Side effects of hyperbaric oxygen therapy in children with cerebral palsy.

BACKGROUND: This article reports the side effects observed in a double-blind placebo-controlled multi-center randomized clinical trial carried out to assess the efficacy and safety of hyperbaric oxygen (HBO2) therapy in children with cerebral palsy. Intention-to-treat analysis did not prove to have a beneficial effect. MATERIAL AND METHODS: 111 children aged 3 to 12 years were included and followed for 8 weeks. They all received 40 compressions of 1 hour (5 days per week). In the treated group (n=57), HBO2 sessions consisted of an exposure to 100% oxygen at 1.75 atmosphere absolute (atm abs) while children in the control group (n=54) received air at 1.3 atm abs. A physician carried out a general health surveillance including an ear examination prior to and immediately following each session. All clinical events occurring during the course of the study were recorded. FINDINGS: Events were classified in 3 categories: Events related to pressure/volume changes, events related to oxygen toxicity, and other events. No events due to oxygen toxicity were noted. Only middle ear barotrauma significantly differed according to the groups (50% in HBO2 session group versus 27.8% in control group). Other events were rare and equivalent in both groups. CONCLUSION: Short-term exposure to HBO2 at medium level pressure (1.75 atm abs) was responsible for a significant increase of middle ear barotrauma compared to children that received very low external pressure (1.3 atm abs).     

A prospective, randomized clinical trial comparing two hyperbaric treatment protocols for carbon monoxide poisoning.

INTRODUCTION: The optimal hyperbaric oxygen (HBO2) treatment protocol for acute carbon monoxide (CO) poisoning is unknown. This is indicated by one study that found 18 different protocols to treat CO poisoning by North American multiplace hyperbaric facilities. A pilot study was conducted to evaluate the feasibility of randomizing patients to different protocols and to determine whether any large differences in clinical outcome were present between the two most common protocols. METHODS: Adult patients with accidental CO poisoning resulting in transient loss of consciousness, presentation to the emergency department within 12 hours, primary language English, high school education, and residence within 100 miles of the hyperbaric facility were recruited. Enrolled patients were randomized to one HBO2 treatment at 2.4 atmospheres absolute (atm abs) pressure with 90 minutes of 100% oxygen breathing vs. treatment by the US Air Force CO protocol (3.0 atm abs maximum pressure). A neurocognitive screening test was performed immediately after hyperbaric treatment and repeated 14-21 days later. RESULTS: From 1995 to 2002, 30 patients age 21 to 88 years were randomized, 18 to treatment at 2.4 atm abs and 12 to 3.0 atm abs. Average carboxyhemoglobin level for the population was 24.8 +/- 8.8% (mean +/- SD). Delay to hyperbaric treatment averaged 313 +/- 129 minutes. Neither variable was different between treatment groups. Six patients had abnormal neurocognitive testing immediately following hyperbaric treatment, 4 in the 2.4 atm abs group (22%) and 2 in the 3.0 atm abs group (17%) (P=0.71). One patient in each group demonstrated abnormality on delayed testing (p=0.75). One in each group did not return for follow-up. CONCLUSIONS: It is feasible to randomize CO-poisoned patients to different hyperbaric treatment protocols. Determination of differences in efficacy between treatment protocols will require a large multicenter trial with the use of detailed neurocognitive testing.     

Emphysematous cystitis: rapid resolution of symptoms with hyperbaric treatment: a case report.

