Beneficial effect of hyperbaric oxygen therapy in solving a nosocomial COVID-19 infection. Case report and short literature review

The infection with the new coronavirus SARS-CoV-2 was declared a global health emergency in early 2020 and, two months later, became recognized as a pandemic, affecting the world’s population regardless of age, ethnicity, geographical area. COVID-19 generally presents with altered general condition (fever, chills, marked fatigue, muscle aches, headache), respiratory manifestations from cough to dyspnea, acute respiratory distress, and multiorgan damage in critical forms. Manifestations can occur between 2 days and two weeks after exposure, the disease evolving from mildly symptomatic to moderate, severe, and even fatal forms. Our reported clinical case of COVID-19 is that of a 59-year-old nurse with diabetes and hypertension as risk factors. Accidental occupational exposure to SARS-CoV-2 infection occurred due to non-compliance with the existing dressing-undressing protective equipment protocols in facilities with treatment beds. We diagnosed a moderate-severe COVID-19, displaying bilateral lung damage and mild desaturation, complicated by bacterial superinfection with Klebsiella spp. The patient underwent antiviral, antibiotic, anticoagulant, cortisone treatment during hospitalization. In the first two months after discharge, we recommended seven hyperbaric therapy sessions to relieve respiratory symptoms and enhance regression of fibrotic lung lesions.

Specific Bacterial Immunotherapy in Treating Chronic Osteomyelitis

The immunological experience is treating osteomyelitis chronic forms at the Istituto Putti in Cortina starts in 1963 by introducing immunotherapy, applied by the progressive administration in growing doses of a staphylococci pool, that had been collected from some patients with bone infections by the same germ and then inactivated in an aqueous solution suspension. This therapy is coadjutant of antibiotics, surgical and hyperbaric therapy and not substitutive of these. This study ascertained indeed a reduction of the phagocytic activity as a whole, and especially the opsonisation activity It has been thought therefore that in immunotherapy more factors are involved; their principal property is to reduce the allergising effect and therefore to desensitise vs. the germ proteins and to increase the phagocytic activity. This condition, neither whose entity nor its lasting may be defined, does not appear to be unlimited. Obviously this desensitisation can be obtained also by the right antibiotic choice that, as already said mainly in acute forms, may develop their bactericidal properties and sterilise the focus. In the chronic forms it is possible to provoke this mechanism by carrying out a surgical toilette that restores the vascularization and stimulation conditions needed for a correct antibiotic action. Checks upon immuno-stimulation treatment termination clearly showed corresponding results between laboratory deficit corrected and clinical conditions bettering. The casuistry is based on 50 patients with hematogenic osteomyelitis, all under the age of 16, age at which the growth plate is still active, and 117 post-traumatic septic non-union, where this term was adopted for cases that showed a lack of non-solidification at 6 months after trauma. We have expressly made a distinction between hematogenic and post-traumatic forms, since the relationships between bacterial counts vs. host response do differ.

Application of Hyperbaric Therapy Following Traumatic Amputation. Case Report

Introduction: The origin of hyperbaric therapy can be traced back to 1662, when the world’s 1stchamber was built and used for this type of treatment. The original precise indications for its use were presented in 1977 by the Executive Committee of the Undersea Medical Society. In 1994, the 1st European Congress on Hyperbaric Medicine was held, clarifying the indications for hyperbaric therapy, the educational requirements and training of staff and equipment for hyperbaric centres. Over the years, the list of indications for hyperbaric chamber treatments has become longer. Aim: The aim of the study was to present the validity of using hyperbaric therapy in a patient after traumatic amputation of the left lower leg. Material and Method: The study was conducted in Hyperbaric Therapy Centre CREATOR in Lodz. An individual case study of a patient with traumatic amputation was used as the method. The report analyses the individual’s interview questionnaire and available medical records. Conclusion: Hyperbaric therapy can be an effective method for treating infections with anaerobic bacteria.

Which Role for Hyperbaric Oxygen Therapy in the treatment of Fournier’s gangrene? A Retrospective Study.

