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Johnson WR, Roney NG, Zhou H, Ciarlone GE, Williams BT, Green WT, Mahon RT, Dainer HM, Hart BB, Hall AA. Comparison of treatment recompression tables for neurologic decompression illness in swine model. PLoS One 2022; 17:e0266236. [PMID: 36197931 PMCID: PMC9534405 DOI: 10.1371/journal.pone.0266236] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/16/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Significant reductions in ambient pressure subject an individual to risk of decompression illness (DCI); with incidence up to 35 per 10,000 dives. In severe cases, the central nervous system is often compromised (>80%), making DCI among the most morbid of diving related injuries. While hyperbaric specialists suggest initiating recompression therapy with either a Treatment Table 6 (TT6) or 6A (TT6A), the optimal initial recompression treatment for severe DCI is unknown. METHODS Swine were exposed to an insult dive breathing air at 7.06 ATA (715.35 kPa) for 24 min followed by rapid decompression at a rate of 1.82 ATA/min (184.41 kPa/min). Swine that developed neurologic DCI within 1 hour of surfacing were block randomized to one of four United States Navy Treatment Tables (USN TT): TT6, TT6A-air (21% oxygen, 79% nitrogen), TT6A-nitrox (50% oxygen, 50% nitrogen), and TT6A-heliox (50% oxygen, 50% helium). The primary outcome was the mean number of spinal cord lesions, which was analyzed following cord harvest 24 hours after successful recompression treatment. Secondary outcomes included spinal cord lesion incidence and gross neurologic outcomes based on a pre- and post- modified Tarlov assessment. We compared outcomes among these four groups and between the two treatment profiles (i.e. TT6 and TT6A). RESULTS One-hundred and forty-one swine underwent the insult dive, with 61 swine meeting inclusion criteria (43%). We found no differences in baseline characteristics among the groups. We found no significant differences in functional neurologic outcomes (p = 0.77 and 0.33), spinal cord lesion incidence (p = 0.09 and 0.07), or spinal cord lesion area (p = 0.51 and 0.17) among the four treatment groups or between the two treatment profiles, respectively. While the trends were not statistically significant, animals treated with TT6 had the lowest rates of functional deficits and the fewest spinal cord lesions. Moreover, across all animals, functional neurologic deficit had strong correlation with lesion area pathology (Logistic Regression, p < 0.01, Somers' D = 0.74). CONCLUSIONS TT6 performed as well as the other treatment tables and is the least resource intensive. TT6 is the most appropriate initial treatment for neurologic DCI in swine, among the tables that we compared.
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Affiliation(s)
- W Rainey Johnson
- Naval Medical Research Center, Bethesda, Maryland, United States of America
| | - Nicholas G Roney
- Naval Medical Research Center, Bethesda, Maryland, United States of America
| | - Hanbing Zhou
- Henry M. Jackson Foundation, Bethesda, Maryland, United States of America
| | | | - Brian T Williams
- Henry M. Jackson Foundation, Bethesda, Maryland, United States of America
| | - William T Green
- Henry M. Jackson Foundation, Bethesda, Maryland, United States of America
| | - Richard T Mahon
- Henry M. Jackson Foundation, Bethesda, Maryland, United States of America
| | - Hugh M Dainer
- Naval Medical Research Center, Bethesda, Maryland, United States of America
| | - Brett B Hart
- Naval Medical Research Center, Bethesda, Maryland, United States of America
| | - Aaron A Hall
- Naval Medical Research Center, Bethesda, Maryland, United States of America
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Hart BB. Hyperbaric oxygen for refractory osteomyelitis. Undersea Hyperb Med 2021; 48:297-321. [PMID: 34390634] [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] [Indexed: 06/13/2023]
Abstract
