scholarly journals Pulmonary barotrauma with cerebral arterial gas embolism from a depth of 0.75−1.2 metres of fresh water or less: A case report

2021 ◽  
Vol 51 (2) ◽  
pp. 224-226
Author(s):  
Ulrika Lindblom ◽  
◽  
Carl Tosterud ◽  
◽  
Keyword(s):  
Hyperbaric Oxygen ◽  
Case Reports ◽  
Escape Training ◽  
Gas Embolism ◽  
Hyperbaric Oxygen Treatment ◽  
Pulmonary Barotrauma ◽  
Altered Level ◽  
Oxygen Treatment ◽  
Arterial Gas Embolism ◽  
Level Of Consciousness

During underwater vehicle escape training with compressed air, a fit 26-year-old soldier suffered pulmonary barotrauma with cerebral arterial gas embolism after surfacing from a depth of 0.75–1.2 metres of freshwater or less. She presented with an altered level of consciousness. Rapid neurological examination noted slurred speech, a sensory deficit and right hemiparesis. Eleven hours after the accident, hyperbaric oxygen treatment was initiated using US Navy Treatment Table 6. The soldier almost completely recovered after repeated hyperbaric oxygen treatment. Given the very shallow depth this is an unusual case with only two similar case reports published previously.

Pathophysiology and management of depth-related disorders

2016 ◽  
Author(s):  
Peter Radermacher ◽  
Claus-Martin Muth
Keyword(s):  
Hyperbaric Oxygen ◽  
Decompression Sickness ◽  
Specific Treatment ◽  
Decompression Illness ◽  
Gas Embolism ◽  
Hyperbaric Oxygen Treatment ◽  
Pulmonary Barotrauma ◽  
Oxygen Treatment ◽  
Technical Issues ◽  
Vascular Obstruction

Decompression illness comprises decompression sickness resulting from tissue inert gas super-saturation and pulmonary barotraumas due to alveolar or airway over-distension. Gas bubbles can cause vascular obstruction or tissue compression, resulting in tissue ischaemia and oedema. Interactions between the blood–gas interface and the endothelium will result in further tissue damage, and trigger an inflammatory cascade with capillary leakage and haemoconcentration. Decompression illness may mimic any other emergency pathology and any emergency coinciding with decompression is ‘due to’ decompression. Pulmonary barotrauma-induced arterial gas embolism and decompression sickness can be discriminated according to the onset of symptoms, with gas embolism predominantly developing within a few minutes after or even during decompression. Specific treatment consists of hyperbaric oxygen treatment, using several empirically-derived hyperbaric oxygen treatment schedules. Currently, there is no recognized pharmacological treatment, but fluid resuscitation is useful to counteract haemoconcentration and dehydration. Early treatment initiation is mandatory, and certain technical issues must be considered for the management of critically-ill patients in a hyperbaric chamber.

Pneumomediastinum and the use of hyperbaric oxygen treatment

2021 ◽  
Vol 51 (1) ◽  
pp. 119-123
Author(s):  
Stephanie M Price ◽  
◽  
Will D Price ◽  
Mickaila J Johnston ◽  
◽  
...  
Keyword(s):  
Hyperbaric Oxygen ◽  
Respiratory Symptoms ◽  
Treatment Algorithm ◽  
Hyperbaric Oxygen Treatment ◽  
Pulmonary Barotrauma ◽  
Oxygen Treatment

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.

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.

Efficacy and safety of hyperbaric oxygen treatment in SARS-COV-2 (COVID-19) pneumonia: a systematic review

2021 ◽  
Vol 51 (3) ◽  
pp. 271-281 ◽  
Author(s):  
Sylvain Boet ◽  
◽  
Cole Etherington ◽  
George Djaiani ◽  
Andrea C Tricco ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Hyperbaric Oxygen ◽  
Case Reports ◽  
Grey Literature ◽  
Hyperbaric Oxygen Treatment ◽  
Invasive Treatment ◽  
Serious Adverse Events ◽  
Oxygen Treatment

Introduction: The need for intubation and mechanical ventilation among COVID-19 patients is associated with high mortality rates and places a substantial burden on the healthcare system. There is a strong pathophysiological rationale suggesting that hyperbaric oxygen treatment (HBOT), a low-risk and non-invasive treatment, may be beneficial for COVID-19 patients. This systematic review aimed to explore the potential effectiveness and safety of HBOT for treating patients with COVID-19. Methods: Medline, Embase, Scopus, and Google Scholar were searched from December 2019 to February 2021, without language restrictions. The grey literature was searched via an internet search engine and targeted website and database searches. Reference lists of included studies were searched. Independent reviewers assessed studies for eligibility and extracted data, with disagreements resolved by consensus or a third reviewer. Risk of bias was assessed using the Newcastle Ottawa Scale. Data were summarised descriptively. Results: Six publications (one cohort study, five case reports/series) met the inclusion criteria with a total of 37 hypoxaemic COVID-19 patients treated with HBOT. Of these 37 patients, the need for intubation and mechanical ventilation and in-hospital survival were assessed for 26 patients across three studies. Of these 26 patients, intubation and mechanical ventilation were not required for 24, and 23 patients survived. No serious adverse events of HBOT in COVID-19 patients were reported. No randomised trials have been published. Conclusions: Limited and weak evidence from non-randomised studies including one propensity-matched cohort study suggests HBOT is safe and may be a promising intervention to optimise treatment and outcomes in hypoxaemic COVID-19 patients. Randomised controlled studies are urgently needed.

Hyperoxic myopia: a case series of four divers

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.

Review on hyperbaric oxygen treatment in femoral head necrosis

2017 ◽  
Vol 44 (6) ◽  
pp. 497-508 ◽  
Author(s):  
Enrico Camporesi ◽  
◽  
Giuliano Vezzani ◽  
Vincenzo Zanon ◽  
Daniele Manelli ◽  
...  
Keyword(s):  
Femoral Head ◽  
Hyperbaric Oxygen ◽  
Femoral Head Necrosis ◽  
Hyperbaric Oxygen Treatment ◽  
Oxygen Treatment
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