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Turner BL, van Ooij PJA, Wingelaar TT, van Hulst RA, Endert EL, Clarijs P, Hoencamp R. Chain of events analysis in diving accidents treated by the Royal Netherlands Navy 1966-2023. Diving Hyperb Med 2024; 54:39-46. [PMID: 38507908 DOI: 10.28920/dhm54.1.39-46] [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: 10/06/2023] [Accepted: 01/13/2024] [Indexed: 03/22/2024]
Abstract
Introduction Diving injuries are influenced by a multitude of factors. Literature analysing the full chain of events in diving accidents influencing the occurrence of diving injuries is limited. A previously published 'chain of events analysis' (CEA) framework consists of five steps that may sequentially lead to a diving fatality. This study applied four of these steps to predominately non-lethal diving injuries and aims to determine the causes of diving injuries sustained by divers treated by the Diving Medical Centre of the Royal Netherlands Navy. Methods This retrospective cohort study was performed on diving injuries treated by the Diving Medical Centre between 1966 and 2023. Baseline characteristics and information pertinent to all four steps of the reduced CEA model were extracted and recorded in a database. Results A total of 288 cases met the inclusion criteria. In 111 cases, all four steps of the CEA model could be applied. Predisposing factors were identified in 261 (90%) cases, triggers in 142 (49%), disabling agents in 195 (68%), and 228 (79%) contained a (possible-) disabling condition. The sustained diving injury led to a fatality in seven cases (2%). The most frequent predisposing factor was health conditions (58%). Exertion (19%), primary diver errors (18%), and faulty equipment (17%) were the most frequently identified triggers. The ascent was the most frequent disabling agent (52%). Conclusions The CEA framework was found to be a valuable tool in this analysis. Health factors present before diving were identified as the most frequent predisposing factors. Arterial gas emboli were the most lethal injury mechanism.
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Affiliation(s)
- Benjamin L Turner
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, The Netherlands
- Corresponding author: Mr Benjamin L Turner, Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, The Netherlands,
| | - Pieter-Jan Am van Ooij
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, The Netherlands
- Department of Respiratory Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Thijs T Wingelaar
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edwin L Endert
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, The Netherlands
| | - Paul Clarijs
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, The Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
- Trauma Research Unit, Department of Trauma Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Defence Healthcare Organization, Ministry of Defence, Utrecht, the Netherlands
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de Jong FJM, Wingelaar TT, van Hulst RA. Reply. Occup Med (Lond) 2023; 73:519. [PMID: 38157488 DOI: 10.1093/occmed/kqad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Feiko J M de Jong
- Royal Netherlands Navy Diving and Submarine Medical Centre, 1780 CA Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
| | - Thijs T Wingelaar
- Royal Netherlands Navy Diving and Submarine Medical Centre, 1780 CA Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
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3
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Geers MS, van der Sar-van der Brugge S, van Norden AGW, van Hulst RA, De Backer ICF. [Cerebral arterial air embolism: the effect of hyperbaric oxygen therapy]. Ned Tijdschr Geneeskd 2023; 167:D7480. [PMID: 37994739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Iatrogenic gas embolism is the presence of gas in vascular structures. Feared are those in coronary or cerebral arteries. These can result in cerebral or myocardial infarction. CASE DESCRIPTION A 79-year-old female underwent CT-guided biopsy of the lung. Minutes later she developed neurological symptoms. After administration of oxygen her symptoms initially improved, but later worsened. Based on her symptoms air embolism was suspected. She recovered fully after treatment with hyperbaric oxygen. CONCLUSION Air embolism is a potentially life-threatening complication of surgical, radiological or vascular interventions. Early recognition can lead to prompt treatment and better prognosis. If air embolism is suspected the patient should be treated according to ABCDE principles and oxygen should be administered. In case of neurological or circulatory symptoms a hospital that could provide hyperbaric oxygen therapy should be contacted as soon as possible.
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Affiliation(s)
- Marloes S Geers
- Erasmus MC, afd. Longgeneeskunde, Rotterdam
- Contact: Marloes S. Geers
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Abstract
One of the hazards of occupational diving is pulmonary oxygen toxicity, which can lead to reduced lung diffusion capacity and fibrosis. The current gold standard to determine the ‘safe limits’ for oxygen was developed more than 50 years ago and lacks the accuracy required for occupational specialists. These restrictions may be overcome by new diagnostic methods like exhaled breath analysis, which would allow occupational specialists to accurately monitor pulmonary health in the individual diver, and thus reduce long-term health effects of professional diving.
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Affiliation(s)
- Feiko J M de Jong
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
- Royal Netherlands Navy Diving and Submarine Medical Centre, 1780 CA Den Helder, The Netherlands
| | - Thijs T Wingelaar
- Royal Netherlands Navy Diving and Submarine Medical Centre, 1780 CA Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
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Lalieu RC, Bol Raap RD, Smit C, Dubois EFL, van Hulst RA. Hyperbaric Oxygen Therapy for Nonhealing Wounds-A Long-term Retrospective Cohort Study. Adv Skin Wound Care 2023; 36:304-310. [PMID: 37017408 DOI: 10.1097/01.asw.0000922696.61546.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To analyze wound healing results of hyperbaric oxygen therapy (HBOT) for a variety of different wound types. METHODS This retrospective cohort study included all patients treated with HBOT and wound care at a single hyperbaric center between January 2017 and December 2020. The primary outcome was wound healing. Secondary outcome measures were quality of life (QoL), number of sessions, adverse effects, and treatment cost. Investigators also examined possible influencing factors, including age, sex, type and duration of wound, socioeconomic status, smoking status, and presence of peripheral vascular disease. RESULTS A total of 774 treatment series were recorded, with a median of 39 sessions per patient (interquartile range, 23-51 sessions). In total, 472 wounds (61.0%) healed, 177 (22.9%) partially healed, 41 (5.3%) deteriorated, and 39 (5.0%) minor and 45 (5.8%) major amputations were performed. Following HBOT, median wound surface area decreased from 4.4 cm 2 to 0.2 cm 2 ( P < .01), and patient QoL improved from 60 to 75 on a 100-point scale ( P < .01). The median cost of therapy was €9,188 (interquartile range, €5,947-€12,557). Frequently recorded adverse effects were fatigue, hyperoxic myopia, and middle ear barotrauma. Attending fewer than 30 sessions and having severe arterial disease were both associated with a negative outcome. CONCLUSIONS Adding HBOT to standard wound care increases wound healing and QoL in selected wounds. Patients with severe arterial disease should be screened for potential benefits. Most reported adverse effects are mild and transient.
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Affiliation(s)
- Rutger C Lalieu
- At Hyperbaric Medical Center, Rijswijk, South Holland, the Netherlands, Rutger C. Lalieu, MD, PhD, is Physician and René D. Bol Raap, MD, is Diving Medical Physician. Casper Smit, MD, PhD, is Vascular Surgeon, Reinier de Graaf Hospital, Delft, South Holland, and Vascular Surgeon at the Hyperbaric Medical Center, Rijswijk. Emile FL Dubois, MD, PhD, is Pulmonary Physician and Consultant, Hyperbaric Medical Center, Rijswijk. Rob A. van Hulst, MD, PhD, is Head of the Hyperbaric Department, Amsterdam University Medical Center
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6
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Geldof NI, van Hulst RA, Ridderikhof ML, Teguh DN. Hyperbaric oxygen treatment for late radiation-induced tissue toxicity in treated gynaecological cancer patients: a systematic review. Radiat Oncol 2022; 17:164. [PMID: 36203216 PMCID: PMC9540739 DOI: 10.1186/s13014-022-02067-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of this study was to investigate the result of hyperbaric oxygen therapy (HBOT) in women with treated gynaecological malignancies who suffer from late radiation-induced tissue toxicity (LRITT). Moreover, which symptoms of LRITT benefit most from HBOT was evaluated as well. Material and Methods An online literature search was conducted using PubMed; Embase and the Cochrane Library. Studies were included if the study examined gynaecological cancer patients who had been treated with radiotherapy, who suffered from LRITT and who subsequently received HBOT. In addition, the outcome measures were based on examining the effects of HBOT. Results Twenty-one articles were included. The study investigating proctitis reported an improvement and three out of four studies investigating cystitis reported decreased complaints in women treated for gynaecological malignancies. In addition, all studies reported improvement in patients with wound complications and fifty percent of the studies reported better Patient Reported Outcome Measurements (PROMS) in women with gynaecological malignancies. Finally, all studies, except one related to pelvic malignancies reported reduced prevalence of symptoms for cystitis and proctitis and all studies reported better PROMS. However, only eleven studies reported p-values, nine of which were significant. Conclusion This study demonstrated that HBOT has a positive effect in women with gynaecological LRITT. Within the included patient group, gynaecological cancer patients with wound complications seem to benefit most from this treatment compared to other late side effects of LRITT. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02067-6.