INTRODUCTION: Emphysematous cystitis is a rare disease that occurs most often in elderly diabetic patients characterized by gas formation in the bladder wall due to infection. The infecting organism is usually an aerobic bacterium, most commonly E. coli although anaerobic species have also been reported. We report the use of hyperbaric oxygen in a patient with emphysematous cystitis and air in the femoral vein in which the treatment rapidly resolved the symptoms and radiological abnormalities. METHODS: A 65-year-old female presented to the Emergency Department with altered mental status, weakness, dark urine, dysuria and fever. She was febrile and lethargic. Abdominal exam showed suprapubic tenderness. Urinalysis was positive for white blood cells and bacteria. A CT scan of the abdomen demonstrated extensive air in the bladder wall with an air bubble in the femoral vein. Presumptive diagnosis was urinary tract infection, emphysematous cystitis, and sepsis. A question of air embolism was raised due to the intravascular gas. The patient was treated with hyperbaric oxygen (2.85 atm abs, 90 minutes) on two separate occasions in the first 12 hours. Within 24 hours, the patient's condition rapidly improved. Repeat CT scan 48 hours after admission showed near complete resolution of the emphysematous cystitis. The patient grew Klebsiella pneumonia from her urine. CONCLUSIONS: Emphysematous cystitis is a rare condition caused by either aerobic or anaerobic bacteria and may be associated with both bladder wall and intravascular gas formation. Hyperbaric oxygen therapy has not been previously reported as a treatment modality. The rapid improvement in our patient may indicate a role for hyperbaric oxygen in addition to IV hydration and antibiotics in this disease.     

高压氧干预对颈动脉弹性影响的定量评价

目的 应用回声跟踪( echo tracking,ET)技术对受试者双侧颈动脉参数进行分析,定量评价高压氧干预对颈动脉弹性的影响.方法 41例行高压氧治疗的患者为高压氧组,20名健康者为高气压组,另20名健康者为高流量组.前2组于进舱前及出舱后即刻、高流量组于吸氧前及吸氧后即刻,应用ET对双侧颈动脉弹性进行检测,检测参数包括血管的压力-应变弹性系数(Ep)、硬化参数(β)及血管顺应性(AC).结果 高压氧组干预后Ep[(112.38±50.94)kPa]及β值(8.29±3.66)较干预前均减小(129.04±52.4)kPa,(9,75±3.83),AC值增大[干预前(0.86±0.34) mm2/kPa,干预后(0.99±0.45)mm2/kpa],差异均有统计学意义(P＜0.01),高气压组干预后β及Ep较值进舱前减小,AC值较进舱前增加,差异均有统计学意义(P＜0.01或P＜0.05);高流量组吸氧前后Ep、β及AC值差异均无统计学意义(P＞0.05);年龄＜40岁的高压氧组及高气压组干预后Ep、β及AC值均有改善,且高压氧组较高气压组改善更明显,2组比较差异有统计学意义(P＜0.05或P＜0.01).结论 高压氧干预即刻即可改善颈动脉弹性.     

The effect of hyperbaric oxygen on human oral cancer cells.

Discoveries of the beneficial cellular and biochemical effects have strengthened the rationale for the administration of hyperbaric oxygen therapy (HBO2) as an adjunctive therapy for the treatment of osteoradionecrosis (ORN). Malignancies, however, are considered a contraindication for HBO2 because of the possible tumor-promoting effects. The aim of this study was to examine the effects of HBO2 therapy on tumor weight, and to measure the progression of apoptosis and tumor cell proliferating activity in a cultured human oral cancer cell line. Twenty 5-week-old male NODscid mice underwent daily HBO2 of 2.5 atm abs, 90 minutes for 20 treatments. The control group, n = 20, did not undergo HBO2 and tumor weight, apoptosis index, and proliferating activity parameters were compared between the two groups. The results showed no significant differences (p < 0.05) in the whole-body weights, tumor weights, apoptotic index or proliferating activity index between the two groups. By using the apoptosis and proliferating activity assays which were better indicators of tumor cell growth than tumor weight alone, our results suggest that the clinical application of HBO2 does not promote the growth or proliferation of human oral cancer cells.     

Gender differences in human skeletal muscle and subcutaneous tissue gases under ambient and hyperbaric oxygen conditions.

