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Freitas C, Salazar L, Duarte-Costa S, Fraga C, Monteiro S, Camacho Ó. Hyperbaric Medicine in Pediatrics - reality of a Portuguese reference center. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 43:e2023230. [PMID: 38985051 DOI: 10.1590/1984-0462/2025/43/2023230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/03/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To identify and characterize the population of Pediatric patients referred to our hyperbaric oxygen therapy center. METHODS Retrospective and observational study, including pediatric patients treated with hyperbaric oxygen therapy, from 2006 to 2021, at the hyperbaric medicine reference center in the north of Portugal. Variables of interest were extracted from electronic medical records. RESULTS Our study included 134 patients. The most frequent reasons for referral were carbon monoxide poisoning (n=59) and sudden sensorineural hearing loss (n=41). In 75 cases (56%), treatment was initiated in an urgent context. Symptom presentation at Emergency Department varied among patients, the most frequent being headache and nausea/vomiting. Concerning carbon monoxide poisoning, the most common sources were water heater, fireplace/brazier, and boiler. Regarding adverse effects, it was identified one case of intoxication by oxygen and four cases of middle ear barotrauma. CONCLUSIONS The most frequent cause for referral was carbon monoxide poisoning. All patients evolved favorably, with few side effects being reported, emphasizing the safety of this therapy. While most pediatricians may not be aware of the potential benefits arising with hyperbaric oxygen therapy, it is of upmost importance to promote them, so that this technique is increasingly implemented.
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Affiliation(s)
| | - Luís Salazar
- Centro Hospitalar Universitário do Porto - Porto, Portugal
| | | | | | - Sara Monteiro
- Centro Hospitalar Universitário do Porto - Porto, Portugal
| | - Óscar Camacho
- Unidade Local de Saúde de Matosinhos - Porto, Portugal
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Ozgok Kangal K, Mirasoglu B. Hyperbaric oxygen treatment for infants: retrospective analysis of 54 patients treated in two tertiary care centres. Diving Hyperb Med 2024; 54:9-15. [PMID: 38507905 PMCID: PMC11227964 DOI: 10.28920/dhm54.1.9-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/21/2023] [Indexed: 03/22/2024]
Abstract
Introduction We aimed to analyse the outcomes of hyperbaric oxygen treatment (HBOT) and describe difficulties encountered in infants, a rare patient population in this therapeutic intervention, with limited scientific reports. Methods This was a retrospective analysis of patients 12 months old or younger who underwent HBOT in two different institutions. Demographic data, clinical presentation, HBOT indication, chamber type, oxygen delivery method, total number of treatments, outcome and complications were extracted from clinical records. Results There were 54 infants in our study. The patients' median age was 3.5 (range 0-12) months. The major HBOT indication was acute carbon monoxide intoxication (n = 32). A total of 275 HBOT treatments were administered, mostly performed in multiplace chambers (n = 196, 71%). Only one patient (2%) required mechanical ventilation. Acute signs were fully resolved in the most patients (n = 40, 74%). No complications related to HBOT were reported. Conclusions This study suggests that HBOT may be a safe and effective treatment for infants. Paediatricians should consider HBOT when indicated in infants even for the preterm age group.
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Affiliation(s)
- Kubra Ozgok Kangal
- Department of Underwater and Hyperbaric Medicine, University of Health Sciences, Gulhane Faculty of Medicine, Gulhane Research and Training Hospital, Ankara, Turkey
- Corresponding author: Associate Professor Kubra Ozgok Kangal, Gen. Dr. Tevfik Saglam Cad. SBÜ-Gülhane Eğitim ve Araştırma Hastanesi, Sualtı Hekimliği ve Hiperbarik Tıp Kliniği, Etlik/Ankara, Turkey,
| | - Bengusu Mirasoglu
- Department of Underwater and Hyperbaric Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Odegard DT, Mullins ME. Perinatal carbon monoxide poisoning with fetal and maternal carboxyhemoglobin measurements. Clin Exp Emerg Med 2023; 10:453-455. [PMID: 38012819 PMCID: PMC10790064 DOI: 10.15441/ceem.23.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Dean T. Odegard
- Department of Pediatrics, St. Louis Children’s Hospital, St. Louis, MO, USA
- Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael E. Mullins
- Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Favede C, Bradshaw C, Sethia R, Kramer S, Jatana K, Elmaraghy C, Grischkan J. Near-Total Ear Avulsion Repaired With Primary Closure and Hyperbaric Oxygen: A Case Series and Review of the Literature. Ann Otol Rhinol Laryngol 2023; 132:1265-1270. [PMID: 36541620 DOI: 10.1177/00034894221142934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Near-total ear avulsion is a rare and challenging problem to repair with many techniques described; primary repair is an attractive option but is not always successful. Healing may be augmented with postoperative hyperbaric oxygen therapy (HBOT), but this technique is under-reported, and an ideal regimen is not known. The study objective is to discuss the role of HBOT in the management of ear avulsion by reviewing 2 unique cases. METHODS Case report and review of the literature. A Pubmed search using the terms ear avulsion and postoperative hyperbaric oxygen was performed. RESULTS Two pediatric patients presented with near-total avulsion of the auricle after suffering a dog bite. Various management options were discussed including observation, primary repair, post-auricular cartilage banking, graft reconstruction with periauricular tissue or rib cartilage, or microsurgical replantation. The decision was made to perform primary reattachment, followed by adjuvant hyperbaric oxygen therapy (HBOT). The patients achieved favorable esthetic results and continue to maintain the function of the reattached ear. Photo documentation was obtained throughout the process. DISCUSSION There is no consensus on the management of near-total ear avulsion. Primary repair is ideal from a cosmetic and ease-of-operation standpoint but does not always yield viable tissue. The use of postoperative HBOT is an attractive option that may boost success rates, but the ideal HBOT regimen is unknown. These cases represent a successful application of this innovative technique in a pediatric patient.
