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Rozbicki P, Usowski J, Krzywdzińska S, Jurkiewicz D, Siewiera J. Assessing the Effectiveness of Different Hyperbaric Oxygen Treatment Methods in Patients with Sudden Sensorineural Hearing Loss. Audiol Res 2024; 14:333-341. [PMID: 38666900 PMCID: PMC11047301 DOI: 10.3390/audiolres14020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION Hyperbaric oxygen therapy (HBOT) is one of the treatment methods in patients with sudden sensorineural hearing loss (SSNHL). It is recommended as an elective treatment in patients undergoing steroid therapy. According to current scientific reports, HBOT should be implemented within two weeks after the first symptoms. However, as far as the profile of HBOT is concerned, there are no straightforward recommendations. METHODS The data obtained from the medical records of 218 patients undergoing HBOT for SSNHL at the Military Institute of Medicine-National Research Institute were analyzed statistically for the impact of the duration and the delay in implementing HBOT on the end results of pure-tone audiometry (PTA). RESULTS A statistically significant hearing improvement in patients undergoing more than 15 cycles of HBOT was detected at all frequencies except for 1500 Hz; in the group reporting for treatment with a delay of more than 10 days, hearing improvement was statistically unsignificant at frequencies of 1500, 3000, and 4000 Hz. CONCLUSIONS The statistical analysis showed that the urgent onset of HBOT could be a significant factor in the therapy of SSNHL.
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Affiliation(s)
- Paweł Rozbicki
- Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Jacek Usowski
- Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Sandra Krzywdzińska
- Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Jacek Siewiera
- Department of Hyperbaric Medicine, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
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Barski M, Jermakow N, Barska K, Siewiera J. Evaluation of the effects of hyperbaric on human attention functions based on eye movements recorded using an infrared camera. ADV CLIN EXP MED 2023; 32:1385-1392. [PMID: 37589224 DOI: 10.17219/acem/162923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/08/2022] [Accepted: 04/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND This study aimed to assess the influence of elevated atmospheric pressure on the functions of attention of medical personnel working in hyperbaric chambers. We enrolled 15 participants who met the inclusion criteria. The test consisted of performing the same medical procedure under 2 conditions. For each of these test conditions, right eye movements were recorded using an oculograph. The obtained results revealed a relationship between elevated atmospheric pressure and the ability of medical personnel to focus. OBJECTIVES To assess the influence of hyperbaric oxygen (HBO2) on visual attention in medical personnel during medical activities performed under normobaric (1 absolute atmosphere (1 ATA)) and hyperbaric (4 ATA) conditions inside a hyperbaric chamber. MATERIAL AND METHODS Each participant had a valid license to act as a medical attendant during therapeutic hyperbaric sessions. Fifteen individuals, 10 men and 5 women aged between 28 and 65 years, participated in the study. The participants were asked to perform a medical procedure involving the preparation of a syringe with a drug administered by an infusion pump under 2 test conditions: 1 ATA corresponding to the atmospheric pressure on land, and 4 ATA corresponding to an underwater depth of 30 m. The order of test conditions was random. Both test conditions were performed inside a hyperbaric chamber. RESULTS The number of fixations in the area of interest (AOI) varied between stages (1, 2 and 3) and task conditions (1 ATA and 4 ATA), with lower values for the 4 ATA condition. Under 1 ATA, 30% of eye fixations were in the AOI, as compared to only 6% under 4 ATA. CONCLUSIONS The obtained results indicate that elevated atmospheric pressure has negative effects on the attention of medical personnel.
