Year: 2017 Language: English Author: Kewal K. Jain Genre: Textbook, Textbook Publisher: Springer Edition: 6th ISBN: 9783319471402 Format: PDF Quality: eBook Pages count: 660 Description: This comprehensive volume captures the latest scientific evidence, technological advances, treatments and impact of biotechnology in hyperbaric oxygen therapy. Divided into three distinct sections, the book begins with basic aspects that include history, equipment, safety and diagnostic approaches; this is followed by clinical applications for hyperbaric oxygen therapy in various modalities; the last section provides an overview of hyperbaric medicine as a specialty with best practices from around the world. Integration of multidisciplinary approaches to complex disorders are also covered. Updated and significantly expanded from previous editions, Textbook of Hyperbaric Medicine, 6th Edition will continue to be the definitive guide to this burgeoning field for students, trainees, physicians and specialists.
Contents
Part I Basic Aspects 1 The History of Hyperbaric Medicine ................................................................................... 3 Hyperbaric Therapy and Diving Medicine ............................................................................... 3 The Development of Hyperbaric Air Therapy ............................................................................ 4 The Development of Hyperbaric Oxygen Therapy ......................................................................... 7 References ........................................................................................................... 9 2 Physical, Physiological, and Biochemical Aspects of Hyperbaric Oxygenation ........................................... 11 Introduction ......................................................................................................... 11 Physical Basics ...................................................................................................... 11 Physiology of Oxygenation ............................................................................................ 12 The Oxygen Pathway ................................................................................................. 12 Ventilation Phase .................................................................................................. 12 Transport Phase .................................................................................................... 12 Shift of the Oxygen-Hemoglobin Dissociation Curve .................................................................. 13 Delivery of Oxygen to the Tissues .................................................................................. 14 Oxygen Transfer at the Capillary Level ............................................................................. 14 Relation Between the Oxygen Transport and Utilization .............................................................. 14 Oxygen Utilization in the Cell ..................................................................................... 15 Effect of Blood Flow ............................................................................................... 15 Effect of Oxygen-Hemoglobin Reaction on Transport of CO2 ........................................................... 15 Autoregulation of the Intracellular pO2 ............................................................................ 16 Hyperbaric Oxygenation ............................................................................................... 16 Theoretical Considerations ......................................................................................... 16 General Effects of HBO on the Healthy Human Body ................................................................... 19 Biochemical Effects of HBO ......................................................................................... 20 Effect of HBO on Enzymes ........................................................................................... 20 Effect of HBO on the Nervous System ................................................................................ 20 Effect of HBO at Molecular Level ................................................................................... 21 Conclusion ........................................................................................................... 21 References ........................................................................................................... 21 3 Effects of Diving and High Pressure on the Human Body ................................................................ 23 Physical Effects of Pressure ......................................................................................... 23 Effects of Pressure on Various Systems of the Body ................................................................... 23 Hematological and Biochemical Effects .............................................................................. 23 Effect on Ammonia Metabolism ....................................................................................... 24 Effect on Blood Cells and Platelets................................................................................. 24 Changes in the Respiratory System and Blood Gases .................................................................. 24 Effects on the Cardiovascular System ............................................................................... 25 Changes in the Endocrine System .................................................................................... 25 Effect on the Skeletal System ...................................................................................... 25 Effects of High-Pressure Environments on the Nervous System ........................................................ 25 Damage to the Middle Ear and Inner Ear in Diving ................................................................... 29 Vertigo and Diving ................................................................................................. 30 Taste Sensation Under High Pressure ................................................................................ 30 Effect of High Pressure on Effect of Drugs ........................................................................... 30 Conclusion ........................................................................................................... 31 References ........................................................................................................... 31 4 Physical Exercise under Hyperbaric Conditions ........................................................................ 33 Introduction ......................................................................................................... 33 Exercise and Hypoxia ................................................................................................. 34 Exercise in Hyperbaric Environments .................................................................................. 34 Exercise Under Hyperoxia ............................................................................................. 35 Physical Exercise Under Hyperbaric Conditions ........................................................................ 35 General Effects .................................................................................................... 35 Effect on Lactate Production and Clearance ......................................................................... 36 Effect of Exercise on Ammonia Metabolism ........................................................................... 37 Effect of HBO on Antioxidant Enzymes in Skeletal Muscle ............................................................ 37 Effect of HBO on Blood Flow to the Muscles During Exercise ......................................................... 37 Physical Exercise in Relation to Toxic Effects of HBO .............................................................. 38 Conclusion ........................................................................................................... 38 References ........................................................................................................... 38 5 Hypoxia .............................................................................................................. 39 Introduction ......................................................................................................... 39 Pathophysiology of Hypoxia ........................................................................................... 39 Hypoxia-Inducible Factor ........................................................................................... 40 Hypoxia and Heat Shock Proteins .................................................................................... 40 Effect of Hypoxia on Cellular Metabolism ........................................................................... 40 Impact of Hypoxia on Various Body Systems ............................................................................ 41 Respiratory Function ............................................................................................... 41 Cardiovascular System .............................................................................................. 41 General Metabolic Effects .......................................................................................... 41 Effects of Hypoxia on the Brain .................................................................................... 42 Role of HBO in the Treatment of Hypoxic States ....................................................................... 46 The Role of Nitric Oxide Synthase in the Effect of HBO in Hypoxia .................................................. 47 Possible Dangers of HBO in Hypoxic States .......................................................................... 47 References ........................................................................................................... 48 6 Oxygen Toxicity ...................................................................................................... 49 Introduction ......................................................................................................... 49 Pathophysiology of Oxygen Toxicity ................................................................................... 50 Free Radical Mechanisms ............................................................................................ 50 Pathology of Oxygen Toxicity ......................................................................................... 50 Pulmonary Oxygen Toxicity .......................................................................................... 52 Normobaric vs. Hyperbaric Oxygen in Induction of Pulmonary Oxygen Toxicity ......................................... 53 Oxygen-Induced Retinopathy ......................................................................................... 53 Factors That Enhance Oxygen Toxicity ............................................................................... 53 Central Nervous System Oxygen Toxicity ............................................................................. 54 Ammonia and Amino Acids ............................................................................................ 56 Biomarkers of Oxygen Neurotoxicity ................................................................................. 56 Neuropathology of Oxygen Toxicity .................................................................................. 56 Manifestations of CNS Oxygen Toxicity .............................................................................. 57 Clinical Monitoring for Oxygen Toxicity ............................................................................ 57 Protection Against Oxygen Toxicity ................................................................................. 57 Extension of Oxygen Tolerance ...................................................................................... 59 Conclusion and Directions for Future Research ........................................................................ 59 References ........................................................................................................... 60 7 Hyperbaric Chambers: Equipment, Technique, and Safety ................................................................ 61 Introduction ......................................................................................................... 61 Monoplace Chambers ................................................................................................. 61 Multiplace Chambers ................................................................................................ 62 Multiplace Chambers for the Critical Care Department ............................................................... 64 Surgery in the Multiplace Chamber .................................................................................. 65 Mobile Multiplace Hyperbaric Chambers .............................................................................. 65 Hyperbaric Chambers for Diving Medicine ............................................................................ 66 Hyperbaric Chambers for Animal Research ............................................................................ 66 Selection of a Hyperbaric Chamber .................................................................................... 68 Technique of Hyperbaric Oxygenation .................................................................................. 68 Ancillary Equipment .................................................................................................. 70 Oxygen Masks and Hoods ............................................................................................. 70 Respirators and Ventilators .......................................................................................... 70 Diagnostic Equipment ................................................................................................. 71 ECG and EEG ........................................................................................................ 71 Transcutaneous Oxygen Tension ...................................................................................... 71 Glucose-Monitoring Devices ......................................................................................... 71 Use of Miscellaneous Medical Devices in the Hyperbaric Chamber ....................................................... 72 Cardiopulmonary Resuscitation ...................................................................................... 72 Use of Defi brillators in Hyperbaric Chambers ...................................................................... 72 Pleural Suction Drainage ........................................................................................... 72 Endotracheal Tubes ................................................................................................. 72 Care of Tracheotomy ................................................................................................ 72 Continuous Bladder Irrigation and HBO .............................................................................. 72 Transdermal Patches for Drug Delivery and Hyperbaric Chamber ....................................................... 73 Implanted Devices in Patients ...................................................................................... 73 Monitoring of Patients in the Hyperbaric Chamber ..................................................................... 73 Safety in the Hyperbaric Chamber ..................................................................................... 74 Operational Safety ................................................................................................. 74 Masks and Breathing Control System ................................................................................. 74 Fire Safety in the Chamber ......................................................................................... 74 Use of Portable Hyperbaric Chambers in Patient's Rooms ............................................................. 76 Regulatory Issues Relevant to Hyperbaric Medicine .................................................................... 76 Staffing of Hyperbaric Facilities .................................................................................... 77 Conclusion ........................................................................................................... 77 References ........................................................................................................... 77 8 Indications, Contraindications, and Complications of HBO Therapy ..................................................... 79 Indications .......................................................................................................... 79 Contraindications .................................................................................................... 79 Complications of Hyperbaric Oxygenation .............................................................................. 81 Middle Ear Barotrauma .............................................................................................. 81 Ophthalmological Complications of HBO .............................................................................. 82 Pulmonary Complications of HBO ..................................................................................... 82 Oxygen Seizures .................................................................................................... 82 Decompression Sickness ............................................................................................. 83 Genetic Effects .................................................................................................... 83 Claustrophobia ..................................................................................................... 83 Anxiety Reactions .................................................................................................. 83 Coincidental Medical Events in the Hyperbaric Chamber .............................................................. 84 Precautions in Selection of Patients for HBO Treatment................................................................ 84 Conclusion ........................................................................................................... 84 References ........................................................................................................... 84 9 Drug Interactions with Hyperbaric Oxygenation ........................................................................ 85 Oxygen as a Drug ..................................................................................................... 85 Drug–Drug Interactions ............................................................................................. 85 Interactions of HBO with Other Drugs ............................................................................... 85 Interaction of HBO with Antimicrobials ............................................................................... 86 Carbapenem Antibiotics ............................................................................................. 86 Aminoglycoside Antibiotics ......................................................................................... 86 Sulfonamides ....................................................................................................... 86 Interaction of HBO with Anticancer Agents ............................................................................ 86 Interaction of HBO with Cardiovascular Drugs ......................................................................... 86 Adrenomimetic, Adrenolytic, and Ganglion- Blocking Agents .......................................................... 86 Digitalis/Digoxin................................................................................................... 87 Antianginal Drugs .................................................................................................. 87 Heparin ............................................................................................................ 87 Interaction of HBO with Drugs Acting on the CNS ...................................................................... 87 Anesthetics ........................................................................................................ 87 CNS Stimulants ..................................................................................................... 87 Ethanol ............................................................................................................ 87 Narcotic Analgesics ................................................................................................ 87 Pentobarbital ...................................................................................................... 87 Scopolamine ........................................................................................................ 87 Interaction of HBO with Miscellaneous Drugs .......................................................................... 88 Practical Considerations of Drug Administration During HBO Therapy ................................................... 88 Drugs that Enhance Oxygen Toxicity ................................................................................... 88 Drugs that Protect Against Oxygen Toxicity ........................................................................... 88 Conclusion ........................................................................................................... 89 References ........................................................................................................... 89 10 Neurophysiologic SPECT Brain Function Imaging and Hyperbaric Oxygen Therapy ......................................... 91 Introduction ......................................................................................................... 91 Case Studies ......................................................................................................... 93 Conclusion ........................................................................................................... 94 Suggested Reading .................................................................................................... 96 Part II Clinical Applications 11 Decompression Sickness .............................................................................................. 101 Introduction ......................................................................................................... 101 Pathophysiology ...................................................................................................... 102 Gas Formation ...................................................................................................... 102 Pulmonary Changes .................................................................................................. 104 Bubble-Induced CNS Injury .......................................................................................... 104 Changes in Blood ................................................................................................... 105 Dysbaric Osteonecrosis ............................................................................................. 106 Role of Free Radicals .............................................................................................. 106 Clinical Features .................................................................................................... 106 Decompression Sickness in Diving ................................................................................... 106 Altitude Decompression Sickness .................................................................................... 107 Ocular Complications of DCS ........................................................................................ 108 Ultrasonic Detection of Bubbles .................................................................................... 109 Diagnosis ............................................................................................................ 109 Blood Examination .................................................................................................. 109 Ultrasound Monitoring of Bubbles ................................................................................... 110 Bone Scanning ...................................................................................................... 110 X-Rays ............................................................................................................. 110 Retinal Angiography ................................................................................................ 110 Imaging .............................................................................................................. 110 Electrophysiological Studies ......................................................................................... 110 Neuropsychological Assessment ........................................................................................ 110 Treatment ............................................................................................................ 110 Emergency Management and Evaluation ................................................................................ 110 Recompression and HBO Treatment .................................................................................... 111 Management of Altitude Decompression Sickness ...................................................................... 111 Management of Neurological Manifestations of Decompression Sickness ................................................ 114 Monoplace vs. Multiplace Chambers .................................................................................... 115 Use of Oxygen vs. Other Gas Mixtures ................................................................................. 115 Drugs ................................................................................................................ 116 Importance of Early Treatment ........................................................................................ 117 Delayed Treatment .................................................................................................... 117 Treatment of Residual Neurological Injury and SPECT Brain Imaging in Type II DCS ..................................... 117 Risk Factors for DCS ................................................................................................. 117 Preventive Measures for DCS .......................................................................................... 118 Prognosis of DCS ..................................................................................................... 118 Conclusion ........................................................................................................... 118 References ........................................................................................................... 119 12 Cerebral Air Embolism ............................................................................................... 121 Introduction ......................................................................................................... 121 Causes ............................................................................................................... 121 Mechanisms ........................................................................................................... 122 Pathophysiology of Cerebral air Embolism ............................................................................. 122 Clinical Features .................................................................................................... 123 Diagnosis ............................................................................................................ 123 Treatment ............................................................................................................ 123 Clinical Applications of HBO for Air Embolism ........................................................................ 124 Ancillary Treatments ................................................................................................. 126 Antiplatelet Drugs ................................................................................................. 126 Steroids ........................................................................................................... 126 Hemodilution ....................................................................................................... 126 Control of Seizures ................................................................................................ 126 Measures to Improve Cerebral Metabolism ............................................................................ 126 Hyperbaric Treatment in Special Situations ........................................................................... 126 Cerebral Edema ..................................................................................................... 126 Cardiovascular Surgery ............................................................................................. 126 Neurosurgery ....................................................................................................... 127 Pulmonary Barotrauma ............................................................................................... 127 Air Embolism During Invasive Medical Procedures .................................................................... 127 Cerebral Air Embolism During Obstetrical Procedures ................................................................ 127 Cerebral Air Embolism in Endoscopic Retrograde Cholangiopancreatography ............................................ 128 Cerebral Embolism Due to Hydrogen Peroxide Poisoning ............................................................... 128 Relapse Following Spontaneous Recovery ............................................................................. 128 Delayed Treatment .................................................................................................. 129 Conclusion ........................................................................................................... 129 References ........................................................................................................... 129 13 Carbon Monoxide and Other Tissue Poisons ............................................................................ 