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Affiliation(s)
- Cecelia Favede
- Prisma Health Children's Hospital, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Charles Bradshaw
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rishabh Sethia
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Scott Kramer
- Ohio ENT & Allergy Physicians, Columbus, OH, USA
| | - Kris Jatana
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Jonathan Grischkan
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
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Myśliwiec AP, Walatek JT, Tarnawa A, Nierwińska K, Doroniewicz I. Can Hyperbaric Oxygen Therapy Be Used to Treat Children after COVID-19? A Bibliographic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15213. [PMID: 36429932 PMCID: PMC9690784 DOI: 10.3390/ijerph192215213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
The coronavirus disease (COVID-19) epidemic is a public health emergency of international concern. It was believed that SARS-CoV-2 virus was much less likely affect children. Statistics show that children account for 2-13% of all COVID-19 patients in individual countries. In the youngest population, acute respiratory failure is not as serious a problem as complications after COVID-19, mainly pediatric inflammatory multisystem syndrome (PIMS, MIS-C). This study used a bibliography review. The Medline database (using the PubMed platform) and the Cochrane Clinical Trials database were searched using the following keywords: hyperbaric oxygen therapy for children, treatment of children with COVID-19, and use of HBOT in the treatment of children following COVID-19. Thirteen publications that quantitatively and qualitatively described the efficacy of HBOT application in the treatment of pediatric diseases were eligible among the studies; those relating to the use of HBOT in the treatment of children with COVID-19 and its complications were not found. The bibliographic review showed that hyperbaric oxygen therapy can be used in the treatment of children after carbon monoxide poisoning, with soft tissue necrosis, bone necrosis, after burns, or after skin transplant. No evidence supported by research has been found in scientific journals on the effectiveness of the use of hyperbaric oxygen therapy in children with a history of COVID-19 infection. Research data are needed to develop evidence-driven strategies with regard to the use of HBOT therapy in the treatment of children and to reduce the number of pediatric patients suffering because of complications after COVID-19.
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Affiliation(s)
- Andrzej P. Myśliwiec
- Laboratory of Physiotherapy and Physioprevention, Institute of Physiotherapy and Health Sciences, Academy of Physical Education in Katowice, 40-065 Katowice, Poland
| | - Julia T. Walatek
- Physiotherapy Center “Galen Rehabilitation”, 43-150 Bieruń, Poland
| | - Anna Tarnawa
- Center for Intensive Rehabilitation of Children “Michałkowo”, 43-360 Wilkowice, Poland
| | - Katarzyna Nierwińska
- Laboratory of Physiotherapy and Physioprevention, Institute of Physiotherapy and Health Sciences, Academy of Physical Education in Katowice, 40-065 Katowice, Poland
| | - Iwona Doroniewicz
- Laboratory of Physiotherapy and Physioprevention, Institute of Physiotherapy and Health Sciences, Academy of Physical Education in Katowice, 40-065 Katowice, Poland
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Laureau J, Pons C, Letellier G, Gross R. Hyperbaric oxygen in children with cerebral palsy: A systematic review of effectiveness and safety. PLoS One 2022; 17:e0276126. [PMID: 36240157 PMCID: PMC9565562 DOI: 10.1371/journal.pone.0276126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To report current evidence regarding the effectiveness of hyperbaric oxygen therapy (HBOT) on the impairments presented by children with cerebral palsy (CP), and its safety. MATERIALS AND METHODS PUBMED, The Cochrane Library, Google Scholar, and the Undersea and Hyperbaric Medical Society database were searched by two reviewers. Methodological quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the modified Downs and Black (m-DB) evaluation tool for non RCTs. A meta-analysis was performed where applicable for RCTs. RESULTS Five RCTs were identified. Four had a high level of evidence. Seven other studies were observational studies of low quality. All RCTs used 100% O2, 1.5 to 1.75 ATA, as the treatment intervention. Pressurized air was the control intervention in 3 RCTs, and physical therapy in 2. In all but one RCTs, similar improvements were observed regarding motor and/or cognitive functions, in the HBOT and control groups. Adverse events were mostly of mild severity, the most common being middle ear barotrauma (up to 50% of children). CONCLUSION There is high-level evidence that HBOT is ineffective in improving motor and cognitive functions, in children with CP. There is moderate-level evidence that HBOT is associated with a higher rate of adverse events than pressurized air in children.
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Affiliation(s)
- Justine Laureau
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, EA 4334, Nantes, France
| | - Christelle Pons
- Pediatric Rehabilitation Department, Fondation ILDYS, Brest, France
- Laboratory of Medical Information Processing, LaTIM- INSERM UMR 1101, Brest, France
- PMR Department, University Hospital Brest, Brest, France
| | - Guy Letellier
- Paediatric Rehabilitation Center ESEAN-APF, Nantes, France
| | - Raphaël Gross
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, EA 4334, Nantes, France
- * E-mail:
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El Hawa AAA, Bekeny JC, Phillips NW, Johnson-Arbor K. Hyperbaric oxygen therapy for paediatric patients: an unintended consequence of the COVID-19 pandemic. J Wound Care 2021; 30:S24-S28. [PMID: 34554855 DOI: 10.12968/jowc.2021.30.sup9.s24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Hyperbaric oxygen therapy (HBOT) is a useful adjunctive treatment for selected complicated wounds, including severe diabetic lower extremity ulcerations and compromised skin grafts or flaps. The Sars-CoV-2 (COVID-19) pandemic has disrupted healthcare delivery, with its effects extending to delivery of HBOT. During the pandemic, paediatric patients in our geographic region who were referred for HBOT faced challenges as centres temporarily closed or were unprepared to treat younger patients. Our monoplace HBOT centre modified existing practices to allow for treatment of these patients. This study aims to outline the steps necessary to adapting a pre-existing HBOT centre for the safe treatment of paediatric patients. METHOD A retrospective review was performed to identify patients 18 years of age or younger referred for HBOT during 2020. Patient characteristics, referral indications and HBOT complications were collected. Changes implemented to the HBOT centre to accommodate the treatment of paediatric patients were documented. RESULTS A total of seven paediatric patients were evaluated for HBOT and six were treated. The mean patient age was four years (range: 1-11 years). Referral diagnoses included sudden sensorineural hearing loss, skin flap or graft compromise, and radiation-induced soft tissue necrosis. All patients tolerated HBOT treatment in monoplace chambers without significant complications noted. Enhancements made to our clinical practice to facilitate the safe and effective treatment of paediatric patients included ensuring the availability of acceptable garments for paediatric patients, maintaining uninterrupted patient grounding (in relation to fire safety), and enhancing social support for anxiety reduction. CONCLUSION The results of our review show that paediatric patients can be safely treated within the monoplace hyperbaric environment.