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Affiliation(s)
- Michał Barski
- Clinical Department of Hyperbaric Medicine, Military Institute of Medicine in Warsaw, Poland
| | - Natalia Jermakow
- Clinical Department of Hyperbaric Medicine, Military Institute of Medicine in Warsaw, Poland
- Clinical Department of Hyperbaric Medicine, Military Institute of Medicine in Warsaw, Poland
| | - Katarzyna Barska
- Clinic of Emergency Medicine, University Clinical Hospital, Wrocław, Poland
| | - Jacek Siewiera
- Clinical Department of Hyperbaric Medicine, Military Institute of Medicine in Warsaw, Poland
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Łuczak MW, Dżaman K, Zaręba Ł, Czerwaty K, Siewiera J, Głuszko A, Olszewska E, Brzost J, Kantor I, Szczepański MJ, Ludwig N. HMGB1 Carried by Small Extracellular Vesicles Potentially Plays a Role in Promoting Acquired Middle Ear Cholesteatoma. Diagnostics (Basel) 2023; 13:3469. [PMID: 37998605 PMCID: PMC10669961 DOI: 10.3390/diagnostics13223469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Cholesteatoma is a specific medical condition involving the abnormal, non-cancerous growth of skin-like tissue in the middle ear, potentially leading to a collection of debris and even infections. The receptor for advanced glycation (RAGE) and its ligand, high-mobility box 1 (HMGB1), are both known to be overexpressed in cholesteatoma and play a potential role in the pathogenesis of the disease. In this study, we investigated the role of small extracellular vesicles (sEVs) in carrying HMGB1 and inducing disease-promoting effects in cholesteatoma. No significant differences in the concentration of isolated sEVs in the plasma of cholesteatoma patients (n = 17) and controls (n = 22) were found (p > 0.05); however, cholesteatoma-derived sEVs carried significantly higher levels of HMGB1 (p < 0.05). In comparison to sEVs isolated from the plasma of controls, cholesteatoma-derived sEVs significantly enhanced keratinocyte proliferation and IL-6 production (p < 0.05), potentially by engaging multiple activation pathways including MAPKp44/p42, STAT3, and the NF-κB pathway. Thus, HMGB1(+) sEVs emerge as a novel factor potentially promoting cholesteatoma progression.
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Affiliation(s)
- Michał W. Łuczak
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI 02906, USA;
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
| | - Karolina Dżaman
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Łukasz Zaręba
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
| | - Katarzyna Czerwaty
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Jacek Siewiera
- Department of Hyperbaric Medicine, Military Institute of Medicine-National Research Institute, 00-902 Warsaw, Poland;
| | - Alicja Głuszko
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Jacek Brzost
- Department of Otolaryngology, The Children’s Memorial Health Institute, 00-328 Warsaw, Poland;
| | - Ireneusz Kantor
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Mirosław J. Szczepański
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Nils Ludwig
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
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Rozbicki P, Usowski J, Siewiera J, Jurkiewicz D. The management of sudden sensorineural hearing loss during COVID-19 pandemic. Otolaryngol Pol 2023; 77:7-11. [PMID: 37772322 DOI: 10.5604/01.3001.0016.3301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
<b>Introduction:</b> The COVID-19 pandemic constituted a significant challenge for healthcare systems. Epidemiological restrictions led to deferral of healthcare and influenced the variety of symptoms reported by patients suffering from Sudden Sensorineural Hearing Loss.</br></br> <b>Aim:</b> The aim of the study was to compare the duration of treatment implementation and symptoms reported by patients suffering from SSNHL before and during the COVID-19 pandemic.</br></br> <b>Material and methods:</b> Patients admitted to the Military Institute of Medicine - National Research Institute for SSNHL treatment were included in a survey conducted between 01.10.2021-31.12.2021. Questions on symptoms reported, chronic conditions, timeframe between first symptoms and implementation of pharmacotherapy, and hyperbaric oxygen therapy were included in the survey. The results were compared with data obtained by the Team between 01.2017-12.2019.</br></br> <b>Results:</b> 34 patients (19 females, 15 males) of the average age of 46.3 who participated in the survey indicated a significantly delayed implementation of pharmacotherapy and hyperbaric oxygen therapy in comparison to population from before the pandemic (12.08 vs. 5.41 [days]; 17.5 vs. 8.29 [days]). The survey also showed differences in the number of symptoms reported.</br></br> <b>Discussion:</b> The differences in time of implementation of SSNHL treatment could have been related to pandemic restrictions which contributed to longer queueing for health benefits and fear of contact with health service. Differences in symptomatology point towards SARS-CoV-2 as a pathogenetic factor of SSNHL.</br></br> <b>Conclusions:</b> The COVID-19 pandemic significantly influenced the treatment of Sudden Sensorineural Hearing Loss. The study demonstrated a diverse symptomatology of SSNHL before and during the pandemic.