131 Classification of Tissue Poisons ..................................................................................... 131 Carbon Monoxide Poisoning ............................................................................................ 131 Historical Aspects of CO Poisoning ................................................................................. 131 Biochemical and Physical Aspects of CO ............................................................................. 131 CO Body Stores ..................................................................................................... 132 Biochemical Effects of CO on Living Organisms ...................................................................... 132 Inhibition of the Utilization of Oxygen by CO ...................................................................... 132 Epidemiology of CO Poisoning ......................................................................................... 133 Causes of CO Poisoning ............................................................................................. 134 Sources of CO Poisoning ............................................................................................ 134 Pathophysiology of CO Poisoning ...................................................................................... 134 CO Binding to Myoglobin ............................................................................................ 134 CO-Induced Hypoxia ................................................................................................. 135 Effects of CO on Various Systems of the Body ......................................................................... 135 Cardiovascular System .............................................................................................. 135 Hemorheological Effects of CO ...................................................................................... 136 Effect of CO on Blood Lactate ...................................................................................... 136 Effect of CO on the Lungs .......................................................................................... 136 Exercise Capacity .................................................................................................. 136 Sleep .............................................................................................................. 136 Effect on Pregnancy ................................................................................................ 136 Musculoskeletal System ............................................................................................. 136 Skin ............................................................................................................... 136 Gastrointestinal System ............................................................................................ 137 Effects on the Peripheral Nervous System ........................................................................... 137 Effects on the Visual System ....................................................................................... 137 Effect on the Auditory System ...................................................................................... 137 Effect on the Central Nervous System ............................................................................... 137 Clinical Features of CO Poisoning .................................................................................... 138 Neuropsychological Sequelae of CO Poisoning ........................................................................ 138 Clinical Diagnosis of CO Poisoning ................................................................................... 140 Pitfalls in the Clinical Diagnosis of CO Poisoning ................................................................. 140 Occult CO Poisoning ................................................................................................ 140 Laboratory Diagnosis of CO Poisoning ................................................................................. 140 Brain Imaging Studies .............................................................................................. 141 General Management of CO Poisoning ................................................................................... 142 Rationale for Oxygen Therapy ( NBO or HBO ) for CO Poisoning ...................................................... 143 Experimental Evidence .............................................................................................. 144 Clinical Use of HBO in CO Poisoning ................................................................................ 144 Clinical Trials of HBO in CO Poisoning ............................................................................. 145 HBO for CO Intoxication Secondary to Methylene Chloride Poisoning .................................................. 148 Treatment of CO Poisoning in Pregnancy ............................................................................. 148 Treatment of Smoke Inhalation ...................................................................................... 149 Prevention and Treatment of Late Sequelae of CO Poisoning........................................................... 149 Controversies in the Use of HBO for CO Poisoning ................................................................... 149 Cyanide Poisoning .................................................................................................... 150 Pathophysiology .................................................................................................... 150 Clinical Features of Cyanide Poisoning ............................................................................. 150 Laboratory Diagnosis ............................................................................................... 150 Treatment .......................................................................................................... 150 Rationale for Use of HBO in Cyanide Poisoning ...................................................................... 150 Hydrogen Sulfi de Poisoning .......................................................................................... 150 Carbon Tetrachloride Poisoning ....................................................................................... 151 Methemoglobinemias ................................................................................................... 151 Treatment .......................................................................................................... 151 Miscellaneous Poisons ................................................................................................ 152 Organophosphorus Compounds ......................................................................................... 152 Conclusions: Poisoning Other Than with CO .......................................................................... 152 References ........................................................................................................... 152 14 HBO Therapy in Infections ........................................................................................... 155 Introduction ......................................................................................................... 155 Host Defense Mechanisms Against Infection .......................................................................... 155 Impairment by Anoxia ............................................................................................... 155 Oxygen as an Antibiotic ............................................................................................ 155 HBO as an Adjuvant to Antibiotics .................................................................................... 157 HBO in the Treatment of Infections ................................................................................... 157 HBO in the Treatment of Soft Tissue Infections ..................................................................... 158 Crepitant Anaerobic Cellulitis ..................................................................................... 158 Progressive Bacterial Gangrene ..................................................................................... 158 Necrotizing Fasciitis .............................................................................................. 158 Nonclostridial Myonecrosis ......................................................................................... 159 Fournier's Gangrene ................................................................................................ 159 Gas Gangrene ....................................................................................................... 160 Fungal Infection ................................................................................................... 163 HBO in the Management of AIDS ...................................................................................... 164 Miscellaneous Infections ........................................................................................... 164 Osteomyelitis ........................................................................................................ 165 Management of Osteomyelitis ........................................................................................ 166 HBO Treatment of Osteomyelitis ..................................................................................... 167 Clinical Results of HBO Treatment in Osteomyelitis ................................................................. 168 Osteomyelitis of the Jaw ........................................................................................... 168 Osteomyelitis of the Sternum ....................................................................................... 168 Malignant Otitis Externa ............................................................................................. 168 References ........................................................................................................... 169 15 Hyperbaric Oxygen Therapy and Chronic Lyme Disease: The Controversy and the Evidence ................................ 171 Introduction to Lyme Disease vs. Chronic Lyme Disease : A Brief Overview ............................................ 171 Chronic Lyme Disease ............................................................................................... 173 HBOT for Lyme Disease and CLD ........................................................................................ 174 Rationale for Using HBOT ........................................................................................... 174 The Need for a HBOT Medical Registry ............................................................................... 179 Conclusion ........................................................................................................... 179 References ........................................................................................................... 180 16 HBO Therapy in Wound Healing, Plastic Surgery, and Dermatology ...................................................... 183 Introduction ......................................................................................................... 183 Wound Healing ........................................................................................................ 184 Role of Oxygen in Wound Healing .................................................................................... 184 Pathophysiology of Nonhealing Wounds ............................................................................... 184 Wound Healing Enhancement by Oxygen ................................................................................ 185 Clinical Applications .............................................................................................. 187 Role of HBO in Nonhealing Wounds and Ulcers ........................................................................ 189 Ulcers Due to Arterial Insuffi ciency .............................................................................. 189 Diabetic Ulcers .................................................................................................... 190 Clinical Use of HBO in Diabetic Foot ............................................................................... 191 Guideline for the Use of HBO in the Treatment of Diabetic Foot Ulcers .............................................. 192 Venous Ulcers ...................................................................................................... 193 Decubitus Ulcers ................................................................................................... 195 Infected Wounds .................................................................................................... 195 Frostbite .......................................................................................................... 195 Spider Bite ........................................................................................................ 196 HBO for Inflammatory Bowel Disease ................................................................................. 197 HBO as an Aid to the Survival of Skin Flaps and Free Skin Grafts ..................................................... 197 Basic Considerations ............................................................................................... 197 Animal Experimental Studies ........................................................................................ 198 Comparison and Combination of HBO with Other Methods for Enhancing Flap Survival ................................... 199 Clinical Applications .............................................................................................. 199 Conclusion ........................................................................................................... 200 HBO as an Adjunct in the Treatment of Thermal Burns .................................................................. 200 Basic Considerations ............................................................................................... 200 Experimental Studies ............................................................................................... 201 Clinical Applications .............................................................................................. 201 Conclusion ........................................................................................................... 202 Applications of HBO in Dermatology ................................................................................... 202 Necrobiosis Lipoidica Diabeticorum ................................................................................. 202 Pyoderma Gangrenosum ............................................................................................... 202 Purpura Fulminans .................................................................................................. 203 Toxic Epidermal Necrolysis ......................................................................................... 203 Psoriasis .......................................................................................................... 203 Scleroderma ........................................................................................................ 203 References ........................................................................................................... 204 17 HBO Therapy in the Management of Radionecrosis ...................................................................... 207 Intoduction .......................................................................................................... 207 Radiation Physics .................................................................................................. 207 Unit of Radiation .................................................................................................. 207 Radiation Biology .................................................................................................... 208 Radiation Pathology .................................................................................................. 208 Clinicopathological Correlations ................................................................................... 208 Effect of Radiation on Blood Vessels ............................................................................... 208 Effect on Soft Tissues ............................................................................................. 208 Radiation Effects on the Nervous System ............................................................................ 208 Radiation Effects on the B one ..................................................................................... 209 HBO Therapy for Radionecrosis ........................................................................................ 209 Effect of HBO on Radiation Damage to Skin and Mucous Membranes ..................................................... 209 Rationale for Clinical Application ................................................................................. 209 Management of Osteoradionecrosis ..................................................................................... 210 Basic Studies ...................................................................................................... 210 Osteoradionecrosis of the Mandible ................................................................................. 211 Osteonecrosis of the Temporal Bone ................................................................................. 212 Osteoradionecrosis of the Chest Wall ............................................................................... 212 Osteoradionecrosis of the Vertebrae ................................................................................ 212 Management of Radionecrosis of CNS ................................................................................. 212 Management of Radionecrosis of Soft Tissues ........................................................................ 214 Effect of HBO on Cancer Recurrence ................................................................................. 216 Conclusion ........................................................................................................... 217 References ........................................................................................................... 217 18 The Use of HBO in Treating Neurological Disorders ................................................................... 221 Introduction ......................................................................................................... 221 Effect of HBO on Cerebral Metabolism ............................................................................... 221 Effect of HBO on Cerebral Blood Flow ............................................................................... 222 Effect of HBO on the Blood–Brain Barrier ........................................................................... 224 Effect of HBO on Oxygen Tension in the Cerebrospinal fl uid ........................................................ 224 Rationale for the Use of HBO in Neurological Disorders ............................................................... 225 Cerebral Hypoxia ................................................................................................... 225 Cerebral Edema ..................................................................................................... 225 Role of HBO in Neuroprotection ....................................................................................... 226 Indications for the Use of HBO in Neurological Disorders ............................................................. 228 Clinical Neurological Assessment of Response to HBO .................................................................. 229 Comatose Patients .................................................................................................. 229 Paraplegics ........................................................................................................ 229 Hemiplegics (Stroke Patients) ...................................................................................... 230 Diagnostic Procedures Used for Assessing the Effect of HBO ........................................................... 230 Electrophysiological Studies ....................................................................................... 230 Cerebral Blood Flow ................................................................................................ 231 Computerized Tomography ............................................................................................ 232 Magnetic Resonance Imaging ......................................................................................... 232 Positron Emission Tomography ....................................................................................... 233 Single Photon Emission Computed Tomography ......................................................................... 233 References ........................................................................................................... 234 19 Role of Hyperbaric Oxygenation in the Management of Stroke .......................................................... 237 Introduction ......................................................................................................... 237 Epidemiology of Stroke ............................................................................................. 238 Risk Factors for Stroke .............................................................................................. 238 Pathophysiology of Stroke .......................................................................................... 239 Causes of Stroke ................................................................................................... 239 Changes in the Brain During Ischemic Stroke ........................................................................ 240 Clinicopathological Correlations ................................................................................... 240 Structure of a Cerebral Infarct .................................................................................... 240 Cerebral Metabolism in Ischemia .................................................................................... 242 Molecular Mechanism in the Pathogenesis of Stroke .................................................................... 244 Gene Expression in Response to Cerebral Ischemia ................................................................... 244 Induction of Heat Shock Proteins ................................................................................... 244 Role of Cytokines and Adhesion Molecules in Stroke ................................................................. 244 DNA Damage and Repair in Cerebral Ischemia ......................................................................... 244 Role of Neurotrophic Factors ....................................................................................... 244 Classification of Ischemic Cerebrovascular Disease ................................................................... 245 Recovery from Stroke ................................................................................................. 245 Complications of Stroke .............................................................................................. 246 Sequelae of Stroke ................................................................................................... 246 Vascular Dementia .................................................................................................. 247 Diagnosis of Stroke .................................................................................................. 247 Stroke Scales ........................................................................................................ 248 Barthel Index ...................................................................................................... 248 Rankin Scale ....................................................................................................... 248 National Institutes of Health Stroke Scale ......................................................................... 248 Unified Neurological Stroke Scale .................................................................................. 248 Canadian Neurological Scale ........................................................................................ 249 Evaluation of Various Scales........................................................................................ 249 An Overview of the Conventional Management of Stroke ................................................................. 249 Acute Ischemic Stroke .............................................................................................. 249 Neuroprotectives ................................................................................................... 250 Management of the Chronic Poststroke Stage ........................................................................... 252 Management of Spasticity ........................................................................................... 252 Role of HBO in the Management of Acute Stroke ........................................................................ 253 HBO in Relation to Cerebral Ischemia and Free Radicals ............................................................. 254 Animal Experiments ................................................................................................. 254 Neuroprotective Effect of HBO Preconditioning ...................................................................... 257 Review of Clinical Studies ......................................................................................... 258 HBO as a Supplement to Rehabilitation of Stroke Patients ........................................................... 262 Conclusions of the Effects of HBO in Stroke Patients ................................................................. 265 Future Prospects ..................................................................................................... 266 References ........................................................................................................... 266 20 HBO Therapy in Global Cerebral Ischemia/Anoxia and Coma ............................................................. 269 Introduction ......................................................................................................... 269 Pathophysiology ...................................................................................................... 270 Rational Basis of HBO Therapy ........................................................................................ 271 Review of Animal Experimental Studies ................................................................................ 298 Review of Human Clinical Studies ..................................................................................... 300 Case Studies ......................................................................................................... 304 Patient 1: HBO Treatment for Coma Due to Traumatic Brain Injury .................................................... 304 Patient 2: Near Drowning, Chronic Phase ............................................................................ 307 Patient 3: Near Drowning, Chronic Phase ............................................................................ 308 Patient 4: Battered Child Syndrome ................................................................................. 309 Conclusion ........................................................................................................... 311 References ........................................................................................................... 314 21 HBO Therapy in Neurosurgery ......................................................................................... 321 Introduction ......................................................................................................... 321 Role of HBO in the Management of Traumatic Brain Injury: TBI ........................................................ 321 Mechanism of Action of HBO in TBI .................................................................................. 322 Effect of HBO on ICP in Acute TBI .................................................................................. 322 Effect of HBO Therapy in Chronic Sequelae of TBI ................................................................... 323 Experimental and Clinical Studies of HBO in TBI .................................................................... 323 Controlled Clinical Trials of HBO for TBI .......................................................................... 325 Use of HBO for TBI in Clinical Practice ............................................................................ 326 Conclusions ........................................................................................................ 326 Role of HBO in the Management of Spinal Cord Injury .................................................................. 326 Effects of Spinal Cord Injury ...................................................................................... 327 Rationale of the Use of HBO in SCI ................................................................................. 327 Animal Experimental Studies of HBO in SCI .......................................................................... 327 Clinical Studies of HBO in SCI ..................................................................................... 328 Role of HBO in Rehabilitation of SCI Patients ...................................................................... 329 Role of HBO in Compressive and Ischemic Lesions of the Spinal Cord ................................................. 329 Conclusions About Use of HBO in SCI ................................................................................ 330 HBO as an Adjunct to Radiotherapy of Brain Tumors .................................................................. 330 Role of HBO in the Management of CNS Infections .................................................................... 331 Role of HBO in Cerebrovascular Surgery ............................................................................. 332 Neuroprotection During Neurosurgery .................................................................................. 