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Affiliation(s)
- Nadine I Geldof
- Department of Surgery, Hyperbaric Medicine, Amsterdam UMC, location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Rob A van Hulst
- Department of Surgery, Hyperbaric Medicine, Amsterdam UMC, location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Milan L Ridderikhof
- Department of Surgery, Hyperbaric Medicine, Amsterdam UMC, location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - David N Teguh
- Department of Surgery, Hyperbaric Medicine, Amsterdam UMC, location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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de Jong FJM, Wingelaar TT, Brinkman P, van Ooij PJAM, Maitland-van der Zee AH, Hollmann MW, van Hulst RA. Pulmonary Oxygen Toxicity Through Exhaled Breath Markers After Hyperbaric Oxygen Treatment Table 6. Front Physiol 2022; 13:899568. [PMID: 35620607 PMCID: PMC9127798 DOI: 10.3389/fphys.2022.899568] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction: The hyperbaric oxygen treatment table 6 (TT6) is widely used to manage dysbaric illnesses in divers and iatrogenic gas emboli in patients after surgery and other interventional procedures. These treatment tables can have adverse effects, such as pulmonary oxygen toxicity (POT). It is caused by reactive oxygen species’ damaging effect in lung tissue and is often experienced after multiple days of therapy. The subclinical pulmonary effects have not been determined. The primary aim of this study was to measure volatile organic compounds (VOCs) in breath, indicative of subclinical POT after a TT6. Since the exposure would be limited, the secondary aim of this study was to determine whether these VOCs decreased to baseline levels within a few hours.Methods: Fourteen healthy, non-smoking volunteers from the Royal Netherlands Navy underwent a TT6 at the Amsterdam University Medical Center—location AMC. Breath samples for GC-MS analysis were collected before the TT6 and 30 min, 2 and 4 h after finishing. The concentrations of ions before and after exposure were compared by Wilcoxon signed-rank tests. The VOCs were identified by comparing the chromatograms with the NIST library. Compound intensities over time were tested using Friedman tests, with Wilcoxon signed-rank tests and Bonferroni corrections used for post hoc analyses.Results: Univariate analyses identified 11 compounds. Five compounds, isoprene, decane, nonane, nonanal and dodecane, showed significant changes after the Friedman test. Isoprene demonstrated a significant increase at 30 min after exposure and a subsequent decrease at 2 h. Other compounds remained constant, but declined significantly 4 h after exposure.Discussion and Conclusion: The identified VOCs consisted mainly of (methyl) alkanes, which may be generated by peroxidation of cell membranes. Other compounds may be linked to inflammatory processes, oxidative stress responses or cellular metabolism. The hypothesis, that exhaled VOCs would increase after hyperbaric exposure as an indicator of subclinical POT, was not fulfilled, except for isoprene. Hence, no evident signs of POT or subclinical pulmonary damage were detected after a TT6. Further studies on individuals recently exposed to pulmonary irritants, such as divers and individuals exposed to other hyperbaric treatment regimens, are needed.
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Affiliation(s)
- Feiko J. M. de Jong
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, Netherlands
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
- *Correspondence: Feiko J. M. de Jong,
| | - Thijs T. Wingelaar
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, Netherlands
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Pieter-Jan A. M. van Ooij
- Royal Netherlands Navy Diving and Submarine Medical Centre, Den Helder, Netherlands
- Department of Respiratory Medicine, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | | | - Marcus W. Hollmann
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Rob A. van Hulst
- Department of Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
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8
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Lansdorp CA, Buskens CJ, Gecse KB, Löwenberg M, Stoker J, Bemelman WA, D'Haens GRAM, van Hulst RA. Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn's disease: Results of the HOT-TOPIC trial after 1-year follow-up. United European Gastroenterol J 2022; 10:160-168. [PMID: 35146959 PMCID: PMC8911540 DOI: 10.1002/ueg2.12189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022] Open
Abstract
Background Previously published short‐term results (week 16) of this trial showed a significant improvement in clinical, radiologic and biochemical outcomes in Crohn's disease patients with therapy‐refractory perianal fistulas after treatment with hyperbaric oxygen therapy. Objective To assess the long‐term (week 60) efficacy, safety and feasibility of hyperbaric oxygen therapy in perianal fistula in Crohn's disease. Methods Crohn's disease patients with high perianal fistula(s) failing conventional treatment >6 months were included. Exclusion criteria were presence of a stoma, rectovaginal fistula(s) and recent changes in treatment regimens. Patients received 40 hyperbaric oxygen sessions and outcomes were assessed at week 16 and week 60. Results Twenty patients were included (median age 34 years). At week 16, median scores of the perianal disease activity index and modified Van Assche index (co‐primary outcomes) decreased from 7.5 (95% CI 6–9) to 4 (95% CI 3–6, p < 0.001) and 9.2 (95% CI 7.3–11.2) to 7.3 (95% CI 6.9–9.7, p = 0.004), respectively. At week 60, the respective scores remained significantly lower than baseline: 4 (95% CI 3–7, p < 0.001) and 7.7 (95% CI 5.2–10.2, p = 0.003). Perianal disease activity index score of 4 or less (representing inactive perianal disease) was observed in 13 patients at week 16 and 12 patients at week 60. Using fistula drainage assessment, 12 and 13 patients showed a clinical response at week 16 and 60, respectively, and clinical remission was achieved in four patients for both time points. At week 16, a statistically significant biochemical improvement (C‐reactive protein and faecal calprotectin levels) was found, but this effect was no longer significant at week 60. Conclusions The clinical and radiologic improvement of perianal fistula in Crohn's disease, that was found at week 16 after treatment with hyperbaric oxygen therapy, is maintained at 1‐year follow‐up.
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Affiliation(s)
- Corine A Lansdorp
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Christianne J Buskens
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
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Lalieu RC, Akkerman I, van Ooij PJA, Boersma-Voogd AA, van Hulst RA. Nutritional status of patients referred for hyperbaric oxygen treatment; a retrospective and descriptive cross-sectional study. Diving Hyperb Med 2021; 51:322-327. [PMID: 34897596 DOI: 10.28920/dhm51.4.322-327] [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: 05/19/2021] [Accepted: 09/11/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Due to the global rise of obesity, the role of nutrition has gathered more attention. Paradoxically, even overweight persons may be malnourished. This may delay wound healing or recovery of late radiation tissue injury (LRTI). Hyperbaric oxygen treatment (HBOT) is used to improve wound healing or LRTI complaints. The aim of this study was to assess the dietary intake levels of nutrients important for recovery in patients referred for HBOT. METHODS This was a retrospective, cross-sectional study of patients referred for HBOT to a single centre between 2014 and 2019. Patients were offered a consultation with a dietitian as standard care. Information on nutrients was calculated from questionnaires, and compared to recommended daily allowances. RESULTS One hundred and forty-six patients were included (80 female). Eighteen patients were treated for diabetic ulcers, 25 for non-diabetic ulcers and 103 for LRTI. Most were overweight or obese (64.4%), but did not consume the recommended quantities of calories, protein, or micronutrients. Vitamin C consumption was higher than recommended. Male patients had a higher intake of calories and protein than female patients but not other nutrients. No differences in intake existed between age or body mass index categories. CONCLUSIONS The nutritional status of patients referred for HBOT may be inadequate for healing wounds or LRTI, despite anthropomorphic data indicating a positive energy balance. Daily attendance for HBOT provides a unique opportunity to monitor and correct these deficiencies. Routine screening for malnutrition and supplement deficiencies is recommended for patients referred for HBOT.
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Affiliation(s)
- Rutger C Lalieu
- Hyperbaric Center Rijswijk, Rijswijk, the Netherlands.,Hyperbaric and Diving Medicine, Anesthesiology, Amsterdam Medical Centre, Amsterdam, the Netherlands.,Corresponding author: Dr Rutger C Lalieu, Hyperbaric Center Rijswijk, Treubstraat 5A, 2288 EG Rijswijk, the Netherlands,
| | - Ida Akkerman
- Independent researcher, de nieuwe delta, Ede, the Netherlands
| | - Peter-Jan Am van Ooij
- Antonius Hypercare, Sneek, the Netherlands.,Diving Medical Center, Royal Netherlands Navy, Den Helder, the Netherlands
| | - Annieke A Boersma-Voogd
- Antonius Hypercare, Sneek, the Netherlands.,Independent researcher, Dieetstyle - Annieke Boersma, Sneek, the Netherlands
| | - Rob A van Hulst
- Hyperbaric and Diving Medicine, Anesthesiology, Amsterdam Medical Centre, Amsterdam, the Netherlands.,Antonius Hypercare, Sneek, the Netherlands
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Lalieu RC, Mulder W, Raap RDB, Stolk S, Smit C, Dubois EF, van Hulst RA. Hyperbaric oxygen treatment for University of Texas grade 3 diabetic foot ulcers: a retrospective cohort study. J Wound Care 2021; 30:722-728. [PMID: 34554839 DOI: 10.12968/jowc.2021.30.9.722] [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] [Indexed: 11/11/2022]
Abstract
AIM Hard-to-heal diabetic foot ulcers (DFUs) may increase the risk of amputation. This study reports the positive influence of hyperbaric oxygen therapy (HBOT) on hard-to-heal DFUs involving underlying bone. METHOD A single-centre, retrospective cohort study reporting the results of HBOT and wound care on hard-to-heal University of Texas grade 3 DFUs (i.e., involving underlying bone) between 2013 and 2019. Outcome measures were primarily (near-) complete wound healing (i.e., ≥80% ulcer surface area reduction) and amputation rate (minor or major), and secondarily the number of hyperbaric sessions and improvement in quality of life (QoL) and pain score. RESULTS The study included 206 patients, of whom 74 (36%) achieved complete wound healing, and 75 (36%) near-complete healing. Amputations were performed in 27 patients (13%): 12 (6%) minor and 15 (7%) major. The median number of HBOT sessions was 42. Participants who achieved complete healing received a median of 43 sessions, compared with 10 for those who required major amputation. Patients with at least 30 sessions were less likely to undergo amputation (odds ratio: 0.08; 95% confidence interval (CI): 0.03-0.21). Mean QoL increased by 7.6 points (95%CI: 3.9-11.3; p<0.01) and median pain score fell from 3 to 1 (0-3) (p<0.01). CONCLUSIONS The addition of HBOT to standard wound care may lead to a decreased amputation risk, improved wound healing and increased QoL for people with a University of Texas grade 3 DFU. An adequate number of HBOT sessions is required to achieve optimal clinical results. Objective selection criteria and shared decision-making are suggested to improve dropout rates.
