Undersea And Hyperbaric Medical Society Research Articles

Survey comparing the treatment of central retinal artery occlusion with hyperbaric oxygen in Australia and New Zealand with the recommended guidelines as outlined by the Undersea and Hyperbaric Medical Society.

Central retinal artery occlusion (CRAO) presents suddenly causing painless loss of vision that is often significant. Meaningful improvement in vision occurs in only 8% of patients with spontaneous reperfusion. Hyperbaric oxygen treatment (HBOT) is considered to be of benefit if commenced before retinal infarction occurs. The Undersea and Hyperbaric Medical Society (UHMS) guidelines on the management of CRAO were last amended in 2019. This survey questioned Australian and New Zealand (ANZ) hyperbaric medicine units (HMUs) about the incidence of CRAO cases referred and compared their subsequent management against the UHMS guidelines. An anonymous survey via SurveyMonkey® was sent to all 12 ANZ HMUs that treat emergency indications, allowing for multiple choice and free text answers regarding their management of CRAO. One-hundred and forty-six cases of CRAO were treated in ANZ HMUs over the last five years. Most (101/146) cases (69%) were initially treated at a pressure of 284 kPa. This was the area of greatest difference noted in CRAO management between the UHMS guidelines and ANZ practice. Few ANZ HMUs strictly followed the UHMS guidelines. We suggest a more simplified management protocol as used by the majority of ANZ HMUs.

Contribution of Hyperbaric Oxygen Therapy in the Management of Gas Gangrene, Necrotizing Fasciitis and Suppuration of the Limbs

Hyperbaric oxygen therapy (HBOT) is defined as a method of administering inhaled oxygen (O2) for therapeutic purposes under a pressure greater than atmospheric pressure. The therapeutic benefits of HBO result, on the one hand, from the physical effects linked to the increase in barometric pressure and the partial pressure of O2 in the tissues and, on the other hand, from the biological effects linked to the production reactive species of O2 and nitrogen. These are likely to interact with many molecular processes responsible for the main anti-ischemic, pro-healing and anti-infective effects. Its indications are regularly evaluated within the framework of international consensus conferences. The references in terms of indications for HBO are, on the one hand, the North American consensus of the Undersea and Hyperbaric Medical Society (UHMS) and, on the other hand, the European consensus of the European Committee of Hyperbaric Medicine (ECHM). HBOT is applied through an hyperbaric chamber. It is a complex technique, which requires a strong human and material investment. It includes some contreindications to respect and well-identified risks to take into account.

Hyperbaric Oxygen Therapy in Orthopaedics: An Adjunct Therapy with an Emerging Role.

Hyperbaric oxygen therapy (HBOT) has emerged as an adjunct treatment modality in various orthopedic and rheumatological conditions. Undersea and Hyperbaric Medical Society (UHMS) defined the minimum number of HBOT cycles, dose, and frequency for various diseases. UHMS laid the 14 absolute indications for HBOT. This article deals with the mechanism of actions of HBOT and evidence of various musculoskeletal disorders where HBOT was utilized to accelerate the healing process of the diseases. The review literature search was conducted by using PubMed, SCOPUS, and other database of medical journals for identifying, reviewing, and evaluating the published clinical trial data, research study, and review articles for the use of HBOT in musculoskeletal disorders. Various clinical researchers documented cellular and biochemical advantages of HBOT which possess allodynic effects, anti-inflammatory, and prooxygenatory effects in patients with musculoskeletal conditions. Studies on the usage of HBOT in avascular necrosis and wound healing provide a platform for exploring the plausible uses of HBOT in other musculoskeletal conditions. Literature evidence states the complications associated with HBOT therapy. The existing HBOT protocols have to be optimized for various musculoskeletal disorders. Large scale blinded RCTs have to be performed for demonstrating the level of evidence in the usage of HBOT in various musculoskeletal clinical scenarios.

Design, development, and evaluation of a registry system for hyperbaric oxygen therapy: A methodological study.

