Diving Hyperb Med
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Editorial Comment
Poorly designed research does not help clarify the role of hyperbaric oxygen in the treatment of chronic diabetic foot ulcers.
Diabetic foot ulcers (DFUs) are one of the most common indications for hyperbaric oxygen treatment (HBOT). The role of HBOT in DFUs is often debated. Recent evidence based guidelines, while recommending its use, urge further studies to identify the patient subgroups most likely to benefit from HBOT. ⋯ As it is possible to identify wounds that have no potential to heal despite HBOT, all studies should incorporate transcutaneous oxygen measurements in their baseline evaluation. As the wounds in this study tended to be small (6.1cm² and 5.8cm² on average) and had persisted for (on average) one year despite state-of-the-art previous wound care, it is likely that at least some of these would not meet the predictive minimal criteria for healing potential with HBOT. The findings of this study do indeed show that the indiscriminate treatment of all diabetic wounds with HBOT is probably not (cost-) effective; however, the study conclusion that "HBO has no benefit in the treatment of chronic diabetic foot wounds" is erroneous.
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Carbon monoxide (CO) poisoning is common in Turkey. Our department is the main provider of emergency hyperbaric oxygen therapy (HBOT) in Ankara and neighboring cities. In this study, we analyzed the characteristics of CO-poisoned patients who were referred by phone to our department for emergency HBOT. ⋯ We found that the duration from admission to an emergency department to HBOT consultation affected our decision-making.
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Comparative Study
The duration of two carbon dioxide absorbents in a closed-circuit rebreather diving system.
Diving rebreathers use canisters containing sodalime preparations to remove carbon dioxide (CO₂) from the expired gas. These preparations have a limited absorptive capacity and therefore may limit dive duration. The Inspiration™ rebreather is designed for use with Sofnolime 797™ but some divers use Spherasorb™ as an alternative. There are no published data comparing the CO2-absorbing efficacy of these sodalime preparations in an Inspiration rebreather. ⋯ Under conditions simulating work at 6 MET during use of an Inspiration rebreather a canister packed with Spherasorb reached CO₂ breakthrough 32% earlier with 10% less mass than Sofnolime packed to similar volume. Divers cannot alternate between these two preparations and expect the same endurance.
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The aim of this study was to review patients with iatrogenic cerebral gas embolism (CGE) referred to The Alfred Hospital hyperbaric unit to determine whether hyperbaric oxygen treatment (HBOT) reduced morbidity and mortality. ⋯ Appropriate treatment of CGE with hyperbaric oxygen was found to be impeded by delays in diagnosis and subsequent transfer of patients. Better neurological outcome was associated with HBOT within eight hours of CGE.
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The vast majority of freshwater cave diving in Australia occurs within the limestone caves of the Gambier karst in the south-east of South Australia. The incidence of decompression illness (DCI) in cave divers is presumed to be higher than open-water recreational divers because of the greater depths involved, but has not previously been reported. Our aim was to determine the incidence of DCI in cave divers, the patterns of diving and the outcome of hyperbaric treatment. ⋯ The estimated incidence of DCS in this series is lower than expected but consistent with other series describing DCI in cold-water recreational diving.