337 Conclusion ........................................................................................................... 337 References ........................................................................................................... 338 22 Oxygen Treatment for Multiple Sclerosis Patients .................................................................... 341 Introduction ......................................................................................................... 341 Pathophysiology ...................................................................................................... 342 Rationale for Hyperbaric Oxygen Treatment ............................................................................ 342 Clinical Trials of HBO in Multiple Sclerosis ......................................................................... 345 Conclusion ........................................................................................................... 349 References ........................................................................................................... 349 23 HBO in the Management of Cerebral Palsy ............................................................................. 351 Introduction: Causes of Cerebral Palsy .............................................................................. 351 Oxygen Therapy in the Neonatal Period ................................................................................ 351 Treatment of Cerebral Palsy with HBO ................................................................................. 353 Published Clinical Trials ............................................................................................ 354 The United States Army Study on Adjunctive HBO Treatment of Children with Cerebral Anoxic Injury ................... 355 The New Delhi Study of HBOT in CP .................................................................................. 356 Unpublished Studies .................................................................................................. 356 The Cornell Study .................................................................................................. 356 Comparative Effectiveness Studies .................................................................................... 356 Recent Studies (Since 2007) .......................................................................................... 357 Side Effects ......................................................................................................... 357 Case Reports ......................................................................................................... 358 Patient 1: Cerebral Palsy .......................................................................................... 358 Patient 2: Cerebral Palsy .......................................................................................... 359 Conclusions .......................................................................................................... 361 References ........................................................................................................... 363 24 HBO Therapy in Miscellaneous Neurological Disorders ................................................................. 365 Introduction ......................................................................................................... 365 HBO in the Treatment of Benign Intracranial Hypertension ............................................................. 365 Peripheral Neuropathy ................................................................................................ 366 HBO for the Treatment of Peripheral Neuropathic Pain ............................................................... 366 HBO for Treatment of Drug-Induced Neuropathy........................................................................ 366 HBO for the Treatment of Trigeminal Neuralgia......................................................................... 367 HBO in Susac's Syndrome .............................................................................................. 367 Cerebral Malaria ..................................................................................................... 367 Vascular Headaches ................................................................................................... 367 Rationale for the Use of HBO in Vascular Headaches ................................................................. 367 Current Status of Use of HBO in Vascular Headaches ................................................................. 368 HBO for Autism Spectrum Disorder ..................................................................................... 368 Neurological Disorders in Which HBO Has Not Been Found to Be Useful .................................................. 368 Dementia Due to Degenerative Disorders of the Brain ................................................................ 368 HBO in the Management of Neuromuscular Disorders ................................................................... 369 References ........................................................................................................... 370 25 HBO Therapy in Cardiovascular Diseases .............................................................................. 371 Introduction ......................................................................................................... 371 Pathophysiology ...................................................................................................... 371 Risk Factors ....................................................................................................... 371 Hypoxia, Hyperoxia, and Atherosclerosis ............................................................................ 371 Hyperbaric Oxygenation in Cardiology ................................................................................. 372 Effect of Hypoxia, Hyperoxia, and Hyperbaric Environments on Cardiovascular Function ............................... 372 Metabolic Effects of HBO on the Heart .............................................................................. 372 Role of HBO in Experimental Myocardial Infarction .................................................................. 373 Clinical Applications of HBO in Cardiology ........................................................................... 373 Acute Myocardial Infarction ........................................................................................ 373 Combination of HBO and Thrombolysis ................................................................................ 376 Chronic Ischemic Heart Disease (Angina Pectoris) ................................................................. 376 Cardiac Arrhythmias ................................................................................................ 377 Heart Failure ...................................................................................................... 377 Cardiac Resuscitation .............................................................................................. 377 HBO as an Adjunct to Cardiac Surgery ................................................................................. 377 Experimental Studies ............................................................................................... 377 Human Cardiac Surgery .............................................................................................. 378 Protective Effect of HBO Preconditioning in Cardiac Surgery ........................................................ 379 CNS Complications of Cardiac Surgery ............................................................................... 379 HBO in Preventive Cardiology ......................................................................................... 380 Prevention and Rehabilitation of Coronary Artery Disease ........................................................... 380 Physical Training of Patients with Chronic Myocardial Insuffi ciency ............................................... 380 Conclusion and Comments ............................................................................................ 380 HBO in Shock ......................................................................................................... 380 Pathophysiology of Shock ........................................................................................... 380 Oxygen Delivery by Blood ........................................................................................... 380 Traumatic and Hypovolemic Shock .................................................................................... 381 Cardiogenic Shock .................................................................................................. 381 Peripheral Vascular Disease .......................................................................................... 381 Causes ............................................................................................................. 381 Symptoms and Signs ................................................................................................. 382 Pathophysiology of Limb Ischemia ................................................................................... 382 Biochemical Changes in Skeletal Muscle in Ischemia and Response to Exercise ........................................ 382 Clinical and Laboratory Assessment of Patients with Peripheral Vascular Disease .................................... 383 General Management of PVD Patients ................................................................................. 384 Drug Therapy ....................................................................................................... 384 Exercise Therapy ................................................................................................... 384 Surgery ............................................................................................................ 384 Role of HBO in the Management of Peripheral Vascular Disease ....................................................... 385 Role of HBO in Miscellaneous Arteriopathies ........................................................................ 389 HBO as an Adjunct to Peripheral Vascular Surgery ................................................................... 389 Conclusions Regarding the Role of HBO in Peripheral Vascular Disease ............................................... 390 References ........................................................................................................... 390 26 HBO Therapy in Hematology and Immunology ............................................................................ 393 Introduction ......................................................................................................... 393 Effect of HBO on Red Blood Cells ..................................................................................... 393 Deformability ...................................................................................................... 393 Oxygen Exchange .................................................................................................... 394 Structure and Biochemistry ......................................................................................... 395 Effect of HBO on Stored Blood ...................................................................................... 395 Hemoglobin ......................................................................................................... 395 Erythropoiesis ..................................................................................................... 396 Effect of HBO on Hemorheology in Human Patients .................................................................... 396 Effect of HBO on Leukocytes .......................................................................................... 396 Effect of HBO on Platelets and Coagulation ........................................................................... 396 Effect of HBO on Stem Cells .......................................................................................... 396 Effect of HBO Treatment on the Immune System ......................................................................... 397 Effect of HBO Treatment on Plasma and Blood Volume ................................................................... 398 The Use of HBO in Conjunction with Oxygen Carriers ................................................................... 399 Clinical Applications of HBO in Disorders of the Blood ............................................................... 399 Hypovolemia and Acute Anemia Due to Blood Loss ..................................................................... 399 Hemolytic Anemia ................................................................................................... 400 Potential Benefi ts of HBO in Cerebrovascular Diseases Due to Blood Disorders ...................................... 400 Contraindication: Congenital Spherocytosis ......................................................................... 400 References ........................................................................................................... 401 27 HBO Therapy in Gastroenterology ..................................................................................... 403 Introduction ......................................................................................................... 403 HBO in Peptic Ulceration ............................................................................................. 403 Pathophysiology and Rationale of HBO Therapy ....................................................................... 403 Experimental Studies in Animals .................................................................................... 404 Clinical Assessment of HBO in Gastric and Duodenal Ulcer Patients .................................................. 404 HBO in the Treatment of Intestinal Obstruction ....................................................................... 404 Basic Considerations and Rationale of HBO Therapy .................................................................. 404 Experimental Studies in Animals .................................................................................... 405 HBO Therapy in Adynamic Ileus ...................................................................................... 406 HBO in Adhesive Intestinal Obstruction ............................................................................. 406 Methods .............................................................................................................. 407 HBO in Chronic Idiopathic Intestinal Pseudo-obstruction ............................................................ 407 HBO in Infl ammatory Bowel Disease ................................................................................... 407 Ulcerative Colitis and Crohn's Disease ............................................................................. 407 Mechanism of Effectiveness of HBO in Ulcerative Colitis ............................................................ 408 HBO in Infections of the Gastrointestinal Tract ...................................................................... 408 Toxic Megacolon .................................................................................................... 408 Pseudomembranous Colitis ........................................................................................... 409 Necrotizing Enterocolitis .......................................................................................... 409 Radiation Enterocolitis .............................................................................................. 409 HBO in Pneumatosis Intestinalis ...................................................................................... 409 Pathophysiology of Pneumatosis Cystoides Intestinalis .............................................................. 409 Rationale for HBO Therapy .......................................................................................... 410 Clinical Experience ................................................................................................ 410 HBO in Ischemic Disorders of the Intestine ........................................................................... 410 Use of Hyperbaric Therapy in Removal of Entrapped Intestinal Balloons ................................................ 411 HBO in Acute Pancreatitis ............................................................................................ 411 Animal Experimental Studies of HBO in Acute Pancreatitis ........................................................... 411 Clinical Applications of HBO in Acute Pancreatitis ................................................................. 411 HBO in Diseases of the Liver ......................................................................................... 412 Effect of HBO on the Normal Liver .................................................................................. 412 Effect of HBO on Experimentally Induced Hepatic Disorders in Animals ............................................... 412 Clinical Applications .............................................................................................. 412 Conclusions Regarding the Use of HBO in Gastroenterology ............................................................. 413 References ........................................................................................................... 414 28 HBO and Endocrinology ............................................................................................... 417 Introduction ......................................................................................................... 417 Thyroid Glands ....................................................................................................... 417 Glucocorticoid Receptors ............................................................................................. 417 Adrenocortical Function .............................................................................................. 417 Epinephrine/Norepinephrine ........................................................................................... 418 Prostaglandins ....................................................................................................... 418 Testosterone ......................................................................................................... 418 Clinical Applications ................................................................................................ 419 Thyroid Disease .................................................................................................... 419 Diabetes Mellitus .................................................................................................. 419 Conclusion ........................................................................................................... 420 References ........................................................................................................... 420 29 HBO and Pulmonary Disorders ......................................................................................... 423 Introduction ......................................................................................................... 423 Effects of HBO on Lungs............................................................................................... 423 Arterial and Pulmonary Arterial Hemodynamics ....................................................................... 423 Lung Mechanics and Pulmonary Gas Exchange .......................................................................... 424 Pulmonary Oxygen Toxicity .......................................................................................... 424 Clinical Applications ................................................................................................ 425 Respiratory Insuffi ciency ......................................................................................... 425 Bronchial Asthma ................................................................................................... 426 Bronchitis ......................................................................................................... 426 Infl ammatory Processes of the Lungs ............................................................................... 426 Pulmonary Embolism ................................................................................................. 426 Pulmonary Edema .................................................................................................... 426 Mechanism of Action of HBO in Type II Decompression Syndrome ....................................................... 427 Contraindications for the Use of HBO ................................................................................. 427 Nitrogen Dioxide Poisoning ......................................................................................... 427 Paraquat Poisoning ................................................................................................. 427 Emphysema .......................................................................................................... 427 Shock Lung ......................................................................................................... 427 Pneumothorax ....................................................................................................... 427 Conclusion ........................................................................................................... 428 References ........................................................................................................... 428 30 Hyperbaric Oxygenation in Traumatology and Orthopedics .............................................................. 429 Introduction ......................................................................................................... 429 Crush Injuries ....................................................................................................... 429 Pathophysiology .................................................................................................... 430 Diagnosis .......................................................................................................... 430 Treatment .......................................................................................................... 430 Role of HBO in Treatment ........................................................................................... 430 Traumatic Ischemia ................................................................................................. 431 Compartment Syndromes .............................................................................................. 433 HBO for High Pressure Water Gun Injection Injury ..................................................................... 433 Peripheral Nerve Injuries ............................................................................................ 433 Rationale for the Use of HBO ....................................................................................... 434 Experimental Studies ............................................................................................... 434 Clinical Applications .............................................................................................. 435 Concluding Remarks ................................................................................................. 435 Fractures ............................................................................................................ 435 Basic and Experimental Considerations .............................................................................. 435 Clinical Experience ................................................................................................ 436 Bone Fractures with Arterial Injuries .............................................................................. 436 Traumatic Amputations and Reimplantations of Body Parts .............................................................. 436 Reimplantation of Limbs ............................................................................................ 436 Reimplantation of Other Body Parts ................................................................................. 437 Role of HBO in Battle Casualties ..................................................................................... 437 Effect of HBO on Osteogenesis ........................................................................................ 437 HBO for Treatment of Osteonecrosis (Aseptic Necrosis) .............................................................. 437 HBO Therapy of Osteonecrosis ....................................................................................... 438 Rheumatoid Arthritis ................................................................................................. 440 Basic Considerations ............................................................................................... 440 Rationale of Use of HBO in Rheumatoid Arthritis .................................................................... 440 Clinical Applications .............................................................................................. 441 Conclusion ........................................................................................................... 441 References ........................................................................................................... 441 31 HBO Therapy in Otolaryngology ....................................................................................... 443 Introduction ......................................................................................................... 443 Tinnitus ............................................................................................................. 443 Sudden Deafness ...................................................................................................... 445 Role of HBO in the Management of Sudden Deafness ................................................................... 445 Rationale for HBO Therapy in Sudden Deafness ....................................................................... 445 Acute Acoustic Trauma .............................................................................................. 446 Concluding Remarks About the Use of HBO in Hearing Loss ............................................................ 449 Effect of HBO in Preventing Hearing Impairment from Chronic Noise Exposure ........................................... 451 Miscellaneous Disturbances of the Inner Ear .......................................................................... 451 Neuro-otological Vascular Disturbances ............................................................................... 451 Meniere's Disease .................................................................................................. 452 Facial Palsy ....................................................................................................... 453 Otological Complications of HBO Therapy .............................................................................. 453 Miscellaneous Conditions in Head and Neck Area ....................................................................... 453 Malignant Otitis Externa ........................................................................................... 453 Aphonia Due to Chronic Laryngitis .................................................................................. 454 Conclusion ........................................................................................................... 454 References ........................................................................................................... 454 32 HBO Therapy and Ophthalmology ....................................................................................... 457 Introduction ......................................................................................................... 457 Review of Pertinent Anatomy and Physiology of the Eye ................................................................ 458 The Process of Vision .............................................................................................. 458 Factors Affecting Vision ........................................................................................... 458 Retinal Blood Supply ............................................................................................... 458 Ocular Oxygen Tension .............................................................................................. 458 Physiology of the Eye in Hyperoxic Conditions ...................................................................... 458 Adverse Effects of Hyperoxia ......................................................................................... 459 Retinal Oxygen Toxicity ............................................................................................ 459 Lenticular Oxygen Toxicity ......................................................................................... 460 Ocular Contraindications to Hyperbaric Oxygen Therapy ................................................................ 461 Pre-HBOT Ocular Examination .......................................................................................... 461 HBO in the Treatment of Diseases of the Eye .......................................................................... 461 Recommended Indications ............................................................................................ 461 Potential Indications for HBOT in Ophthalmology .................................................................... 468 Other Reported Uses ................................................................................................ 474 Emergency HBO in Patients with Acute Vision Loss ................................................................... 477 Conclusion ........................................................................................................... 478 References ........................................................................................................... 478 33 Hyperbaric Oxygenation in Obstetrics and Gynecology ................................................................. 485 Introduction ......................................................................................................... 485 HBO and Risk of Congenital Malformations ............................................................................. 