Paradoxical herniation associated with hyperbaric oxygen therapy after decompressive craniectomy: A case report

BACKGROUND Whether hyperbaric oxygen therapy(HBOT)can cause paradoxical herniation is still unclear.CASE SUMMARY A 65-year-old patient who was comatose due to brain trauma underwent decompressive craniotomy and gradually regained consciousness after surgery.HBOT was administered 22 d after surgery due to speech impairment.Paradoxical herniation appeared on the second day after treatment,and the patient’s condition worsened after receiving mannitol treatment at the rehabilitation hospital.After timely skull repair,the paradoxical herniation was resolved,and the patient regained consciousness and had a good recovery as observed at the follow-up visit.CONCLUSION Paradoxical herniation is rare and may be caused by HBOT.However,the underlying mechanism is unknown,and the understanding of this phenomenon is insufficient.The use of mannitol may worsen this condition.Timely skull repair can treat paradoxical herniation and prevent serious complications.

Hyperbaric oxygen therapy as a complementary treatment for radiation proctitis:Useless or useful?-A literature review

Radiotherapy(RT)is the backbone of multimodality treatment of more than half of cancer cases.Despite new modern RT techniques,late complications may occur such as radiation proctitis(RP).The natural history of RP is unpredictable.Minor symptoms may resolve spontaneously or require conservative treatment.On the other hand,for similar and uncomplicated clinical contexts,symptoms may persist and can even be refractory to the progressive increase in treatment measures.Over the last decades,an enormous therapeutic armamentarium has been considered in RP,including hyperbaric oxygen therapy(HBOT).Currently,the evidence regarding the impact of HBOT on RP and its benefits is conflicting.Additional prospective and randomised studies are necessary to validate HBOT’s effectiveness in the‘real world’clinical practice.This article reviewed the relevant literature on pathophysiology,clinical presentation,different classifications and discuss RP management including a proposal for a therapeutic algorithm with a focus on HBOT.

Hyperbaric oxygen therapy combined with Schwann cell transplantation promotes spinal cord injury recovery

Schwann cell transplantation and hyperbaric oxygen therapy each promote recovery from spinal cord injury, but it remains unclear whether their combination improves therapeutic results more than monotherapy. To investigate this, we used Schwann cell transplantation via the tail vein, hyperbaric oxygen therapy, or their combination, in rat models of spinal cord contusion injury. The combined treatment was more effective in improving hindlimb motor function than either treatment alone; injured spinal tissue showed a greater number of neurite-like structures in the injured spinal tissue, somatosensory and motor evoked potential latencies were notably shorter, and their amplitudes greater, after combination therapy than after monotherapy. These findings indicate that Schwann cell transplantation combined with hyperbaric oxygen therapy is more effective than either treatment alone in promoting the recovery of spinal cord in rats after injury.

Hyperbaric oxygen therapy as a new treatment approach for Alzheimer's disease

Hyperbaric oxygen therapy as a new treatment approach for Alzheimer’s disease（AD）：Alongside the increase in life expectancy,the prevalence of age-related disorders,such as neurodegenerative diseases,is on the rise.For example,AD,the most common form of dementia in the elderly,accounts for 60–80%of all dementia cases.

Hyperbaric oxygen therapy and chemokine administration - a combination with potential therapeutic value for treating diabetic wounds

Non-healing wounds impart serious medical problems to people with diabetes.Amongst 15%of diabetic patients,the incidence of foot ulcer is the most prevailing,which confers a significant risk of limb amputation,mainly due to hypoxia and impairment in cell signaling.Alteration in the expression of chemokines and the related factors in diabetic conditions delays the recruitment of different cell types,including fibroblasts,keratinocytes,and immune cells such as macrophages to the site of injury,further impairing neovasculogenesis,reepithelialization,and extracellular matrix formation.Thus,proper activation of effector cells through an accurate signal pathway is necessary for better therapeutic application.Hyperbaric oxygen therapy(HBOT)is the current treatment prescribed by medical practitioners,shown to have increased the wound healing rate by reducing the need for significant amputation among the diabetic population.However,the risk of morbidity associated with HBOT needs complete attention through rigorous research to avoid adverse outcomes.Altering the level of pro-angiogenic chemokines may regulate the inflammatory response,further promote vascularization,and enhance the complete healing of wounds in diabetic patients.Thus,a combination of better therapeutic approaches could pave the way for developing a successful treatment for diabetic foot and wound healing.