Background and AimsHyperbaric oxygen therapy (HBOT), utilizes 100% oxygen at pressures greater than sea‐level atmospheric pressure, for the treatment of conditions in which the tissues starve for oxygen. The Undersea and Hyperbaric Medical Society (UHMS) has granted HBOT approval for the treatment of various conditions. On the other hand, applying informatics registry systems can improve care delivery, ameliorate outcomes, and reduce the costs and medical errors for the patients receiving HBOT treatment. Therefore, we aimed to design, develop, and evaluate a registry system for patients undergoing HBOT.MethodsIn the first phase, the conceptual and logical models were designed after conducting symposiums with experts and having other experts review the models. In the second phase, the system was developed on the web using ASP.NET and C# programming languages frameworks. The last phase involved Nielsen's heuristic evaluation method for the system's usability. Five experts evaluated the system, including three health information management specialists and two medical informatics specialists.ResultsThe hyperbaric patient information registry system (HPIRS) interacts with three types of users—a specialist physician, a nurse, and a system administrator. A scenario for each predefined activity was designed, and all the information was stored in the SQL servers. The five experts independently found 152 issues, of which 84 were duplicates. The 68 distinct issues of the system were then resolved.ConclusionsThe design and development of such registry systems can make data available and stored carefully to improve clinical care and medical research and decrease costs and errors. These registries can provide the healthcare systems with E‐health applications, improved data management, more secure data transfer, and support for statistical reporting. The implemented heuristic evaluation method can also provide a low‐cost and readily available system to fix the issues of the designed systems.

International Multicenter Registry for Hyperbaric Oxygen Therapy: Results through June 2021

Introduction: The International Multicenter Registry for Hyperbaric Oxygen Therapy (International Report Registered Identifier DERR1-10.2196/18857) was established in 2011 to capture outcomes and complications data for both Undersea and Hyperbaric Medical Society (UHMS) approved and selected unapproved hyperbaric oxygen (HBO2) therapy indications. Methods: A Research Electronic Data Capture (REDCap) template was designed and distributed to all participating centers for prospective data collection. Centers contributed de-identified demographic, treatment, complications, and outcome data. This report provides summary data on sites and enrollment, as well as pre- and post-treatment data on quality of life (EQ-5D-5L questionnaire), head and neck radiation outcomes, non-healing wounds (Strauss score), and idiopathic sudden sensorineural hearing loss. Data were analyzed mainly using the Wilcoxon signed-rank test. Results: Twenty-two centers contributed data for 2,880 patients. The most common UHMS-approved indication was delayed radiation injury, followed by enhancement of wound healing, and carbon monoxide poisoning. One hundred and twenty-five patients were treated for non-UHMS approved indications. Quality of life, head and neck radiation symptoms, Strauss wound scores, and hearing were significantly improved after HBO2. Complication rates were low and comparable to previous reports. The registry also offered the ability to analyze factors that affect outcomes, such as smoking and severity of hearing loss. Discussion: The registry accrues prospective data on defined outcomes from multiple centers and allows for analysis of factors affecting outcomes. This registry does not have a control group, which is a limitation. Nevertheless, the registry provides a unique, comprehensive dataset on HBO2 outcomes from multiple centers internationally.

Operation of a hyperbaric oxygen therapy center in Korea: Report of our experience from a setting in its nascent stages

Hyperbaric medicine is nascent in Korea when compared to other developed countries, such as the United States and Japan. Our facility has been managed by physicians with certifications from the Undersea and Hyperbaric Medical Society (UHMS) and National Oceanic and Atmospheric Administration in diving and clinical diseases since October 2016. This study was conducted to share similar issues that are encountered during the establishment of a program in a new area through our experiences in the operation of a hyperbaric oxygen (HBO2) therapy center. In this retrospective observational study we collected data on HBO2 patients treated at our center between October 2016 and June 2018 after HBO2 was conducted by HBO2-certified physicians. We then compared demographic data of patients with data from January 2011 to September 2015 - before HBO2 operations were conducted by HBO2-certified physicians. A total of 692 patients received 5,130 treatments. Twelve indicated diseases were treated using HBO2 therapy. Fifty-six critically ill patients with intubation received HBO2. Although two patients experienced seizure due to oxygen toxicity during the study period, certified physicians and inside attendant took immediate corrective action. After the establishment of the HBO2 center operated by physicians with certification, more patients, including critically ill patients, received HBO2 safely for various diseases. In order to improve the practice of hyperbaric medicine in Korea, the Korean Academy of Undersea and Hyperbaric Medicine (KAUHM), an advanced and well-organized academic society, should communicate often with HBO2 centers, with the aim to set Korean education programs at UHMS course levels and increase reimbursement for HBO2 therapy.