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Affiliation(s)
- Areeg A Abu El Hawa
- Georgetown University School of Medicine, Washington, District of Columbia, US
| | - Jenna C Bekeny
- Georgetown University School of Medicine, Washington, District of Columbia, US
| | - Nituna W Phillips
- Center for Wound Healing and Hyperbaric Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, US
| | - Kelly Johnson-Arbor
- Georgetown University School of Medicine, Washington, District of Columbia, US.,Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, US
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Celebi ARC. Hyperbaric Oxygen Therapy for Central Retinal Artery Occlusion: Patient Selection and Perspectives. Clin Ophthalmol 2021; 15:3443-3457. [PMID: 34413628 PMCID: PMC8370578 DOI: 10.2147/opth.s224192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/04/2021] [Indexed: 12/22/2022] Open
Abstract
The central retinal artery occlusion (CRAO) is a rare ophthalmological emergency that can occur in the eye. CRAO can affect persons of any age, however it is most common in people over the age of 60. CRAO is associated with a number of risk factors, including giant cell arteritis, carotid artery atherosclerosis, cardiogenic emboli, hypertension, smoking, diabetes, and thromboembolic disease. The chance of each of these etiologies being present is assessed during the course of the investigation. Hyperbaric oxygen treatment (HBOT) is classified by the American Heart Association for CRAO at level IIb. In accordance with that, HBOT might be considered for the treatment of such a severe condition. HBOT can maintain retinal oxygenation during ischemic events by allowing oxygen to diffuse through choroidal capillaries that have been exposed to elevated partial pressures of oxygen. As a result, ischemia-related damage is reversed if applied within proper time frame. The amount of time that has passed prior to initiation of HBOT is considered to be the most critical factor in determining the best visual prognosis. According to the Undersea and Hyperbaric Medical Society, patients who are identified with CRAO after the onset of symptoms should be evaluated for HBOT within 24 hours. HBOT has the advantage of having a low risk profile, and it can be utilized to improve visual outcomes in proper patients.
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Affiliation(s)
- Ali Riza Cenk Celebi
- Atakent Education and Research Hospital, Department of Ophthalmology, Acibadem University School of Medicine, Istanbul, Turkey
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Mirasoglu B, Cetin H, Ozdemir Akgun S, Aktas S. Hyperbaric oxygen treatment for intrauterine limb ischaemia: a newborn in the chamber. Diving Hyperb Med 2021; 51:220-223. [PMID: 34157740 DOI: 10.28920/dhm51.2.220-223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/11/2021] [Indexed: 11/05/2022]
Abstract
Intrauterine limb ischaemia is a rare condition that may have devastating results. Various treatments are reported in the literature; however, results are not always promising and amputations may be required for some patients. Post-natal hyperbaric oxygen treatment (HBOT) may be a useful treatment option for the salvage of affected limbs. A patient who was born with total brachial artery occlusion and severe limb ischaemia was referred for HBOT. The patient underwent the first HBOT session at her 48th hour of life. A total of 47 HBOT sessions were completed (243.1 kPa [2.4 atmospheres absolute], duration 115 minutes being: 15 minutes of compression; three 25-minute oxygen periods separated by five-minute air breaks; and 15 minutes of decompression), four in the first 24 hours. Full recovery was achieved with this intense HBOT schedule combined with anticoagulation, fasciotomy and supportive care. The new-born tolerated HBOT well and no complications or side effects occurred. To the best of our knowledge, our patient is one of the youngest patients reported to undergo HBOT.
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Affiliation(s)
- Bengusu Mirasoglu
- Istanbul Faculty of Medicine, Underwater and Hyperbaric Medicine Department, Istanbul, Turkey.,Corresponding author: Dr Bengusu Mirasoglu, Istanbul Tip Fakultesi, Sualti Hekimligi ve Hiperbarik Tip Anabilim Dali, 34093 Fatih, Istanbul, Turkey,
| | - Hande Cetin
- Istanbul Faculty of Medicine, Underwater and Hyperbaric Medicine Department, Istanbul, Turkey
| | | | - Samil Aktas
- Istanbul Faculty of Medicine, Underwater and Hyperbaric Medicine Department, Istanbul, Turkey
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Werner D, Alawi SA. Four Extremity Amputation and Bionic Prosthesis Supply after Disseminated Intravascular Coagulation: A Follow-Up on Functionality and Quality of Life after Bionic Prosthesis Supply. World J Plast Surg 2019; 8:146-162. [PMID: 31309051 PMCID: PMC6620819 DOI: 10.29252/wjps.8.2.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Disseminated intravascular coagulopathy (DIC) is a rare symptom complex that causes embolisms within the microvasculature and extensive necrosis of the skin and the acres. During surgical decision-making, preserving functionally important structures must be weighed against radical debridement. The aim was to analyze functional recovery and quality of life of patients sustaining amputations from disseminated intravascular coagulopathy and supplied with bionic prostheses. METHODS A monocentric, retrospective review of patients with disseminated intravascular coagulopathy after sepsis was conducted from 2016 to 2018. After initial reconstruction and intensive care treatment, patients were provided with bionic prosthetic devices. A follow-up survey measuring function and quality of life was performed. RESULTS Three patients (mean: 45 years; median: 50 years) were analyzed. The first necrectomy and amputation were performed, on average, after >4 weeks post-symptom onset. All patients required re-amputation, averaging two or one re-amputations in the right or left upper extremity, respectively, and one in the lower extremities. On average, 12 operations for reconstruction of skin defects were required (x͂=8). On average, patients tolerated their prostheses for 5.67 h per day. Satisfaction metrics were either sufficient (SF-36, x̅=69) or moderate (TAPES-R, x̅=4.7). Physical skills were rated poor to fair (average TAPES-R=2.67). CONCLUSION Supplying bionic prostheses after DIC yielded sufficient to moderate results. However, prothesis weight, signal transmission disorders, and repeated functional failures were suboptimal. For extensive stump scarring, implantable signal electrodes may improve signal transmission.