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Affiliation(s)
- Rutger C Lalieu
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands.,Amsterdam University Medical Centers, Department of Anesthesiology, Amsterdam, the Netherlands
| | - Willem Mulder
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands
| | | | - Saskia Stolk
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands
| | - Casper Smit
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands.,Reinier de Graaf Gasthuis, Department of Surgery, Delft, the Netherlands
| | | | - Rob A van Hulst
- Amsterdam University Medical Centers, Department of Anesthesiology, Amsterdam, the Netherlands.,Amsterdam University Medical Centers, Department of Surgery, Hyperbaric Dept, Amsterdam, the Netherland
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11
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Lalieu RC, Akkerman I, van Hulst RA. Hyperbaric Oxygen Therapy for Venous Leg Ulcers: A 6 Year Retrospective Study of Results of a Single Center. Front Med (Lausanne) 2021; 8:671678. [PMID: 34395470 PMCID: PMC8355540 DOI: 10.3389/fmed.2021.671678] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Venous leg ulcers (VLUs) are common and have a large impact on healthcare budgets worldwide. Hyperbaric oxygen therapy (HBOT) may improve healing of these ulcers. Methods: Retrospective, single-center cohort study between 2013 and 2019. All patients with a VLU from an outpatient clinic providing HBOT and wound care were included. The primary outcome measure was wound healing, determined at discharge from the center. Other outcome measures were improvement in patient related outcome measures (PROMs), as assessed by the EQ-5D-3L questionnaire and including quality of life (QoL) and pain score. Results: Fifty patients were included, 53% female, with a mean age of 73.4 (±12.2). Most wounds (83%) had existed longer than 3 months before starting treatment. Patients received an average of 43 (±20) sessions of HBOT. After treatment, 37 patients (63%) achieved complete or near-complete wound healing. Wound size decreased from a median of 14 cm2 [interquartile range (IQR) 32 cm2] to 0.5 cm2 (IQR 5.3 cm2), a median decrease of 7.5 (IQR 16.2 cm2) in cm2 (94%). Patients mostly reported improvement for all health aspects on the questionnaire. Pain score decreased from 5.7 (±2.5) to 2.1 (±2.2) (p < 0.0001) and health score increased from 57.2 (±15.6) to 69.9 (±18.9) (p = 0.02). Conclusions: Patients with non-healing VLUs may benefit from HBOT to achieve complete or substantial wound healing. We recommend a well-designed randomized clinical trial with a number of patients allowing enough statistical power, and of a reasonable duration, to establish the potential of additional HBOT on hard-to-heal venous ulcers.
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Affiliation(s)
- Rutger C Lalieu
- Hyperbaar Geneeskundig Centrum, Rijswijk, Netherlands.,Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Ida Akkerman
- Independent Researcher, De Nieuwe Delta, Ede, Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands.,Department of Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands.,Hyperbaric Department, Amsterdam University Medical Center, Amsterdam, Netherlands
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12
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de Bakker HM, Tijsterman M, de Bakker-Teunissen OJGB, Soerdjbalie-Maikoe V, van Hulst RA, de Bakker BS. Response. Chest 2021; 158:1780. [PMID: 33036090 DOI: 10.1016/j.chest.2020.05.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Henri M de Bakker
- Department of Radiology, Groene Hart Hospital, Gouda, The Netherlands
| | - Melanie Tijsterman
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Vidija Soerdjbalie-Maikoe
- Division of Special Services, Section Forensic Pathology, Netherlands Forensic Institute, The Hague, The Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernadette S de Bakker
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Komdeur P, Wingelaar TT, van Hulst RA. A survey on the health status of Dutch scuba diving instructors. Diving Hyperb Med 2021; 51:18-24. [PMID: 33761537 DOI: 10.28920/dhm51.1.18-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/24/2020] [Accepted: 10/10/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION As the diving population is ageing, so are the diving instructors. Health issues and the use of prescribed medications are more common when ageing. The death of two diving instructors during one weekend in 2017 in the Netherlands, most likely due to cardiovascular disease, motivated investigation of the prevalence of relevant comorbidities in Dutch diving instructors. METHODS All Dutch Underwater Federation diving instructors were invited to complete an online questionnaire. Questions addressed diving experience and current and past medical history including the use of medications. RESULTS A response rate of 27% yielded 497 questionnaires (87% male, average age 57.3 years [SD 8.5]). Older instructors were over-represented among responders (82% of males and 75% of females > 50 years versus 66% of males and 51% of females among the invited cohort). Forty-six percent of respondents reported no current medical condition. Hypertension was the most commonly reported condition followed by hay fever and problems equalising ears and sinuses. Thirty-two percent reported no past medical condition. Problems of equalising ears and sinuses was the most common past medical condition, followed by hypertension, joint problems or surgery, and hay fever. Fifty-nine percent used non-prescription medication; predominantly analgesics and nose or ear drops. Forty-nine percent used prescription medicine, mostly cardiovascular and respiratory drugs. Body mass index (BMI) was > 25 kg·m-2 in 66% of males and 38% of females. All instructors with any type of cardiovascular disease were overweight. CONCLUSIONS Nineteen percent of responding diving instructors suffered from cardiovascular disease with above-normal BMI and almost 60% used prescribed or non-prescribed medication. Some dived while suffering from medical issues or taking medications, which could lead to medical problems during emergency situations with their students.
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Affiliation(s)
- Prashant Komdeur
- Sports Medical Center Papendal, Hengstdal 3, 6574 NA Ubbergen, the Netherlands.,Corresponding author: Dr Prashant Komdeur, Sports Medical Center Papendal, Hengstdal 3, 6574 NA Ubbergen, the Netherlands,
| | - Thijs T Wingelaar
- Diving Medical Center, Royal Netherlands Navy, Den Helder, the Netherlands.,Department of Anaesthesiology, University Medical Center, Amsterdam, the Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology, University Medical Center, Amsterdam, the Netherlands
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14
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Lansdorp CA, Gecse KB, Buskens CJ, Löwenberg M, Stoker J, Bemelman WA, D’Haens GR, van Hulst RA. Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn's disease. Aliment Pharmacol Ther 2021; 53:587-597. [PMID: 33326623 PMCID: PMC7898636 DOI: 10.1111/apt.16228] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/24/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Positive effects of hyperbaric oxygen on perianal fistulas in Crohn's disease have been reported. AIM To assess efficacy, safety and feasibility of hyperbaric oxygen in Crohn's disease patients with therapy-refractory perianal fistulas. METHODS Twenty consecutive patients were recruited at the out-patient fistula clinic of the Amsterdam UMC. Crohn's disease patients with high perianal fistula(s) failing conventional treatment for over 6 months were included. Exclusion criteria were presence of a stoma, rectovaginal fistula(s) and recent changes in treatment regimens. Patients received treatment with 40 hyperbaric oxygen sessions and outcome parameters were assessed at Week 16. RESULTS Seven women and 13 men were included (median age 34 years). At Week 16, median scores of perianal disease activity index and modified van Assche index (co-primary outcome parameters) decreased from 7.5 (95% CI 6-9) to 4 (95% CI 3-6, P < 0.001), and from 9.2 (95% CI 7.3-11.2) to 7.3 (95% CI 6.9-9.7, P = 0.004) respectively. Perianal disease activity index scores ≤4 (representing inactive perianal disease) were observed in 13/20 patients (65%). Twelve patients showed a clinical response (60%) and four (20%) clinical remission, assessed with fistula drainage assessment. Median C-reactive protein and faecal calprotectin levels decreased from 4.2 mg/mL (95% CI 1.6-8) to 2.2 (95% CI 0.9-4.3, P = 0.003) and from 399 µg/g (95% CI 52-922) to 31 (95% CI 16-245, P = 0.001), respectively. CONCLUSIONS We found significant clinical, radiological and biochemical improvement in Crohn's disease patients with therapy-refractory perianal fistulas after treatment with hyperbaric oxygen. CLINICAL TRIAL REGISTRATION www.trialregister.nl/trial/6489.
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Affiliation(s)
- Corine A. Lansdorp
- Department of Anesthesiology/Hyperbaric MedicineAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Krisztina B. Gecse
- Department of Gastroenterology and HepatologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | | | - Mark Löwenberg
- Department of Gastroenterology and HepatologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear MedicineAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Willem A. Bemelman
- Department of SurgeryAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Geert R.A.M. D’Haens
- Department of Gastroenterology and HepatologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Rob A. van Hulst
- Department of Anesthesiology/Hyperbaric MedicineAmsterdam UMC, location AMCAmsterdamThe Netherlands
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15
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Wingelaar TT, Bakker L, Nap FJ, van Ooij PJAM, Endert EL, van Hulst RA. Routine Chest X-Rays Are Inaccurate in Detecting Relevant Intrapulmonary Anomalies During Medical Assessments of Fitness to Dive. Front Physiol 2021; 11:613398. [PMID: 33488401 PMCID: PMC7816860 DOI: 10.3389/fphys.2020.613398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/02/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Intrapulmonary pathology, such as bullae or blebs, can cause pulmonary barotrauma when diving. Many diving courses require chest X-rays (CXR) or high-resolution computed tomography (HRCT) to exclude asymptomatic healthy individuals with these lesions. The ability of routine CXRs and HRCT to assess fitness to dive has never been evaluated. Methods: Military divers who underwent yearly medical assessments at the Royal Netherlands Navy Diving Medical Center, including CXR at initial assessment, and who received a HRCT between January and June 2018, were included. The correlations of CXR and HRCT results with fitness to dive assessments were analyzed using Fisher's exact tests. Results: This study included 101 military divers. CXR identified bullae or blebs in seven divers, but HRCT found that these anomalies were not present in three subjects and were something else in four. CXR showed no anomalies in 94 subjects, but HRCT identified coincidental findings in 23 and bullae or blebs in seven. The differences between CXR and HRCT results were statistically significant (p = 0.023). Of the 34 subjects with anomalies on HRCT, 18 (53%) were disqualified for diving. Discussion: Routine CXR in asymptomatic military divers does not contribute to the identification of relevant pathology in fitness to dive assessments and has a high false negative rate (32%). HRCT is more diagnostic than CXR but yields unclear results, leading to disqualification for diving. Fitness to dive tests should exclude routine CXR; rather, HRCT should be performed only in subjects with clinical indications.