UHMS Medical Fitness to Work Guidelines for Multiplace Inside Attendants 1st edition

Report of the Hyperbaric Oxygen Safety Committee of the Undersea and Hyperbaric Medical Society This document was written and reviewed by members of the Safety Committee of the UHMS and approved by the UHMS Board of Directors Preface The Board of Directors of the Undersea and Hyperbaric Medical Society (UHMS) acknowledges the work of the authors and the UHMS Safety Committee. It is our hope that this publication will prove helpful to practitioners in the field of hyperbaric medicine. The subject matter in this guide refers to the medical fitness of inside attendants (IAs) to work in a compressed-gas environment. This publication does not replace or supersede any local, state or institutional code or standard. It is a guideline put together by experts in the field, to be used as a reference in evaluating the health and tness to work of multiplace IAs. Users of this publication are invited to visit the UHMS web site (www.membership.uhms.org) for more information and are invited to email comments or questions to uhms@uhms.org.

Hyperbaric oxygen in the treatment of acute retinal artery occlusion.

Acute retinal artery occlusion (ARAO) is a major cause of sudden, painless visual loss, often leaving no useful vision in the affected eye. Its incidence is cited at 0.85 per 100,000 persons per year but may be higher because of under-reporting. The natural history is difficult to study, but a spontaneous resolution rate of < 1-8% for acute, non-arteritic ARAO has been cited. Occurrence in an only eye is devastating for the patient. There is currently no consensus regarding management of ARAO and little evidence to support any treatment modality. Despite only limited case series, hyperbaric oxygen treatment (HBOT) is recommended for ARAO by the Undersea and Hyperbaric Medical Society (UHMS) and by the European Committee for Hyperbaric Medicine. Between early 2003 and December 2012, all ARAO patients presenting to Christchurch Hospital were referred for consideration of HBOT. These 31 consecutive patients' medical records were reviewed retrospectively. The time delay from onset of visual loss to commencing HBOT; the presenting visual acuity; various demographic data; the HBOT administered and the outcome visual acuity were documented. All 31 patients underwent at least one HBOT (median 4, range 1-7) at a pressure of 203-284 kPa for 1.5 to 2.0 h. One patient's treatment was terminated after 60 min at their request; another declined further HBOT and one suffered middle ear barotrauma. Thirteen patients also received anticoagulants at the discretion of the referring ophthalmologist. Twenty three patients had temporarily improved vision with the first HBOT. Seven patients had permanent, good visual recovery (6/18 or better; Snellen chart); and two only modest improvement (6/60). All nine patients who improved permanently were treated within 10 hours of symptom onset. Where available, HBOT is indicated for ARAO. Our protocol may not have been aggressive enough and the UHMS protocol is recommended. A multi-centre, randomised controlled trial is feasible, but would be logistically difficult and expensive and may be ethically unsupportable given the lack of alternative, effective treatments.

The Use of Hyperbaric Oxygen Therapy in Dentistry.