485 Role of HBO in Obstetrics ............................................................................................ 486 Experimental Studies ............................................................................................... 486 Clinical Applications .............................................................................................. 486 Use of HBO for Medical Conditions in Pregnancy ....................................................................... 487 Acute Carbon Monoxide Poisoning During Pregnancy ................................................................... 487 Diabetes ........................................................................................................... 487 Management of Pregnancy and Delivery in Women with Heart Disease ................................................... 487 Applications of HBO in Neonatology ................................................................................... 487 HBO in Gynecology .................................................................................................... 488 Animal Experimental Studies ........................................................................................ 488 Clinical Applications in Gynecology ................................................................................ 488 Conclusion ........................................................................................................... 488 References ........................................................................................................... 489 34 Use of Hyperbaric Oxygenation (HBO) in Neonatal Patients ............................................................ 491 Introduction ......................................................................................................... 491 Hypoxic–Ischemic Encephalopathy of the Newborn ....................................................................... 492 Uses of Hyperbaric Oxygenation in Hypoxic–Ischemic Encephalopathy and Necrotizing Enterocolitis of the Neonate ....... 492 Use of Hyperbaric Oxygenation in Neonates ............................................................................ 493 Results .............................................................................................................. 494 Discussion ........................................................................................................... 495 References ........................................................................................................... 495 35 Hyperbaric Oxygenation in Geriatrics ................................................................................ 499 Introduction ......................................................................................................... 499 Physiology of Aging .................................................................................................. 499 Theories of Aging .................................................................................................. 499 Changes in the Brain with Aging .................................................................................... 501 Applications of HBO in Geriatrics .................................................................................... 502 Rationale .......................................................................................................... 502 Safety of HBO Treatments in the Elderly ............................................................................ 504 Conclusion ........................................................................................................... 504 References ........................................................................................................... 504 36 HBO as an Adjuvant in Rehabilitation and Sports Medicine ............................................................ 505 Introduction ......................................................................................................... 505 Role of HBO in Rehabilitation ........................................................................................ 505 Indications ........................................................................................................ 505 Advantages ......................................................................................................... 506 Applications of HBO in Rehabilitation of Neurological Disorders .................................................... 506 Rehabilitation of patients with CNS injuries ....................................................................... 506 Role of HBO in Rehabilitation after Myocardial Infarction .......................................................... 506 HBO as an Adjunct to Rehabilitation in Peripheral Vascular Disease ................................................. 506 HBO as an Adjunct to Rehabilitation of Limb Amputees ............................................................... 507 HBO for Treatment of Sports Injuries ................................................................................. 507 HBO as an Adjunct to Sports Training ................................................................................. 508 Future Prospects ..................................................................................................... 509 References ........................................................................................................... 509 37 Nursing and Hyperbaric Medicine ..................................................................................... 511 History .............................................................................................................. 511 The Nursing Process ................................................................................................ 513 Hyperbaric Patient Education ......................................................................................... 513 Hyperbaric Nursing Research .......................................................................................... 521 References ........................................................................................................... 521 38 Role of HBO in Enhancing Cancer Radiosensitivity .................................................................... 523 Introduction ......................................................................................................... 523 Role of Hypoxia in Tumors............................................................................................. 523 Rationale of Use of HBO as Adjunct to Radiotherapy ................................................................... 524 Experimental Studies of the Radiosensitizing Effect of HBO ........................................................... 524 Clinical Studies of HBO as Radiation Sensitizer ...................................................................... 525 Carcinoma of the Cervix ............................................................................................ 525 Head and Neck Cancer ............................................................................................... 525 Carcinoma of the Lung .............................................................................................. 526 Carcinoma of the Bladder ........................................................................................... 526 Malignant Melanoma ................................................................................................. 526 Malignant Glioma ................................................................................................... 526 Advantages of HBO as an Adjunct to Radiotherapy ...................................................................... 528 Limitations of HBO as Adjunct to Radiotherapy of Cancer .............................................................. 528 Drawbacks of HBO as Adjunct to Radiotherapy of Cancer .............................................................. 528 Alternative Methods for Enhancing Radiosensitivity of Cancer ......................................................... 528 Combination of Other Methods with HBO and Irradiation for Cancer ..................................................... 529 Hyperthermia ....................................................................................................... 529 Hypothermia ........................................................................................................ 529 Vasodilators ....................................................................................................... 529 Induced Anemia and Red Cell Infusion ............................................................................... 529 Radiation Sensitizing Agents ....................................................................................... 529 Use of Perfluorochemicals as Oxygen Carriers ....................................................................... 529 HBO and Antineoplastic Agents ........................................................................................ 529 HBO and Photodynamic Therapy ......................................................................................... 530 Conclusion ........................................................................................................... 530 References ........................................................................................................... 530 39 HBO Therapy and Organ Transplants ................................................................................... 533 Background ........................................................................................................... 533 Role of HBO .......................................................................................................... 534 Ischemia-Reperfusion Injury .......................................................................................... 534 Inflammation ......................................................................................................... 534 Lung Transplants ..................................................................................................... 535 Pancreas Transplants ................................................................................................. 535 Renal Transplants .................................................................................................... 536 Liver Transplants..................................................................................................... 536 Face Transplants...................................................................................................... 537 Hand Transplants ..................................................................................................... 537 Miscellaneous Organs and Tissues ..................................................................................... 537 Clinical Applications ................................................................................................ 538 Conclusion ........................................................................................................... 538 References ........................................................................................................... 538 40 Hyperbaric Oxygen Pretreatment and Preconditioning .................................................................. 541 Introduction ......................................................................................................... 541 Hyperbaric Medicine Perspective ...................................................................................... 541 Diving Medicine ...................................................................................................... 542 References ........................................................................................................... 543 41 Anesthesia in the Hyperbaric Environment ............................................................................ 545 Historical Perspective ............................................................................................... 545 Current Indications .................................................................................................. 546 Physical Considerations Concerning Anesthetic ........................................................................ 546 Physiological Considerations ......................................................................................... 546 Cardiovascular Effects ............................................................................................. 547 Central Nervous System ............................................................................................. 547 Nitrous Oxide Anesthesia ........................................................................................... 547 Intravenous Anesthesia ............................................................................................. 548 Pharmacokinetics in the Hyperbaric Environment ..................................................................... 548 Practical Aspects of Anesthesia in the Pressure Chamber .............................................................. 548 Noise .............................................................................................................. 548 Airway Equipment ................................................................................................... 548 Ventilators ........................................................................................................ 548 Monitoring ......................................................................................................... 549 Prophylactic Myringotomy to Prevent Middle Ear Barotrauma .......................................................... 549 Conclusion ........................................................................................................... 550 References ........................................................................................................... 550 42 Hyperbaric Oxygen in Resuscitation .................................................................................. 551 Introduction ......................................................................................................... 551 Indications .......................................................................................................... 553 Cardiopulmonary Resuscitation ........................................................................................ 553 Case Studies ......................................................................................................... 554 Case 1 ............................................................................................................. 554 Case 2 ............................................................................................................. 558 Discussion ........................................................................................................... 562 Future Applications .................................................................................................. 563 Conclusion ........................................................................................................... 564 References ........................................................................................................... 565 43 HBO in Military Medicine ............................................................................................ 567 Hyperbaric Oxygen Therapy and Combat Medicine ........................................................................ 567 Gas Gangrene: Crush Injuries and Traumatic Wounds .................................................................. 568 Exceptional Loss of Blood .......................................................................................... 568 Burns .............................................................................................................. 568 Postconcussion Syndrome, Traumatic Brain Injuries, Posttraumatic Stress Disorders .................................. 569 Hearing Loss and Tinnitus .......................................................................................... 570 Spinal Cord Injury ................................................................................................. 570 Hyperbaric Oxygen Therapy and Military Response to Natural Catastrophes ............................................ 570 Hyperbaric Activities in Military Environment ........................................................................ 571 Offensive Activities or Activities Carried out During Wartime ...................................................... 571 Defensive Activities or Activities Carried out During Peacetime .................................................... 572 Field of HBO Application in Military Diving Medicine ................................................................. 573 Military Diving Operations ......................................................................................... 573 Diving Methods...................................................................................................... 573 Employee's Safety .................................................................................................. 573 Personnel Training ................................................................................................. 573 Personnel Recruitment .............................................................................................. 573 Submarine Medicine ................................................................................................... 573 Submarines' Rescue ................................................................................................. 573 Technical Aspects of Rescue Operations ............................................................................. 573 Transfer Under Pressure ............................................................................................ 574 References ........................................................................................................... 574 Part III Hyperbaric Medicine as a Specialty 44 Training and Practice of Hyperbaric Medicine ........................................................................ 579 Introduction ......................................................................................................... 579 Relation of Hyperbaric Medicine to Other Medical Specialties ......................................................... 580 Hyperbaric Medicine and Diving Medicine ............................................................................ 580 Training in Hyperbaric Medicine ...................................................................................... 580 Admission Requirements ............................................................................................. 580 Training Program ................................................................................................... 580 Examinations ....................................................................................................... 580 Proposal for a Curriculum for a Diploma Course in Hyperbaric and Diving Medicine ..................................... 581 Training of Nonphysician Healthcare Personnel for Hyperbaric Medicine................................................. 581 Practice of Hyperbaric Medicine ...................................................................................... 581 Economic Aspects ..................................................................................................... 582 Conclusion ........................................................................................................... 582 45 Research in Hyperbaric Medicine ..................................................................................... 583 Introduction ......................................................................................................... 583 Basic Research in HBO ................................................................................................ 583 Animal Experimental Studies .......................................................................................... 584 Application of Biotechnologies in Hyperbaric Medicine ................................................................ 584 Biomarkers of Effect of HBO ........................................................................................ 584 Action of HBO on Gene Expression ................................................................................... 585 HBO as Adjunct to Cell therapy and Regenerative Medicine ........................................................... 586 Nanobiotechnology and HBO .......................................................................................... 586 Clinical Trials of HBO Therapy ....................................................................................... 587 Problems with Clinical Trials of HBO ............................................................................... 587 Ethical Aspects of Clinical Trials with HBO ........................................................................ 588 Conclusion ........................................................................................................... 588 References ........................................................................................................... 588 46 Personalized Hyperbaric Medicine .................................................................................... 589 Introduction ......................................................................................................... 589 Molecular Diagnostics as Guide to HBO Therapy ........................................................................ 590 Role of Sequencing in Personalized Medicine ........................................................................ 590 Biomarkers for Personalized HBO Therapy ............................................................................ 591 Imaging for Personalized HBO Therapy ............................................................................... 591 Brain Imaging as Guide to Therapy of Multiple Sclerosis ............................................................ 591 Imaging Tumor Hypoxia for Personalized Cancer Therapy .............................................................. 591 Pharmacogenomics and Pharmacogenetics of HBO ......................................................................... 592 Oxygen Toxicity and Genes .......................................................................................... 592 Susceptibility to HBO-Induced Cataract Formation ................................................................... 592 Economical Aspects of Personalized HBO Therapy ....................................................................... 592 Conclusion ........................................................................................................... 592 References ........................................................................................................... 592 47 The Future of Hyperbaric Medicine ................................................................................... 593 Introduction to Future Medicine ...................................................................................... 593 Important Medical Advances in the Next Decade ...................................................................... 593 Advances in Surgery ................................................................................................ 594 Important Areas for Future Development ............................................................................. 594 Role of HBO in Future Medicine ....................................................................................... 595 Role of Hyperbaric Oxygen in the Multidisciplinary Healthcare Systems of the Future .................................. 595 Future Needs in Hyperbaric Medicine .................................................................................. 595 References ........................................................................................................... 596 48 Ethical Issues, Standards, and Quality Control in the Practice of Hyperbaric Medicine ............................... 597 Alternative Medical Treatments and Off-Label Use of Hyperbaric Oxygen ................................................ 598 The Risks of the Public Information Gap ............................................................................ 598 Is There an Alternative to HBOT? ................................................................................... 599 Safety and Fire Hazard Issues from Misuse of Hyperbaric Chambers ................................................... 599 The Controversy of Low Pressure Oxygen ............................................................................. 602 The “Chamber” Effect ............................................................................................... 602 Ethical Challenges with HBOT Clinical Trial Design ................................................................... 603 Informed Consent ................................................................................................... 604 Desperate Measures ................................................................................................. 604 HBOT Fraud ......................................................................................................... 605 HBOT Market Regulations .............................................................................................. 605 Food, Drug, and Cosmetic Act (FDC) 510(k) Clearance ................................................................ 605 National Hyperbaric Oxygen Therapy Registry ........................................................................ 606 Conclusion ........................................................................................................... 606 References ........................................................................................................... 607 49 Worldwide Overview of Hyperbaric Medicine ........................................................................... 609 Introduction ......................................................................................................... 609 Hyperbaric Medicine in China ......................................................................................... 609 Hyperbaric Medicine in Japan ......................................................................................... 610 Hyperbaric Medicine in Russia ........................................................................................ 611 Hyperbaric Medicine in Germany........................................................................................ 612 World Distribution of Hyperbaric Facilities .......................................................................... 613 Conclusion ........................................................................................................... 614 Reference ............................................................................................................ 614 50 Hyperbaric Medicine in the United States ............................................................................ 615 Introduction ......................................................................................................... 615 American College of Hyperbaric Medicine .............................................................................. 617 National Board of Diving and Hyperbaric Medical Technology ........................................................... 619 Baromedical Nurses Association ....................................................................................... 619 Indications for Use of Hyperbaric Oxygen ............................................................................. 620 Resources ............................................................................................................ 620 Organizations for Subspecialty Certifi cation ...................................................................... 621 Currently Offered Fellowship Training Locations in Undersea and Hyperbaric Medicine ................................ 621 51 Hyperbaric Medicine in Latin America ................................................................................ 623 History .............................................................................................................. 623 Introduction ......................................................................................................... 623 Existing General Standards ........................................................................................... 624 Responsible Existing Authorities ..................................................................................... 624 Industry ........................................................................................................... 624 Labor .............................................................................................................. 624 Health ............................................................................................................. 624 Insurance .......................................................................................................... 624 Latin American Consensus ............................................................................................. 624 Implementation of Minimum Standards and Regulations .................................................................. 625 Index .................................................................................................................. 627
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Textbook of Hyperbaric Medicine, 6th Edition
Language: English
Author: Kewal K. Jain
Genre: Textbook, Textbook
Publisher: Springer
Edition: 6th
ISBN: 9783319471402
Format: PDF
Quality: eBook
Pages count: 660
Description: This comprehensive volume captures the latest scientific evidence, technological advances, treatments and impact of biotechnology in hyperbaric oxygen therapy. Divided into three distinct sections, the book begins with basic aspects that include history, equipment, safety and diagnostic approaches; this is followed by clinical applications for hyperbaric oxygen therapy in various modalities; the last section provides an overview of hyperbaric medicine as a specialty with best practices from around the world. Integration of multidisciplinary approaches to complex disorders are also covered.