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Affiliation(s)
- Dennis Werner
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Seyed Arash Alawi
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
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Savvidou OD, Kaspiris A, Bolia IK, Chloros GD, Goumenos SD, Papagelopoulos PJ, Tsiodras S. Effectiveness of Hyperbaric Oxygen Therapy for the Management of Chronic Osteomyelitis: A Systematic Review of the Literature. Orthopedics 2018; 41:193-199. [PMID: 30035798 DOI: 10.3928/01477447-20180628-02] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hyperbaric oxygen has been used as an adjunctive measure in the treatment of chronic osteomyelitis. The aim of this systematic literature review was to analyze the outcome and the complications of hyperbaric oxygen for chronic osteomyelitis. Forty-five of 96 studies reporting the use of hyper-baric oxygen for 460 patients with chronic osteomyelitis met the inclusion criteria and were analyzed qualitatively. All patients previously received antibiotics and surgical debridement. Mixed bacterial flora was detected in most of the studies. Staphylococcus aureus was the isolated pathogen in 12 (60%) of the 20 cohort and in 4 (20%) of the 20 case studies. Adjuvant hyperbaric oxygen was effective in 16 (80%) of the 20 cohort and 19 (95%) of the 20 case studies. Overall, 308 (73.5%) of 419 patients with complete data had a successful outcome and no reported relapse. Available evidence supports a potentially beneficial role of adjunctive hyperbaric oxygen, especially in refractory cases of chronic osteomyelitis. [Orthopedics. 2018; 41(4):193-199.].
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Bartek Jr. J, Skyrman S, Nekludov M, Mathiesen T, Lind F, Schechtmann G. Hyperbaric Oxygen Therapy as Adjuvant Treatment for Hardware-Related Infections in Neuromodulation. Stereotact Funct Neurosurg 2018; 96:100-107. [DOI: 10.1159/000486684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
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Hyperbaric oxygen therapy in branch retinal artery occlusion in a 15-year-old boy with methylenetetrahydrofolate reductase mutation. Case Rep Ophthalmol Med 2015; 2015:640247. [PMID: 25722905 PMCID: PMC4334424 DOI: 10.1155/2015/640247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/15/2015] [Indexed: 11/29/2022] Open
Abstract
Purpose. To report the efficacy of hyperbaric oxygen (HBO) therapy in a case of branch retinal artery occlusion (BRAO) in a 15-year-old boy. Methods. We report a 15-year-old boy with sudden loss of vision due to BRAO. Examination included laboratory evaluation for systemic risk factors. Follow-up exams included visual acuity, fundus examination, fundus fluorescein angiography, and visual field testing. HBO therapy was employed for treatment. Results. Medical history was positive for isolated glucocorticoid deficiency. Laboratory evaluation disclosed hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) mutation. The visual acuity 0.05 at presentation improved to 0.8 after 20 days of HBO therapy. There was no change on visual fields. Conclusion. In this pediatric case, HBO therapy was useful in the treatment of BRAO.
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Frawley G, Bennett M, Thistlethwaite K, Banham N. Australian paediatric hyperbaric oxygen therapy 1998-2011. Anaesth Intensive Care 2013; 41:74-81. [PMID: 23362893 DOI: 10.1177/0310057x1304100113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For a large number of ischaemic, infective, inflammatory or traumatic conditions, hyperbaric oxygen therapy is either the only treatment or an adjunct that significantly reduces morbidity and mortality. The primary aim of this review is to identify clinical conditions treated in a paediatric population referred to Australian hyperbaric units. Secondary aims are to describe outcomes of treatment and detail any complications occurring during treatment or during transfer between units. This was a retrospective cohort study (January 1998-December 2011) of children treated at four Australian hyperbaric medical units. A total of 112 children underwent 1099 hyperbaric treatments for 14 indications. Ages were not normally distributed with a median age of 14 years (interquartile range 11-16; range 0.25-16 years). Treatments were completed as planned in 81.5% of cases with 25 patients' treatment terminated at the request of physicians, parents or patients. Complications relating to hyperbaric oxygen therapy occurred in 58 treatments (5.3%). Central nervous system oxygen toxicity occurred in 1:366 treatments. Our findings indicate that provision of hyperbaric oxygen therapy to children is feasible in major regional hyperbaric units and is associated with low complication rates. Management of children in an adult hyperbaric facility, however, requires significant cooperation between paediatric, intensive care and hyperbaric consultants, as the need for transfer to another hospital and prolonged transports often impacts on optimal ongoing surgical and intensive care management.
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Affiliation(s)
- G Frawley
- Alfred Hyperbaric Unit, Alfred Hospital, Melbourne, Victoria.