Refractory osteomyelitis is defined as a chronic osteomyelitis that persists or recurs after appropriate interventions have been performed or where acute osteomyelitis has not responded to accepted management techniques [1]. To date, no randomized clinical trials examining the effects of hyperbaric oxygen (HBO2) therapy on refractory osteomyelitis exist, and the number of new osteomyelitis clinical trials conducted over the past decade has been limited. However, based on a comprehensive review of the scientific literature, the addition of HBO2 therapy to routine surgical and antibiotic treatment of previously refractory osteomyelitis appears to be both safe and ultimately improves infection resolution rates. In most cases, the best clinical results are obtained when HBO2 treatment is administered in conjunction with culture-directed antibiotics and initiated soon after clinically indicated surgical debridement. Where extensive surgical debridement or removal of fixation hardware is relatively contraindicated (e.g., cranial, spinal, sternal, or pediatric osteomyelitis), a trial of culture-directed antibiotics and HBO2 therapy prior to undertaking more than limited surgical interventions provides a reasonable prospect for osteomyelitis cure. HBO2 therapy is ordinarily delivered on a once daily basis, five-seven days per week, for 90-120 minutes using 2.0-3.0 atmospheres absolute (ATA) pressure. Where prompt clinical improvement is seen, the existing regimen of antibiotics and HBO2 therapy should be continued for approximately four to six weeks. Typically, 20-40 HBO2 sessions are required to achieve sustained therapeutic benefit. In contrast, if prompt clinical response is not noted or osteomyelitis recurs after this initial treatment period, then continuation of the current antibiotic and HBO2 treatment regimen is unlikely to be effective. Instead, clinical management strategies should be reassessed and additional surgical debridement and/or modification of antibiotic therapy considered. Subsequent reinstitution of HBO2 therapy will again help maximize the overall chances for treatment success in these persistently refractory patients.
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Affiliation(s)
- Brett B Hart
- Department of Emergency Medicine and Research Institute of Hyperbaric Medicine and Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Hart BB, Wilson SH, Churchill S, Deru K, Weaver LK, Minnakanti M, Lindblad AS. Extended follow-up in a randomized trial of hyperbaric oxygen for persistent post-concussive symptoms. Undersea Hyperb Med 2019; 46:313-327. [PMID: 31394601] [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] [Indexed: 06/10/2023]
Abstract
To date, several Department of Defense (DoD) and civilian studies have evaluated hyperbaric oxygen for mild forms of traumatic brain injury. Prior to the DoD-sponsored "Brain Injury and Mechanisms of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (mTBI) (BIMA)" trial, none included post-intervention follow-up beyond three to six months. Post-hoc attempts at long-term follow-up were complicated by low participation and potential self-selection bias. BIMA planned for follow-up through 12 months but was amended to add post-concussive and post-traumatic stress disorder, quality of life, pain, depression, anxiety, and alcohol use assessments at 24 and 36 months. A total of 42 of 71 BIMA participants consented to extendedfollow-up, and 40 and 14 completed a 24- or 36-month visit, respectively, representing an overall response rate of 59% and 20%. Participants who completed extended follow-up were similar to the study group that did not in terms of demographics, perceived intervention allocation, and initial response to intervention. There were no significant differences at 24 or 36 months between intervention groups, and group mean scores were near pre-intervention values. This return to baseline could be due to waning treatment effect, selection bias, or participant or perception effects. Though BIMA implemented several participant retention strategies, more frequent participant contact and increased compensation might improve long-term retention in future studies. clinicaltrials.gov Identifier NCT01611194.