Updated and significantly expanded from previous editions, Textbook of Hyperbaric Medicine, 6th Edition will continue to be the definitive guide to this burgeoning field for students, trainees, physicians and specialists.
Contents
1 The History of Hyperbaric Medicine ................................................................................... 3
Hyperbaric Therapy and Diving Medicine ............................................................................... 3
The Development of Hyperbaric Air Therapy ............................................................................ 4
The Development of Hyperbaric Oxygen Therapy ......................................................................... 7
References ........................................................................................................... 9
2 Physical, Physiological, and Biochemical Aspects of Hyperbaric Oxygenation ........................................... 11
Introduction ......................................................................................................... 11
Physical Basics ...................................................................................................... 11
Physiology of Oxygenation ............................................................................................ 12
The Oxygen Pathway ................................................................................................. 12
Ventilation Phase .................................................................................................. 12
Transport Phase .................................................................................................... 12
Shift of the Oxygen-Hemoglobin Dissociation Curve .................................................................. 13
Delivery of Oxygen to the Tissues .................................................................................. 14
Oxygen Transfer at the Capillary Level ............................................................................. 14
Relation Between the Oxygen Transport and Utilization .............................................................. 14
Oxygen Utilization in the Cell ..................................................................................... 15
Effect of Blood Flow ............................................................................................... 15
Effect of Oxygen-Hemoglobin Reaction on Transport of CO2 ........................................................... 15
Autoregulation of the Intracellular pO2 ............................................................................ 16
Hyperbaric Oxygenation ............................................................................................... 16
Theoretical Considerations ......................................................................................... 16
General Effects of HBO on the Healthy Human Body ................................................................... 19
Biochemical Effects of HBO ......................................................................................... 20
Effect of HBO on Enzymes ........................................................................................... 20
Effect of HBO on the Nervous System ................................................................................ 20
Effect of HBO at Molecular Level ................................................................................... 21
Conclusion ........................................................................................................... 21
References ........................................................................................................... 21
3 Effects of Diving and High Pressure on the Human Body ................................................................ 23
Physical Effects of Pressure ......................................................................................... 23
Effects of Pressure on Various Systems of the Body ................................................................... 23
Hematological and Biochemical Effects .............................................................................. 23
Effect on Ammonia Metabolism ....................................................................................... 24
Effect on Blood Cells and Platelets................................................................................. 24
Changes in the Respiratory System and Blood Gases .................................................................. 24
Effects on the Cardiovascular System ............................................................................... 25
Changes in the Endocrine System .................................................................................... 25
Effect on the Skeletal System ...................................................................................... 25
Effects of High-Pressure Environments on the Nervous System ........................................................ 25
Damage to the Middle Ear and Inner Ear in Diving ................................................................... 29
Vertigo and Diving ................................................................................................. 30
Taste Sensation Under High Pressure ................................................................................ 30
Effect of High Pressure on Effect of Drugs ........................................................................... 30
Conclusion ........................................................................................................... 31
References ........................................................................................................... 31
4 Physical Exercise under Hyperbaric Conditions ........................................................................ 33
Introduction ......................................................................................................... 33
Exercise and Hypoxia ................................................................................................. 34
Exercise in Hyperbaric Environments .................................................................................. 34
Exercise Under Hyperoxia ............................................................................................. 35
Physical Exercise Under Hyperbaric Conditions ........................................................................ 35
General Effects .................................................................................................... 35
Effect on Lactate Production and Clearance ......................................................................... 36
Effect of Exercise on Ammonia Metabolism ........................................................................... 37
Effect of HBO on Antioxidant Enzymes in Skeletal Muscle ............................................................ 37
Effect of HBO on Blood Flow to the Muscles During Exercise ......................................................... 37
Physical Exercise in Relation to Toxic Effects of HBO .............................................................. 38
Conclusion ........................................................................................................... 38
References ........................................................................................................... 38
5 Hypoxia .............................................................................................................. 39
Introduction ......................................................................................................... 39
Pathophysiology of Hypoxia ........................................................................................... 39
Hypoxia-Inducible Factor ........................................................................................... 40
Hypoxia and Heat Shock Proteins .................................................................................... 40
Effect of Hypoxia on Cellular Metabolism ........................................................................... 40
Impact of Hypoxia on Various Body Systems ............................................................................ 41
Respiratory Function ............................................................................................... 41
Cardiovascular System .............................................................................................. 41
General Metabolic Effects .......................................................................................... 41
Effects of Hypoxia on the Brain .................................................................................... 42
Role of HBO in the Treatment of Hypoxic States ....................................................................... 46
The Role of Nitric Oxide Synthase in the Effect of HBO in Hypoxia .................................................. 47
Possible Dangers of HBO in Hypoxic States .......................................................................... 47
References ........................................................................................................... 48
6 Oxygen Toxicity ...................................................................................................... 49
Introduction ......................................................................................................... 49
Pathophysiology of Oxygen Toxicity ................................................................................... 50
Free Radical Mechanisms ............................................................................................ 50
Pathology of Oxygen Toxicity ......................................................................................... 50
Pulmonary Oxygen Toxicity .......................................................................................... 52
Normobaric vs. Hyperbaric Oxygen in Induction of Pulmonary Oxygen Toxicity ......................................... 53
Oxygen-Induced Retinopathy ......................................................................................... 53
Factors That Enhance Oxygen Toxicity ............................................................................... 53
Central Nervous System Oxygen Toxicity ............................................................................. 54
Ammonia and Amino Acids ............................................................................................ 56
Biomarkers of Oxygen Neurotoxicity ................................................................................. 56
Neuropathology of Oxygen Toxicity .................................................................................. 56
Manifestations of CNS Oxygen Toxicity .............................................................................. 57
Clinical Monitoring for Oxygen Toxicity ............................................................................ 57
Protection Against Oxygen Toxicity ................................................................................. 57
Extension of Oxygen Tolerance ...................................................................................... 59
Conclusion and Directions for Future Research ........................................................................ 59
References ........................................................................................................... 60
7 Hyperbaric Chambers: Equipment, Technique, and Safety ................................................................ 61
Introduction ......................................................................................................... 61
Monoplace Chambers ................................................................................................. 61
Multiplace Chambers ................................................................................................ 62
Multiplace Chambers for the Critical Care Department ............................................................... 64
Surgery in the Multiplace Chamber .................................................................................. 65
Mobile Multiplace Hyperbaric Chambers .............................................................................. 65
Hyperbaric Chambers for Diving Medicine ............................................................................ 66
Hyperbaric Chambers for Animal Research ............................................................................ 66
Selection of a Hyperbaric Chamber .................................................................................... 68
Technique of Hyperbaric Oxygenation .................................................................................. 68
Ancillary Equipment .................................................................................................. 70
Oxygen Masks and Hoods ............................................................................................. 70
Respirators and Ventilators .......................................................................................... 70
Diagnostic Equipment ................................................................................................. 71
ECG and EEG ........................................................................................................ 71
Transcutaneous Oxygen Tension ...................................................................................... 71
Glucose-Monitoring Devices ......................................................................................... 71
Use of Miscellaneous Medical Devices in the Hyperbaric Chamber ....................................................... 72
Cardiopulmonary Resuscitation ...................................................................................... 72
Use of Defi brillators in Hyperbaric Chambers ...................................................................... 72
Pleural Suction Drainage ........................................................................................... 72
Endotracheal Tubes ................................................................................................. 72
Care of Tracheotomy ................................................................................................ 72
Continuous Bladder Irrigation and HBO .............................................................................. 72
Transdermal Patches for Drug Delivery and Hyperbaric Chamber ....................................................... 73
Implanted Devices in Patients ...................................................................................... 73
Monitoring of Patients in the Hyperbaric Chamber ..................................................................... 73
Safety in the Hyperbaric Chamber ..................................................................................... 74
Operational Safety ................................................................................................. 74
Masks and Breathing Control System ................................................................................. 74
Fire Safety in the Chamber ......................................................................................... 74
Use of Portable Hyperbaric Chambers in Patient's Rooms ............................................................. 76
Regulatory Issues Relevant to Hyperbaric Medicine .................................................................... 76
Staffing of Hyperbaric Facilities .................................................................................... 77
Conclusion ........................................................................................................... 77
References ........................................................................................................... 77
8 Indications, Contraindications, and Complications of HBO Therapy ..................................................... 79
Indications .......................................................................................................... 79
Contraindications .................................................................................................... 79
Complications of Hyperbaric Oxygenation .............................................................................. 81
Middle Ear Barotrauma .............................................................................................. 81
Ophthalmological Complications of HBO .............................................................................. 82
Pulmonary Complications of HBO ..................................................................................... 82
Oxygen Seizures .................................................................................................... 82
Decompression Sickness ............................................................................................. 83
Genetic Effects .................................................................................................... 83
Claustrophobia ..................................................................................................... 83
Anxiety Reactions .................................................................................................. 83
Coincidental Medical Events in the Hyperbaric Chamber .............................................................. 84
Precautions in Selection of Patients for HBO Treatment................................................................ 84
Conclusion ........................................................................................................... 84
References ........................................................................................................... 84
9 Drug Interactions with Hyperbaric Oxygenation ........................................................................ 85
Oxygen as a Drug ..................................................................................................... 85
Drug–Drug Interactions ............................................................................................. 85
Interactions of HBO with Other Drugs ............................................................................... 85
Interaction of HBO with Antimicrobials ............................................................................... 86
Carbapenem Antibiotics ............................................................................................. 86
Aminoglycoside Antibiotics ......................................................................................... 86
Sulfonamides ....................................................................................................... 86
Interaction of HBO with Anticancer Agents ............................................................................ 86
Interaction of HBO with Cardiovascular Drugs ......................................................................... 86
Adrenomimetic, Adrenolytic, and Ganglion- Blocking Agents .......................................................... 86
Digitalis/Digoxin................................................................................................... 87
Antianginal Drugs .................................................................................................. 87
Heparin ............................................................................................................ 87
Interaction of HBO with Drugs Acting on the CNS ...................................................................... 87
Anesthetics ........................................................................................................ 87
CNS Stimulants ..................................................................................................... 87
Ethanol ............................................................................................................ 87
Narcotic Analgesics ................................................................................................ 87
Pentobarbital ...................................................................................................... 87
Scopolamine ........................................................................................................ 87
Interaction of HBO with Miscellaneous Drugs .......................................................................... 88
Practical Considerations of Drug Administration During HBO Therapy ................................................... 88
Drugs that Enhance Oxygen Toxicity ................................................................................... 88
Drugs that Protect Against Oxygen Toxicity ........................................................................... 88
Conclusion ........................................................................................................... 89
References ........................................................................................................... 89
10 Neurophysiologic SPECT Brain Function Imaging and Hyperbaric Oxygen Therapy ......................................... 91
Introduction ......................................................................................................... 91
Case Studies ......................................................................................................... 93
Conclusion ........................................................................................................... 94
Suggested Reading .................................................................................................... 96
Part II Clinical Applications
11 Decompression Sickness .............................................................................................. 101
Introduction ......................................................................................................... 101
Pathophysiology ...................................................................................................... 102
Gas Formation ...................................................................................................... 102
Pulmonary Changes .................................................................................................. 104
Bubble-Induced CNS Injury .......................................................................................... 104
Changes in Blood ................................................................................................... 105
Dysbaric Osteonecrosis ............................................................................................. 106
Role of Free Radicals .............................................................................................. 106
Clinical Features .................................................................................................... 106
Decompression Sickness in Diving ................................................................................... 106
Altitude Decompression Sickness .................................................................................... 107
Ocular Complications of DCS ........................................................................................ 108
Ultrasonic Detection of Bubbles .................................................................................... 109
Diagnosis ............................................................................................................ 109
Blood Examination .................................................................................................. 109
Ultrasound Monitoring of Bubbles ................................................................................... 110
Bone Scanning ...................................................................................................... 110
X-Rays ............................................................................................................. 110
Retinal Angiography ................................................................................................ 110
Imaging .............................................................................................................. 110
Electrophysiological Studies ......................................................................................... 110
Neuropsychological Assessment ........................................................................................ 110
Treatment ............................................................................................................ 110
Emergency Management and Evaluation ................................................................................ 110
Recompression and HBO Treatment .................................................................................... 111
Management of Altitude Decompression Sickness ...................................................................... 111
Management of Neurological Manifestations of Decompression Sickness ................................................ 114
Monoplace vs. Multiplace Chambers .................................................................................... 115
Use of Oxygen vs. Other Gas Mixtures ................................................................................. 115
Drugs ................................................................................................................ 116
Importance of Early Treatment ........................................................................................ 117
Delayed Treatment .................................................................................................... 117
Treatment of Residual Neurological Injury and SPECT Brain Imaging in Type II DCS ..................................... 117
Risk Factors for DCS ................................................................................................. 117
Preventive Measures for DCS .......................................................................................... 118
Prognosis of DCS ..................................................................................................... 118
Conclusion ........................................................................................................... 118
References ........................................................................................................... 119
12 Cerebral Air Embolism ............................................................................................... 121
Introduction ......................................................................................................... 121
Causes ............................................................................................................... 121
Mechanisms ........................................................................................................... 122
Pathophysiology of Cerebral air Embolism ............................................................................. 122
Clinical Features .................................................................................................... 123
Diagnosis ............................................................................................................ 123
Treatment ............................................................................................................ 123
Clinical Applications of HBO for Air Embolism ........................................................................ 124
Ancillary Treatments ................................................................................................. 126
Antiplatelet Drugs ................................................................................................. 126
Steroids ........................................................................................................... 126
Hemodilution ....................................................................................................... 126
Control of Seizures ................................................................................................ 126
Measures to Improve Cerebral Metabolism ............................................................................ 126
Hyperbaric Treatment in Special Situations ........................................................................... 126
Cerebral Edema ..................................................................................................... 126
Cardiovascular Surgery ............................................................................................. 126
Neurosurgery ....................................................................................................... 127
Pulmonary Barotrauma ............................................................................................... 127
Air Embolism During Invasive Medical Procedures .................................................................... 127
Cerebral Air Embolism During Obstetrical Procedures ................................................................ 127
Cerebral Air Embolism in Endoscopic Retrograde Cholangiopancreatography ............................................ 128
Cerebral Embolism Due to Hydrogen Peroxide Poisoning ............................................................... 128
Relapse Following Spontaneous Recovery ............................................................................. 128
Delayed Treatment .................................................................................................. 129
Conclusion ........................................................................................................... 129
References ........................................................................................................... 129
13 Carbon Monoxide and Other Tissue Poisons ............................................................................ 131
Classification of Tissue Poisons ..................................................................................... 131
Carbon Monoxide Poisoning ............................................................................................ 131
Historical Aspects of CO Poisoning ................................................................................. 131
Biochemical and Physical Aspects of CO ............................................................................. 131