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Affiliation(s)
- Paweł Rozbicki
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw
| | - Jacek Usowski
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw
| | - Jacek Siewiera
- Clinical Department of Hyperbaric Medicine, Military Institute of Medicine - National Research Institute, Warsaw
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
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Siewiera J, Brodaczewska K, Jermakow N, Lubas A, Kłos K, Majewska A, Kot J. Effectiveness of Hyperbaric Oxygen Therapy in SARS-CoV-2 Pneumonia: The Primary Results of a Randomised Clinical Trial. J Clin Med 2022; 12:jcm12010008. [PMID: 36614808 PMCID: PMC9820955 DOI: 10.3390/jcm12010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Mortality in COVID-19 is mainly associated with respiratory failure, cytokine storm, and macrophage activation. Oxygenation and anti-inflammatory effects of Hyperbaric Oxygen Therapy (HBOT) suggest that it is a promising adjunct treatment for COVID-19. Repeated sessions of HBO with standard COVID-19 therapy were used to reduce the inflammation and increase oxygenation. We evaluated the safety and efficacy of HBOT in avoiding the replacement ventilation and/or ECMO and its effect on the inflammatory process. Twenty-eight moderate-to-severe COVID-19 patients were randomized into control or HBOT group. HBOT patients participated in 5 hyperbaric sessions (60 min). Before and after each session blood gas levels and vital parameters were monitored. Blood samples were collected for extended biochemical tests, blood morphology and immunological assays. There were 3 deaths in the control, no deaths in the HBOT group. No adverse events leading to discontinuation of HBOT were observed and patients receiving HBOT required lower oxygen delivery. We observed decrease in CRP, ferritin and LDH and increase in CD3 in HBOT group compared to control. This study confirmed the feasibility and safety of HBOT in patients with COVID-19 and indicated HBOT can lead to alleviation of inflammation and partial restoration of T cell responses.
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Affiliation(s)
- Jacek Siewiera
- Department of Hyperbaric Medicine, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Klaudia Brodaczewska
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Natalia Jermakow
- Department of Hyperbaric Medicine, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Arkadiusz Lubas
- Department of Internal Diseases Nephrology and Dialysis, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Krzysztof Kłos
- Department of Infectious Diseases and Allergology, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
| | - Aleksandra Majewska
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine—National Research Institute, 04-141 Warsaw, Poland
- Postgraduate School of Molecular Medicine (SMM), Warsaw Medical University, 02-091 Warsaw, Poland
- Correspondence:
| | - Jacek Kot
- National Centre for Hyperbaric Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 81-519 Gdynia, Poland
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Rozbicki P, Usowski J, Siewiera J, Jurkiewicz D. The Influence of Steroid Therapy on the Treatment Results in Patients with Sudden Sensorineural Hearing Loss. J Clin Med 2022; 11:jcm11206085. [PMID: 36294406 PMCID: PMC9605235 DOI: 10.3390/jcm11206085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/28/2022] Open
Abstract
Oral, intravenous, or intratympanic steroid therapy (ST) are commonly applied methods of pharmacotherapy in Sudden Sensorineural Hearing Loss (SSNHL). There are vast discrepancies on the recommended initial dose and the duration of ST in medical reports. The aim of the research is a retrospective comparison of patients’ examination results with different therapeutical strategies. The medical records of 218 patients treated for SSNHL at the Military Institute of Medicine were subjected to retrospective analysis by comparison of the results of pure tone audiometry prior to and after treatment with steroid therapy (first-dose delay, mass of first dose, duration of treatment). Postponement of implementation of ST to 5 days resulted in a significant improvement of hearing across all frequencies. The implementation of ST sequentially in periods (5th−10th day; >10th day) resulted in a statistically insignificant improvement of hearing in the following frequencies: 250 Hz, 1000 Hz, 1500 Hz, 2000 Hz, 3000 Hz, 4000 Hz. There was a statistical improvement of hearing within all frequencies analyzed for the initial dose of prednisone above 50 mg. For an initial dose below 50 mg, in 4000 Hz, the improvement of hearing was statistically insignificant. The research demonstrated a significant influence of steroid therapy on treatment results in patients with Sudden Sensorineural Hearing Loss.