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Affiliation(s)
| | | | - Susan Churchill
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
| | - Kayla Deru
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
| | - Lindell K Weaver
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah U.S
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Hart BB, Weaver LK, Wilson SH, Lindblad AS, Churchill S, Deru K. Executive summary: Secondary analyses of DoD-sponsored studies examining hyperbaric oxygen for persistent post-concussive symptoms after mild traumatic brain injury. Undersea Hyperb Med 2019; 46:221-226. [PMID: 31394593] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Lindell K Weaver
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah U.S
| | | | | | - Susan Churchill
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
| | - Kayla Deru
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
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Hart BB, Weaver LK, Gupta A, Wilson SH, Vijayarangan A, Deru K, Hebert D. Hyperbaric oxygen for mTBI-associated PCS and PTSD: Pooled analysis of results from Department of Defense and other published studies. Undersea Hyperb Med 2019; 46:353-383. [PMID: 31394604] [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] [Indexed: 06/10/2023]
Abstract
BACKGROUND Some clinical trials report improvement in persistent post-concussive symptoms (PCS) with hyperbaric oxygen (HBO2) following mild traumatic brain injury (mTBI), but questions remain regarding the utility of HBO2 for PCS, the effects of HBO2 on post-traumatic stress disorder (PTSD), and the influences of sham control exposures. METHODS A systematic review and pooled analysis was conducted to summarize available evidence for HBO2 in mTBI-associated PCS ± PTSD. Data aggregated from four Department of Defense (DoD) studies with participant-level data (n=254) were grouped into pooled HBO2 and sham intervention groups. Changes from baseline to post-intervention on PCS, PTSD, and neuropsychological measures were assessed using linear mixed models to evaluate main intervention and intervention-by-baseline PTSD effects. Potential dose-response relationships to oxygen partial pressures were investigated. Intervention effects from three other published studies with summary-level participant data (n=135) were also summarized.. RESULTS Pooled DoD data analyses indicated trends toward improvement favoring HBO2 for PCS (Rivermead Total Score: -2.3, 95% CI [-5.6, 1.0], p=0.18); PTSD (PTSD Checklist Total Score: -2.7, 95% CI [-5.8, 0.4], p=0.09); and significant improvement in verbal memory (CVLT-II Trial 1-5 Free Recall: 3.8; 95% CI [1.0, 6.7], p=0.01). A dose-response trend to increasing oxygen partial pressure was also found, with a greater HBO2 effect in mTBI-associated PTSD suggested. The direction of results was consistent with other published studies. CONCLUSION A definitive clinical trial, with an appropriate control group, should be considered to identify the optimal HBO2 dosing regimen for individuals with mTBI-associated PTSD ± PCS.
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Affiliation(s)
| | - Lindell K Weaver
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah U.S
| | | | | | | | - Kayla Deru
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
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Skipper LD, Churchill S, Wilson SH, Deru K, Labutta RJ, Hart BB. Hyperbaric oxygen for persistent post-concussive symptoms: long-term follow-up. Undersea Hyperb Med 2016; 43:601-613. [PMID: 28768076] [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] [Indexed: 06/07/2023]
Abstract
We report results of an observational cohort study investigating long-term follow-up in participants from two completed United States military trials of hyperbaric oxygen (HBO₂) for persistent post-concussive symptoms (PCS), as well as challenges in recruitment and retention in active-duty military personnel. After informed consent, participants completed an electronic survey assessing PCS, post-traumatic stress disorder (PTSD), anxiety, depression and quality of life. Of 132 HBO₂ study participants, 40 (30%) completed the survey (42 could not be contacted; 50 were lost to follow-up or declined). All were male, age 28.1 ±6.6 years (mean ±1SD). Time to follow-up was 39.2 ±6.1 months. At follow-up, participants reported continued symptoms of PTSD, depression, anxiety and reduced quality of life. Among DARPA/VCU study participants, total PCS scores worsened in the 1.5 atmospheres absolute (ATA) equivalent HBO₂ group (mean change 7.4 ±15.8) and improved in the sham (-8.0 ±7.7) and 2.0 atmospheres absolute equivalent HBO₂ groups (-3.3 ±7.4). Individual changes varied widely, range -23 to +28 points. In participants from the HOPPS study, total PCS scores worsened in all groups: local care (10.5 ±8.7), sham (7.9 ±11.9) and 1.5 ATA HBO₂ (1.0 ±19.4). In this limited, cross-sectional sample, PCS and PTSD symptoms did not appear to improve over time by descriptive analyses. Low participation rates and potential response bias limit our ability to perform statistical hypothesis testing and to draw conclusions from these data. Future studies should prospectively plan longitudinal follow-up and regular engagement with participants to minimize attrition.