CO Body Stores ..................................................................................................... 132
Biochemical Effects of CO on Living Organisms ...................................................................... 132
Inhibition of the Utilization of Oxygen by CO ...................................................................... 132
Epidemiology of CO Poisoning ......................................................................................... 133
Causes of CO Poisoning ............................................................................................. 134
Sources of CO Poisoning ............................................................................................ 134
Pathophysiology of CO Poisoning ...................................................................................... 134
CO Binding to Myoglobin ............................................................................................ 134
CO-Induced Hypoxia ................................................................................................. 135
Effects of CO on Various Systems of the Body ......................................................................... 135
Cardiovascular System .............................................................................................. 135
Hemorheological Effects of CO ...................................................................................... 136
Effect of CO on Blood Lactate ...................................................................................... 136
Effect of CO on the Lungs .......................................................................................... 136
Exercise Capacity .................................................................................................. 136
Sleep .............................................................................................................. 136
Effect on Pregnancy ................................................................................................ 136
Musculoskeletal System ............................................................................................. 136
Skin ............................................................................................................... 136
Gastrointestinal System ............................................................................................ 137
Effects on the Peripheral Nervous System ........................................................................... 137
Effects on the Visual System ....................................................................................... 137
Effect on the Auditory System ...................................................................................... 137
Effect on the Central Nervous System ............................................................................... 137
Clinical Features of CO Poisoning .................................................................................... 138
Neuropsychological Sequelae of CO Poisoning ........................................................................ 138
Clinical Diagnosis of CO Poisoning ................................................................................... 140
Pitfalls in the Clinical Diagnosis of CO Poisoning ................................................................. 140
Occult CO Poisoning ................................................................................................ 140
Laboratory Diagnosis of CO Poisoning ................................................................................. 140
Brain Imaging Studies .............................................................................................. 141
General Management of CO Poisoning ................................................................................... 142
Rationale for Oxygen Therapy ( NBO or HBO ) for CO Poisoning ...................................................... 143
Experimental Evidence .............................................................................................. 144
Clinical Use of HBO in CO Poisoning ................................................................................ 144
Clinical Trials of HBO in CO Poisoning ............................................................................. 145
HBO for CO Intoxication Secondary to Methylene Chloride Poisoning .................................................. 148
Treatment of CO Poisoning in Pregnancy ............................................................................. 148
Treatment of Smoke Inhalation ...................................................................................... 149
Prevention and Treatment of Late Sequelae of CO Poisoning........................................................... 149
Controversies in the Use of HBO for CO Poisoning ................................................................... 149
Cyanide Poisoning .................................................................................................... 150
Pathophysiology .................................................................................................... 150
Clinical Features of Cyanide Poisoning ............................................................................. 150
Laboratory Diagnosis ............................................................................................... 150
Treatment .......................................................................................................... 150
Rationale for Use of HBO in Cyanide Poisoning ...................................................................... 150
Hydrogen Sulfi de Poisoning .......................................................................................... 150
Carbon Tetrachloride Poisoning ....................................................................................... 151
Methemoglobinemias ................................................................................................... 151
Treatment .......................................................................................................... 151
Miscellaneous Poisons ................................................................................................ 152
Organophosphorus Compounds ......................................................................................... 152
Conclusions: Poisoning Other Than with CO .......................................................................... 152
References ........................................................................................................... 152
14 HBO Therapy in Infections ........................................................................................... 155
Introduction ......................................................................................................... 155
Host Defense Mechanisms Against Infection .......................................................................... 155
Impairment by Anoxia ............................................................................................... 155
Oxygen as an Antibiotic ............................................................................................ 155
HBO as an Adjuvant to Antibiotics .................................................................................... 157
HBO in the Treatment of Infections ................................................................................... 157
HBO in the Treatment of Soft Tissue Infections ..................................................................... 158
Crepitant Anaerobic Cellulitis ..................................................................................... 158
Progressive Bacterial Gangrene ..................................................................................... 158
Necrotizing Fasciitis .............................................................................................. 158
Nonclostridial Myonecrosis ......................................................................................... 159
Fournier's Gangrene ................................................................................................ 159
Gas Gangrene ....................................................................................................... 160
Fungal Infection ................................................................................................... 163
HBO in the Management of AIDS ...................................................................................... 164
Miscellaneous Infections ........................................................................................... 164
Osteomyelitis ........................................................................................................ 165
Management of Osteomyelitis ........................................................................................ 166
HBO Treatment of Osteomyelitis ..................................................................................... 167
Clinical Results of HBO Treatment in Osteomyelitis ................................................................. 168
Osteomyelitis of the Jaw ........................................................................................... 168
Osteomyelitis of the Sternum ....................................................................................... 168
Malignant Otitis Externa ............................................................................................. 168
References ........................................................................................................... 169
15 Hyperbaric Oxygen Therapy and Chronic Lyme Disease: The Controversy and the Evidence ................................ 171
Introduction to Lyme Disease vs. Chronic Lyme Disease : A Brief Overview ............................................ 171
Chronic Lyme Disease ............................................................................................... 173
HBOT for Lyme Disease and CLD ........................................................................................ 174
Rationale for Using HBOT ........................................................................................... 174
The Need for a HBOT Medical Registry ............................................................................... 179
Conclusion ........................................................................................................... 179
References ........................................................................................................... 180
16 HBO Therapy in Wound Healing, Plastic Surgery, and Dermatology ...................................................... 183
Introduction ......................................................................................................... 183
Wound Healing ........................................................................................................ 184
Role of Oxygen in Wound Healing .................................................................................... 184
Pathophysiology of Nonhealing Wounds ............................................................................... 184
Wound Healing Enhancement by Oxygen ................................................................................ 185
Clinical Applications .............................................................................................. 187
Role of HBO in Nonhealing Wounds and Ulcers ........................................................................ 189
Ulcers Due to Arterial Insuffi ciency .............................................................................. 189
Diabetic Ulcers .................................................................................................... 190
Clinical Use of HBO in Diabetic Foot ............................................................................... 191
Guideline for the Use of HBO in the Treatment of Diabetic Foot Ulcers .............................................. 192
Venous Ulcers ...................................................................................................... 193
Decubitus Ulcers ................................................................................................... 195
Infected Wounds .................................................................................................... 195
Frostbite .......................................................................................................... 195
Spider Bite ........................................................................................................ 196
HBO for Inflammatory Bowel Disease ................................................................................. 197
HBO as an Aid to the Survival of Skin Flaps and Free Skin Grafts ..................................................... 197
Basic Considerations ............................................................................................... 197
Animal Experimental Studies ........................................................................................ 198
Comparison and Combination of HBO with Other Methods for Enhancing Flap Survival ................................... 199
Clinical Applications .............................................................................................. 199
Conclusion ........................................................................................................... 200
HBO as an Adjunct in the Treatment of Thermal Burns .................................................................. 200
Basic Considerations ............................................................................................... 200
Experimental Studies ............................................................................................... 201
Clinical Applications .............................................................................................. 201
Conclusion ........................................................................................................... 202
Applications of HBO in Dermatology ................................................................................... 202
Necrobiosis Lipoidica Diabeticorum ................................................................................. 202
Pyoderma Gangrenosum ............................................................................................... 202
Purpura Fulminans .................................................................................................. 203
Toxic Epidermal Necrolysis ......................................................................................... 203
Psoriasis .......................................................................................................... 203
Scleroderma ........................................................................................................ 203
References ........................................................................................................... 204
17 HBO Therapy in the Management of Radionecrosis ...................................................................... 207
Intoduction .......................................................................................................... 207
Radiation Physics .................................................................................................. 207
Unit of Radiation .................................................................................................. 207
Radiation Biology .................................................................................................... 208
Radiation Pathology .................................................................................................. 208
Clinicopathological Correlations ................................................................................... 208
Effect of Radiation on Blood Vessels ............................................................................... 208
Effect on Soft Tissues ............................................................................................. 208
Radiation Effects on the Nervous System ............................................................................ 208
Radiation Effects on the B one ..................................................................................... 209
HBO Therapy for Radionecrosis ........................................................................................ 209
Effect of HBO on Radiation Damage to Skin and Mucous Membranes ..................................................... 209
Rationale for Clinical Application ................................................................................. 209
Management of Osteoradionecrosis ..................................................................................... 210
Basic Studies ...................................................................................................... 210
Osteoradionecrosis of the Mandible ................................................................................. 211
Osteonecrosis of the Temporal Bone ................................................................................. 212
Osteoradionecrosis of the Chest Wall ............................................................................... 212
Osteoradionecrosis of the Vertebrae ................................................................................ 212
Management of Radionecrosis of CNS ................................................................................. 212
Management of Radionecrosis of Soft Tissues ........................................................................ 214
Effect of HBO on Cancer Recurrence ................................................................................. 216
Conclusion ........................................................................................................... 217
References ........................................................................................................... 217
18 The Use of HBO in Treating Neurological Disorders ................................................................... 221
Introduction ......................................................................................................... 221
Effect of HBO on Cerebral Metabolism ............................................................................... 221
Effect of HBO on Cerebral Blood Flow ............................................................................... 222
Effect of HBO on the Blood–Brain Barrier ........................................................................... 224
Effect of HBO on Oxygen Tension in the Cerebrospinal fl uid ........................................................ 224
Rationale for the Use of HBO in Neurological Disorders ............................................................... 225
Cerebral Hypoxia ................................................................................................... 225
Cerebral Edema ..................................................................................................... 225
Role of HBO in Neuroprotection ....................................................................................... 226
Indications for the Use of HBO in Neurological Disorders ............................................................. 228
Clinical Neurological Assessment of Response to HBO .................................................................. 229
Comatose Patients .................................................................................................. 229
Paraplegics ........................................................................................................ 229
Hemiplegics (Stroke Patients) ...................................................................................... 230
Diagnostic Procedures Used for Assessing the Effect of HBO ........................................................... 230
Electrophysiological Studies ....................................................................................... 230
Cerebral Blood Flow ................................................................................................ 231
Computerized Tomography ............................................................................................ 232
Magnetic Resonance Imaging ......................................................................................... 232
Positron Emission Tomography ....................................................................................... 233
Single Photon Emission Computed Tomography ......................................................................... 233
References ........................................................................................................... 234
19 Role of Hyperbaric Oxygenation in the Management of Stroke .......................................................... 237
Introduction ......................................................................................................... 237
Epidemiology of Stroke ............................................................................................. 238
Risk Factors for Stroke .............................................................................................. 238
Pathophysiology of Stroke .......................................................................................... 239
Causes of Stroke ................................................................................................... 239
Changes in the Brain During Ischemic Stroke ........................................................................ 240
Clinicopathological Correlations ................................................................................... 240
Structure of a Cerebral Infarct .................................................................................... 240
Cerebral Metabolism in Ischemia .................................................................................... 242
Molecular Mechanism in the Pathogenesis of Stroke .................................................................... 244
Gene Expression in Response to Cerebral Ischemia ................................................................... 244
Induction of Heat Shock Proteins ................................................................................... 244
Role of Cytokines and Adhesion Molecules in Stroke ................................................................. 244
DNA Damage and Repair in Cerebral Ischemia ......................................................................... 244
Role of Neurotrophic Factors ....................................................................................... 244
Classification of Ischemic Cerebrovascular Disease ................................................................... 245
Recovery from Stroke ................................................................................................. 245
Complications of Stroke .............................................................................................. 246
Sequelae of Stroke ................................................................................................... 246
Vascular Dementia .................................................................................................. 247
Diagnosis of Stroke .................................................................................................. 247
Stroke Scales ........................................................................................................ 248
Barthel Index ...................................................................................................... 248
Rankin Scale ....................................................................................................... 248
National Institutes of Health Stroke Scale ......................................................................... 248
Unified Neurological Stroke Scale .................................................................................. 248
Canadian Neurological Scale ........................................................................................ 249
Evaluation of Various Scales........................................................................................ 249
An Overview of the Conventional Management of Stroke ................................................................. 249
Acute Ischemic Stroke .............................................................................................. 249
Neuroprotectives ................................................................................................... 250
Management of the Chronic Poststroke Stage ........................................................................... 252
Management of Spasticity ........................................................................................... 252
Role of HBO in the Management of Acute Stroke ........................................................................ 253
HBO in Relation to Cerebral Ischemia and Free Radicals ............................................................. 254
Animal Experiments ................................................................................................. 254
Neuroprotective Effect of HBO Preconditioning ...................................................................... 257
Review of Clinical Studies ......................................................................................... 258
HBO as a Supplement to Rehabilitation of Stroke Patients ........................................................... 262
Conclusions of the Effects of HBO in Stroke Patients ................................................................. 265
Future Prospects ..................................................................................................... 266
References ........................................................................................................... 266
20 HBO Therapy in Global Cerebral Ischemia/Anoxia and Coma ............................................................. 269
Introduction ......................................................................................................... 269
Pathophysiology ...................................................................................................... 270
Rational Basis of HBO Therapy ........................................................................................ 271
Review of Animal Experimental Studies ................................................................................ 298
Review of Human Clinical Studies ..................................................................................... 300
Case Studies ......................................................................................................... 304
Patient 1: HBO Treatment for Coma Due to Traumatic Brain Injury .................................................... 304
Patient 2: Near Drowning, Chronic Phase ............................................................................ 307
Patient 3: Near Drowning, Chronic Phase ............................................................................ 308
Patient 4: Battered Child Syndrome ................................................................................. 309
Conclusion ........................................................................................................... 311
References ........................................................................................................... 314
21 HBO Therapy in Neurosurgery ......................................................................................... 321
Introduction ......................................................................................................... 321
Role of HBO in the Management of Traumatic Brain Injury: TBI ........................................................ 321
Mechanism of Action of HBO in TBI .................................................................................. 322
Effect of HBO on ICP in Acute TBI .................................................................................. 322
Effect of HBO Therapy in Chronic Sequelae of TBI ................................................................... 323
Experimental and Clinical Studies of HBO in TBI .................................................................... 323
Controlled Clinical Trials of HBO for TBI .......................................................................... 325
Use of HBO for TBI in Clinical Practice ............................................................................ 326
Conclusions ........................................................................................................ 326
Role of HBO in the Management of Spinal Cord Injury .................................................................. 326
Effects of Spinal Cord Injury ...................................................................................... 327
Rationale of the Use of HBO in SCI ................................................................................. 327
Animal Experimental Studies of HBO in SCI .......................................................................... 327
Clinical Studies of HBO in SCI ..................................................................................... 328
Role of HBO in Rehabilitation of SCI Patients ...................................................................... 329
Role of HBO in Compressive and Ischemic Lesions of the Spinal Cord ................................................. 329
Conclusions About Use of HBO in SCI ................................................................................ 330
HBO as an Adjunct to Radiotherapy of Brain Tumors .................................................................. 330
Role of HBO in the Management of CNS Infections .................................................................... 331
Role of HBO in Cerebrovascular Surgery ............................................................................. 332
Neuroprotection During Neurosurgery .................................................................................. 337