Background: In Fournier’s gangrene the surgical debridement plus broad-spectrum antimicrobial therapy is the mainstay treatment but can cause a great loss of tissue. Moreover, the local poor blood supply, the infection and the damage to the vessels can delay the healing. Consequently, the disease needs long hospital stays and, despite all, has high mortality rate. The aim of our study is to investigate the improvement offered by hyperbaric therapy in Fournier’s gangrene.Methods: We retrospectively evaluated data on 23 consecutive patients admitted for Fournier’s gangrene at the University hospital “P.Giaccone” of Palermo from 2011 to 2018. The relation between hyperbaric therapy, hospital stay and mortality was evaluated. Factors related to mortality were also examined.Results: The use of hyperbaric therapy was offered to 13(56.5%) patients. Hospital stay was longer in patients treated with HBOT[mean11(C.I.0.50-21,89)vs25(C.I.18.02-31.97);p=0.02]. Mortality occurred in three patients(13.1%), two of whom treated with HBOT. Mortality was not statistically related to sex(p=0.20), BMI(p=0.53), renal failure (p=1.00), diabetes(p=0.49), age>65 years old(p=0.55), simplified FGSI>2(p=0.05), higher ASA scores(>=4)(p=0.47), symptoms at admission lasting since more than 72 hours (p=0.28), HBOT(p=1.00), need of colostomy(p=0.06), several operations(p=1.00), several operations plus HBOT(P=1.00). Conversely, the delay between admission and surgical operation was statistically related to mortality, 1.7 days(C.I.0.9-3.5) in survivals vs 6.8 days(C.I.3.5-13.4) in death patients(p=0.001).Conclusions: Our study proves that a delay in the treatment of patients with Fournier’s gangrene has a correlation with the mortality rate, while the use of HBOT seems to not improve the survival rate, increasing the hospital stay instead.

TERAPIA HIPERBÁRICA, EFECTIVIDAD EN EL TRATAMIENTO DE PIE DIABÉTICO

Introducción: La Diabetes Mellitus Tipo 2 (DM2), enfermedad de alta incidencia. Un 15% de diabéticos presentan úlceras y lesiones en miembros inferiores cuyos tratamientos son dolorosos, largos y caros. Objetivo: determinar la efectividad de la terapia hiperbárica en el tratamiento del pie diabético. Métodos: Estudio no experimental, descriptivo, observacional y longitudinal, incluyó 160 pacientes, se aplican terapias de 30´ a 45´ minutos, cada 10 días durante 2 meses o más, evaluadas en fichas de seguimiento. Resultados: Pacientes con más de 6 años de diagnóstico de DM2, mayores de 40 años; 60% femenino; lesiones 70% tipo II y IV según Clasificación Meggitt-Wagner. Bacterias encontradas 40% Enterococcus spp., 25%, Staphylococcus aureus, 20%, Estreptococos pyogenes y 15% Corynebacterium spp. 85% de lesiones sin infección luego de 3 sesiones, en un 95% la epitelización y cicatrización inicia luego de 6 sesiones. Conclusiones: Altas concentraciones tisulares de oxígeno reducen el tiempo de eliminación de infecciones. Tratamiento más económico. Disminuyen procedimientos quirúrgicos de amputación. Abstract Introduction:Type 2 Diabetes Mellitus (DM2), a high incidence disease. 15% of diabetics have ulcers and lesions in the lower limbs whose treatments are painful, long and expensive. Objective: to determine the effectiveness of hyperbaric therapy in the treatment of diabetic foot. Methods: Non--experimental, descriptive, observational and longitudinal study; included 160 patients, therapies were treated from 30´ to 45´ minutes, every 10 days for 2 months or more, evaluated in follow-up cards. Results: Patients with more than 6 years of DM2 diagnosis, older than 40 years; 60% female; 70% type II and IV injuries according to the Meggitt-Wagner classification. Bacteria found 40% Enterococcus spp., 25%, Staphylococcus aureus, 20%, Streptococcus pyogenes and 15% Corynebacterium spp. 85% of lesions without infection after 3 sessions, in 95% epithelialization and healing started after 6 sessions. Conclusions: High tissue oxygen complications reduce infection clearance time. Cheaper treatment. Decrease surgical amputation procedures

Formal and Professional Requirements for Medical, Paramedical and Technical Staff of Hyperbaric Centres. Part 2

This two-part article reviews the current legal situation of professional personnel implementing hyperbaric procedures other than those used for diving. Numerous inconsistencies between the existing legal acts and the lack of legal regulations concerning procedures not financed from the State budget are shown.The first significant problem was the lack of mutual correlation of various regulations of the Minister of Health concerning hyperbaric diseases, as well as incoherence with medical and nursing specialisation programs in force in Poland.The second problem is the lack of requirements in the documents of the Ministry of Health for medical staff other than doctors and nurses, including technical staff, necessary for the implementation of a safe oxybarotherapy procedure.The situation is clearer with respect to technical personnel than in relation to medical personnel. There are provisions which strictly define the qualifications of such staff for a very narrow group of technical personnel. Although they deal with issues related to the use of hyperbaric chambers in diving, to date no other separate regulations have been developed for medical applications of hyperbaric therapy. Unfortunately, both in centres financed by the National Health Fund and in private centres, no-one observes these regulations because there is no such formal requirement.The same applies to occupational research (occupational medicine) for all groups of personnel involved in hyperbaric oxygen therapy treatments.It was also found that medical hyperbaric centres not seeking funding from the budget (the National Health Fund) do not have even minimum qualification requirements for the medical staff working there. Furthermore, there is no knowledge of the requirements set out in other legal acts other than those concerning medicine.