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Affiliation(s)
- Paweł Rozbicki
- Department of Otolaryngology and Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland
- Correspondence: ; Tel.: +48-261-816-471
| | - Jacek Usowski
- Department of Otolaryngology and Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Jacek Siewiera
- Department of Hyperbaric Medicine, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Cranio-Maxillo-Facial Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland
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Głuszko A, Szczepański MJ, Whiteside TL, Reichert TE, Siewiera J, Ludwig N. Small Extracellular Vesicles from Head and Neck Squamous Cell Carcinoma Cells Carry a Proteomic Signature for Tumor Hypoxia. Cancers (Basel) 2021; 13:cancers13164176. [PMID: 34439329 PMCID: PMC8393921 DOI: 10.3390/cancers13164176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022] Open
Abstract
Tissue hypoxia is commonly observed in head and neck squamous cell carcinomas (HNSCCs), resulting in molecular and functional alterations of the tumor cells. The aim of this study was to characterize tumor-derived small extracellular vesicles (sEVs) released under hypoxic vs. normoxic conditions and analyze their proteomic content. HNSCC cells (FaDu, PCI-30, SCC-25) and HaCaT keratinocytes were cultured in 21, 10, 5, and 1% O2. sEVs were isolated from supernatants using size exclusion chromatography (SEC) and characterized by nanoparticle tracking analysis, electron microscopy, immunoblotting, and high-resolution mass spectrometry. Isolated sEVs ranged in size from 125-135 nm and contained CD63 and CD9 but not Grp94. sEVs reflected the hypoxic profile of HNSCC parent cells: about 15% of the total detected proteins were unique for hypoxic cells. Hypoxic sEVs expressed a common signature of seven hypoxia-related proteins (KT33B, DYSF, STON2, MLX, LIPA3, NEK5, P12L1) and were enriched in pro-angiogenic proteins. Protein profiles of sEVs reflected the degree of tumor hypoxia and could serve as potential sEV-based biomarkers for hypoxic conditions. Adaptation of HNSCC cells to hypoxia is associated with increased release of sEVs, which are enriched in a unique protein profile. Thus, tumor-derived sEVs can potentially be useful for evaluating levels of hypoxia in HNSCC.
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Affiliation(s)
- Alicja Głuszko
- Chair and Department of Biochemistry, Medical University of Warsaw, 1 Banacha St., 02-097 Warsaw, Poland;
| | - Mirosław J. Szczepański
- Chair and Department of Biochemistry, Medical University of Warsaw, 1 Banacha St., 02-097 Warsaw, Poland;
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 03-242 Warsaw, Poland
- Correspondence:
| | - Theresa L. Whiteside
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
- Department of Immunology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Department of Pathology, UPMC Hillman Cancer Centre, Pittsburgh, PA 15213, USA
| | - Torsten E. Reichert
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (T.E.R.); (N.L.)
| | - Jacek Siewiera
- Department of Hyperbaric Medicine, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | - Nils Ludwig
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (T.E.R.); (N.L.)
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Siewiera J, Szałański P, Tomaszewski D, Kot J. High-Altitude Decompression Sickness Treated with Hyperbaric Therapy and Extracorporeal Oxygenation. Aerosp Med Hum Perform 2020; 91:106-109. [PMID: 31980050 DOI: 10.3357/amhp.5457.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: High-altitude decompression sickness (HADCS) is a rare condition that has been associated with aircraft accidents. To the best of our knowledge, the present paper is the first case report of a patient treated for severe HADCS using recompression therapy and veno-venous extracorporeal oxygenation (VV-ECMO) with a complete recovery.CASE REPORT: After depressurization of a cabin, the 51-yr-old jet pilot was admitted to the Military Institute of Medicine with a life-threatening HADCS approximately 6 h after landing from a high-altitude flight, in a dynamically deteriorating condition, with progressing dyspnea and edema, reporting increasing limb paresthesia, fluctuating consciousness, and right-sided paresis. Hyperbaric oxygen therapy in the intensive care mode was initiated. A therapeutic recompression with U.S. Navy Treatment Table 6 was performed with neurological improvement. Due to cardiovascular collapse, sedation, mechanical ventilation, and significant doses of catecholamines were started, followed by continuous veno-venous hemodialysis. In the face of disturbances in oxygenation, during the second day of treatment the patient was commenced on veno-venous extracorporeal oxygenation. Over the next 6 d, the patient's condition slowly improved. On day 7, VV-ECMO was discontinued. On day 19, the patient was discharged with no neurological deficits.DISCUSSION: We observed two distinct stages during the acute phase of the disease. During the first stage, signs of hypoperfusion, neurological symptoms, and marbled skin were observed. During the second stage, multiple organ dysfunction dominated, including heart failure, pulmonary edema, acute kidney injury, and fluid overload, all of which can be attributed to extensive endothelial damage.Siewiera J, Szałański P, Tomaszewski D, Kot J. High-altitude decompression sickness treated with hyperbaric therapy and extracorporeal oxygenation. Aerosp Med Hum Perform. 2020; 91(2):106-109.