Conclusion ........................................................................................................... 337
References ........................................................................................................... 338
22 Oxygen Treatment for Multiple Sclerosis Patients .................................................................... 341
Introduction ......................................................................................................... 341
Pathophysiology ...................................................................................................... 342
Rationale for Hyperbaric Oxygen Treatment ............................................................................ 342
Clinical Trials of HBO in Multiple Sclerosis ......................................................................... 345
Conclusion ........................................................................................................... 349
References ........................................................................................................... 349
23 HBO in the Management of Cerebral Palsy ............................................................................. 351
Introduction: Causes of Cerebral Palsy .............................................................................. 351
Oxygen Therapy in the Neonatal Period ................................................................................ 351
Treatment of Cerebral Palsy with HBO ................................................................................. 353
Published Clinical Trials ............................................................................................ 354
The United States Army Study on Adjunctive HBO Treatment of Children with Cerebral Anoxic Injury ................... 355
The New Delhi Study of HBOT in CP .................................................................................. 356
Unpublished Studies .................................................................................................. 356
The Cornell Study .................................................................................................. 356
Comparative Effectiveness Studies .................................................................................... 356
Recent Studies (Since 2007) .......................................................................................... 357
Side Effects ......................................................................................................... 357
Case Reports ......................................................................................................... 358
Patient 1: Cerebral Palsy .......................................................................................... 358
Patient 2: Cerebral Palsy .......................................................................................... 359
Conclusions .......................................................................................................... 361
References ........................................................................................................... 363
24 HBO Therapy in Miscellaneous Neurological Disorders ................................................................. 365
Introduction ......................................................................................................... 365
HBO in the Treatment of Benign Intracranial Hypertension ............................................................. 365
Peripheral Neuropathy ................................................................................................ 366
HBO for the Treatment of Peripheral Neuropathic Pain ............................................................... 366
HBO for Treatment of Drug-Induced Neuropathy........................................................................ 366
HBO for the Treatment of Trigeminal Neuralgia......................................................................... 367
HBO in Susac's Syndrome .............................................................................................. 367
Cerebral Malaria ..................................................................................................... 367
Vascular Headaches ................................................................................................... 367
Rationale for the Use of HBO in Vascular Headaches ................................................................. 367
Current Status of Use of HBO in Vascular Headaches ................................................................. 368
HBO for Autism Spectrum Disorder ..................................................................................... 368
Neurological Disorders in Which HBO Has Not Been Found to Be Useful .................................................. 368
Dementia Due to Degenerative Disorders of the Brain ................................................................ 368
HBO in the Management of Neuromuscular Disorders ................................................................... 369
References ........................................................................................................... 370
25 HBO Therapy in Cardiovascular Diseases .............................................................................. 371
Introduction ......................................................................................................... 371
Pathophysiology ...................................................................................................... 371
Risk Factors ....................................................................................................... 371
Hypoxia, Hyperoxia, and Atherosclerosis ............................................................................ 371
Hyperbaric Oxygenation in Cardiology ................................................................................. 372
Effect of Hypoxia, Hyperoxia, and Hyperbaric Environments on Cardiovascular Function ............................... 372
Metabolic Effects of HBO on the Heart .............................................................................. 372
Role of HBO in Experimental Myocardial Infarction .................................................................. 373
Clinical Applications of HBO in Cardiology ........................................................................... 373
Acute Myocardial Infarction ........................................................................................ 373
Combination of HBO and Thrombolysis ................................................................................ 376
Chronic Ischemic Heart Disease (Angina Pectoris) ................................................................. 376
Cardiac Arrhythmias ................................................................................................ 377
Heart Failure ...................................................................................................... 377
Cardiac Resuscitation .............................................................................................. 377
HBO as an Adjunct to Cardiac Surgery ................................................................................. 377
Experimental Studies ............................................................................................... 377
Human Cardiac Surgery .............................................................................................. 378
Protective Effect of HBO Preconditioning in Cardiac Surgery ........................................................ 379
CNS Complications of Cardiac Surgery ............................................................................... 379
HBO in Preventive Cardiology ......................................................................................... 380
Prevention and Rehabilitation of Coronary Artery Disease ........................................................... 380
Physical Training of Patients with Chronic Myocardial Insuffi ciency ............................................... 380
Conclusion and Comments ............................................................................................ 380
HBO in Shock ......................................................................................................... 380
Pathophysiology of Shock ........................................................................................... 380
Oxygen Delivery by Blood ........................................................................................... 380
Traumatic and Hypovolemic Shock .................................................................................... 381
Cardiogenic Shock .................................................................................................. 381
Peripheral Vascular Disease .......................................................................................... 381
Causes ............................................................................................................. 381
Symptoms and Signs ................................................................................................. 382
Pathophysiology of Limb Ischemia ................................................................................... 382
Biochemical Changes in Skeletal Muscle in Ischemia and Response to Exercise ........................................ 382
Clinical and Laboratory Assessment of Patients with Peripheral Vascular Disease .................................... 383
General Management of PVD Patients ................................................................................. 384
Drug Therapy ....................................................................................................... 384
Exercise Therapy ................................................................................................... 384
Surgery ............................................................................................................ 384
Role of HBO in the Management of Peripheral Vascular Disease ....................................................... 385
Role of HBO in Miscellaneous Arteriopathies ........................................................................ 389
HBO as an Adjunct to Peripheral Vascular Surgery ................................................................... 389
Conclusions Regarding the Role of HBO in Peripheral Vascular Disease ............................................... 390
References ........................................................................................................... 390
26 HBO Therapy in Hematology and Immunology ............................................................................ 393
Introduction ......................................................................................................... 393
Effect of HBO on Red Blood Cells ..................................................................................... 393
Deformability ...................................................................................................... 393
Oxygen Exchange .................................................................................................... 394
Structure and Biochemistry ......................................................................................... 395
Effect of HBO on Stored Blood ...................................................................................... 395
Hemoglobin ......................................................................................................... 395
Erythropoiesis ..................................................................................................... 396
Effect of HBO on Hemorheology in Human Patients .................................................................... 396
Effect of HBO on Leukocytes .......................................................................................... 396
Effect of HBO on Platelets and Coagulation ........................................................................... 396
Effect of HBO on Stem Cells .......................................................................................... 396
Effect of HBO Treatment on the Immune System ......................................................................... 397
Effect of HBO Treatment on Plasma and Blood Volume ................................................................... 398
The Use of HBO in Conjunction with Oxygen Carriers ................................................................... 399
Clinical Applications of HBO in Disorders of the Blood ............................................................... 399
Hypovolemia and Acute Anemia Due to Blood Loss ..................................................................... 399
Hemolytic Anemia ................................................................................................... 400
Potential Benefi ts of HBO in Cerebrovascular Diseases Due to Blood Disorders ...................................... 400
Contraindication: Congenital Spherocytosis ......................................................................... 400
References ........................................................................................................... 401
27 HBO Therapy in Gastroenterology ..................................................................................... 403
Introduction ......................................................................................................... 403
HBO in Peptic Ulceration ............................................................................................. 403
Pathophysiology and Rationale of HBO Therapy ....................................................................... 403
Experimental Studies in Animals .................................................................................... 404
Clinical Assessment of HBO in Gastric and Duodenal Ulcer Patients .................................................. 404
HBO in the Treatment of Intestinal Obstruction ....................................................................... 404
Basic Considerations and Rationale of HBO Therapy .................................................................. 404
Experimental Studies in Animals .................................................................................... 405
HBO Therapy in Adynamic Ileus ...................................................................................... 406
HBO in Adhesive Intestinal Obstruction ............................................................................. 406
Methods .............................................................................................................. 407
HBO in Chronic Idiopathic Intestinal Pseudo-obstruction ............................................................ 407
HBO in Infl ammatory Bowel Disease ................................................................................... 407
Ulcerative Colitis and Crohn's Disease ............................................................................. 407
Mechanism of Effectiveness of HBO in Ulcerative Colitis ............................................................ 408
HBO in Infections of the Gastrointestinal Tract ...................................................................... 408
Toxic Megacolon .................................................................................................... 408
Pseudomembranous Colitis ........................................................................................... 409
Necrotizing Enterocolitis .......................................................................................... 409
Radiation Enterocolitis .............................................................................................. 409
HBO in Pneumatosis Intestinalis ...................................................................................... 409
Pathophysiology of Pneumatosis Cystoides Intestinalis .............................................................. 409
Rationale for HBO Therapy .......................................................................................... 410
Clinical Experience ................................................................................................ 410
HBO in Ischemic Disorders of the Intestine ........................................................................... 410
Use of Hyperbaric Therapy in Removal of Entrapped Intestinal Balloons ................................................ 411
HBO in Acute Pancreatitis ............................................................................................ 411
Animal Experimental Studies of HBO in Acute Pancreatitis ........................................................... 411
Clinical Applications of HBO in Acute Pancreatitis ................................................................. 411
HBO in Diseases of the Liver ......................................................................................... 412
Effect of HBO on the Normal Liver .................................................................................. 412
Effect of HBO on Experimentally Induced Hepatic Disorders in Animals ............................................... 412
Clinical Applications .............................................................................................. 412
Conclusions Regarding the Use of HBO in Gastroenterology ............................................................. 413
References ........................................................................................................... 414
28 HBO and Endocrinology ............................................................................................... 417
Introduction ......................................................................................................... 417
Thyroid Glands ....................................................................................................... 417
Glucocorticoid Receptors ............................................................................................. 417
Adrenocortical Function .............................................................................................. 417
Epinephrine/Norepinephrine ........................................................................................... 418
Prostaglandins ....................................................................................................... 418
Testosterone ......................................................................................................... 418
Clinical Applications ................................................................................................ 419
Thyroid Disease .................................................................................................... 419
Diabetes Mellitus .................................................................................................. 419
Conclusion ........................................................................................................... 420
References ........................................................................................................... 420
29 HBO and Pulmonary Disorders ......................................................................................... 423
Introduction ......................................................................................................... 423
Effects of HBO on Lungs............................................................................................... 423
Arterial and Pulmonary Arterial Hemodynamics ....................................................................... 423
Lung Mechanics and Pulmonary Gas Exchange .......................................................................... 424
Pulmonary Oxygen Toxicity .......................................................................................... 424
Clinical Applications ................................................................................................ 425
Respiratory Insuffi ciency ......................................................................................... 425
Bronchial Asthma ................................................................................................... 426
Bronchitis ......................................................................................................... 426
Infl ammatory Processes of the Lungs ............................................................................... 426
Pulmonary Embolism ................................................................................................. 426
Pulmonary Edema .................................................................................................... 426
Mechanism of Action of HBO in Type II Decompression Syndrome ....................................................... 427
Contraindications for the Use of HBO ................................................................................. 427
Nitrogen Dioxide Poisoning ......................................................................................... 427
Paraquat Poisoning ................................................................................................. 427
Emphysema .......................................................................................................... 427
Shock Lung ......................................................................................................... 427
Pneumothorax ....................................................................................................... 427
Conclusion ........................................................................................................... 428
References ........................................................................................................... 428
30 Hyperbaric Oxygenation in Traumatology and Orthopedics .............................................................. 429
Introduction ......................................................................................................... 429
Crush Injuries ....................................................................................................... 429
Pathophysiology .................................................................................................... 430
Diagnosis .......................................................................................................... 430
Treatment .......................................................................................................... 430
Role of HBO in Treatment ........................................................................................... 430
Traumatic Ischemia ................................................................................................. 431
Compartment Syndromes .............................................................................................. 433
HBO for High Pressure Water Gun Injection Injury ..................................................................... 433
Peripheral Nerve Injuries ............................................................................................ 433
Rationale for the Use of HBO ....................................................................................... 434
Experimental Studies ............................................................................................... 434
Clinical Applications .............................................................................................. 435
Concluding Remarks ................................................................................................. 435
Fractures ............................................................................................................ 435
Basic and Experimental Considerations .............................................................................. 435
Clinical Experience ................................................................................................ 436
Bone Fractures with Arterial Injuries .............................................................................. 436
Traumatic Amputations and Reimplantations of Body Parts .............................................................. 436
Reimplantation of Limbs ............................................................................................ 436
Reimplantation of Other Body Parts ................................................................................. 437
Role of HBO in Battle Casualties ..................................................................................... 437
Effect of HBO on Osteogenesis ........................................................................................ 437
HBO for Treatment of Osteonecrosis (Aseptic Necrosis) .............................................................. 437
HBO Therapy of Osteonecrosis ....................................................................................... 438
Rheumatoid Arthritis ................................................................................................. 440
Basic Considerations ............................................................................................... 440
Rationale of Use of HBO in Rheumatoid Arthritis .................................................................... 440
Clinical Applications .............................................................................................. 441
Conclusion ........................................................................................................... 441
References ........................................................................................................... 441
31 HBO Therapy in Otolaryngology ....................................................................................... 443
Introduction ......................................................................................................... 443
Tinnitus ............................................................................................................. 443
Sudden Deafness ...................................................................................................... 445
Role of HBO in the Management of Sudden Deafness ................................................................... 445
Rationale for HBO Therapy in Sudden Deafness ....................................................................... 445
Acute Acoustic Trauma .............................................................................................. 446
Concluding Remarks About the Use of HBO in Hearing Loss ............................................................ 449
Effect of HBO in Preventing Hearing Impairment from Chronic Noise Exposure ........................................... 451
Miscellaneous Disturbances of the Inner Ear .......................................................................... 451
Neuro-otological Vascular Disturbances ............................................................................... 451
Meniere's Disease .................................................................................................. 452
Facial Palsy ....................................................................................................... 453
Otological Complications of HBO Therapy .............................................................................. 453
Miscellaneous Conditions in Head and Neck Area ....................................................................... 453
Malignant Otitis Externa ........................................................................................... 453
Aphonia Due to Chronic Laryngitis .................................................................................. 454
Conclusion ........................................................................................................... 454
References ........................................................................................................... 454
32 HBO Therapy and Ophthalmology ....................................................................................... 457
Introduction ......................................................................................................... 457
Review of Pertinent Anatomy and Physiology of the Eye ................................................................ 458
The Process of Vision .............................................................................................. 458
Factors Affecting Vision ........................................................................................... 458
Retinal Blood Supply ............................................................................................... 458
Ocular Oxygen Tension .............................................................................................. 458
Physiology of the Eye in Hyperoxic Conditions ...................................................................... 458
Adverse Effects of Hyperoxia ......................................................................................... 459
Retinal Oxygen Toxicity ............................................................................................ 459
Lenticular Oxygen Toxicity ......................................................................................... 460
Ocular Contraindications to Hyperbaric Oxygen Therapy ................................................................ 461
Pre-HBOT Ocular Examination .......................................................................................... 461
HBO in the Treatment of Diseases of the Eye .......................................................................... 461
Recommended Indications ............................................................................................ 461
Potential Indications for HBOT in Ophthalmology .................................................................... 468
Other Reported Uses ................................................................................................ 474
Emergency HBO in Patients with Acute Vision Loss ................................................................... 477
Conclusion ........................................................................................................... 478