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Affiliation(s)
- Thijs T Wingelaar
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands.,Department of Anaesthesiology, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Leonie Bakker
- Woensdrecht Airbase, Royal Netherlands Airforce, Woensdrecht, Netherlands
| | - Frank J Nap
- Department of Radiology, Central Military Hospital, Ministry of Defence, Utrecht, Netherlands
| | - Pieter-Jan A M van Ooij
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands.,Department of Pulmonology, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Edwin L Endert
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
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16
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Teguh DN, Bol Raap R, Koole A, Knippenberg B, Smit C, Oomen J, van Hulst RA. Hyperbaric oxygen therapy for nonhealing wounds: Treatment results of a single center. Wound Repair Regen 2020; 29:254-260. [PMID: 33377598 PMCID: PMC7986203 DOI: 10.1111/wrr.12884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/12/2020] [Accepted: 11/12/2020] [Indexed: 12/29/2022]
Abstract
The present article evaluates the results of the treatment with adjuvant hyperbaric oxygen therapy (HBOT) of patients with nonhealing, chronic wounds. In the period 2013 to 2016, 248 patients were referred from various hospitals because of chronic wounds that were recalcitrant in healing despite standard wound care as described in national and international guidelines. After inclusion, all patients were treated with HBOT and subjected to a weekly standard wound care treatment. During each HBOT session, 100% O2 was administered for 75 minutes under increased pressure of 2.4 ATA. Wounds and quality of life were assessed before and after the total treatment period. A total of 248 patients have been evaluated. Diabetic foot ulcers were present in 134 patients, the remainder (114 patients) showed a variety of wound locations and etiologies. The number of HBOT treatments amounted to an average of 48 (range 20-68) sessions. Before referral to our clinic, 31% of all wounds had existed for at least 18 months (72 patients). After HBOT, 81% of all wounds were near complete healing or completely healed, in 13% of the cases the wound was stable, and in 2% minor or major amputation had to be carried out. The mean treatment time for wounds pre-existing fewer than 6 weeks ("early referrals") was 67 days, and 119 days for wounds pre-existing more than 18 months ("late referrals"). A majority of the patients in our study referred with nonhealing wounds clinically improved when adjuvant HBOT was added to standard wound care protocols. No differences in success rate were seen between diabetic and nondiabetic wounds. It showed that HBOT is a well-tolerated treatment.
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Affiliation(s)
- David N Teguh
- Department of Surgery, Hyperbaric Medicine, Amsterdam UMC, Location Academic Medical Center (AMC), University of Amsterdam (UVA), Amsterdam, The Netherlands
| | - René Bol Raap
- Hyperbaar Geneeskundig Centrum, Rijswijk, The Netherlands
| | - Arne Koole
- Hyperbaar Geneeskundig Centrum, Rijswijk, The Netherlands
| | | | - Casper Smit
- Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Jan Oomen
- Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology, Hyperbaric Medicine, Amsterdam UMC, Location AMC, UVA, Amsterdam, The Netherlands
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17
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Lansdorp CA, Buskens CJ, Gecse KB, D'Haens GRAM, van Hulst RA. Letter: off-label use of hyperbaric oxygen therapy in inflammatory bowel disease. Aliment Pharmacol Ther 2020; 52:215-216. [PMID: 32529770 DOI: 10.1111/apt.15775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Corine A Lansdorp
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | | | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
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18
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Lalieu RC, Bol Raap RD, Dubois EF, van Hulst RA. Sudden death after oxygen toxicity seizure during hyperbaric oxygen treatment: Case report. Diving Hyperb Med 2020; 50:185-188. [PMID: 32557424 DOI: 10.28920/dhm50.2.185-188] [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: 12/03/2019] [Accepted: 03/18/2020] [Indexed: 11/05/2022]
Abstract
Acute cerebral oxygen toxicity (ACOT) is a known side effect of hyperbaric oxygen treatment (HBOT), which can cause generalised seizures. Fortunately, it has a low incidence and is rarely harmful. Nevertheless, we present a case of a 37 year-old patient with morbid obesity who died unexpectedly after an oxygen toxicity seizure in the hyperbaric chamber. Considering possible causes, physiologic changes in obesity and obesity hypoventilation syndrome may increase the risk of ACOT. Obesity, especially in extreme cases, may hinder emergency procedures, both in- and outside of a hyperbaric chamber. Physicians in the hyperbaric field should be aware of the possibility of a fatal outcome after ACOT through the described mechanisms and take appropriate preventative measures. Basic airway management skills are strongly advised for involved physicians, especially when specialised personnel and equipment are not immediately available.
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Affiliation(s)
- Rutger C Lalieu
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands.,Amsterdam University Medical Centres, Department of Anaesthesiology, Amsterdam, the Netherlands.,Corresponding author: Rutger C Lalieu, Treubstraat 5A, 2288 EG Rijswijk, the Netherlands,
| | | | | | - Rob A van Hulst
- Amsterdam University Medical Centres, Department of Anaesthesiology, Amsterdam, the Netherlands.,Amsterdam University Medical Centres, Department of Surgery, Hyperbaric Dept., Amsterdam, the Netherlands
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19
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Wingelaar TT, Brinkman P, Hoencamp R, van Ooij PJA, Maitland-van der Zee AH, Hollmann MW, van Hulst RA. Assessment of pulmonary oxygen toxicity in special operations forces divers under operational circumstances using exhaled breath analysis. Diving Hyperb Med 2020; 50:2-7. [PMID: 32187611 DOI: 10.28920/dhm50.1.2-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/28/2019] [Accepted: 10/12/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The Netherlands Maritime Special Operations Forces use closed circuit oxygen rebreathers (O₂-CCR), which can cause pulmonary oxygen toxicity (POT). Recent studies demonstrated that volatile organic compounds (VOCs) can be used to detect POT in laboratory conditions. It is unclear if similar VOCs can be identified outside the laboratory. This study hypothesised that similar VOCs can be identified after O₂-CCR diving in operational settings. METHODS Scenario one: 4 h O₂-CCR dive to 3 metres' seawater (msw) with rested divers. Scenario two: 3 h O₂-CCR dive to 3 msw following a 5 day physically straining operational scenario. Exhaled breath samples were collected 30 min before and 30 min and 2 h after diving under field conditions and analysed using gas chromatography-mass spectrometry (GC-MS) to reconstruct VOCs, whose levels were tested longitudinally using a Kruskal-Wallis test. RESULTS Eleven divers were included: four in scenario one and seven in scenario two. The 2 h post-dive sample could not be obtained in scenario two; therefore, 26 samples were collected. GC-MS analysis identified three relevant VOCs: cyclohexane, 2,4-dimethylhexane and 3-methylnonane. The intensities of 2,4-dimethylhexane and 3-methylnonane were significantly (P = 0.048 and P = 0.016, respectively) increased post-dive relative to baseline (range: 212-461%) in both scenarios. Cyclohexane was increased not significantly (P = 0.178) post-dive (range: 87-433%). CONCLUSIONS VOCs similar to those associated with POT in laboratory conditions were identified after operational O₂-CCR dives using GC-MS. Post-dive intensities were higher than in previous studies, and it remains to be determined if this is attributable to different dive profiles, diving equipment or other environmental factors.
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Affiliation(s)
- Thijs T Wingelaar
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, the Netherlands.,Department of Anesthesiology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands.,Corresponding author: Dr Thijs T Wingelaar, Royal Netherlands Navy Diving Medical Centre, Rijkszee en marinehaven, 1780 CA, Den Helder, the Netherlands,
| | - Paul Brinkman
- Department of Pulmonology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands.,Defence Healthcare Organisation, Ministry of Defence, Utrecht, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Pieter-Jan Am van Ooij
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, the Netherlands.,Department of Pulmonology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | | | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
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20
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Brouwer RJ, Lalieu RC, Hoencamp R, van Hulst RA, Ubbink DT. A systematic review and meta-analysis of hyperbaric oxygen therapy for diabetic foot ulcers with arterial insufficiency. J Vasc Surg 2020; 71:682-692.e1. [DOI: 10.1016/j.jvs.2019.07.082] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/26/2019] [Indexed: 12/09/2022]
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21
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Wingelaar TT, Endert EL, Hoencamp R, van Ooij PJA, van Hulst RA. Longitudinal screening of hearing threshold in navy divers: is diving really a hazard? Diving Hyperb Med 2020; 49:283-290. [PMID: 31828747 DOI: 10.28920/dhm49.4.283-290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/18/2019] [Accepted: 06/08/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hearing loss (HL) is common in the adult working population. It is widely assumed that diving is a risk factor for HL. However, studies with sufficient follow-up comparing HL in divers to non-divers are limited. This study aimed to assess the hearing threshold (HT) of Royal Netherlands Navy divers who had been diving for more than 15 years and to compare it to the ISO standard 7029:2017 reference table. METHODS In this 25-year retrospective cohort study the Royal Netherlands Navy Diving Medical Centre audited the medical records of 1,117 Navy divers. Yearly dive medical assessments were performed according to professional standards, including audiometry. HTs were compared to the ISO 7029:2017 reference table, including Z-distribution, using paired t-tests. RESULTS Thirty-five divers were included who had been diving for 15 years or longer. The HT increased significantly in nine of the 16 measured frequencies, while the Z-score decreased significantly in nine of the 16 tested frequencies (eight in both ears). In the 25-year follow-up the pattern was more obvious, with one significantly increased HT, and 10 significantly decreased Z-scores. DISCUSSION The absolute HT increases after 15 years of military diving, but less than would be expected from normal age-related deterioration. Moreover, when comparing Z-scores, this sample of divers actually hear better than non-divers. We conclude that military diving is not an increased risk for HL compared to regular occupational hazards and suggest withdrawing the requirement for routine yearly audiometric evaluation as part of a dive medical examination.