Hyperbaric oxygen therapy for skin flap blood flow disorder: a case report

A female patient at the age of 17 received dilator implant on the right part of her face to prepare skin flap for her facial scar.The skin flap was in good conditions before scar cutting,but showed poor blood circulation after being transferred.Hyperbaric oxygen therapy was given at 0.2 MPa(2ATA) in double pure oxygen cabins for 90 min every day for 10 d.The skin flap showed in sound viability and sound blood circulation after the treatment.Hyperbaric oxygen therapy can be used to treat blood circulation disorder in transferred skin flap.

It's all about timing, early treatment with hyperbaric oxygen therapy and corticosteroids is essential in acute acoustic trauma

Background: Acute acoustic trauma (AAT) is an acute hearing impairment caused by intense noiseimpact. The current management strategy for AAT with substantial hearing loss in the Dutch militaryis the combination therapy with corticosteroids and hyperbaric oxygen therapy (HBOT). In a previousstudy, early initiation of the combination therapy was associated with better outcomes. Therefore, weperformed a new analysis to assess the difference in hearing outcome between patients in whomcombination therapy was started within two days, versus after more than two days.Methods: A retrospective analysis was performed on military patients diagnosed with AAT with substantial hearing loss who presented between February 2018 and March 2020. Absolute and relativehearing improvement between first and last audiograms were calculated for all affected frequencies(defined as loss of 20 dB on initial audiogram). We also determined the amount of patients whorecovered to the level of Dutch military requirement, and performed speech discrimination tests.Results: In this analysis, 30 male patients (49 ears) with AAT were included. The median age was 24.5years (IQR 23e29). The median time to initiation of therapy with corticosteroids and HBOT were one andtwo days, respectively. HBOT was started within two days in 31 ears, and after more than two days in 18ears. The mean absolute and relative hearing gains were 18.8 dB (SD 14.6) and 46.8% (SD 31.3) on allaffected frequencies. The 100% discrimination/speech perception level improved from 64.0 dB to 51.7 dB(gain 12.3 dB ± 14.1). There was significantly more improvement in absolute and relative hearingimprovement when HBOT was started in 2 days, compared to >2 days.Conclusion: Our analysis shows results in favor of early initiation ( 2 days) of the combination treatmentof HBOT and corticosteroids in patients with AAT.

The Comparison of Acute Clinical Outcome between 30 and 40 Sessions of Hyperbaric Oxygen Therapy for Management of Visible Hematuria from Radiation-Induced Hemorrhagic Cystitis

Background: Radiotherapy is one of the most popular treatments for pelvic malignancy, which causes patients suffering from the adverse effect such as cystitis, hematuria, proctitis, hematochezia and distal ureteric stricture. The hematuria condition from radiation-induced hemorrhagic cystitis is the most common adverse event suffering the patients, losing properties, wasting time, and deteriorating quality of life. One of the most effective treatments for radiation-induced hemorrhagic cystitis is the hyperbaric oxygen therapy with no necessity for patients to be hospitalized, no need of anesthesia use, and also non-invasion. However, it requires that patients spend 90 - 120 minutes a day for 40 days administered out-patient treatment session. The transportation cost as well as the accommodation one will greatly burden the self-pay health care patients. In addition, there is still no definite standardized number of HBOT treatment session assignment at present. Objectives: To compare the treatment outcome (bladder mucosal characteristics, red blood cells in urine) between 30 and 40 sessions of HBOT for treatment of radiation-induced hemorrhagic cystitis. Methods: Prospective cohort observational study of patients (n = 15) who were diagnosed with radiation-induced hemorrhagic cystitis that were treated with hyperbaric oxygen therapy in Somdechprapinklao Hospital between October 2020 and September 2021. We compared the parameter about hemoglobin concentration, red blood cell number in urine during the course of HBOT treatment every 10 sessions and cystoscopic finding severity as EORTC/RTOG classification for radiation-induced hemorrhagic cystitis in Table 1 before treatment, and after 30 and 40 sessions of treatment. Results: From 15 of treated patients, 93.3% of patients had evidence of posterior wall lesion. The mean duration from radiotherapy (radiation and brachytherapy) to the first episode gross hematuria is 112 months. This study shows no statistically different cystoscopic findings as EORTC/RTOG classification for radiation-induced hemorrhagic cystitis after 30 and 40 sessions of HBOT (p = 0.653) and statistically significant improvement after the treatment of more than 30 sessions (p = 0.008). No relationship was found with the hemoglobin concentration and red blood cell number in urine during the course of HBOT. Conclusions: Radiation-induced hemorrhagic cystitis can be treated with HBOT. There is no different treatment outcome between 30 and 40 sessions of HBOT.