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Affiliation(s)
- Leonard D Skipper
- Hyperbaric Oxygen Project Office, US Army Medical Materiel Development Activity (USAMMDA), Fort Detrick, Maryland U.S
- Neurotrauma and Psychological Health USAMMDA, Fort Detrick, Maryland U.S
| | - Susan Churchill
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, Utah, and Intermountain LDS Hospital, Salt Lake City, Utah U.S
| | | | - Kayla Deru
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, Utah, and Intermountain LDS Hospital, Salt Lake City, Utah U.S
| | - Robert J Labutta
- Hyperbaric Oxygen Project Office, US Army Medical Materiel Development Activity (USAMMDA), Fort Detrick, Maryland U.S
- Neurotrauma and Psychological Health USAMMDA, Fort Detrick, Maryland U.S
| | - Brett B Hart
- Hyperbaric Oxygen Project Office, US Army Medical Materiel Development Activity (USAMMDA), Fort Detrick, Maryland U.S
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Cifu DX, Walker WC, West SL, Hart BB, Franke LM, Sima A, Graham CW, Carne W. Hyperbaric oxygen for blast-related postconcussion syndrome: three-month outcomes. Ann Neurol 2014; 75:277-86. [PMID: 24255008 DOI: 10.1002/ana.24067] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/14/2013] [Accepted: 11/15/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI) and postconcussion syndrome (PCS) are common among military combatants. Hyperbaric oxygen (HBO2 ) is a proposed treatment for these conditions, but it has not been rigorously studied. The objective of this study was to determine the effects of HBO2 by 3 months post compression at 2 commonly employed dosing levels to treat PCS; whether specific subgroups may have benefited; and if no overall effect was found, whether benefit is masked by other conditions. METHODS This randomized, double-blind, sham-controlled study was conducted at the Naval Air Station in Pensacola, Florida on 61 male Marines with a history of mTBI and PCS. Intervention consisted of 40 once daily 60-minute hyperbaric chamber compressions at 2.0 atmospheres absolute (ATA) at 1 of 3 randomly preassigned oxygen fractions, resulting in respective blinded groups with an oxygen-breathing exposure equivalent to (1) surface air (sham), (2) 100% oxygen at 1.5ATA, or (3) 100% oxygen at 2.0ATA. The main outcome measure was the Rivermead Post-Concussion Questionnaire-16 (RPQ-16) collected before compressions and at 2 later points. RESULTS The interaction of time by intervention group was not significant for improvement on the RPQ-16. Nor was there evidence of efficacy on the RPQ-16 for any subgroup. No significant time by intervention interaction was found for any functional, cognitive, or psychomotor secondary outcome measure at an unadjusted 0.05 significance level. INTERPRETATION Using a randomized control trial design and analysis including a sham, results showed no evidence of efficacy by 3 months post-compression to treat the symptomatic, cognitive, or behavioral sequelae of PCS after combat-related mTBI.