Dear Editor, We appreciate the article “Hyperbaric Oxygen Therapy(HBOT) - Can It Be the New Era in Dentistry?” written by Devaraj et al., [1]. In present review, the authors have mentioned the history, mode of action, indications, contraindications, complications and the applications of hyperbaric oxygen therapy in dentistry. Thanks to the authors for their contribution on the literature. HBOT is increasingly used to treat the many conditons. In the present review, HBOT is defined as administration of 100% oxygen to a patient with a pressure greater than one atmosphere at sea level. According to the Undersea and Hyperbaric Medical Society (UHMS) committee report 2003 and most hyperbaric medicine specialists, the oxygen pressure should be applied 1.4 atmospheres absolute (ATA) as the minimum therapeutic dosage to gain benefit from hyperbaric oxygen therapy. Besides the mentioned 13 approved indications of hyperbaric oxygen therapy, sudden hearing loss is also approved by UHMS Board of Directors since October 8, 2011 [2]. The authors stated “Asymptomatic pulmonary lesions which are seen on chest. X- ray” as one of the contraindications of hyperbaric oxygen therapy. We agree with the authors. Air cysts or blebs in the lungs may predispose pulmonary barotrauma (PBT) by causing air trapping. Interestingly, Toklu et al., surveyed 98 European HBO centres for their attitude to patients with bleb and bullae. They found that a significant portion of the HBO centers accept patients with pulmonary bleb or bullae, X-ray is the mostly used screening tool for patients with a history of pulmonary disease and the prevalence of pulmonary barotrauma in these centers was found only 0.00045%, surprisingly [3]. These study results make us to question the outcome of asymptomatic pulmonary lesions. Furthermore X-Ray screening tool has a low sensitivity for this kind of lesions. The authors mentioned about the pressure equalization problems which predominantly affect the middle ear and the nasal sinus. We think that additionally to these concerns, barotraumatic lesions can occur in any trapped air e.g. dental abscess after failed filling or in periodontitis and subgingival anaerobes which may cause gaseous lesions. These lesions can cause a very strong sharp pain particularly in the ascent phase of the hyperbaric oxygen therapy when the pressure decreases and volume begins to re-expanse. As a conclusion, hyperbaric oxygen therapy provides the most benefit in tissues with vessels which have good blood flow, the anatomical structure of the mouth with its rich vascular beds is an advantage to benefit from this treatment. So we support the idea of using this treatment modality in dentistry.

Cutaneous wound healing: Current concepts and advances in wound care.

A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care.[1] It is a snapshot of a patient's total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors.[2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT), as used at our institution (CAMC), and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society) may vary widely from country to country and payment system.[3] In the USA, CMS (Centers for Medicare and Medicaid Services) approved indications for HBOT vary from that of the UHMS for logistical reasons.[1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise.

The Undersea and Hyperbaric Medical Society. A report on the annual scientific meeting 2012, Phoenix, AZ, USA June 21–23

This is a report on the content of the 45th annual scientific meeting of the Undersea and Hyperbaric Medical Society (UHMS) in Phoenix AZ, USA last June 21-23, 2012. The UHMS is the major representative body for both physicians and scientists in diving and hyperbaric physiology and medicine.

Hyperbaric oxygen and cerebral physiology

Hyperbaric oxygen (HBO) therapy is defined by the Undersea and Hyperbaric Medical Society (UHMS) as a treatment in which a patient intermittingly breathes 100% oxygen under a pressure that is greater than the pressure at sea level [a pressure greater than 1 atmosphere absolute (ATA)]. HBO has been shown to be a potent means to increase the oxygen content of blood and has been advocated for the treatment of various ailments, including air embolism, carbon monoxide poisoning, wound healing and ischemic stroke. However, definitive established mechanisms of action are still lacking. This has led to uncertainty among clinicians, who have understandingly become hesitant in regard to using HBO therapy, even in situations where it could prove beneficial. Therefore, this review will summarize the literature regarding the effects of HBO on brain oxygenation, cerebral blood flow and intracranial pressure in both the healthy and injured brains, as well as discuss how changes in these three factors can impart protection.