Mandibular Reconstruction with Autogenous Fragment of Previous Iliac Crest Associated to Hyperbaric Oxygen Therapy： Case Report

Early efforts at mandibular reconstruction are described from ancient China and the Etruscans to even Hippocrates, involving wooden, terracotta and metal prostheses attached to bone or teeth. Since then, modem surgery has developed more effective techniques, including no vascularized bone grafts, better alloplastic materials, vascularized loco regional grafts, soft and hard tissue compounds, bone fixation and stretching materials, and mechanisms for study models. These components have become indispensable in the surgeon＇s arsenal with regard to reconstructive surgery. A gold standard for mandibular bone reconstruction is the use of autogenous grafts. The objective of this study was to describe a clinical case of mandibular reconstruction with autogenous graft associated with adjuvant hyperbaric oxygen therapy. The clinical case presented shows the treatment performed for after-effects correction due to the non-consolidation of sagittal mandibular osteotomy performed for correction of standard III dentofacial deformity, resulting in a pseudoarthrosis with bite deviation and facial asymmetry. As a treatment plan, mandibular reconstruction was instituted with autogenous graft of anterior iliac crest associated with the use prototyping biomodel and hyperbaric oxygen therapy. After a control of 1 year and 6 months, no signs of recurrence were identified and the radiographic image showed excellent positioning, good volume and maintenance of the mandibular contour.

Clinical Efficacy of Hyperbaric Oxygen Therapy at Different Pressures in the Treatment of Sudden Deafness

Objective:To analyze the efficacy of hyperbaric oxygen at different pressures in the treatment of sudden deafness.Methods:Eighty-two patients with sudden deafness treated in the Affiliated Hospital of Hebei University from September 2019 to September 2021 were selected as the research subjects.The patients were randomly divided into study group 1 and study group 2,and they were treated with hyperbaric oxygen on the basis of routine treatment,in which the pressure used was 1.8 ATA and 2.2 ATA,respectively.Oxygen was delivered via the pressure stabilizing mask for 60 minutes.The patients received two courses of treatment,each lasting 10 days.The changes in hearing(pure tone audiometry)and the clinical efficacy of both the groups were compared before and after treatment.The data obtained were statistically analyzed using SPSS 19.0.Results:The total effective rate of study group 1 was 90.00%,while that of study group 2 was 76.19%.The differences between the two groups were statistically significant(p<0.05).Conclusion:For patients with sudden deafness treated with hyperbaric oxygen,the clinical efficacy of 1.8 ATA is more significant than that of 2.2 ATA.

Observation on the Clinical Effect of Different Pressures in Hyperbaric Oxygen Therapy on Patients with Diffuse Axonal Injury

Objective:To observe the efficacy and significance of hyperbaric oxygen at different pressures in the treatment of diffuse axonal injury(DAI).Methods:Sixty patients with DAI were randomly divided into 1.8 ATA group(30 cases)and 2.2 ATA group(30 cases).The routine treatment for each group was the same.The 1.8 ATA.group received hyperbaric oxygen therapy under 1.8 ATA on the basis of routine treatment,whereas the 2.2 ATA group received hyperbaric oxygen therapy under 2.2 ATA.on the basis of routine treatment.The therapy was given once a day over 3 consecutive courses,with each course having 10 sessions.The Glasgow Coma Scale(GCS)on day 10,day 20,and day 30 after treatment,as well as the Glasgow Outcome Scale(GOS)after 6 months were compared between the two groups.Results:The mean GCS on day 10,day 20,and day 30 after treatment,as well as the mean GOS after 6 months of treatment in the 2.2 ATA group were significantly higher than those in the 1.8 ATA group(p<0.05).Conclusion:For patients with dififtise axonal injury,hyperbaric oxygen therapy is more effective with 2.2 ATA.compared with 1.8 ATA.

The new insights of hyperbaric oxygen therapy:focus on inflammatory bowel disease

Inflammatory bowel diseases(IBD),with an increasing incidence,pose a significant health burden.Although there have been significant advances in the treatment of IBD,more progress is still needed.Hyperbaric oxygen therapy(HBOT)has been shown to treat a host of conditions such as carbon monoxide poisoning,decompression sickness,and gas gangrene.In the last few years,there has been an increase in research into the use of HBOT as an adjunct to conventional treatment for IBD.Related research has shown that HBOT may exert its therapeutic effects by decreasing oxidative stress,inhibiting mucosal inflammation,promoting ulcer healing,influencing gut microbes,and reducing the incidence of IBD complications.This paper aims to provide a comprehensive review of experimental and clinical trials exploring HBOT as a supplement to IBD treatment strategies.