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Affiliation(s)
- David X Cifu
- Physical Medicine and Rehabilitation Program Office, Department of Veterans Affairs, Washington, DC; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Center for Rehabilitation Sciences and Engineering, Richmond, VA
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Walker WC, Franke LM, Cifu DX, Hart BB. Randomized, Sham-Controlled, Feasibility Trial of Hyperbaric Oxygen for Service Members With Postconcussion Syndrome: Cognitive and Psychomotor Outcomes 1 Week Postintervention. Neurorehabil Neural Repair 2013; 28:420-32. [PMID: 24370568 DOI: 10.1177/1545968313516869] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Mild traumatic brain injury (mTBI) and residual postconcussion syndrome (PCS) are common among combatants of the recent military conflicts in Iraq and Afghanistan. Hyperbaric oxygen (HBO2) is a proposed treatment but has not been rigorously studied for this condition. Objectives In a secondary analysis, examine for possible effects on psychomotor (balance and fine motor) and cognitive performance 1 week after an HBO2 intervention in service members with PCS after mTBI. Methods A randomized, double-blind, sham control, feasibility trial comparing pretreatment and posttreatment was conducted in 60 male active-duty marines with combat-related mTBI and PCS persisting for 3 to 36 months. Participants were randomized to 1 of 3 preassigned oxygen fractions (10.5%, 75%, or 100%) at 2.0 atmospheres absolute (ATA), resulting in respective groups with an oxygen exposure equivalent to (1) breathing surface air (Sham Air), (2) 100% oxygen at 1.5 ATA (1.5 ATAO2), and (3) 100% oxygen at 2.0 ATA (2.0 ATAO2). Over a 10-week period, participants received 40 hyperbaric chamber sessions of 60 minutes each. Outcome measures, including computerized posturography (balance), grooved pegboard (fine motor speed/dexterity), and multiple neuropsychological tests of cognitive performance, were collected preintervention and 1-week postintervention. Results Despite the multiple sensitive cognitive and psychomotor measures analyzed at an unadjusted 5% significance level, this study demonstrated no immediate postintervention beneficial effect of exposure to either 1.5 ATAO2 or 2.0 ATAO2 compared with the Sham Air intervention. Conclusions These results do not support the use of HBO2 to treat cognitive, balance, or fine motor deficits associated with mTBI and PCS.
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Affiliation(s)
- William C Walker
- Virginia Commonwealth University, Richmond, VA, USA Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA Richmond Defense and Veterans Brain Injury Center, Richmond, VA, USA
| | - Laura Manning Franke
- Virginia Commonwealth University, Richmond, VA, USA Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA Richmond Defense and Veterans Brain Injury Center, Richmond, VA, USA
| | - David X Cifu
- Virginia Commonwealth University, Richmond, VA, USA Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA Department of Veterans Affairs, Washington, DC, USA
| | - Brett B Hart
- Navy Medicine Operational Training Center, Pensacola, FL, USA
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Robertson PW, Hart BB. Assessment of tissue oxygenation. Respir Care Clin N Am 1999; 5:221-63. [PMID: 10333450] [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: 02/12/2023]
Abstract
A continuous supply of oxygen to all tissues is necessary for the efficient production of ATP, and this supply is considered sufficient when aerobic metabolism is maintained. Nonhealing wounds, necrotizing infections, radiation-induced necrosis, crush injury, decompression illness, and CO poisoning all exhibit impaired tissue oxygenation. The need for efficacy of HBO therapy in such conditions is in part determined by the prevailing state of tissue oxygen supply and demand. The methods currently available or under development for assessing the adequacy of tissue oxygenation include blood gas analysis, transcutaneous oxygen measurement, gastric tonometry, pulse oximetry, near-infrared spectroscopy, functional MR imaging, MR spectroscopy, electron paramagnetic resonance, positron emission tomography, and single photon emission computed tomography. The clinical and experimental applications of these methods are discussed and emphasis is placed on their role in hyperbaric medicine.
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Affiliation(s)
- P W Robertson
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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Moon RE, Hart BB. Operational use and patient monitoring in a multiplace hyperbaric chamber. Respir Care Clin N Am 1999; 5:21-49. [PMID: 10205812] [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: 02/11/2023]
Abstract
Multiplace hyperbaric chambers can be used to deliver patient care with enormous flexibility. Standard critical care techniques, such as mechanical ventilation, endotracheal suctioning, hemodynamic monitoring, blood gas measurement, and emergency therapy such as cardiopulmonary resuscitation, including defibrillation and cardioversion, can all be performed inside a multiplace chamber. The multiplace chamber can be considered an extension of the intensive care unit. This flexibility is accompanied by increased complexity of chamber operation. Careful attention must be paid to minimization of fire hazards and maintenance of a safe chamber atmosphere. Although life support apparatus can easily be taken inside the chamber and will usually work under hyperbaric conditions, care must be given to facilitate the benefits to the patient of hyperbaric oxygen treatment in the face of potential risks associated with rapid changes in environmental pressure and the partial pressures of the component gases.