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Affiliation(s)
- Thijs T Wingelaar
- Diving Medical Center, Royal Netherlands Navy, Den Helder, the Netherlands.,Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Corresponding author: Royal Netherlands Navy Diving Medical Center, Rijkszee en marinehaven. 1780 CA Den Helder, the Netherlands,
| | - Edwin L Endert
- Diving Medical Center, Royal Netherlands Navy, Den Helder, the Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands.,Defense Healthcare Organisation, Ministry of Defence, Utrecht, the Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rob A van Hulst
- Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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22
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Abstract
BACKGROUND Calcific uremic arteriolopathy (calciphylaxis) is a rare and highly lethal vascular disease. Vascular calcification with calcium depositions lead to ischemic ulcers associated with gangrene, severe pain and poor healing. Although hyperbaric oxygen (HBO2) therapy has been used in the treatment of calciphylaxis, evidence of its effectiveness is limited. OBJECTIVE To determine whether HBO2 therapy has a beneficial effect in the healing of calciphylaxis ulcers. METHODS A search was made in PubMed using a comprehensive strategy to identify the effect of HBO2 on calciphylaxis wounds. Included in the analysis were studies published up to October 2018 involving a minimum of four patients receiving HBO2 therapy. RESULTS Ten retrospective (case) series were included. This review included a total of 131 patients with calciphylaxis who were treated with HBO2 therapy; of these, 58 patients (45%) had full response on HBO2 with complete wound closure. Regarding partial response, 17 of the patients (13%) experienced substantial wound improvement on different wound scale scores. CONCLUSION Patients with calcific uremic arteriolopathy can benefit from HBO2. More research is needed using standardized wound scores. Outcomes related to quality of life and pain relief should also be assessed.
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Affiliation(s)
| | - David N Teguh
- Department of Surgery/Hyperbaric Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Rob A van Hulst
- Professor of Anesthesiology/Hyperbaric Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
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23
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Lalieu RC, Brouwer RJ, Ubbink DT, Hoencamp R, Bol Raap R, van Hulst RA. Hyperbaric oxygen therapy for nonischemic diabetic ulcers: A systematic review. Wound Repair Regen 2019; 28:266-275. [PMID: 31667898 PMCID: PMC7079107 DOI: 10.1111/wrr.12776] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/28/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022]
Abstract
Diabetic foot ulcers are a common complication of diabetes, which affects 25% of patients and may ultimately lead to amputation of affected limbs. Research suggests hyperbaric oxygen therapy improves healing of these ulcers. However, this has not been reflected in previous reviews, possibly because they did not differentiate between patients with and without peripheral arterial occlusive disease. Therefore, we performed a systematic review of published literature in the MEDLINE, Embase, and Cochrane CENTRAL databases on nonischemic diabetic foot ulcers with outcome measures including complete ulcer healing, amputation rate (major and minor), and mortality. Seven studies were included, of which two were randomized clinical trials. Two studies found no difference in major amputation rate, whereas one large retrospective study found 2% more major amputations in the hyperbaric oxygen group. However, this study did not correct for baseline differences. Two studies showed no significant difference in minor amputation rate. Five studies reporting on complete wound healing showed no significant differences. In conclusion, the current evidence suggests that hyperbaric oxygen therapy does not accelerate wound healing and does not prevent major or minor amputations in patients with a diabetic foot ulcer without peripheral arterial occlusive disease. Based on the available evidence, routine clinical use of this therapy cannot be recommended. However, the available research for this specific subgroup of patients is scarce, and physicians should counsel patients on expected risks and benefits. Additional research, focusing especially on patient selection criteria, is needed to better identify patients that might profit from this therapy modality.
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Affiliation(s)
| | - Robin J Brouwer
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Dirk T Ubbink
- Academic Medical Center, Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.,Ministry of Defense, Defense Healthcare Organization, Utrecht, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - René Bol Raap
- Hyperbaar Geneeskundig Centrum, Rijswijk, The Netherlands
| | - Rob A van Hulst
- Academic Medical Center, Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Academic Medical Center, Department of Anesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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24
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de Bakker HM, Tijsterman M, de Bakker-Teunissen OJG, Soerdjbalie-Maikoe V, van Hulst RA, de Bakker BS. Prevalence of Pulmonary Bullae and Blebs in Postmortem CT Imaging With Potential Implications for Diving Medicine. Chest 2019; 157:916-923. [PMID: 31759963 DOI: 10.1016/j.chest.2019.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/22/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pulmonary bullae and blebs can result in a pneumothorax. Their prevalence in the normal population is currently unknown. Postmortem CT (PMCT) images from a forensic database were used to determine the prevalence of pulmonary bullae/blebs in the normal Dutch adult population and its consequence for diving medicine, as bullae and blebs are often considered a contraindication for diving. METHODS Forensic PMCT scans of 130 adults were analyzed for the presence of bullae and/or blebs in a cross-section of the Dutch population without pulmonary disorders. The lungs had to be unharmed, expanded, and without signs of illnesses. Normal early-stage postmortem changes in the lungs were accepted. RESULTS Analysis was performed per decade. Group I (aged 21-30 years) included 26 patients. Blebs were observed in four persons; one exhibited blebs and bullae. Group II (aged 31-40 years) included 28 patients; blebs were observed in nine individuals, one with bullae. Group III (aged 41-50 years) included 27 patients; blebs were noted in nine individuals, bullae in one, and bullae and blebs in four. Group IV (aged 51-60 years) included 28 patients; blebs were noted in seven individuals and two with bullae and blebs. Group V (aged 61-70 years) included 21 patients; blebs were noted in three persons, bullae and blebs in two, and isolated bullae in one. On average, most bullae/blebs were < 10 mm, and none exceeded 20 mm. CONCLUSIONS By reassessing pulmonary PMCT scans, we found a surprisingly high incidence of small bullae and/or blebs in one-third (33.8%; 95% CI, 25.7-41.9) of the general population without underlying lung disease. This finding can have potential implications for diving medicine.
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Affiliation(s)
- Henri M de Bakker
- Department of Radiology, Groene Hart Hospital, Gouda, The Netherlands
| | - Melanie Tijsterman
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Vidija Soerdjbalie-Maikoe
- Division of Special Services, Section Forensic Pathology, Netherlands Forensic Institute, The Hague, The Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernadette S de Bakker
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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25
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Wingelaar TT, Brinkman P, de Vries R, van Ooij PJA, Hoencamp R, Maitland-van der Zee AH, Hollmann MW, van Hulst RA. Detecting Pulmonary Oxygen Toxicity Using eNose Technology and Associations between Electronic Nose and Gas Chromatography-Mass Spectrometry Data. Metabolites 2019; 9:metabo9120286. [PMID: 31766640 PMCID: PMC6950559 DOI: 10.3390/metabo9120286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/04/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Exposure to oxygen under increased atmospheric pressures can induce pulmonary oxygen toxicity (POT). Exhaled breath analysis using gas chromatography–mass spectrometry (GC–MS) has revealed that volatile organic compounds (VOCs) are associated with inflammation and lipoperoxidation after hyperbaric–hyperoxic exposure. Electronic nose (eNose) technology would be more suited for the detection of POT, since it is less time and resource consuming. However, it is unknown whether eNose technology can detect POT and whether eNose sensor data can be associated with VOCs of interest. In this randomized cross-over trial, the exhaled breath from divers who had made two dives of 1 h to 192.5 kPa (a depth of 9 m) with either 100% oxygen or compressed air was analyzed, at several time points, using GC–MS and eNose. We used a partial least square discriminant analysis, eNose discriminated oxygen and air dives at 30 min post dive with an area under the receiver operating characteristics curve of 79.9% (95%CI: 61.1–98.6; p = 0.003). A two-way orthogonal partial least square regression (O2PLS) model analysis revealed an R² of 0.50 between targeted VOCs obtained by GC–MS and eNose sensor data. The contribution of each sensor to the detection of targeted VOCs was also assessed using O2PLS. When all GC–MS fragments were included in the O2PLS model, this resulted in an R² of 0.08. Thus, eNose could detect POT 30 min post dive, and the correlation between targeted VOCs and eNose data could be assessed using O2PLS.