Effects of hyperbaric oxygen therapy on human psychomotor performance:A review

Psychomotor performance is the coordination of a sensory or ideational(cognitive)process and a motor activity.All sensorimotor processes involved in planning and execution of voluntary movements need oxygen supply and seem to be significantly disrupted in states of hypoxia.Hyperbaric oxygen therapy has become a widely used treatment in routine medicine and sport medicine due to its beneficial effects on different aspects of human physiology and performance.This paper presents state-of-the-art data on the effects of hyperbaric oxygen therapy on different aspects of human psychomotor function.The therapy’s influence on musculoskeletal properties and motor abilities as well as the effects of hyperbaric oxygenation on cognitive,myocardial and pulmonary functions are presented.In this review the molecular and physiological processes related to human psychomotor performance in response to hyperbaric oxygen are discussed to contribute to this fast-growing field of research in integrative medicine.

Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate

Objective： Keloids are exuberant cutaneous scars that form due to abnormal growth of fibrous tissue fol- lowing an injury. The primary aim of this study was to assess the efficacy and mechanism of hyperbaric oxygen therapy （HBOT） to reduce the keloid recurrence rate after surgical excision and radiotherapy. Methods： （1） A total of 240 patients were randomly divided into two groups. Patients in the HBOT group （O group） received HBOT after surgical excision and radiotherapy. Patients in the other group were treated with only surgical excision and radiotherapy （K group）. （2） Scar tissue from recurrent patients was collected after a second operation. Hematoxylin and eosin （H＆E） staining was used to observe keloid morphology. Certain inflammatory factors （interleukin-6 （IL-6）, hypoxia-inducible factor-1α （HIF-1α）, tumor necrosis factor-α （TNF-α）, nuclear factor KB （NF-κB）, and vascular endothelial growth factor （VEGF）） were measured using immunohistochemical staining. Results： （1） The recurrence rate of the O group （5.97%） was significantly lower than that of the K group （14.15%）, P〈0.05. Moreover, patients in the O group reported greater satisfaction than those in the K group （P〈0.05）. （2） Compared with the recurrent scar tissue of the K group, the expression levels of the inflammatory factors were lower in the recurrent scar tissue of the O group. Conclusions： Adjunctive HBOT effectively reduces the keloid recurrence rate after surgical excision and radiotherapy by improving the oxygen level of the tissue and alleviating the inflammatory process.

Hyperbaric Oxygen Treatment for Long COVID:From Molecular Mechanism to Clinical Practice

Long COVID symptoms typically occur within 3 months of an initial COVID-19 infection,last for more than 2 months,and cannot be explained by other diagnoses.The most common symptoms include fatigue,dyspnea,coughing,and cognitive impairment.The mechanisms of long COVID are not fully understood,but several hypotheses have been put forth.These include coagulation and fibrosis pathway activation,inflammatory and autoimmune manifestations,persistent virus presence,and Epstein-Barr virus reactivation.Hyperbaric oxygen therapy(HBOT)is a therapeutic method in which a person inhales 100%oxygen under pressure greater than that of the atmosphere.HBOT has some therapeutic effects,including improvement of microcirculation,inhibition of cytokine release leading to a reduction in inflammatory responses,inhibition of autoimmune responses,and promotion of neurological repair.Several clinical trials have been carried out using HBOT to treat long COVID.The results suggest that HBOT helps to improve symptom severity,reduce symptom duration,and enhance patients’quality of life.It is believed that HBOT is an effective option for patients with long COVID,which is worth actively promoting.

Hyperbaric oxygen therapy for chronic antibioticrefractory ischemic pouchitis

Hyperbaric oxygen therapy(HBOT)has been shown to be efficacious in treating various conditions,including perianal Crohn’s disease.Here we present a case of a 59-year-old male with a history of ulcerative colitis,who underwent a total proctocolectomy and two-stage J-pouch construction.He later developed chronic antibiotic-refractory pouchitis with endoscopic features of ischemia.At the completion of HOBT-a total of 20 sessions of 100%oxygen at 2.5-3.0 atmospheres absolute for 60-90 minutes per session-a repeat pouchoscopy showed marked improvement of endoscopic mucosal inflammation.HBOT is known to increase tissue oxygenation,reduce tissue hypoxia,alter inflammatory pathways and promote tissue healing.This case demonstrated the therapeutic role of HBOT as well as the possible disease mechanism in chronic antibiotic-refractory pouchitis.