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Abstract
OBJECTIVES The aim of this review is to identify clinical conditions currently treated in a pediatric population referred to the Alfred hyperbaric unit, to describe outcomes, and detail any complications occurring during treatment or transfer between units. DESIGN Retrospective, noncontrolled, clinical study. SETTING Adult hyperbaric unit in a university hospital. PATIENTS Children aged <16 yrs referred for hyperbaric oxygen therapy between January 1998 and December 2010. INTERVENTIONS Hyperbaric oxygen therapy at pressures from 2.0 to 3.0 atmospheres absolute. MEASUREMENTS AND MAIN RESULTS Fifty-four patients with a median age at presentation of 15 yrs (range, 0.25-16 yrs) received 668 treatment sessions (mean, 12.4; 95% confidence interval, 9.2-15.5). Fourteen patients were identified as having successfully completed treatment while managed in intensive care units. There were 44 events in 668 treatments (6.6%) in the pediatric group and 12 events in 126 treatments (9.6%) in the pediatric intensive care unit group. There were two oxygen toxicity convulsion (0.3%), two episodes of progressive hypoxemia (0.3%), and four episodes of brief hypotension (0.6%). CONCLUSIONS Provision of hyperbaric oxygen to children with significant illness is feasible and associated with a low risk of complications. The most difficult aspect of managing pediatric hyperbaric oxygen therapy is in the coordination of the treatment with ongoing surgical and intensive care management. The lack of pediatric staff and facilities in major hyperbaric units necessitates multiple transfers for appropriate treatment.
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Ergul Y, Soydemir D, Tastan Y, Omeroglu RE. Does early hyperbaric oxygen therapy prevent extremity necrosis in Nicolau syndrome? Pediatr Int 2012; 54:e15-8. [PMID: 22631583 DOI: 10.1111/j.1442-200x.2011.03475.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Yakup Ergul
- Department of Pediatric, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Cesca E, Garetto G, Frascella E, Cesaro S, Dall'igna P, Cecchetto G. Hyperbaric oxygen treatment of superficial soft tissue lesions in children with oncologic disease. Pediatr Rep 2012; 4:e1. [PMID: 22690301 PMCID: PMC3357608 DOI: 10.4081/pr.2012.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 10/24/2011] [Indexed: 12/03/2022] Open
Abstract
This study aimed to assess the feasibility and results of hyperbaric oxygen therapy (HOT) as supportive treatment of lesions of superficial soft tissues in children with oncological diseases. This was a retrospective analysis and review of all records of children observed at the Pediatric Hematology-Oncology Department of the University of Padova and treated adjuvantly with HOT. Between 1996 and 2010, 12 patients (5 males and 7 females, median age 7 years, range 0.5-16) underwent HOT. The effectiveness of HOT varied according to the lesion treated. Ten out of 12 patients were cured. Efficacy was most questionable in 2 patients with skin graft and flaps at risk. Compliance to therapy was close to 100%. In just one case, HOT was interrupted for the appearance of local skin metastases close to the site of primary tumor. HOT showed itself to be safe and effective in most patients even those immunocompromised or critically ill.
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Zhao H, Zhang Q, Xue Y, Chen X, Haun RS. Effects of hyperbaric oxygen on the expression of claudins after cerebral ischemia-reperfusion in rats. Exp Brain Res 2011; 212:109-17. [PMID: 21626096 DOI: 10.1007/s00221-011-2702-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 04/15/2011] [Indexed: 01/09/2023]
Abstract
The malfunction of tight junctions (TJs) between endothelial cells in the blood brain barrier (BBB) is the pathophysiological basis for cerebral ischemia-reperfusion (IR) injury. Claudins, major molecular elements of the TJs, play a key role in the paracellular permeability of the BBB. Although several studies have demonstrated the impact of hyperbaric oxygenation (HBO) on boosting oxygen supply and reducing infarct size, its effect and underlying mechanism on the integrity of the BBB is unknown. To study the function of HBO on claudins and the permeability of the BBB, we replicated the animal model of local cerebral IR. Using Evans blue dye, permeability of the BBB was examined. Transmission electron microscopy (TEM), immunohistochemistry, western blot, and gelatin zymography were used to detect the integrity of the BBB, the expression of claudin-1 and claudin-5, and the activity of matrix metalloproteinases (MMPs) in brain microvessel endothelium. Our data indicate that compared with the sham-operated group, IR increased permeability of the BBB to Evans blue dye (P < 0.01), peaking at 4 h. The BBB ultrastructure was disrupted and the expression of claudin-5 and claudin-1 decreased (P < 0.01) in the 4 and 72 h IR group, respectively. Increased claudin-5 and claudin-1 expression and decreased permeability of the BBB were observed in the HBO + IR group (P < 0.01) via the suppression of MMP-2 and MMP-9, respectively. Our study provides direct evidence that HBO decreases the permeability of the BBB by reducing the enzymatic activity of MMPs and augmenting the expression of claudins at different stages in cerebral IR injury.
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Affiliation(s)
- Hong Zhao
- Department of Experimental Center of Functional Subjects, College of Basic Medicine, China Medical University, Shenyang 110001, China.
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Meningococcal purpura fulminans in children: I. Initial orthopedic management. J Child Orthop 2010; 4:401-7. [PMID: 21966303 PMCID: PMC2946526 DOI: 10.1007/s11832-010-0284-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 07/29/2010] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Purpura fulminans is a rare and extremely severe infection, mostly due to Neisseria meningitidis frequently causing early orthopedic lesions. Few studies have reported on the initial surgical management of acute purpura fulminans. The aim of this study is to look at the predictive factors in orthopedic outcome in light of the initial surgical management in children surviving initial resuscitation. METHODS Nineteen patients referred to our institution between 1987 and 2005 were taken care of at the very beginning of the purpura fulminans. All cases were retrospectively reviewed so as to collect information on the total skin necrosis, vascular insufficiency, gangrene, and total duration of vasopressive treatment. RESULTS All patients had multiorgan failure; only one never developed any skin necrosis or ischemia. Eighteen patients lost tissue, leading to 22 skin grafts, including two total skin grafts. There was only one graft failure. Thirteen patients were concerned by an amputation, representing, in total, 54 fingers, 36 toes, two transmetatarsal, and ten transtibial below-knee amputations, with a mean delay of 4 weeks after onset of the disease. Necrosis seems to affect mainly the lower limbs, but there is no predictive factor that impacted on the orthopedic outcome. We did not perform any fasciotomy or compartment pressure measurement to avoid non-perfusion worsening; nonetheless, our outcome in this series is comparable to existing series in the literature. V.A.C.(®) therapy could be promising regarding the management of skin necrosis in this particular context. While suffering from general multiorgan failure, great care should be observed not to miss any additional osseous or articular infection, as some patients also develop local osteitis and osteomyelitis that are often not diagnosed. CONCLUSIONS We do not advocate very early surgery during the acute phase of purpura fulminans, as it does not change the orthopedic outcome in these children. By performing amputations and skin coverage some time after the acute phase, we obtained similar results to those found in the literature.