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Affiliation(s)
- Thijs T. Wingelaar
- Diving and Submarine Medical Center, Royal Netherlands Navy, Rijkszee en Marinehaven, 1780 CA Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-889-510-480
| | - Paul Brinkman
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rianne de Vries
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Breathomix, Pascalstraat 13H, 2811 EL Reeuwijk, the Netherlands
| | - Pieter-Jan A.M. van Ooij
- Diving and Submarine Medical Center, Royal Netherlands Navy, Rijkszee en Marinehaven, 1780 CA Den Helder, The Netherlands
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
- Defense Healthcare Organisation, Ministry of Defence, Herculeslaan 1, 3584 AB Utrecht, The Netherlands
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rob A. van Hulst
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Hoencamp E, van Dongen TT, van Ooij PJA, Wingelaar TT, Vervelde ML, Koch DA, van Hulst RA, Hoencamp R. Systematic review on the effects of medication under hyperbaric conditions: consequences for the diver. Diving Hyperb Med 2019; 49:127-136. [PMID: 31177519 DOI: 10.28920/dhm49.2.127-136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/28/2018] [Accepted: 04/15/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Physiological changes are induced by immersion, swimming and using diving equipment. Divers must be fit to dive. Using medication may impact the capacity to adapt to hyperbaric conditions. The aim of this systematic review is to assess the interaction of diving/hyperbaric conditions and medication and to provide basic heuristics to support decision making regarding fitness to dive in medicated divers. METHODS This was a systematic review of human and animal studies of medications in the hyperbaric environment. Studies were subdivided into those describing a medication/hyperbaric environment interaction and those concerned with prevention of diving disorders. Studies without a relation to diving with compressed air, and those concerning oxygen toxicity, hyperbaric oxygen therapy or the treatment of decompression sickness were excluded. RESULTS Forty-four studies matched the inclusion criteria. Animal studies revealed that diazepam and valproate gave limited protection against the onset of the high-pressure neurological syndrome. Lithium had a protective effect against nitrogen-narcosis and losartan reduced cardiac changes in repetitive diving. Human studies showed no beneficial or dangerous pressure-related interactions. In prevention of diving disorders, pseudoephedrine reduced otic barotrauma, vitamins C and E reduced endothelial dysfunction after bounce diving and hepatic oxidative stress in saturation diving. DISCUSSION AND CONCLUSIONS Animal studies revealed that psycho-pharmaceuticals can limit the onset of neurologic symptoms and cardiovascular protective drugs might add a potential protective effect against decompression sickness. No evidence of significant risks due to changes in pharmacologic mechanisms were revealed and most medication is not a contraindication to diving. For improving decision making in prescribing medicine for recreational and occupational divers and to enhance safety by increasing our understanding of pharmacology in hyperbaric conditions, future research should focus on controlled human studies.
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Affiliation(s)
- Erik Hoencamp
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Thijs Tcf van Dongen
- Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.,Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.,Corresponding author: Thijs TCF van Dongen, Department of Surgery, Alrijne Hospital, PO Box 4220, 2350 CC Leiderdorp, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands,
| | | | - Thijs T Wingelaar
- Diving Medical Center, Royal Netherlands Navy, Den Helder, The Netherlands
| | | | - Dave Aa Koch
- Diving Medical Center, Royal Netherlands Navy, Den Helder, The Netherlands
| | - Rob A van Hulst
- Diving Medical Center, Royal Netherlands Navy, Den Helder, The Netherlands.,Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rigo Hoencamp
- Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.,Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.,Division of Surgery, Leiden University Medical Center, Leiden
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Brouwer RJ, Engberts AC, Borger van der Burg BL, van Dongen TT, van Hulst RA, Hoencamp R. Meta-analysis on the effect of hyperbaric oxygen as adjunctive therapy in the outcome of anastomotic healing of experimental colorectal resections in rats. Diving Hyperb Med 2019; 48:173-185. [PMID: 30199890 DOI: 10.28920/dhm48.3.173-185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Colorectal cancer is the third most common form of cancer and colorectal surgery is the treatment of choice in local disease. Anastomotic leakage following colorectal surgery is a major complication with a high incidence and mortality. Adjuvant hyperbaric oxygen treatment (HBOT) may be associated with reduction of anastomotic leakage. A systematic review was conducted regarding HBOT as an adjunctive therapy to colorectal surgery. METHODS Systematic review (1900-2017) using PubMed, Cochrane, EMBASE, Web of Science and EMCARE. All original published studies on the effect of HBOT as an adjunctive therapy for colorectal surgery with the creation of an anastomosis were considered. RESULTS Thirteen small animal trials were included for qualitative synthesis. We found no human trials. Eleven trials used bursting pressure whilst eight used hydroxyproline levels as a marker for collagen synthesis as primary outcome to assess the strength of the anastomosis. A meta-analysis performed for normal and ischaemic anastomoses showed that postoperative HBOT improves bursting pressure and hydroxyproline levels significantly in both normal (p ≤ 0.001 and p = 0.02) and ischaemic anastomoses (p ≤ 0.001 and p = 0.04). CONCLUSION Postoperative HBOT has a positive effect on colorectal anastomoses in rats. Further research should focus on a larger systematic animal study.
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Affiliation(s)
- Robin J Brouwer
- Corresponding author: Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands,
| | | | | | - Thijs Tcf van Dongen
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.,Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Amsterdam Medical Center, Amsterdam, The Netherlands.,Maritime Medical Expertise Center, Diving Medical Center, Royal Netherlands Navy, Den Helder, The Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.,Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Wingelaar TT, van Ooij PJAM, Brinkman P, van Hulst RA. Pulmonary Oxygen Toxicity in Navy Divers: A Crossover Study Using Exhaled Breath Analysis After a One-Hour Air or Oxygen Dive at Nine Meters of Sea Water. Front Physiol 2019; 10:10. [PMID: 30740057 PMCID: PMC6355711 DOI: 10.3389/fphys.2019.00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/08/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction: Exposure to hyperbaric hyperoxic conditions can lead to pulmonary oxygen toxicity. Although a decrease in vital capacity has long been the gold standard, newer diagnostic modalities may be more accurate. In pulmonary medicine, much research has focussed on volatile organic compounds (VOCs) associated with inflammation in exhaled breath. In previous small studies after hyperbaric hyperoxic exposure several methyl alkanes were identified. This study aims to identify which VOCs mark the development of pulmonary oxygen toxicity. Methods: In this randomized crossover study, 12 divers of the Royal Netherlands Navy made two dives of one hour to 192.5 kPa (comparable to a depth of 9 msw) either with 100% oxygen or compressed air. At 30 min before the dive, and at 30 min and 1, 2, 3, and 4 h post-dive, exhaled breath was collected and followed by pulmonary function tests (PFT). Exhaled breath samples were analyzed using gas chromatography–mass spectrometry (GC–MS). After univariate tests and correlation of retention times, ion fragments could be identified using a standard reference database [National Institute of Standards and Technology (NIST)]. Using these fragments VOCs could be reconstructed, which were then tested longitudinally with analysis of variance. Results: After GC–MS analysis, seven relevant VOCs (generally methyl alkanes) were identified. Decane and decanal showed a significant increase after an oxygen dive (p = 0.020 and p = 0.013, respectively). The combined intensity of all VOCs showed a significant increase after oxygen diving (p = 0.040), which was at its peak (+35%) 3 h post-dive. Diffusion capacity of nitric oxide and alveolar membrane capacity showed a significant reduction after both dives, whereas no other differences in PFT were significant. Discussion: This study is the largest analysis of exhaled breath after in water oxygen dives to date and the first to longitudinally measure VOCs. The longitudinal setup showed an increase and subsequent decrease of exhaled components. The VOCs identified suggest that exposure to a one-hour dive with a partial pressure of oxygen of 192.5 kPa damages the phosphatidylcholine membrane in the alveoli, while the spirometry and diffusion capacity show little change. This suggests that exhaled breath analysis is a more accurate method to measure pulmonary oxygen toxicity.
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Affiliation(s)
- Thijs T Wingelaar
- Diving Medical Center, Royal Netherlands Navy, Den Helder, Netherlands.,Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Paul Brinkman
- Department of Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Lansdorp CA, van Hulst RA. Double-blind trials in hyperbaric medicine: A narrative review on past experiences and considerations in designing sham hyperbaric treatment. Clin Trials 2018; 15:462-476. [PMID: 29865904 PMCID: PMC6136075 DOI: 10.1177/1740774518776952] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Hyperbaric oxygen therapy, which consists of breathing 100% oxygen under a
higher atmospheric pressure than normal, is utilized worldwide in the
treatment of several diseases. With the growing demand for evidence-based
research, hyperbaric oxygen therapy has been criticized for delivering too
little high-quality research, mainly in the form of randomized controlled
trials. While not always indispensable, the addition of a sham-controlled
group to such a trial can contribute to the quality of the research.
However, the design of a sham (hyperbaric) treatment is associated with
several considerations regarding adequate blinding and the use of pressure
and oxygen. This narrative review discusses information on the sham profile
and the blinding and safety of double-blind trials in hyperbaric medicine,
irrespective of the indication for treatment. Methods MEDLINE, Embase and CENTRAL were searched for sham-controlled trials on
hyperbaric oxygen therapy. The control treatment was considered sham if
patients were blinded to their allocation and treatment took place in a
hyperbaric chamber, with no restrictions regarding pressurization, oxygen
levels or indication. Studies involving children or only one session of
hyperbaric oxygen were excluded. Information on (the choice of) treatment
profile, blinding measures, patient’s perception regarding allocation and
safety issues was extracted from eligible studies. Results A total of 42 eligible trials were included. The main strategies for sham
treatment were (1) use of a lower pressure than that of the hyperbaric
oxygen group, while breathing 21% oxygen; (2) use of the same pressure as
the hyperbaric oxygen group, while breathing an adjusted percentage of
oxygen; and (3) use of the same pressure as the hyperbaric oxygen group,
while breathing 21% oxygen. The advantages and disadvantages of each
strategy are discussed using the information provided by the trials. Conclusion Based on this review, using a lower pressure than the hyperbaric oxygen group
while breathing 21% oxygen best matches the inertness of the placebo.
Although studies show that use of a lower pressure does allow adequate
blinding, this is associated with more practical issues than with the other
strategies. The choice of which sham profile to use requires careful
consideration; moreover, to ensure proper performance, a clear and detailed
protocol is also required.