OBJECTIVES: The purpose of this study is to ascertain if gender differences exist in human skeletal muscle (MM) and subcutaneous (SC) tissue gases using monoplace and multiplace hyperbaric oxygen (HBO2) treatment protocols. METHODS: Gas tensions in resting MM and SQ tissues were recorded at 4-minute intervals using two protocols: The 150 minute monoplace HBO2 chamber protocol utilized continuous oxygen (O2) breathing at 202.6 kPa, that is 2 atmospheres absolute (2 ATA). The multiplace HBO2 chamber protocol had four 5-minute air breaks between five 20 minute O2 breathing periods at 2 ATA and took 180 minutes to complete. Tissue gas samples were obtained by the vacuum technique through a low permeable Teflon membrane and analyzed using a mass spectrometer. RESULTS: Over 40,000 individual step analyses showed gas tensions changed (repeated measures of variance, p = 0.00001) with time as the gas pressures and mixtures breathed were altered. Statistically significant differences between males and females in loading and unloading of SC nitrogen (N2) (P = 0.0001), SC O2 (P = 0.001) and MM O2 (P = 0.003) were observed in the multiplace protocol. Females release SC N2 more slowly; while increasing their MM and SC O2 tensions higher than males. Muscle and SC CO2 levels decrease in both males and females when exposed to HBO2 and increase when breathing air. CONCLUSIONS: Three main gender differences are observed in tissue gas loading and unloading under hyperbaric oxygen exposures: Females release SC N2 more slowly and saturate MM O2 and SC O2 to greater extents. Finally, female MM and SC O2 rose to higher levels in the multiplace protocol than in the monoplace protocol, which was not observed in the male subjects. This information may help explain why males and females respond differently to diving decompression stresses and the clinical application of HBO2.     

Venous gas embolism in chamber attendants after hyperbaric exposure.

An initial occupational survey (OS) was initiated to investigate the prevalence of venous gas embolism (VGE) in chamber attendants assisting hyperbaric oxygen (HBO2) treatments. Nine female subjects were exposed for three consecutive days to the routine hospital procedure of compressed air exposure to 240 kPa for approximately 115 min with 12 min of terminal oxygen (O2) breathing. VGE was monitored with ultrasound Doppler in 15 min intervals for 2h after the first and third exposure. A follow-up experimental study was completed to investigate whether changed breathing gases and decompression would affect the high incidence of VGE observed in the OS. Ten female subjects were randomly exposed to the routine or revised profile (12 and 24 min of terminal O2 breathing respectively), and a Nitrox profile (breathing gas 40.5% O2 in Nitrogen during 90 min of the isobaric phase). VGE was monitored with transthoracic ultrasound scanner and Doppler. In the OS precordial VGE grade III (Doppler) was observed in five subjects, but median resting precordial VGE was Grade 0 both days and VGE score at all sites were equal Days 1 and 3. In the experimental study, median resting precordial VGE was Grade 0 (Doppler) and Grade 1 (Scanner). VGE Grade III (Doppler) was observed in all series, but VGE scores were not significantly different between the series. We conclude that chamber attendants assisting HBO2 treatment at 240 kPa for approximately 115 min are exposed to a significant decompression stress using the profiles tested in the present study.     

不同氧疗方式对急性一氧化碳中毒大鼠血气的影响

目的 观察不同氧疗方式对急性一氧化碳中毒(acute carbon monoxide poisoning,ACOP)大鼠血气的影响.方法 将70只雄性Wistar大鼠随机分成健康对照组10只;染毒即刻组12只;余48只CO染毒后再分为4组,分别为空气组、鼻导管组、面罩组、HBO组各12只.制备ACOP动物模型,给予3种不同方式的氧疗,自腹主动脉取血行血气分析.结果 pH值:染毒即刻即出现明显下降(P<0.01),鼻导管及面罩吸氧后均低于正常(P<0.05),HBO治疗后接近正常(P>0.05).PaO2及PaCO2:染毒后各组差异无统计学意义(P>0.05).乳酸及COHb%:染毒即刻即出现明显升高(P<0.01),经鼻导管吸氧后高于正常(P<0.05);面罩及高压氧治疗后接近正常(P>0.05).HCO3-:染毒后各组均明显低于正常(P<0.01).结论 ACOP后不同氧疗方式均可改善ACOP缺氧和大鼠的代谢性酸中毒,在3种方式的氧疗中,HBO组清除大鼠体内COHb最显著.     