INFECTIOUS SKULL BASE OSTEOMYELITIS-STILL A LIFE-THREATENING DISEASE

To the Editor: We read with great interest the article by Drs. Djalilian, Shamloo, Thakkar, and Najme-Rahim titled "Treatment of culture-negative skull base osteomyelitis", presenting new treatment regimen of culture-negative skull base osteomyelitis which resulted in a high cure rate and a short (4 days) hospitalization period. All six patients, after 6 weeks of antibiotic therapy, were carried out of the authors' institution (1). Because acute osteomyelitis of the skull base develops mostly in patients initially treated for benign external otitis with poorly controlled diabetes, it would be interesting to learn about glycemia level in these patients. Aggressive and strict control of blood sugar level is imperative to enhance immune function and reverse acidosis. The authors did not present the staging of skull base osteomyelitis; thus, information given in the article show the absence of poor prognostic factors such as facial paralysis, multiple cranial neuropathy, or intracranial extension, which suggests stage II by Davis et al. (2). In these cases, applying of generally accepted treatment regimen is usually successful. Antibiotic therapy carried out of the authors' institution doubtlessly lead to reduced treatment costs, but what is questionable is the level of medical safety of the patient. In Poland, intravenous antibiotic therapy is possible only in hospital. Opinions on the value of topical antibacterial drops are inconsistent. Some authors state that the use of topical antibacterial drops is inadequate and changes the bacterial flora, altering future cultures should they be necessary in the face of resistant bacteria and the necessity of future bacterial flora assessment. Others promote this kind of therapy (3,4). In our patients, we apply topical antibacterial drops after receiving a final result of bacteriologic examination of the ear swab; at this moment, only steroid drops are given. There are several opinions concerning hyperbaric oxygen (HBO) therapy value in skull base osteomyelitis. This clinical entity is generally accepted by national hyperbaric societies, American Undersea and Hyperbaric Medical Society (UHMS) and European Committee for Hyperbaric Medicine (ECHM), as an indication for HBO therapy. Rationality of HBO treatment in this disease has been proven in experimental and clinical trials. The following changes, resulting from exposition to HBO, were observed: vasoconstriction and decreased edema of damaged tissues, proliferation of fibroblasts, activation of neoangiogenesis, increase of dependent antibacterial activity of leukocytes, improved activity of osteoblasts and osteoclasts, and increased antibacterial effectiveness of some antibiotics (5). In the Department of Otolaryngology, Medical University of Gdansk, in the years 1997 to 2003, there were eight patients treated for malignant otitis externa. In six patients, infection was caused by Pseudomonas aeruginosa; in one patient, infection was caused by Staphylococcus sp., and in another one, infection was caused by Aspergillus sp. In three patients, clinical Stage I was diagnosed; in four patients, Stage II was diagnosed, and in one patient, Stage III. Standard mixed pharmacotherapy, topical management, and adjuvant HBO therapy were applied. Complete recovery was achieved in seven patients; in one patient with osteomyelitis caused by Aspergillus sp., intracranial complications developed, and the patient died. In this case, only serologic test for antimycotic antibodies and subsequent bacteriologic investigations were allowed to diagnose otogenic skull base osteomyelitis caused by invasive fungal infection (Fig. 1). Application aggressive antibiotic and antimycotic therapy was ineffective, the patient died 54 days after admission to our department.FIG. 1: A 65-year-old man; insulin-dependent diabetes mellitus; palsy of VII, IX, X, and XII nerves. Axial computed tomographic scan demonstrating extensive destruction of the right pyramid.The given above case report shows that infectious osteomyelitis, despite revolutionary pharmacotherapy progress, still remains a life-threatening disease. So in these cases, especially when etiology is unknown, applying treatment outside the hospital may be risky for patients. In our opinion, the treatment regimen presented by the authors is indicated only in limited number of patients, who, in general, are in good condition, with a disease of bacterial etiology, with well-controlled glycemia, without advanced osteomyelitis, and with a disease not involving the cranial nerves. Each case of infectious osteomyelitis should be considered as an indication for adjuvant HBO therapy, especially in advanced clinical stages (II and III) or cases that failed in "typical" treatment. Waldemar Narozny, M.D. Jerzy Kuczkowski, M.D. Boguslaw Mikaszewski, M.D. Department of Otolaryngology Medical University of Gdansk Gdansk, Poland

Hyperbaric oxygen: its uses, mechanisms of action and outcomes.