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Newcomb A, Frawley G, Fock A, Bennett M, d'Udekem Y. Hyperbaric Oxygenation in the Management of Cerebral Arterial Gas Embolism During Cavopulmonary Connection Surgery. J Cardiothorac Vasc Anesth 2008; 22:576-80. [DOI: 10.1053/j.jvca.2007.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Indexed: 11/11/2022]
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Pandey A, Gangopadhyay AN, Upadhyaya VD. Necrotising fasciitis in children and neonates: current concepts. J Wound Care 2008; 17:5-10. [PMID: 18210950 DOI: 10.12968/jowc.2008.17.1.27914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
While the incidence is very low, necrotising fasciitis in neonates and children is a potentially life-threatening infection that requires rapid diagnosis and treatment. This review describes its aetiology, symptoms, clinical feature and treatment.
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Affiliation(s)
- A Pandey
- Institute of Medical Sciences, Banaras Hindu University,Varanasi, India
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Lorenzoni A, Wideman R. Inhaling One Hundred Percent Oxygen Eliminates the Systemic Arterial Hypoxemic Response of Broilers to Intravenous Microparticle Injections. Poult Sci 2008; 87:146-54. [DOI: 10.3382/ps.2007-00364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Prusakowski MK. A teenage boy with weakness and syncope. Pediatr Emerg Care 2007; 23:673-5. [PMID: 17876264 DOI: 10.1097/pec.0b013e31814e0882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Melanie K Prusakowski
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Aydinoz S, Yildiz S. A different approach to the management of necrotizing fasciitis in neonates: hyperbaric oxygen. Int Wound J 2007; 4:94-5. [PMID: 17425553 PMCID: PMC7951709 DOI: 10.1111/j.1742-481x.2007.00304.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Aydinoz S, Yildiz S. "Conservative management of necrotizing fasciitis in children". J Pediatr Surg 2007; 42:912. [PMID: 17502211 DOI: 10.1016/j.jpedsurg.2007.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wiebers J, Purdy I, Lieber M, Milisavljevic V. Hyperbaric oxygen in treatment of neonatal arterial thromboembolism of lower extremities. J Perinatol 2006; 26:777-9. [PMID: 17122788 DOI: 10.1038/sj.jp.7211606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Arterial thromboembolism (TE) in the absence of current or recent history of a central catheter is a rare condition in newborn period. We report a case of severe lower extremities arterial TE of unclear etiology in a full-term neonate. By adding hyperbaric oxygenation to thrombolytic and antithrombotic therapy, we achieved improved perfusion of the upper leg tissues, preserving the knee and enabling below-the-knee amputation.
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Affiliation(s)
- J Wiebers
- Division of Neonatology & Developmental Biology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA 90095, USA
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Gast T, Kowal-Vern A, An G, Hanumadass ML. Purpura fulminans in an adult patient with Haemophilus influenzae sepsis: case report and review of the literature. J Burn Care Res 2006; 27:102-7. [PMID: 16566545 DOI: 10.1097/01.bcr.0000194269.95027.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpura fulminans is a rare complication of a coagulopathy or an infection. Haemophilus influenzae infection, which has decreased since the haemophilus influenzae type B vaccine was initiated, is an unusual initiating cause of purpura fulminans. This case is the first reported in the literature of an adult who developed purpura fulminans after Haemophilus influenzae sepsis. Her elevated beta2 glycoprotein 1 ratio may have contributed to the severity of her disease. Although rare, Haemophilus influenzae may precipitate purpura fulminans. Current therapy is directed at control of precipitating factors, removal of nonviable tissue, treatment of secondary infections, and physiologic support. There also is evidence that patients respond well to hyperbaric oxygen therapy, with decreasing limb and tissue loss.
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Affiliation(s)
- Thomas Gast
- Department of Trauma, Sumner L. Koch Burn Center, John H. Stroger, Jr., Hospital of Cook County, Chicago, Illinois 60612, USA
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Tilelli JA, Farrell MM. Hyperbaric oxygen therapy for purpura fulminans-comment. Pediatr Emerg Care 2006; 22:394. [PMID: 16714977 DOI: 10.1097/01.pec.0000216801.58512.bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kurschel S, Mohia A, Weigl V, Eder HG. Hyperbaric oxygen therapy for the treatment of brain abscess in children. Childs Nerv Syst 2006; 22:38-42. [PMID: 15875200 DOI: 10.1007/s00381-005-1147-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The treatment of brain abscess remains a challenging topic usually involving a multimodal concept. METHODS We report our experience with hyperbaric oxygen (HBO) therapy in five children presenting with brain abscesses between 1995 and 2002 at the Department of Neurosurgery, Graz. Mean age was 14.8 (range 11-17 years). All abscesses were located supratentorially. One child had a single abscess and one had multilocated abscesses. Two other patients presented with both subdural empyema and brain abscess, one of them showing an epidural empyema as well. In another child, the brain abscess was associated with meningoencephalitis and subdural empyema. In all of them the underlying condition was spread of infection from the paranasal sinuses, except for one, who was immunocompromised due to cytotoxic chemotherapy for acute lymphocytic leukaemia. RESULTS One single brain abscess and one of the multiple abscesses were drained. All subdural/epidural empyemas were treated surgically. Antibiotics were administered intravenously for 13 to 22 days (mean 22 days). All patients underwent HBO therapy; the number of treatments ranged from 26 to 45 "dives" (mean 30). Treatments were given once daily at 2.2 atmosphere absolutes for 60 min at 12 m. During the hospital stay all improved their clinical condition, with continued regression of abnormalities on magnetic resonance imaging (MRI). In the following weeks, other interventions were performed to treat the origin of the infections. At 6 months follow-up they were all in good clinical condition, either symptom free or with minor residual symptoms. MRI at this time showed no evidence of disease in three, a residual dural enhancement in one and a residual shrunken collection in the child with multilocated abscesses. No recurrence was observed during a mean follow-up of 21 months (range from 7 to 72 months). CONCLUSION HBO therapy in children with brain abscesses seems to be safe and effective, even when they are associated with subdural or epidural empyemas. It provides a helpful adjuvant tool in the usual multimodal treatment of cerebral infections and may reduce the intravenous course of antibiotics and, consequently, the duration of hospitalization. Multidisciplinary management is recommended to optimize care for these critically ill children.
