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Schiavo S, Brenna CTA, Bhatia A, Middleton WJ, Katznelson R. Clinical Considerations for Implanted Neurological Devices in Patients Undergoing Hyperbaric Oxygen Therapy: A Case Report and Review of Manufacturer Guidelines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095693. [PMID: 37174212 PMCID: PMC10177826 DOI: 10.3390/ijerph20095693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Patients with implanted medical devices are increasingly referred for hyperbaric oxygen therapy (HBOT), and the safety of exposing some of these devices to hyperbaric environments has not previously been explored. There is a paucity of evidence surrounding the management of implanted neurological devices such as neurostimulators and intrathecal drug delivery (IDD) pumps in the context of HBOT. However, these devices can be expected to harbor unique risks; for example, vacant space in the reservoir of an implanted IDD pump may change in pressure and volume during the compression and decompression phases of HBOT, resulting in a damaged or dysfunctional device. We present the case of a 27-year-old woman with cerebral palsy referred for HBOT to manage a necrotizing soft tissue infection cultured from a dehiscent abdominal wound at the previous implantation site of an intrathecal baclofen pump. An HBOT protocol was ultimately chosen in partnership with the patient and her family, but treatment was not performed due to a paucity of evidence that the implanted IDD pump could safely withstand hyperbaric exposure. In this review, we have synthesized manufacturer recommendations regarding the management of implanted neurological devices before, during, and after HBOT to inform future decision-making in this setting. Among these recommendations, we highlight that neurostimulators should be switched off for the duration of HBOT and implanted pumps should be refilled prior to each treatment session to minimize empty reservoir space.
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Affiliation(s)
- Simone Schiavo
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON M5G 1E2, Canada
- Hyperbaric Medicine Unit, Toronto General Hospital, Toronto, ON M5G 2C4, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Connor T A Brenna
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Anuj Bhatia
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON M5G 1E2, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada
| | - William J Middleton
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON M5G 1E2, Canada
- Hyperbaric Medicine Unit, Toronto General Hospital, Toronto, ON M5G 2C4, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Rita Katznelson
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON M5G 1E2, Canada
- Hyperbaric Medicine Unit, Toronto General Hospital, Toronto, ON M5G 2C4, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON M5G 2C4, Canada
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Miclăuş T, Valla V, Koukoura A, Nielsen AA, Dahlerup B, Tsianos GI, Vassiliadis E. Impact of Design on Medical Device Safety. Ther Innov Regul Sci 2020; 54:839-849. [PMID: 32557299 PMCID: PMC7362883 DOI: 10.1007/s43441-019-00022-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
The growing number of emerging medical technologies and sophistication of modern medical devices (MDs) that improve both survival and quality of life indexes are often challenged by alarming cases of vigilance data cover-up and lack of sufficient pre- and post-authorization controls. Combining Quality with Risk Management processes and implementing them as early as possible in the design of MDs has proven to be an effective strategy to minimize residual risk. This article aims to discuss how the design of MDs interacts with their safety profile and how this dipole of intended performance and safety may be supported by Human Factors Engineering (HFE) throughout the Total Product Life-Cycle (TPLC) of an MD in order to capitalize on medical technologies without exposing users and patients to unnecessary risks.
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Affiliation(s)
- Teodora Miclăuş
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| | - Vasiliki Valla
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| | - Angeliki Koukoura
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| | - Anne Ahlmann Nielsen
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| | - Benedicte Dahlerup
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| | | | - Efstathios Vassiliadis
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
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