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Affiliation(s)
- C A Lansdorp
- Department of Anesthesiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Academic Medical Centre, Amsterdam, The Netherlands
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Wingelaar TT, Clarijs P, van Ooij PJA, Koch DA, van Hulst RA. Modern assessment of pulmonary function in divers cannot rely on old reference values. Diving Hyperb Med 2018; 48:17-22. [PMID: 29557097 DOI: 10.28920/dhm48.1.17-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pulmonary function testing (PFT) is an important part of dive medical examinations. Depending on the standard used to assess fitness to dive, different reference sets and fixed cut-off points are used. Reference values are part of an ongoing debate regarding the validity and accuracy related to different age groups, sex and ethnic backgrounds. The Global Lung Initiative (GLI) has provided an all-age reference set which corrects for sex and ethnicity (GLI-2012); this has had substantial impact on pulmonary medicine. METHOD We present an algorithm that can be used to standardise analysis of PFT in divers using the GLI-2012 reference set. Differences in the analysis of PFT between the ECSC/ERS-1993 and the GLI-2012 reference values are illustrated by means of three case reports. CONCLUSION Using a valid database of reference values increases accuracy and might prevent additional medical investigations and/or incorrect assessment of fitness to dive. Although our algorithm needs further evaluation to ensure its validity, the preliminary results are promising. Whatever algorithm is used, we urge dive medical physicians to consider using valid reference sets when analysing PFT for assessment of fitness to dive.
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Affiliation(s)
- Thijs T Wingelaar
- Royal Netherlands Navy Diving Medical Centre, Den Helder, The Netherlands.,Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, The Netherlands.,Royal Netherlands Navy Diving Medical Centre, Rijkszee en marinehaven, 1780 CA Den Helder, The Netherlands,
| | - Paul Clarijs
- Royal Netherlands Navy Diving Medical Centre, Den Helder, The Netherlands
| | | | - Dave Aa Koch
- Royal Netherlands Navy Diving Medical Centre, Den Helder, The Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, The Netherlands
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Wingelaar TT, van Ooij PJAM, van Hulst RA. Oxygen Toxicity and Special Operations Forces Diving: Hidden and Dangerous. Front Psychol 2017; 8:1263. [PMID: 28790955 PMCID: PMC5524741 DOI: 10.3389/fpsyg.2017.01263] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/11/2017] [Indexed: 12/04/2022] Open
Abstract
In Special Operations Forces (SOF) closed-circuit rebreathers with 100% oxygen are commonly utilized for covert diving operations. Exposure to high partial pressures of oxygen (PO2) could cause damage to the central nervous system (CNS) and pulmonary system. Longer exposure time and higher PO2 leads to faster development of more serious pathology. Exposure to a PO2 above 1.4 ATA can cause CNS toxicity, leading to a wide range of neurologic complaints including convulsions. Pulmonary oxygen toxicity develops over time when exposed to a PO2 above 0.5 ATA and can lead to inflammation and fibrosis of lung tissue. Oxygen can also be toxic for the ocular system and may have systemic effects on the inflammatory system. Moreover, some of the effects of oxygen toxicity are irreversible. This paper describes the pathophysiology, epidemiology, signs and symptoms, risk factors and prediction models of oxygen toxicity, and their limitations on SOF diving.
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Affiliation(s)
- Thijs T Wingelaar
- Diving Medical Center, Royal Netherlands NavyDen Helder, Netherlands.,Department of Anaesthesiology, Academic Medical CenterAmsterdam, Netherlands
| | | | - Rob A van Hulst
- Department of Anaesthesiology, Academic Medical CenterAmsterdam, Netherlands
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Wingelaar TT, van Ooij PJA, van Hulst RA. Otitis externa in military divers: more frequent and less harmful than reported. Diving Hyperb Med 2017; 47:4-8. [PMID: 28357818 PMCID: PMC6147244 DOI: 10.28920/dhm47.1.4-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Although otitis externa (OE) is a common disease, data related to (military) divers are limited. This study aimed to determine the incidence of OE in military divers during their initial training. We also wished to consider seasonal influences on incidence and whether early detection increases completion of the diving course. METHODS From January 2011 to October 2016 the Royal Netherlands Navy Diving School trained 189 divers. Up to December 2015 we used the training records for the analyses. From January 2016 onward all divers were prospectively screened. Pearson's chi-squared 2 and Fisher's exact tests were used to analyse the data. RESULTS In the 162 included divers, 30 cases of OE were identified. The incidence in 2016 was significantly higher than in 2011-2015 (17/35 (49%) versus 13/127 (10%), P < 0.001). Almost all cases developed after three weeks of diving. No influence of season was found (P = 0.354). Early diagnosis and treatment of OE does not seem to affect completion of diving courses (P = 0.28). Only in three cases did a diver have to discontinue the course due to OE. DISCUSSION This study suggests that OE is more frequent among military divers than earlier reported, most likely caused by prolonged water exposure. Diving activities can often be continued with standard topical treatment.
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Affiliation(s)
- Thijs T Wingelaar
- Royal Netherlands Navy Diving Medical Center, Rijkszee en marinehaven, 1780 CA Den Helder, The Netherlands
- Department of Anesthesiology, Academic Medical Center, University of Amsterdam
| | | | - Rob A van Hulst
- Department of Anesthesiology, Academic Medical Center, University of Amsterdam
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Teguh DN, Bol Raap R, Struikmans H, Verhoef C, Koppert LB, Koole A, Huang Y, van Hulst RA. Hyperbaric oxygen therapy for late radiation-induced tissue toxicity: prospectively patient-reported outcome measures in breast cancer patients. Radiat Oncol 2016; 11:130. [PMID: 27682427 PMCID: PMC5041335 DOI: 10.1186/s13014-016-0700-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/14/2016] [Accepted: 09/13/2016] [Indexed: 12/20/2022] Open
Abstract
Introduction This study examines patient reported outcome measures of women undergoing hyperbaric oxygen treatment (HBOT) after breast-conserving therapy. Method Included were 57 women treated with HBOT for late radiation-induced tissue toxicity (LRITT) referred in the period January 2014-December 2015. HBOT consisted of (on average) 47 sessions. In total, 80 min of 100 % O2 was administered under increased pressure of 2.4 ATA. Quality of life was assessed before and after treatment using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR23, and a NRS pain score. Results Fifty-seven women were available for evaluation before and after treatment. Before HBOT, patients had severe complaints of pain in the arm/shoulder (46 %), swollen arm/hand (14 %), difficulty to raise arm or move it sideways (45 %), pain in the area of the affected breast (67 %), swollen area of the affected breast (45 %), oversensitivity of the affected breast (54 %), and skin problems on/in the area of the affected breast (32 %); post HBOT, severe complaints were still experienced in 17, 7, 22, 15, 13, 15, and 11 % of the women, respectively. Differences were all significant. The NRS pain score improved at least 1 point (range 0–10) in 81 % of the patients (p < 0.05). Conclusion In these breast cancer patients treated with HBOT for LRITT, the patient-reported outcomes were positive and improvements were observed. HBOT was a well-tolerated treatment for LRITT and its side-effects were both minimal and reversible.
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Affiliation(s)
- David N Teguh
- Hyperbaar Geneeskundig Centrum Rijswijk, Treubstraat 5a, 2288 EG, Rijswijk, The Netherlands. .,Department of Surgery/Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - René Bol Raap
- Hyperbaar Geneeskundig Centrum Rijswijk, Treubstraat 5a, 2288 EG, Rijswijk, The Netherlands
| | - Henk Struikmans
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, The Netherlands.,Radiotherapy Centre West, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Cees Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arne Koole
- Hyperbaar Geneeskundig Centrum Rijswijk, Treubstraat 5a, 2288 EG, Rijswijk, The Netherlands
| | - Yadi Huang
- University of Leuven, Leuven, The Netherlands
| | - Rob A van Hulst
- Hyperbaar Geneeskundig Centrum Rijswijk, Treubstraat 5a, 2288 EG, Rijswijk, The Netherlands.,Department of Anesthesiology/Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Teguh DN, Raap RB, Struikmans H, van Hulst RA. Hyperbaric oxygen therapy for chronic bowel dysfunction after pelvic radiotherapy. Lancet Oncol 2016; 17:e130-e131. [PMID: 27300667 DOI: 10.1016/s1470-2045(16)00108-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/25/2022]
Affiliation(s)
- David N Teguh
- Hyperbaar Geneeskundig Centrum, 2288 EG Rijswijk, Netherlands; Department of Surgery/Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
| | - René Bol Raap
- Hyperbaar Geneeskundig Centrum, 2288 EG Rijswijk, Netherlands
| | - Henk Struikmans
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, Netherlands; Radiotherapy Centre West, Medical Centre Haaglanden, The Hague, Netherlands
| | - Rob A van Hulst
- Hyperbaar Geneeskundig Centrum, 2288 EG Rijswijk, Netherlands; Department of Anesthesiology/Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Fijen VA, Westerweel PE, van Ooij PJAM, van Hulst RA. Tympanic membrane bleeding complications during hyperbaric oxygen treatment in patients with or without antiplatelet and anticoagulant drug treatment. Diving Hyperb Med 2016; 46:22-25. [PMID: 27044458] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Middle ear barotrauma (MEBt) is a frequently occurring complication of hyperbaric oxygen treatment (HBOT). High-grade MEBt may involve tympanic membrane (TM) haemorrhaging. Although many patients undergoing HBOT use antiplatelet or anticoagulant drugs, it is unknown whether these drugs increase the risk of MEBt and particularly TM bleeding complications. METHODS This multicentre, prospective cohort study investigates the prevalence of MEBt and TM bleeding during HBOT in patients using antiplatelet/anticoagulant drugs, compared with control patients not on such medications. MEBt was assessed by video otoscopy of the TM pre and post HBOT and scored according to the modified Teed score. Any complications from previous HBOT sessions were retrospectively documented. RESULTS Of 73 patients receiving HBOT, 34 used antiplatelet/anticoagulant drugs. Mild MEBt (Teed score 1 or 2) occurred in 23 of these 34 patients and in 31 of the 39 controls. Teed score 3 MEBt occurred in only two of the control-group patients and none of the patients using antiplatelet/anticoagulant drugs. Two patients using anticoagulant drugs reported epistaxis during a previous HBOT session, epistaxis was not reported by any control patients. CONCLUSION Low-grade MEBt is common during HBOT, however, high-grade barotrauma is rare with current chamber operating procedures. Patients using antiplatelet/anticoagulant drugs potentially may be prone to MEBt-associated haemorrhagic complications, but we did not observe any such increase in this cohort. Only mild epistaxis occurred in patients using anticoagulant drugs.