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Mews J, Królikowska K, Siewiera J, Wawrzyniak A, Kalicki B. Assessment of hyperbaric oxygen efficacy in children with carbon monoxide poisoning. PEDIATR MED RODZ 2019. [DOI: 10.15557/pimr.2019.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Hyperbaric oxygen therapy (HBOT), which is a centuries-old treatment, has now increasingly often been used in the pediatric population. The basic indications for HBOT are well-known disease entities, i.e. carbon monoxide poisoning or decompression sickness. Due to the immunomodulatory properties of hyperbaric oxygen, attempts are made to use HBOT in the treatment of atopic dermatitis or inflammatory bowel diseases. The close cooperation between pediatricians and hyperbaric medicine teams is very important to obtain optimal results. The aim of this article is to present the mechanism of hyperbaric oxygen activity, and its influence on selected disease entities. The paper outlines new perspectives for HBOT in the pediatric population.
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Affiliation(s)
- Jacek Siewiera
- Clinical Department of Hyperbaric Medicine at the Military Institute of Medicine, Warsaw, Poland,Judyta Mews Klinika Pediatrii Nefrologii i Alergologii Dziecięcej Wojskowy Instytut Medyczny ul. Szaserów 128, 04-141 Warszawa tel. 507 299 035
| | - Judyta Mews
- Department of Pediatrics, Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland,Judyta Mews Klinika Pediatrii Nefrologii i Alergologii Dziecięcej Wojskowy Instytut Medyczny ul. Szaserów 128, 04-141 Warszawa tel. 507 299 035
| | - Katarzyna Królikowska
- Department of Pediatrics, Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Bolesław Kalicki
- Department of Pediatrics, Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Jobs
- Department of Pediatrics, Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
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Siewiera J, Tomaszewski D, Piechocki J, Kübler A. Withholding and withdrawing life-sustaining treatment: Experiences in limiting futile therapy from three Polish intensive care departments. ADV CLIN EXP MED 2019; 28:541-546. [PMID: 30277672 DOI: 10.17219/acem/78775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND In intensive care units (ICUs), a patient's vital functions may be maintained, regardless of the patient's chances of survival. A key issue is how to precisely determine the moment in which life-support treatment should be withheld. In many countries, the decision-making process is regulated by the guidelines of scientific societies. However, heuristic errors may influence this process. OBJECTIVES The objective of this study was to assess factors involved in decisions to implement or withhold treatment in general ICUs in Poland. MATERIAL AND METHODS The medical records of patients treated in 3 clinical ICUs of general, cardiosurgical and neurosurgical profile were retrospectively analyzed. Patients with a diagnosis of brain death were finally excluded from the study. RESULTS The records of 1,449 patients hospitalized between January 1, 2014 and December 31, 2014 were analyzed. Of these, 226 patient cases were evaluated. There were no correlations between the placement of restrictions on resuscitation in specific cases, use of noradrenaline, frequency of blood gas testing, and patients' age. There was a relationship between these factors and the duration of hospitalization in the ICU. There was a direct relation between a "do not resuscitate" (DNR) order in a patient's record and the frequency of both resuscitation procedures and withholding catecholamine treatment in the hours preceding a patient's death. CONCLUSIONS Treatment was withheld in about 20% of cases involving dying patients in analyzed ICUs, regardless of age. Placing a limit on treatment consisted of either withholding new procedures or withdrawing existing therapy. The length of stay in the ICU affected the decisions to limit treatment.