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Affiliation(s)
- Senta Kurschel
- Department of Neurosurgery, Medical University, Auenbruggerplatz 29, 8036 Graz, Austria
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Abstract
Osteomyelitis is one of the more common invasive bacterial infections in children leading to hospitalization and prolonged antibiotic administration. Over the past decade, increasing microbial virulence, diminishing antibiotic susceptibility, and advances in diagnostic molecular microbiology and imaging techniques have led to changes in the clinical management of children with suspected osteomyelitis, which are reviewed in this article.
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Affiliation(s)
- Sheldon L Kaplan
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
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Tilelli JA, Farrell MM. Hyperbaric oxygen therapy for purpura fulminans: comment. Pediatr Emerg Care 2005; 21:484; author reply 485. [PMID: 16027587 DOI: 10.1097/01.pec.0000169441.52185.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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LeDez KM, Zbitnew G. Hyperbaric treatment of cerebral air embolism in an infant with cyanotic congenital heart disease. Can J Anaesth 2005; 52:403-8. [PMID: 15814756 DOI: 10.1007/bf03016284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Infants with cyanotic congenital heart disease are at risk for cerebral arterial gas embolism (CAGE) from iv infusion lines. Concern about the hazards and difficulty of caring for such patients inside a hyperbaric chamber may deter referral. We report a complex case in which a small infant was managed successfully using a modified hyperbaric oxygen treatment (HBOT) schedule. CLINICAL FEATURES A four-month-old 6.19 kg male infant with a recent Glenn shunt for double-outlet right ventricle had a seizure and became unstable immediately after an iv drug infusion. The patient was sedated, intubated and ventilated and dobutamine was commenced. A computerized tomography (CT) scan performed ten hours later demonstrated three intracranial air bubbles. About ten hours later the patient was referred for HBOT which commenced soon afterwards in a multiplace chamber. Since the right-to-left shunt would greatly increase the risk of decompression illness from breathing hyperbaric air HBOT was modified by the use of an abbreviated schedule at reduced pressure. Two 90-min HBOT sessions were administered within 24 hr at 38 feet of sea-water pressure, equivalent to 2.15 atmospheres absolute without any air break. During treatment the infant was ventilated using an Oxford Penlon ventilator. A subsequent CT scan demonstrated the absence of air. After extubation he appeared neurologically intact except for some weakness of the left arm. CONCLUSION Hyperbaric oxygen may be utilized to treat CAGE in small infants with right-to-left shunt and should be commenced promptly.
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Affiliation(s)
- Kenneth M LeDez
- Department of Anesthesia, Memorial University of Newfoundland, Health Sciences Centre, 300 Prince Phillip Drive, St. John's, Newfoundland A1B 3V6, Canada.
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Krzelj V, Petri NM, Mestrovic J, Andric D, Biocic M. Purpura fulminans successfully treated with hyperbaric oxygen--a report of 2 cases. Pediatr Emerg Care 2005; 21:31-4. [PMID: 15643321 DOI: 10.1097/01.pec.0000150986.19228.81] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wheeler JS, Anderson BJ, De Chalain TMB. Surgical interventions in children with meningococcal purpura fulminans--a review of 117 procedures in 21 children. J Pediatr Surg 2003; 38:597-603. [PMID: 12677574 DOI: 10.1053/jpsu.2003.50130] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE There are few reports describing the surgical management and outcome of children suffering purpura fulminans secondary to meningococcal sepsis. New Zealand is in the grips of a meningococcal epidemic, and, with the attendant sequalae of the disease process, the authors sought to formally review the children who have required surgical involvement. METHODS A retrospective case review of children with the sequalae of meningococcal disease presenting to the Orthopedic and Plastic Surgical Units in a university teaching hospital was undertaken. RESULTS There were 117 procedures in 21 children performed over a 12-year period. Surgical management was separated into 2 phases-early and late. The mean delay from admission with acute sepsis to the first surgical procedure (ie, early intervention) was 15.9 days. Debridement and autologous skin grafting was the mainstay of managing the necrotic defects; however, allograft skin proved a useful adjunct as a physiologic dressing. Local flaps were used with deep defects down to bone, but in the extremities amputation to viable tissue was required once gangrene was demarcated. Amputations were carried out in 9 of 21 children. Late interventions were related to relief of contractures or fibula overgrowth causing stump ulceration. Clinical follow-up showed that all children interviewed over 5 years of age (9 children) attend ordinary regular school classes and were physically active within the context of their physical disabilities. CONCLUSIONS The data would suggest that children requiring surgery for purpura fulminans achieve age-appropriate milestones and are primarily limited by their physical disability related to amputations, scarring, and abnormal bone growth.