Hyperbaric oxygen for post-concussion syndrome: design of Department of Defense clinical trials

The current wars in the Middle East have resulted in between 10-20% of U.S. service members with mild traumatic brain injury (mTBI). While anecdotal reports have associated hyperbaric oxygen (HBO2) with improved outcomes after mTBI, controlled research is lacking. The Department of Defense (DoD), in collaboration with the Department of Veterans Affairs (DVA), has a comprehensive program examining this issue. The DoD's four randomized controlled trials will enroll a total of 242 service members with post-concussion syndrome and expose them to a range of control, sham and HBO2 conditions for 40 sessions over a period of eight to 11 weeks. Compression pressures will range from 1.2 atm abs (sham) to 2.4 atm abs, and oxygen concentration will range from room air (sham and control) to 100%. Outcomes measures include both subjective and objective measures performed at baseline, at exposure completion, and at three to 12 months' follow-up. This integrated program of clinical trials investigating the efficacy of HBO2 in service members with persistent symptoms following mTBI exposure will be important to define practice guidelines and, if needed, for the development of definitive clinical trials in this population.     

Normal diffusion-weighted imaging in cerebral air embolism complicating angiography

We report a case of cerebral air embolism resulting from accidental air infection during cerebral angiography. A 60-year-old man was accidentally injected with air via the left subclavian artery. Angiography demonstrated air within the basilar artery. The patient showed signs of posterior circulation ischaemia (confusion, blindness, gaze palsy and hemiparesis). However, MRI, including diffusion-weighted imaging, showed no abnormality 4 h later. The patient was treated with hyperbaric oxygen within 5 h of the embolism. All symptoms and signs resolved completely within a week. Received: 2 April 1999/Accepted: 12 July 1999     

Hyperbaric oxygen therapy in two patients with non-arteritic anterior optic neuropathy who did not respond to prednisone

Recent advances in understanding the effects of hyperbaric oxygen (HBO) on retinal anoxia gave rise to new interest in the possibility of using it as therapeutic treatment for ischemic conditions of the retina and optic nerve. Two patients with non-arteritic anterior ischemic optic neuropathy due to a high-grade ophthalmic artery stenosis were treated with HBO at 2 atm abs in an effort to increase oxygen delivery for the eye. Both patients showed marked improvements of visual acuity and visual field 3-5 months following the event. Our results are intriguing although the achieved improvement could be coincidental.     

脑挫裂伤伴脑疝形成术后高压氧治疗的临床疗效分析

目的:探讨高压氧治疗对脑挫裂伤伴脑疝形成术后患者神经功能康复及并发症发生的影响。方法:回顾性分析川北医学院附属医院近6年脑挫裂伤伴脑疝形成术后患者的病历资料,将符合要求的病例按照治疗过程中是否愿意接受高压氧治疗分为高压氧治疗组和对照组,对照组患者接受常规治疗,高压氧组患者在常规治疗基础上接受1个疗程以上的高压氧治疗。比较2组患者外伤性癫痫、脑积水、硬膜下积液的发生率及特定时间格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOC)评分。结果:155份病历资料被纳入统计,其中高压氧组85例,对照组70例。2组各发生外伤性癫痫7例,差异无统计学意义(χ 2=0.145, P=0.70);2组分别发生外伤性脑积水3例、9例,差异有统计学意义(χ 2=4.676, P=0.03);2组外伤性硬膜下积液分别出现8例、19例,差异有统计学意义(χ 2=8.390, P=0.004)。术后2周高压氧组GCS评分为(7.72±1.51)分,高于对照组的(7.26±1.13)分,差异有统计学意义( t=2.164, P=0.03);术后4周高压氧组GCS评分为(8.94±1.74)分,高于对照组的(8.08±1.48)分,差异有统计学意义( t=3.261, P=0.001)。术后6个月GOS评分高压氧组[(3.75±0.65)分]高于对照组[(3.16±0.79)分],差异有统计学意义( t=4.883, P<0.001)。 结论:脑挫裂伤伴脑疝形成术后高压氧治疗有助于降低脑积水和硬膜下积液的发生率,促进患者神经功能的恢复和生活质量的提高。     