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Affiliation(s)
- R E Moon
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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Abstract
OBJECTIVE To examine the effects of electromyographic (EMG) biofeedback training on the recovery of gait in the acute phase post stroke. DESIGN Patients were randomly assigned to EMG biofeedback or control groups. They received treatment three times a week for six weeks. All patients were assessed prior to treatment, after 18 treatment sessions, and at three months follow-up. SETTING The study was carried out at Scunthorpe General Hospital in North Lincolnshire. The subjects were acute stroke patients who had been admitted on to the medical and elderly wards. INTERVENTIONS The EMG biofeedback group were treated using EMG as an adjunct to physiotherapy. The patients were encouraged to facilitate or inhibit abnormal muscle tone via auditory or visual signals transmitted from electrodes placed over the appropriate muscles. The control group were treated using the same techniques, electrodes were used with this group of patients, but the EMG machine was turned off and faced away from the patient and the therapist to control the placebo effect. OUTCOME MEASURES A large battery of outcome measures was used for physical and psychological assessment. The physical measures consisted of active movement, muscle tone, sensation, proprioception, mobility and activities of daily living (ADL). The psychological measures included orientation, memory, spatial performance, language and IQ. RESULTS Twenty-one patients were included in the study. Scores were combined into four groups: mild EMG, severe EMG, mild control and severe control. Results showed that there was an improvement in physical scores for active movement, mobility and ADL over time, but there was no significant difference between the EMG and control groups. Scores on the psychological tests were within normal limits, and there was no difference in performance between the EMG and control groups. CONCLUSIONS This study showed no significant differences in the rate of improvement after stroke between the two groups. Although EMG biofeedback was used as an adjunct to physiotherapy and represented clinical practice, the results provide little evidence to support the clinical significance of using EMG biofeedback to improve gait in the acute phase after stroke.
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Affiliation(s)
- L Bradley
- Physiotherapy Service, Scunthorpe General Hospital, North Lincolnshire, UK
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Hart BB, Stanford GG, Ziegler MG, Lake CR, Chernow B. Catecholamines: study of interspecies variation. Crit Care Med 1989; 17:1203-22. [PMID: 2676350] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In the last three decades, numerous articles on plasma catecholamine concentrations in various settings have been published in the medical literature. Despite this abundance of information, no summary article has analyzed the species variations in circulating catecholamine concentrations. In this paper, the plasma catecholamine responses to various stresses in 31 animal groups have been compiled from greater than 200 publications (with greater than 5000 animal subjects). Primitive cartilaginous fish such as the shark and the lamprey have the highest reported basal plasma catecholamine concentrations. Birds, mammals, and teleost fish have the lowest concentrations. The lower circulating catecholamine concentrations parallel anatomical changes in the development of the adrenal medulla and the development of the nervous system. Decapitation, hypoxia, hemorrhage, and hypothermia are the experimental conditions associated with the greatest stress-induced changes in plasma catecholamine concentrations. The differences in experimental design are tabulated to afford the reader an opportunity to compare catecholamine levels among species. The table provides a detailed guide to normal concentrations and normal responses in 31 species. This report gives a dynamic overview of catecholamine concentrations in human and animal physiology and may be particularly helpful to investigators involved in catecholamine research.
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Affiliation(s)
- B B Hart
- F. Edward Hèbert School of Medicine, Uniform Services University of the Health Sciences, Bethesda, MD
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Abstract
Twelve male neat-mute schizophrenics were divided into a model-plus-reinforcement group; a model-only group; and a control group, to test the hypothesis that the presence of a verbalizing model to 35 mm slides would serve as an eliciting stimulus to increase speech output. Significant increases in verbalizations were found over treatment sessions, the model-plus-reinforcement condition showing the most marked improvement. Generalization to the ward was found for only three subjects.
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Hart BB. Emergency care and the schools. Testing a multimedia course. Health Educ 1975; 6:8-9, 12. [PMID: 805107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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