Hyperbaric oxygen therapy (HBO) is increasingly used in a number of areas of medical practice. It is a unique intervention whose method of action is not well understood. Clinicians may request its use for their patients, but often will not fully understand its mechanisms. It is hoped that this review and discussion of HBO and the literature surrounding its use may be useful to clinicians who are unsure whether their patients will benefit from this exciting intervention. Hyperbaric oxygen therapy is defined by the Undersea and Hyperbaric Medical Society (UHMS) as a treatment in which a patient intermittently breathes 100% oxygen while the treatment chamber is pressurized to a pressure greater than sea level (1 atmosphere absolute, ATA).1 The pressure increase must be systemic, and may be applied in monoplace (single person) or multiplace chambers. Multiplace chambers are pressurized with air, with oxygen given via face-mask, hood tent or endotracheal tube; while monoplace chambers are pressurized with oxygen. We began by obtaining the most recent UHMS committee report,1 and performed Medline searches (1966 to present), with the search terms ‘hyperbaric’ and ‘oxygen’, combining this basic search with searches for each of the thirteen indications recommended by the UHMS. Using information from these papers, and the resulting references, this paper outlines the history, physiology, current indications for and effects of hyperbaric oxygen therapy. Hyperbaric therapy was first documented in 1662, when Henshaw built the first hyperbaric chamber, or ‘domicilium’.2 Since this time, reports of beneficial effects from increased pressure have increased, and by 1877, chambers were used widely for many conditions, though there was little scientific rationale or evidence. In 1879, the surgical application of hyperbaric therapy in prolonging safe anaesthesia was realized and explored.3 In 1927, Cunningham4 reported improvement in circulatory disorders at sea level … Address correspondence to Dr C.N.A. Bell, Division of Oral & Maxillo-Facial Surgery, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY. e-mail: chris.bell{at}bristol.ac.uk

HYPERBARIC OXYGEN THERAPY: Applications in the Trauma Patient

The use of hyperbaric oxygen (HBO) for acute and postacute traumatic syndromes has not been clearly codified as a separate therapeutic category by the Hyperbaric Oxygen Committee of the Undersea and Hyperbaric Medical Society (UHMS) in the listing of approved uses; however, a standardized approach in this area can greatly benefit HBO because it is important to stratify patients in various categories that must be treated with HBO, those who might benefit, or those in which HBO is not useful. Another effect of such an analysis is to evaluate timing of HBO therapy in the sequential approach to trauma, that is, when HBO is of maximum benefit to the victim. A final benefit for the organized hyperbaric medical unit is to elevate its effectiveness and to become integrated within the institution where it is located to achieve appropriate visibility and to provide services in full support to other surgical, emergency, and critical care groups.

The applications of hyperbaric oxygen therapy in emergency medicine

Hyperbaric oxygen therapy involves the administration of oxygen in an environment where the ambient pressure has been increased. The ensuing hyperoxia and the elevated pressure have a number of beneficial clinical effects. Many of the clinical indications for hyperbaric oxygen therapy (HBOT) involve emergent conditions. It is therefore important for emergency physicians to be familiar with the applications of HBOT. Emergency physicians have become well represented in hyperbaric medicine. Currently, emergency physicians comprise approximately 15% of the membership of the Undersea and Hyperbaric Medical Society (UHMS). Along with internal medicine and anesthesiology/critical care medicine, emergency medicine is among the most heavily represented specialities in the UHMS (UHMS personal communication, February 1991). This is not surprising, considering the variety of emergent conditions that can be treated with HBOT. and the general attributes of an emergency physician: a broad general background, the ability to resuscitate unstable patients, and 24-hour in-house availability. The UHMS recognized the important association between Emergency Medicine and Hyperbaric Medicine when they convened a symposium entitled “Hyperbaric Oxygen in Emergency Medical Care” in 1983.’ This will not be a comprehensive review of hyperbaric medicine. Outstanding reviews of diving medicine and clinical hyperbaric medicine6-9 already have been written. This review will examine the relevance of HBO therapy to emergency medicine. It is necessary, however, to preface this review with a brief discussion of the background, the basic physics, and the physiology of HBOT.