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Affiliation(s)
- Valerie A Fijen
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands, Phone: +31-(0)65-220-2206, E-mail:
| | - Peter E Westerweel
- Albert Schweitzer Hospital, Dept. Internal Medicine, Dordrecht, The Netherlands
| | | | - Rob A van Hulst
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands
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Santema TB, Stoekenbroek RM, van Steekelenburg KC, van Hulst RA, Koelemay MJ, Ubbink DT. Economic outcomes in clinical studies assessing hyperbaric oxygen in the treatment of acute and chronic wounds. Diving Hyperb Med 2015; 45:228-234. [PMID: 26687309] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/22/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Hyperbaric oxygen treatment (HBOT) is used to treat acute and chronic wounds. This systematic review was conducted to summarise and evaluate existing evidence on the costs associated with HBOT in the treatment of wounds. METHODS We searched multiple electronic databases in March 2015 for cohort studies and randomised clinical trials (RCTs) that reported on the clinical effectiveness and treatment costs of HBOT in the treatment of acute or chronic wounds. RESULTS One RCT and three cohort studies reported on economic as well as clinical outcomes. These studies comprised different disorders (ischaemic diabetic foot ulcers, thermal burns, Fournier's gangrene and necrotising soft tissue infections) and employed different clinical and economic outcome measures. Only the RCT had a good methodological quality. Three of the included studies reported that their primary clinical outcomes (wound healing, hospital stay, complications) improved in the HBOT group. The effects of HBOT on costs were variable. CONCLUSIONS Currently, there is little direct evidence on the cost-effectiveness of HBOT in the treatment of acute and chronic wounds. Although there is some evidence suggesting effectiveness of HBOT, further studies should include economic outcomes in order to make recommendations on the cost-effectiveness of applying HBOT in wound care.
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Affiliation(s)
- Trientje B Santema
- Department of Surgery, room G4-132, Academic Medical Center, P O Box 22660, 1100 DD Amsterdam, The Netherlands, Phone: +31-(0)20-566-3405, Fax: +31-(0)20-566-6569, E-mail:
| | | | | | - Rob A van Hulst
- Department of Hyperbaric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Mark Jw Koelemay
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Dirk T Ubbink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Stoekenbroek RM, Santema TB, Koelemay MJ, van Hulst RA, Legemate DA, Reekers JA, Ubbink DT. Is additional hyperbaric oxygen therapy cost-effective for treating ischemic diabetic ulcers? Study protocol for the Dutch DAMOCLES multicenter randomized clinical trial? J Diabetes 2015; 7:125-32. [PMID: 24674297 DOI: 10.1111/1753-0407.12155] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/20/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The value of hyperbaric oxygen therapy (HBOT) in the treatment of diabetic ulcers is still under debate. Available evidence suggests that HBOT may improve the healing of diabetic ulcers, but it comes from small trials with heterogeneous populations and interventions. The DAMOCLES-trial will assess the (cost-)effectiveness of HBOT for ischemic diabetic ulcers in addition to standard of care. METHODS In a multicenter randomized clinical trial, including 30 hospitals and all 10 HBOT centers in the Netherlands, we plan to enroll 275 patients with Types 1 or 2 diabetes, a Wagner 2, 3 or 4 ulcer of the leg present for at least 4 weeks, and concomitant leg ischemia, defined as an ankle systolic blood pressure of <70 mmHg, a toe systolic blood pressure of <50 mmHg or a forefoot transcutaneous oxygen tension (TcpO2) of <40 mmHg. Eligible patients may be candidates for revascularization. Patients will be randomly assigned to standard care with or without 40 HBOT-sessions. RESULTS Primary outcome measures are freedom from major amputation after 12 months and achievement of, and time to, complete wound healing. Secondary endpoints include freedom from minor amputations, ulcer recurrence, TcpO2 , quality of life, and safety. In addition, we will assess the cost-effectiveness of HBOT for this indication. CONCLUSION The DAMOCLES trial will be the largest trial ever performed in the realm of HBOT for chronic ulcers, and it is unique for addressing patients with ischemic diabetic foot ulcers who may also receive vascular reconstructions. This matches the treatment dilemma in current clinical practice.
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van der Veen EL, van Hulst RA, de Ru JA. Hyperbaric Oxygen Therapy in Acute Acoustic Trauma: A Rapid Systematic Review. Otolaryngol Head Neck Surg 2014; 151:42-5. [PMID: 24647641 DOI: 10.1177/0194599814526555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 01/16/2014] [Accepted: 02/12/2014] [Indexed: 11/16/2022]
Abstract
In this rapid systematic review, we studied the clinical question, What is the effect of hyperbaric oxygen therapy on hearing thresholds in patients who suffered a recent acute acoustic trauma? After screening for eligible titles and abstracts and extracting duplicates, 6 original research papers could be found. The general methodology of the studies was weak and the differences between these studies were too profound to pool the data, especially because of heterogeneity in adjuvant therapies, follow-up, and treatment protocol. The mean dB of hearing recovery in these studies ranged from 17 to 47 dB in the groups treated with hyperbaric oxygen versus 5 to 46 dB in the groups who did not receive hyperbaric oxygen therapy. We conclude that the effect of hyperbaric oxygen therapy on hearing thresholds in patients with hearing loss caused by a recent acute acoustic trauma remains unclear. A well-designed randomized controlled trial with enough power is advised to answer this clinical question.
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Affiliation(s)
- Erwin L van der Veen
- Department of Otorhinolaryngology, Central Military Hospital, Utrecht, The Netherlands Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rob A van Hulst
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands Department of Hyperbaric Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - J Alexander de Ru
- Department of Otorhinolaryngology, Central Military Hospital, Utrecht, The Netherlands Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Schellart NAM, van Rees Vellinga TP, van Hulst RA. Body fat does not affect venous bubble formation after air dives of moderate severity: theory and experiment. J Appl Physiol (1985) 2013; 114:602-10. [PMID: 23305985 DOI: 10.1152/japplphysiol.00949.2012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
For over a century, studies on body fat (BF) in decompression sickness and venous gas embolism of divers have been inconsistent. A major problem is that age, BF, and maximal oxygen consumption (Vo2max) show high multicollinearity. Using the Bühlmann model with eight parallel compartments, preceded by a blood compartment in series, nitrogen tensions and loads were calculated with a 40 min/3.1 bar (absolute) profile. Compared with Haldanian models, the new model showed a substantial delay in N2 uptake and (especially) release. One hour after surfacing, an increase of 14-28% in BF resulted in a whole body increase of the N2 load of 51%, but in only 15% in the blood compartment. This would result in an increase in the bubble grade of only 0.01 Kisman-Masurel (KM) units at the scale near KM = I-. This outcome was tested indirectly by a dry dive simulation (air breathing) with 53 male divers with a small range in age and Vo2max to suppress multicollinearity. BF was determined with the four-skinfold method. Precordial Doppler bubble grades determined at 40, 80, 120, and 160 min after surfacing were used to calculate the Kisman Integrated Severity Score and were also transformed to the logarithm of the number of bubbles/cm(2) (logB). The highest of the four scores yielded logB = -1.78, equivalent to KM = I-. All statistical outcomes of partial correlations with BF were nonsignificant. These results support the model outcomes. Although this and our previous study suggest that BF does not influence venous gas embolism (Schellart NAM, van Rees Vellinga TP, van Dijk FH, Sterk W. Aviat Space Environ Med 83: 951-957, 2012), more studies with different profiles under various conditions are needed to establish whether BF remains (together with age and Vo2max) a basic physical characteristic or will become less important for the medical examination and for risk assessment.
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Affiliation(s)
- Nico A M Schellart
- Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Verster JC, Kienhorst EAM, van Hulst RA. Alcohol, drugs, and diving: implications for health and fitness to dive. Curr Drug Abuse Rev 2012; 5:85-86. [PMID: 22530799 DOI: 10.2174/1874473711205020085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Gho JMIHIH, Kramer IF, van Hulst RA, Kramer WLM. [Decompression illness: minor symptoms, major consequences]. Ned Tijdschr Geneeskd 2012; 156:A4985. [PMID: 22951132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Nowadays, diving is being performed ever more frequently; it is thus important to take diving injuries into consideration in patients presenting with even minor complaints after diving. Every dive is risky and could result in decompression illness, barotrauma and/or death. We report on two cases of decompression illness: a 30-year old man, an occupational diver, and a 46-year old man, an experienced diver, who were both clinically suspected of having decompression illness and were treated with hyperbaric oxygen in a recompression chamber. Both were eventually symptom-free after several treatments. Decompression illness is caused by a reduction in ambient pressure, which results in intra- or extravascular bubbles. Symptoms vary and are dependent on the site affected: from minor pain to neurological symptoms and death. If patients are suspected of having diving injuries, we recommend contacting a centre specialised in diving and hyperbaric medicine. Recompression in a hyperbaric chamber is the definitive treatment for decompression illness and should be performed as soon as possible.
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Affiliation(s)
- J M I H Ing Han Gho
- Universitair Medisch Centrum Utrecht, Afd. Cardiologie, Utrecht, the Netherlands.
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