高压氧早期综合治疗急性脑梗死的临床疗效观察

目的 探讨高压氧早期治疗急性脑梗死的临床疗效.方法 132例急性脑梗死患者,按照高压氧治疗时期分为早期治疗组(发病后7 d内)及晚期治疗组(发病14 d后).高压氧治疗30次后采用改良的爱丁堡-斯堪的纳维亚量表进行神经功能缺损评分(NFD),用改良的Barthel指数(MBI)进行患者的日常生活活动能力评分(ADL).结果 2组患者治疗后的NFD、MBI评分比较差异有统计学意义(P<0.05).结论 高压氧早期治疗对急性脑梗死患者的神经功能恢复、日常生活活动能力均有良好的促进作用,对急性脑梗死的患者应尽早进行高压氧治疗.     

早期高压氧治疗对急性颅脑外伤患者失语症的疗效观察

目的 研究早期高压氧(HBO)治疗对急性颅脑外伤患者失语症的疗效.方法 将2004年1月至2007年8月在我院住院的62例急性颅脑外伤患者分为HBO治疔组和常规治疗组,常规治疗组采用临床常规治疗,HBO治疗组在常规治疗的基础上,实施24～48次HBO治疗,并且在治疗结束后1年内每3个月进行1次随访.在治疗前、后分别采用西方失语成套测试法(western aphasia,WAB)检测并进行CT检查,对他们的语言功能和恢复情况进行评价和比较.结果 HBO治疗组显效率(83.8%)显著高于常规治疗组(54.8%),经x2检验P＜0.05;CT检查证实患者病变部位阻塞的血管已经恢复冉通或已获得重建.结论 早期HBO治疗有利于促进或恢复患者的语言功能.     

急性脑梗死早期高压氧治疗疗效观察

目的 研究早期应用高压氧治疗急性脑梗死的疗效和安全性.方法 90例确诊为首次发病的急性前循环脑梗死患者分为2组,每组45例.高压氧组在发病后12 h内开始进行高压氧治疗,对照组不进行高压氧治疗.结果 治疗后第14、28、90天,2组患者的神经功能缺损评分和日常生活能力评分均有改善,高压氧组较对照组提高明显(P＜0.05),2组均未发生严重不良事件.结论 0.22MPa高压氧治疗首次发病的急性前循环脑梗死患者,在发病后12 h以内,能改善患者神经功能缺损,提高日常生活能力.同时,高压氧对急性脑梗死的治疗是安全的.     

Clinical case report: treatment of a central retinal vein occlusion with hyperbaric oxygen.

A case of retinal central vein occlusion (CRVO) in a 43-year-old man is presented in which hyperbaric oxygen (HBO2) was used as the only treatment method. CRVO is a relatively common cause of visual loss, with hypertension, diabetes, glaucoma and hypercoagulable conditions identified as risk factors. The patient in this report had none of these risk factors and declined treatments other than hyperbaric oxygen. HBO2 was effective in sustaining the ischemic retina and controlling retinal edema until the retina revascularized and vision stabilized. The initial visual acuity in the left eye was 20/200 (corrected), and after two hyperbaric treatments it was 20/30 (corrected). Following three months of HBO2 treatments the vision stabilized to 20/20 (corrected) in the affected eye. Treatment considerations in using HBO2 as adjunctive therapy for CRVO are early institution of treatment, and continuation of HBO2 until the retinal edema has resolved and vision has stabilized.     

高压氧对急性脑梗死患者血浆D-二聚体含量的影响

目的　探讨高压氧 (HBO)治疗脑梗死患者对血浆 D-二聚体 (D-dimer)含量的影响。方法　对 3 6例正常人对照组、1 69例 HBO组与 87例同期常规治疗组的脑梗死急性期血浆 D-dim er含量变化进行观察。结果　 HBO组和常规治疗组患者第 1天、第 1 0天的血浆 D-dim er水平高于正常对照组 (P<0 .0 5)。 HBO组患者第 1 0天的水平低于同期常规治疗组 (P<0 .0 5)。结论　 HBO治疗使急性脑梗死患者血浆 D-dim er含量降低     

Lung metastatic load limitation with hyperbaric oxygen.