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Affiliation(s)
- Jacek Siewiera
- Department of Anesthesiology and Intensive Therapy, Military Institute of Medicine, Warszawa, Poland
| | | | | | - Andrzej Kübler
- 1st Department of Anesthesiology and Intensive Care, Wroclaw Medical University, Poland
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Erlebacher A, Siewiera J, Nancy P. Epigenetic regulation of decidual inflammation. J Reprod Immunol 2016. [DOI: 10.1016/j.jri.2016.04.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zamaro-Michalska A, Adamczyk A, Mikaszewska-Sokolewicz M, Siewiera J, Łazowski T. [New definition of ventilator associated pneumonia might not necessarily have been a step in the right direction. Key takeaways from published studies after two years in clinical use]. Pol Merkur Lekarski 2015; 39:382-388. [PMID: 26802693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections. VAP is associated with prolonged hospitalization and visibly increased mortality, which in the group of patients with VAP ranges from 25% to 47%. In January 2013 Centers of Disease Control and Prevention introduced a new definition for VAP. Subjective criteria in the previous VAP definition were the reason for difficulties in VAP surveillance and assessment of efficacy of ventilator bundles and other quality improvement initiatives. The purpose of this article is to summarise the new definition of VAP and the first researches after two years of use of the new definition. The new definition of ventilator-associated events (VAE) identifies a broader group of patients than the previous VAP definition. Surveillance of all complications of mechanical ventilation aimed to create more efficient prophylaxis bundles and to decrease the mortality in critically ill patients. The latest published studies suggest that most of the complications defined as VAE are patient-related, not modifiable risk factors and these patients had no evidence of hospital-acquired complications. The new definition failed to detect many patients with VAP and it has not resolved the ambiguities related to the diagnosis of this complication. It seems that the new surveillance program will not lead to introducing new prevention strategies that could decrease the mortality in intensive care unit patients.
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Affiliation(s)
| | - Agata Adamczyk
- I Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | | | - Jacek Siewiera
- Department of Anaesthesiology and Intensive Care, Military Institute of Medicine in Warsaw, Poland
| | - Tomasz Łazowski
- I Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
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Kübler A, Siewiera J, Durek G, Kusza K, Piechota M, Szkulmowski Z. Guidelines regarding the ineffective maintenance of organ functions (futile therapy) in ICU patients incapable of giving informed statements of will. Anaesthesiol Intensive Ther 2015; 46:215-20. [PMID: 25293473 DOI: 10.5603/ait.a2014.0038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Andrzej Kübler
- National Consultant in intensive therapy, Chair and 1st Department of Anaesthesiology and Intensive Therapy, Wrocław Medical University, Poland.
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15
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Susło R, Trnka J, Siewiera J, Drobnik J. Ondine’s Curse – Genetic and Iatrogenic Central Hypoventilation as Diagnostic Options in Forensic Medicine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 861:65-73. [DOI: 10.1007/5584_2015_143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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16
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Siewiera J, Kübler A, Filipowska M, Trnka J, Zamaro-Michalska A. The issue of penal and legal protection of the intensive care unit physician within the context of patient's consent to treatment. Part II: unconscious patient. Anaesthesiol Intensive Ther 2014; 46:55-9. [PMID: 24643930 DOI: 10.5603/ait.2014.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Indexed: 11/25/2022] Open
Abstract
Cultural changes in Western societies, as well as the rapid development of medical technology during the last quarter of a century, have led to many changes in the relationship between a physician and a patient. During this period, the patient's consent to treatment has proven to be an essential component of any decision relating to the patient's health. The patient's will component, as an essential element of the legality of the treatment process, is also reflected in the Polish legislation. The correct interpretation of the legal regulations and the role the patient's will plays in the therapeutic decision-making process within the Intensive Care Unit (ICU) requires the consideration of both the good of the patient and the physician's safety in terms of his criminal responsibility. Clinical experience indicates that the physicians' decisions result in the choice of the best treatment strategy for a patient only if they are based on current medical knowledge and an assessment of therapeutic opportunities. The good of the patient must be the sole objective of the physician's actions, and as a result of the current state of medical knowledge and the medical prognosis, all the conditions of the legal safety of a physician taking decisions must be met. In this paper, the authors have set out how to obtain consent (substantive consent) to treat an unconscious patient in the ICU in light of the current Polish law, as well as a physician's daily practice. The solutions proposed in the text of the publication are aimed at increasing the legal safety of the ICU physicians when making key decisions relating to the strategy of the treatment of ICU patients.