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Affiliation(s)
- Jonathan Simon Wheeler
- Centre for Reconstructive and Plastic Surgery at Middlemore Hospital and the Department of Anaesthesia at Auckland Children's Hospital, Auckland, NZ
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Greenberg JE, Falabella AF, Bello YM, Schachner LA. Tissue-engineered skin in the healing of wound stumps from limb amputations secondary to purpura fulminans. Pediatr Dermatol 2003; 20:169-72. [PMID: 12657020 DOI: 10.1046/j.1525-1470.2003.20218.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Currently wound treatment options of amputation stumps due to purpura fulminans include healing by secondary intention from wound debridement, split-thickness skin grafting, tissue and muscle flaps, plantar skin free transfer, skin expansion, artificial skin, and hyperbaric oxygen therapy. We saw a 6-month-old girl with purpura fulminans as a complication of meningococcemia. She developed necrosis of the distal extremities resulting in bilateral amputation of the lower limbs. Shortly thereafter the leg stumps also became necrosed and she underwent unsuccessful split-thickness grafts of lower limb ulcers. The patient's difficult-to-heal wounds made her an excellent candidate for treatment with tissue-engineered skin. At 10 months of age, this was applied to her previously nonhealing wounds. The tissue-engineered skin induced rapid healing of the patient's chronic amputation stump ulcers and provided her with substantial pain relief. In conclusion, tissue-engineered skin appears to be a potential beneficial treatment for chronic wounds in children with nonhealing amputation stumps.
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Affiliation(s)
- J E Greenberg
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida, USA
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Mathieu-Nolf M. Poisons in the air: a cause of chronic disease in children. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 2002; 40:483-91. [PMID: 12217001 DOI: 10.1081/clt-120006751] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Children represent the largest subpopulation of those susceptible to the adverse effects of air pollution. Compared to adults, children express a greater vulnerability, which can be explained by differences in: the circumstances of exposure related to age, their activities, their child status, differences in lung anatomy and physiology, differences in the clinical expression of disease, and their organ maturity. Many factors have to be assessed in order to evaluate the severity of toxic exposures: pollutant solubility, particle size, concentration, reactivity of pollutants, and pattern of ventilation. Within the numerous air pollutants, some are of special concern for children. For example, ozone has been shown to affect the lungs of healthy school children, especially asthmatics. Airborne particles, nitrogen oxides, sulfur oxides, and acid aerosols have also been shown to induce acute respiratory symptoms, asthma, and bronchitis. Of particular importance is carbon monoxide, which, under certain circumstances, may be found in highly toxic concentrations indoors where children spend most of their time. Special attention has to be given to children's unique differences in order to evaluate the clinical consequences of their toxic exposures. This circumstance emphasizes the key roles of poison centers, clinical toxicologists, and pediatricians, all of whom can collaborate on the identification, assessment, and surveillance of toxic risk for child health and development.
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Andreasen TJ, Green SD, Childers BJ. Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans. Plast Reconstr Surg 2001; 107:1025-35. [PMID: 11252099 DOI: 10.1097/00006534-200104010-00019] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEARNING OBJECTIVES After studying the article, the participant should be able to: 1. Describe the most common bacteriology of necrotizing fasciitis and purpura fulminans. 2. Describe the "finger test" in the diagnosis of necrotizing fasciitis. 3. Discuss the three presentation patterns of necrotizing fasciitis. 4. Discuss the pathophysiology of acute infectious purpura fulminans. 5. Discuss the treatment strategies for necrotizing fasciitis and purpura fulminans, including the use of artificial skin substitutes. Necrotizing fasciitis and purpura fulminans are two destructive processes that involve skin and soft tissues. The plastic and reconstructive surgeon may frequently be called on for assistance in the diagnosis, treatment, and/or reconstruction of patients with these conditions. Understanding the natural history and unique characteristics of these processes is essential for effective surgical management and favorable patient outcome. A comprehensive review of the literature pertaining to these two conditions is presented, outlining the different pathophysiologies, the patterns of presentation, and the treatment strategies necessary for successful management of these massive infectious soft-tissue diseases.
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Affiliation(s)
- T J Andreasen
- Division of Plastic and Reconstructive Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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Leclerc F, Leteurtre S, Cremer R, Fourier C, Sadik A. Do new strategies in meningococcemia produce better outcomes? Crit Care Med 2000; 28:S60-3. [PMID: 11007200 DOI: 10.1097/00003246-200009001-00013] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Meningococcal septic shock (MSS) has high mortality and morbidity rates. In addition to the traditional prompt antibiotics and respiratory and circulatory support, new treatment strategies have been proposed. AGAINST THE INFLAMMATORY CASCADE Immunotherapy, such as antiserum to Escherichia coli J5 and human antilipid A monoclonal antibodies/centoxin (HA-1A), did not significantly alter the mortality rate of MSS; we are awaiting the results of the bactericidal/permeability-increasing protein multicenter trial. Two series reported the effects of hemofiltration and hemodiafiltration in MSS, but the true benefits remain unknown. TO TREAT HEMOSTATIC ABNORMALITIES In MSS, heparin is still controversial and antithrombin concentrate use has been reported in only one child. Several case reports on protein C and recombinant tissue plasminogen activator have been published; the efficacy (improvement in shock and organ dysfunction and reduction in amputation rate) and safety (intracerebral hemorrhage with recombinant tissue plasminogen activator) of these treatments need further evaluation. Blood and plasma exchange appear to be safe and are supposed to reduce mortality, but it is difficult to draw firm conclusions from published studies. Finally, local application of medicinal leeches has been reported to improve purpuric lesions. TO INDUCE VASODILATION Prostacyclin, or epoprostenol, infusion, sodium nitroprussiate infusion, sympathetic blockade, and topical nitroglycerin have been reported to improve distal perfusion; however, these reports are all anecdotal. OTHER STRATEGIES Improvement in limb perfusion was achieved after hyperbaric oxygenation in patients with purpura fulminans caused by different pathogens. Most authors recommend monitoring of compartment pressures and performing fasciotomy as indicated. Finally, extracorporeal membrane oxygenation was recently proposed to support seven children with intractable MSS. CONCLUSIONS There is no proof that unconventional treatments have a significant impact on outcome in MSS; prospective multicenter trials are needed. At present, early recognition of meningococcal sepsis and appropriate treatment seem to be the optimal methods of improving outcome. Efforts to find an effective meningococcal vaccine must be continued.
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Affiliation(s)
- F Leclerc
- Pediatric Intensive Care Unit, University Hospital of Lille, France.
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