Despite some theoretical concern about cancer-enhancing effects ofhyperbaric oxygen (HBO2) therapy, it is frequently administered to cancer patients. We evaluated the growth of murine breast cancer cells in the lung after hyperbaric oxygen treatment in an experimental metastasis assay. Young nu/nu mice were injected intravenously with 3 x 10(3) 4T1-GFP tumor cells per g body weight followed by lung isolation, perfusion, and intact organ epifluorescence microscopy 1 to 37 days after injection. A group of animals (n=32) was exposed once daily for 5 days a week to 45 min of 2.8 ATA hyperbaric oxygen (HBO2) in a research animal HBO2 chamber. Control animals (n=31) were not subjected to HBO2 treatment, but received similar intravenous administration of 3 x 10(3) 4T 1-GFP tumor cells. Single tumor cells and colonies were counted in the subpleural vessels in areas of about 0.5 cm2 of lung surface. HBO2 treatment did not lead to an increase in the number of the large or small colonies in the lungs. Rather, a significant reduction in the number of the large colonies was observed at 1 and 16 to 21-day periods of measurements after hyperbaric treatment. However, most importantly, there was a significant decrease in large colony size in the HBO2 group during all periods of observation. The results indicate that HBO2 is not prometastatic for breast cancer cells; rather it restricts the growth of large tumor cell colonies.     

Improvement in motor and cognitive impairment after hyperbaric oxygen therapy in a selected group of patients with cerebrovascular disease: a prospective single-blind controlled trial.

BACKGROUND: Clinical and experimental evidence suggests that a localized decrease in oxygen brain tissue availability contributes to the neurological deficit in patients with cerebrovascular disease (CVD) who also present with frontal leukoaraiosis (LA) (periventricular hypodensity on CT scan) and lacunar infarcts. In a prospective controlled trial blinded to patients but not to investigators, we tested the effect of HBO2 on this group of patients. METHODS: Selected patients with symptomatic CVD, LA and lacunar infarcts received daily exposures of 45 minutes for 10 days to hyperbaric oxygen (n=18, HBO2 group) or hyperbaric air (n=8, control group). The control group subsequently received HBO2. Scores of conventional scales for motor and cognitive functions were obtained and videotaped before and after exposure. After the exposures, participants were followed on a monthly basis with systematic clinical neurological examination for up to 6 months. Results. There was a statistically significant improvement in all scales for the HBO2 group compared with the placebo group and in the placebo group after receiving HBO2 (p<0.05). Neurological improvement persisted in the majority of patients for up to 6 months. Repetition of the HBO2 protocol in 9 patients in whom symptoms recurred after 6 months resulted in improvement of symptoms. CONCLUSIONS: These data provide evidence consistent with the notion that HBO2 improves neurological function in patients with CVD, lacunar infarcts and frontal LA. Because of the lack of investigator blinding and a relatively small sample size in this study, larger, randomized controlled studies are needed to further test this hypothesis and to further define the role of oxygen therapy for brain repair in chronic brain disease.     

高压氧综合治疗蛛网膜下腔出血后迟发性脑血管痉挛的疗效观察

目的 探讨高压氧对蛛网膜下腔出血后迟发性脑血管痉挛的疗效.方法 回顾性分析2006年3月至2008年10月在我院治疗的42例动脉瘤蛛网膜下腔出血患者,高压氧组(21例)在常规治疗脑血管痉挛基础上辅以高压氧治疗,对照组(21例)采用常规方法治疗脑血管痉挛,对2组的临床疗效进行比较.结果 高压氧组迟发性脑血管痉挛的发生率为14.3%,脑梗死发生率为4.8%;对照组迟发性脑血管痉挛的发生率为47.6%,脑梗死发生率为23.8%.高压氧组迟发性脑血管痉挛和脑梗死发生率均较对照组低,2组比较差异有统计学意义(P<0.05).结论 高压氧治疗对蛛网膜下腔出血迟发性脑血管痉挛有一定的效果.