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Affiliation(s)
- Jacek Siewiera
- Department of Medical Law, Chair of Forensic Medicine, Piastowie Śląscy Medical University in Wrocław, Poland Department of Anaesthesiology and Intensive Therapy, Health Care Centre in Bolesławiec, Poland.
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17
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Siewiera J, Trnka J, Kübler A. The issue of legal protection of the intensive care unit physician within the context of patient consent to treatment. Part I: conscious patient, refusing treatment. Anaesthesiol Intensive Ther 2014; 46:50-4. [PMID: 24643929 DOI: 10.5603/ait.2014.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Indexed: 11/25/2022] Open
Abstract
In daily clinical practice, physicians working in intensive care units (ICUs) face situations when their professional duty to protect the patient's life is in conflict with the obligation to respect the will of the patient and to assess his or her chances of treatment. Although the mere fact of conflict between these fundamental values for the ICU physician is a natural and obvious element in the chosen specialisation, many 'non-medical' circumstances make the given conflict not only very difficult but also dangerous for the physician. So far, the ethical and legal aspects of dying have been commented upon by a large group of lawyers and experts involved in the interpretation of the Polish regulations. The authors believe that a detailed analysis of the regulations should be carried out by persons of legal education, possessing a genuine medical experience associated with the specificity of end of life care in ICUs. In this paper, the authors have compared the current regulations of legislative acts of the common law relating to medical activities at anaesthesiology and intensive care units as well as based on the judgements of the common court of law over the past ten years. In the act of dissuading an ICU doctor from a medical procedure, all factors influencing the doctor's responsibility should be taken into account in accordance with the criminal law. In the case of a patient's death due to a refusal of treatment with the patient's full awareness, and given proper notification as to the consequences of refusing treatment, the doctor's responsibility lies under article 150 of the Polish penal code.
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Affiliation(s)
- Jacek Siewiera
- Department of Medical Law, Chair of Forensic Medicine, Piastowie Śląscy Medical University in Wrocław, Poland Department of Anaesthesiology and Intensive Therapy, Health Care Centre in Bolesławiec, Poland.
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18
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Kübler A, Siewiera J, Durek G, Kusza K, Piechota M, Szkulmowski Z. Guidelines regarding the ineffective maintenance of organ functions (futile therapy) in ICU patients incapable of giving informed statements of will. Anaesthesiol Intensive Ther 2014:VM/OJS/J/39188. [PMID: 25184400 DOI: 10.5603/ait.2014.0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/15/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Andrzej Kübler
- Uniwersytet Medyczny im. Piastów Śląskich we Wrocławiu; Wydział Lekarski; Katedra i Klinika Anestezjologii i Intensywnej Terapii.
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19
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Siewiera J, Trnka J, Kübler A. Consent to eventual treatment in the intensive care unit expressed within the consent form for elective anaesthesia and surgery. Anaesthesiol Intensive Ther 2013; 45:44-8. [PMID: 23572309 DOI: 10.5603/ait.2013.0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Indexed: 11/25/2022] Open
Abstract
In contemporary clinical practice, the issue of requesting patient consent to perform therapeutic treatment plays an important role. The conscious consent of a patient as an expression of one's will greatly strengthens the legality of medical procedures performed by a physician, regardless of the medical field. However, obtaining consent to treatment in the intensive care unit (ICU) often poses enormous difficulties in daily clinical work, and has in recent decades been the cause of much dispute between doctors and lawyers. The correct interpretation of the provisions under the relevant laws determines the safety and comfort of the medical practice in the ICU. This study compared the current rules of normative acts of Polish common law relating to medical practice in intensive care units and issued on the basis of the judgments of the common court of law over the past ten years. On the basis of those provisions, the authors conclude that the patient should be informed by the anaesthesiologist during the visit as to the possibility of postoperative therapy in the ICU. The extent of such information depends on the likelihood of having treatment in the ICU. The consent of the patient for hospitalisation in the ICU should be mandatory in the case of treatments which are very likely to necessitate such hospitalisation. This concerns especially cardiac surgery, neurosurgery and treatments for patients with a significant burden of disease. The authors of this study propose that an information and consent form to undergo treatment in the intensive care unit should be included within the anaesthesia consent form.
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Affiliation(s)
- Jacek Siewiera
- Department of Anaesthesiology and Intensive Therapy, 4th Military Hospital, Wrocław, Poland.
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