References ........................................................................................................... 478
33 Hyperbaric Oxygenation in Obstetrics and Gynecology ................................................................. 485
Introduction ......................................................................................................... 485
HBO and Risk of Congenital Malformations ............................................................................. 485
Role of HBO in Obstetrics ............................................................................................ 486
Experimental Studies ............................................................................................... 486
Clinical Applications .............................................................................................. 486
Use of HBO for Medical Conditions in Pregnancy ....................................................................... 487
Acute Carbon Monoxide Poisoning During Pregnancy ................................................................... 487
Diabetes ........................................................................................................... 487
Management of Pregnancy and Delivery in Women with Heart Disease ................................................... 487
Applications of HBO in Neonatology ................................................................................... 487
HBO in Gynecology .................................................................................................... 488
Animal Experimental Studies ........................................................................................ 488
Clinical Applications in Gynecology ................................................................................ 488
Conclusion ........................................................................................................... 488
References ........................................................................................................... 489
34 Use of Hyperbaric Oxygenation (HBO) in Neonatal Patients ............................................................ 491
Introduction ......................................................................................................... 491
Hypoxic–Ischemic Encephalopathy of the Newborn ....................................................................... 492
Uses of Hyperbaric Oxygenation in Hypoxic–Ischemic Encephalopathy and Necrotizing Enterocolitis of the Neonate ....... 492
Use of Hyperbaric Oxygenation in Neonates ............................................................................ 493
Results .............................................................................................................. 494
Discussion ........................................................................................................... 495
References ........................................................................................................... 495
35 Hyperbaric Oxygenation in Geriatrics ................................................................................ 499
Introduction ......................................................................................................... 499
Physiology of Aging .................................................................................................. 499
Theories of Aging .................................................................................................. 499
Changes in the Brain with Aging .................................................................................... 501
Applications of HBO in Geriatrics .................................................................................... 502
Rationale .......................................................................................................... 502
Safety of HBO Treatments in the Elderly ............................................................................ 504
Conclusion ........................................................................................................... 504
References ........................................................................................................... 504
36 HBO as an Adjuvant in Rehabilitation and Sports Medicine ............................................................ 505
Introduction ......................................................................................................... 505
Role of HBO in Rehabilitation ........................................................................................ 505
Indications ........................................................................................................ 505
Advantages ......................................................................................................... 506
Applications of HBO in Rehabilitation of Neurological Disorders .................................................... 506
Rehabilitation of patients with CNS injuries ....................................................................... 506
Role of HBO in Rehabilitation after Myocardial Infarction .......................................................... 506
HBO as an Adjunct to Rehabilitation in Peripheral Vascular Disease ................................................. 506
HBO as an Adjunct to Rehabilitation of Limb Amputees ............................................................... 507
HBO for Treatment of Sports Injuries ................................................................................. 507
HBO as an Adjunct to Sports Training ................................................................................. 508
Future Prospects ..................................................................................................... 509
References ........................................................................................................... 509
37 Nursing and Hyperbaric Medicine ..................................................................................... 511
History .............................................................................................................. 511
The Nursing Process ................................................................................................ 513
Hyperbaric Patient Education ......................................................................................... 513
Hyperbaric Nursing Research .......................................................................................... 521
References ........................................................................................................... 521
38 Role of HBO in Enhancing Cancer Radiosensitivity .................................................................... 523
Introduction ......................................................................................................... 523
Role of Hypoxia in Tumors............................................................................................. 523
Rationale of Use of HBO as Adjunct to Radiotherapy ................................................................... 524
Experimental Studies of the Radiosensitizing Effect of HBO ........................................................... 524
Clinical Studies of HBO as Radiation Sensitizer ...................................................................... 525
Carcinoma of the Cervix ............................................................................................ 525
Head and Neck Cancer ............................................................................................... 525
Carcinoma of the Lung .............................................................................................. 526
Carcinoma of the Bladder ........................................................................................... 526
Malignant Melanoma ................................................................................................. 526
Malignant Glioma ................................................................................................... 526
Advantages of HBO as an Adjunct to Radiotherapy ...................................................................... 528
Limitations of HBO as Adjunct to Radiotherapy of Cancer .............................................................. 528
Drawbacks of HBO as Adjunct to Radiotherapy of Cancer .............................................................. 528
Alternative Methods for Enhancing Radiosensitivity of Cancer ......................................................... 528
Combination of Other Methods with HBO and Irradiation for Cancer ..................................................... 529
Hyperthermia ....................................................................................................... 529
Hypothermia ........................................................................................................ 529
Vasodilators ....................................................................................................... 529
Induced Anemia and Red Cell Infusion ............................................................................... 529
Radiation Sensitizing Agents ....................................................................................... 529
Use of Perfluorochemicals as Oxygen Carriers ....................................................................... 529
HBO and Antineoplastic Agents ........................................................................................ 529
HBO and Photodynamic Therapy ......................................................................................... 530
Conclusion ........................................................................................................... 530
References ........................................................................................................... 530
39 HBO Therapy and Organ Transplants ................................................................................... 533
Background ........................................................................................................... 533
Role of HBO .......................................................................................................... 534
Ischemia-Reperfusion Injury .......................................................................................... 534
Inflammation ......................................................................................................... 534
Lung Transplants ..................................................................................................... 535
Pancreas Transplants ................................................................................................. 535
Renal Transplants .................................................................................................... 536
Liver Transplants..................................................................................................... 536
Face Transplants...................................................................................................... 537
Hand Transplants ..................................................................................................... 537
Miscellaneous Organs and Tissues ..................................................................................... 537
Clinical Applications ................................................................................................ 538
Conclusion ........................................................................................................... 538
References ........................................................................................................... 538
40 Hyperbaric Oxygen Pretreatment and Preconditioning .................................................................. 541
Introduction ......................................................................................................... 541
Hyperbaric Medicine Perspective ...................................................................................... 541
Diving Medicine ...................................................................................................... 542
References ........................................................................................................... 543
41 Anesthesia in the Hyperbaric Environment ............................................................................ 545
Historical Perspective ............................................................................................... 545
Current Indications .................................................................................................. 546
Physical Considerations Concerning Anesthetic ........................................................................ 546
Physiological Considerations ......................................................................................... 546
Cardiovascular Effects ............................................................................................. 547
Central Nervous System ............................................................................................. 547
Nitrous Oxide Anesthesia ........................................................................................... 547
Intravenous Anesthesia ............................................................................................. 548
Pharmacokinetics in the Hyperbaric Environment ..................................................................... 548
Practical Aspects of Anesthesia in the Pressure Chamber .............................................................. 548
Noise .............................................................................................................. 548
Airway Equipment ................................................................................................... 548
Ventilators ........................................................................................................ 548
Monitoring ......................................................................................................... 549
Prophylactic Myringotomy to Prevent Middle Ear Barotrauma .......................................................... 549
Conclusion ........................................................................................................... 550
References ........................................................................................................... 550
42 Hyperbaric Oxygen in Resuscitation .................................................................................. 551
Introduction ......................................................................................................... 551
Indications .......................................................................................................... 553
Cardiopulmonary Resuscitation ........................................................................................ 553
Case Studies ......................................................................................................... 554
Case 1 ............................................................................................................. 554
Case 2 ............................................................................................................. 558
Discussion ........................................................................................................... 562
Future Applications .................................................................................................. 563
Conclusion ........................................................................................................... 564
References ........................................................................................................... 565
43 HBO in Military Medicine ............................................................................................ 567
Hyperbaric Oxygen Therapy and Combat Medicine ........................................................................ 567
Gas Gangrene: Crush Injuries and Traumatic Wounds .................................................................. 568
Exceptional Loss of Blood .......................................................................................... 568
Burns .............................................................................................................. 568
Postconcussion Syndrome, Traumatic Brain Injuries, Posttraumatic Stress Disorders .................................. 569
Hearing Loss and Tinnitus .......................................................................................... 570
Spinal Cord Injury ................................................................................................. 570
Hyperbaric Oxygen Therapy and Military Response to Natural Catastrophes ............................................ 570
Hyperbaric Activities in Military Environment ........................................................................ 571
Offensive Activities or Activities Carried out During Wartime ...................................................... 571
Defensive Activities or Activities Carried out During Peacetime .................................................... 572
Field of HBO Application in Military Diving Medicine ................................................................. 573
Military Diving Operations ......................................................................................... 573
Diving Methods...................................................................................................... 573
Employee's Safety .................................................................................................. 573
Personnel Training ................................................................................................. 573
Personnel Recruitment .............................................................................................. 573
Submarine Medicine ................................................................................................... 573
Submarines' Rescue ................................................................................................. 573
Technical Aspects of Rescue Operations ............................................................................. 573
Transfer Under Pressure ............................................................................................ 574
References ........................................................................................................... 574
Part III Hyperbaric Medicine as a Specialty
44 Training and Practice of Hyperbaric Medicine ........................................................................ 579
Introduction ......................................................................................................... 579
Relation of Hyperbaric Medicine to Other Medical Specialties ......................................................... 580
Hyperbaric Medicine and Diving Medicine ............................................................................ 580
Training in Hyperbaric Medicine ...................................................................................... 580
Admission Requirements ............................................................................................. 580
Training Program ................................................................................................... 580
Examinations ....................................................................................................... 580
Proposal for a Curriculum for a Diploma Course in Hyperbaric and Diving Medicine ..................................... 581
Training of Nonphysician Healthcare Personnel for Hyperbaric Medicine................................................. 581
Practice of Hyperbaric Medicine ...................................................................................... 581
Economic Aspects ..................................................................................................... 582
Conclusion ........................................................................................................... 582
45 Research in Hyperbaric Medicine ..................................................................................... 583
Introduction ......................................................................................................... 583
Basic Research in HBO ................................................................................................ 583
Animal Experimental Studies .......................................................................................... 584
Application of Biotechnologies in Hyperbaric Medicine ................................................................ 584
Biomarkers of Effect of HBO ........................................................................................ 584
Action of HBO on Gene Expression ................................................................................... 585
HBO as Adjunct to Cell therapy and Regenerative Medicine ........................................................... 586
Nanobiotechnology and HBO .......................................................................................... 586
Clinical Trials of HBO Therapy ....................................................................................... 587
Problems with Clinical Trials of HBO ............................................................................... 587
Ethical Aspects of Clinical Trials with HBO ........................................................................ 588
Conclusion ........................................................................................................... 588
References ........................................................................................................... 588
46 Personalized Hyperbaric Medicine .................................................................................... 589
Introduction ......................................................................................................... 589
Molecular Diagnostics as Guide to HBO Therapy ........................................................................ 590
Role of Sequencing in Personalized Medicine ........................................................................ 590
Biomarkers for Personalized HBO Therapy ............................................................................ 591
Imaging for Personalized HBO Therapy ............................................................................... 591
Brain Imaging as Guide to Therapy of Multiple Sclerosis ............................................................ 591
Imaging Tumor Hypoxia for Personalized Cancer Therapy .............................................................. 591
Pharmacogenomics and Pharmacogenetics of HBO ......................................................................... 592
Oxygen Toxicity and Genes .......................................................................................... 592
Susceptibility to HBO-Induced Cataract Formation ................................................................... 592
Economical Aspects of Personalized HBO Therapy ....................................................................... 592
Conclusion ........................................................................................................... 592
References ........................................................................................................... 592
47 The Future of Hyperbaric Medicine ................................................................................... 593
Introduction to Future Medicine ...................................................................................... 593
Important Medical Advances in the Next Decade ...................................................................... 593
Advances in Surgery ................................................................................................ 594
Important Areas for Future Development ............................................................................. 594
Role of HBO in Future Medicine ....................................................................................... 595
Role of Hyperbaric Oxygen in the Multidisciplinary Healthcare Systems of the Future .................................. 595
Future Needs in Hyperbaric Medicine .................................................................................. 595
References ........................................................................................................... 596
48 Ethical Issues, Standards, and Quality Control in the Practice of Hyperbaric Medicine ............................... 597
Alternative Medical Treatments and Off-Label Use of Hyperbaric Oxygen ................................................ 598
The Risks of the Public Information Gap ............................................................................ 598
Is There an Alternative to HBOT? ................................................................................... 599
Safety and Fire Hazard Issues from Misuse of Hyperbaric Chambers ................................................... 599
The Controversy of Low Pressure Oxygen ............................................................................. 602
The “Chamber” Effect ............................................................................................... 602
Ethical Challenges with HBOT Clinical Trial Design ................................................................... 603
Informed Consent ................................................................................................... 604
Desperate Measures ................................................................................................. 604
HBOT Fraud ......................................................................................................... 605
HBOT Market Regulations .............................................................................................. 605
Food, Drug, and Cosmetic Act (FDC) 510(k) Clearance ................................................................ 605
National Hyperbaric Oxygen Therapy Registry ........................................................................ 606
Conclusion ........................................................................................................... 606
References ........................................................................................................... 607
49 Worldwide Overview of Hyperbaric Medicine ........................................................................... 609
Introduction ......................................................................................................... 609
Hyperbaric Medicine in China ......................................................................................... 609
Hyperbaric Medicine in Japan ......................................................................................... 610
Hyperbaric Medicine in Russia ........................................................................................ 611
Hyperbaric Medicine in Germany........................................................................................ 612
World Distribution of Hyperbaric Facilities .......................................................................... 613
Conclusion ........................................................................................................... 614
Reference ............................................................................................................ 614
50 Hyperbaric Medicine in the United States ............................................................................ 615
Introduction ......................................................................................................... 615
American College of Hyperbaric Medicine .............................................................................. 617
National Board of Diving and Hyperbaric Medical Technology ........................................................... 619
Baromedical Nurses Association ....................................................................................... 619
Indications for Use of Hyperbaric Oxygen ............................................................................. 620
Resources ............................................................................................................ 620
Organizations for Subspecialty Certifi cation ...................................................................... 621
Currently Offered Fellowship Training Locations in Undersea and Hyperbaric Medicine ................................ 621
51 Hyperbaric Medicine in Latin America ................................................................................ 623
History .............................................................................................................. 623
Introduction ......................................................................................................... 623
Existing General Standards ........................................................................................... 624
Responsible Existing Authorities ..................................................................................... 624
Industry ........................................................................................................... 624
Labor .............................................................................................................. 624
Health ............................................................................................................. 624
Insurance .......................................................................................................... 624
Latin American Consensus ............................................................................................. 624
Implementation of Minimum Standards and Regulations .................................................................. 625
Index .................................................................................................................. 627
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