplement to conventional culture techniques. All the cases all demonstrated a significant clinical improvement after introduction of HBOT. When HBOT is available, it should be considered as adjunctive treatment in extensive infections with anaerobes.

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Approach to the Airway in the Emergency Department (ED) and Intensive Care Unit (ICU) in a Portuguese University Hospital Center: a prospective observational study

10.21203/rs.2.517/v1 ◽

2019 ◽

Author(s):

Tiago Cabral ◽

Helena Figueira ◽

Ricardo Oliveira ◽

Ângela Mota ◽

Irene Aragão ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Statistical Analysis ◽

Observational Study ◽

Airway Management ◽

Prospective Observational Study ◽

Orotracheal Intubation ◽

University Hospital ◽

The University

Abstract Background Airway management is a commonly performed procedure in the Emergency Department (ED) and Intensive Care Unit (ICU), being tracheal intubation the gold standard with relatively high rates of complications in these settings. The purpose of our study was to analyse the airway approach in our institution at ED and ICU identifying the main complications associated and taking notice of possible factors related to them. Methods Prospective observational study conducted between May and September 2014 in the ICU and ED of Santo Antonio Hospital, with the primary aim of identifying the main complications of the airway approach in the critical patient and secondary aim to take notice of possible factors related with complications of the airway approach related to technical skills of the operator, patient´s specificities and airway approach techniques. The statistical analysis was done in cooperation with the Medical Informatics and Biostatistics Department of the Faculty of Medicine of the University of Porto. P values <0.05 were considered significant for all hypothesis testing. The analysis was done using the statistical analysis program SPSS® v.21.0 Results A total of 182 patients were included, corresponding to 257 attempted tracheal intubations (ATI). The rate of successful first-pass orotracheal intubation was 67%. Complications related to ATI were reported in 30% of all attempts, being most frequently among residents (81%, p=0.001) and those with little experience in airway approach (46%, p<0.001). The majority of complications was failed intubation (18%). In the group with complications, relation with an identifiable obvious cause was seen in 87% of cases (p<0.001), the major being inexperience in 42% of operators with complications, instead of 1% in the group without complications (p<0.001). Conclusions Failed ATI and its complications are largely dependent on operator´s expertise. Factors related to patient, lack of appropriate equipment and inappropriate strategy delineation also play a role. Recognition of patients at particular risk of difficult airway management is crucial.

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Hyperbaric oxygen treatment of superficial soft tissue lesions in children with oncologic disease

Pediatric Reports ◽

10.4081/pr.2012.e1 ◽

2011 ◽

Vol 4 (1) ◽

pp. 1

Author(s):

Eleonora Cesca ◽

Giacomo Garetto ◽

Emanuela Frascella ◽

Simone Cesaro ◽

Patrizia Dall'Igna ◽

...

Keyword(s):

Hyperbaric Oxygen ◽

Oxygen Therapy ◽

Soft Tissues ◽

Hyperbaric Oxygen Treatment ◽

Local Skin ◽

Pediatric Hematology ◽

Oxygen Treatment ◽

Oncological Diseases ◽

The University ◽

Superficial Soft Tissue

This study aimed to assess the feasibility and results of hyperbaric oxygen therapy (HOT) as supportive treatment of lesions of superficial soft tissues in children with oncological diseases. This was a retrospective analysis and review of all records of children observed at the Pediatric Hematology-Oncology Department of the University of Padova and treated adjuvantly with HOT. Between 1996 and 2010, 12 patients (5 males and 7 females, median age 7 years, range 0.5-16) underwent HOT. The effectiveness of HOT varied according to the lesion treated. Ten out of 12 patients were cured. Efficacy was most questionable in 2 patients with skin graft and flaps at risk. Compliance to therapy was close to 100%. In just one case, HOT was interrupted for the appearance of local skin metastases close to the site of primary tumor. HOT showed itself to be safe and effective in most patients even those immunocompromised or critically ill.

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Postoperative Hyperbaric Oxygen Treatment of Peripheral Nerve Damage,

10.21236/ada255842 ◽

1992 ◽

Author(s):

Zhao Dewei ◽

Cui Zhenjiang

Keyword(s):

Peripheral Nerve ◽

Hyperbaric Oxygen ◽

Nerve Damage ◽

Hyperbaric Oxygen Treatment ◽

Peripheral Nerve Damage ◽

Oxygen Treatment

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Method for Estimating the Remaining Capacity of the Carbon Dioxide Scrubber in the Hyperbaric Oxygen Treatment Pack

10.21236/ada442777 ◽

2002 ◽

Author(s):

Dan E. Warkender ◽

John R. Clarke

Keyword(s):

Carbon Dioxide ◽

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Treatment ◽

Oxygen Treatment ◽

Remaining Capacity

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Hyperoxic myopia: a case series of four divers

Undersea and Hyperbaric Medicine ◽

10.22462/04.06.2020.12 ◽

2020 ◽

pp. 261-265

Author(s):

Jonathan W. Brügger ◽

Glenn A. Rauscher ◽

John P. Florian ◽

Keyword(s):

Hyperbaric Oxygen ◽

Prolonged Exposure ◽

Case Series ◽

Oxygen Toxicity ◽

Hyperbaric Oxygen Treatment ◽

Subjective Data ◽

Residual Symptoms ◽

Oxygen Treatment ◽

Blurry Vision ◽

Record Review

Hyperoxic myopia is a phenomenon reported in individuals who have prolonged exposure to an increased partial pressure of oxygen (PO2) and subsequently have a myopic (nearsighted) change in their vision. To date, there are numerous accounts of hyperoxic myopia in dry hyperbaric oxygen treatment patients; however, there have been only three confirmed cases reported in wet divers. This case series adds four confirmed cases of hyperoxic myopia in wet divers using 1.35 atmospheres (ATM) PO2 at the Navy Experimental Diving Unit (NEDU). The four divers involved were the first author’s patients at NEDU. Conditions for two divers were confirmed via record review, whereas the other two divers were diagnosed by the first author. All subjects were interviewed to correlate subjective data with objective findings. Each subject completed five consecutive six-hour hyperoxic (PO2 of 1.35 ATM) dives with 18-hour surface intervals. Each individual was within the U. S. Navy Dive Manual’s standards for general health. Visual acuity was measured prior to diving. Within three to four days after diving, the individuals reported blurry vision with an associated myopic refraction shift. Each diver had spontaneous resolution of his myopia over the next two to three weeks, with no significant residual symptoms. The divers in this case series were exposed to an increased PO2 (1.35 ATM for 30 hours over five days), a lesser exposure than that in other reports of hyperoxic myopia in wet divers diagnosed with hyperoxic myopia (1.3-1.6 ATM for 45-85 hours in 12-18 days). Furthermore, this pulse of exposure was more concentrated than typically seen with traditional hyperbaric oxygen therapy. Hyperoxic myopia continues to be a risk for those conducting intensive diving with a PO2 between 1.3-1.6 ATM. Additional investigation is warranted to better define risk factors and PO2 limits regarding ocular oxygen toxicity.

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