Heel pad avulsion injury:an approach with hyperbaric oxygen therapy

Aim:Crush injuries of the foot are often associated with partial or complete degloving of the heel pad.The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion injuries,including hyperbaric oxygen(HBO)therapy in the treatment regimen.Methods:We present a prospective study of 27 patients with various types of heel pad avulsion managed in our institution from December 2012 to June 2013.Heel pad avulsion injuries were classified according to the angiosomal pattern.Partial or complete avulsions were classified and treated accordingly.HBO therapy was administered postoperatively.The postoperative period,hospital course,and follow-up were documented in patients with heel pad avulsion injuries.Results:Of 27 patients,20 cases presented with partial avulsion and 7 cases were complete avulsion.Of 20 cases of partial avulsion,one of the flaps was anchored with K-wire.Nineteen cases of partial heel pad avulsion were managed by suturing.Eight patients out of 20 required skin grafting as a secondary procedure at a later date.Out of 7 cases of complete avulsion,one was managed by full-thickness skin grafting,one case by reverse sural artery flap coverage,and four cases were managed by free tissue transfer.No flap revisions were required,and no complications were experienced for the transferred flaps.Conclusion:HBO therapy may be a useful adjunct in the treatment of heel pad avulsion injuries.

Hyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction

Aim:The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps,by including hyperbaric oxygen(HBO)therapy in the treatment regimen with flap delay.Methods:We present a prospective study of 23 patients with various types of soft tissue defects of the foot,and lower third of leg managed in our institution from December 2012 to December 2013.All soft tissue defects were treated by a reverse pedicle flap.Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy.The postoperative period,hospital course,and follow-up were documented.Results:Of 12 patients with flap delay and HBO,10 patients did not suffer any complications secondary to flap transfer.One patient had discoloration of the tip of the flap,which settled without the intervention,and 1 patient had recurrent abscess formation,which required debridement and closure.Of 11 patients with direct transfer,6 patients presented with complications including flap congestion,partial flap loss,and tip necrosis,which required secondary intervention.Conclusion:HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.

Hyperbaric oxygen therapy improves outcome of snake envenomation:tertiary center experience

Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartment syndrome,bleeding abnormalities,septicemia,hypotension,and disseminated intravascular coagulation,resulting in significant morbidity and mortality.The purpose of the study is to share our experience of hyperbaric oxygen(HBO)therapy in the management of snakebite injuries.Methods:All patients who were treated for snakebite injuries in our department between October 2012 and October 2013 were included in the study.Results:Out of a total 395 patients,174 patients treated with anti-snake venom with a mortality of 17 posttreatment.Forty-four out of the 174 patients was in the pediatric age group.Out of the patients referred to our department,23 presented with cellulitis,7 with compartment syndrome and 17 for the management of soft tissue cover over the extremities.Of the 47 patients,30 involved the lower extremity and rest involved the upper extremity.All patients were subjected to HBO therapy as an adjunct.Six patients required flap cover:cross finger flap(n=2),anterolateral thigh free tissue transfer(n=1),lateral supramalleolar flap(n=1),groin flap(n=1),and dorsal metacarpal artery flap(n=1).There was no need for fasciotomy among the patients who suffered impending compartment syndrome.Conclusion:HBO therapy may reduce the incidence of fasciotomy and increase the effectiveness of plastic surgical modalities if administered early and may be used as a useful adjunct in the management of snake envenomation injury.

Long-Term Evaluation of Retinal Artery Occlusion Patients Who Applied Hyperbaric Oxygen Treatment

Introduction： Hyperbaric oxygen treatment （HBOT） is one of the treatment modalities for retinal artery occlusion （RAO）. HBOT may be beneficial if initiated within 2-12 hours of onset of symptoms. The objective of this study was to evaluate the usefulness of HBOT on the patients who had applied to our center for HBOT with an RAO diagnose. Methods： Sixteen patients were included in this study for a three-year period those were applied HBOT with RAO diagnosis. HBOT sessions of these patients had been started as quick as possible soon after they have arrived. Also, all patients had been started medication by ophthalmologists who sent them. To evaluate the outcome of the treatment the patients were called with telephone and ophthalmology clinic control examinations were obtained. Patients were asked survey questions about their visual ameliorations before and after HBOT. Results： Mean initiation duration of patients to get HBOT was about 28 hours. Only one patient has initiated treatment after 13 days from the event and no visual improvement was recorded. Within this patient, no visual amelioration was recorded for two more patients. Among the other 13 patients, three had 80% and more, three had 50-79% and seven had below 50% visual amelioration. Eleven of 13 patients had peripheral visual field amelioration. Discussion： With the medical treatment, an immediate intervention of HBOT was considered a useful treatment modality for RAO. The visual improvement of the visual fields was considered especially in the peripheral vision rather than central vision.