1. WELCOME

2. 臨床高壓氧之併發症 人次治療分析
吳文宏 M.D.
光田綜合醫院 外科部 整形外科

3. Purpose: Clinical HBOT for various dis. is much more popular today.
2. Large series, longterm follow-up complication reports in Taiwan are still rare.

4.   Materials and methods :
p’ts ( from Aug. of 2000 to Jul. of 2016)
. M:F=766:520 ( 1.5:1 )
. Age: 3-90 years old (mean: 49.2)
tx. for each p’t (mean:16, total:20664)
. Test dose for each p’t before standard dose

5. Materials and methods :
. Test dose: 1.9 ATA for 35 min.
. Standard dose: 2.4 ATA for 120 min.
. Follow up: 1-60 months (mean: 3 months)
. 18 patients had ear membrane ventilation tube
insertion (18/1286=1.40%)
. 10/18 (55.56%) for intolerance of air pressure
. 8/18 (44.44%) unclear patients for prevention of barotrauma

6. Results: (complications)
1) Middle ear effusion: 6 p’ts (10ears)(6/1286=0.467%)
2) Myopia: 2 p’ts (2/1286=0.156%)
one got 3 diopters after 140 tx.
one got 1.7 diopters after 80 tx,
3) Oxygen seizure: 3 p’t (3/20664)= %) ) Mild oxygen toxicity: 1 p’t

7. DISCUSSION :

11. 46feet=2.4ATA

12. Why did we use 1.9 ATA as the testing dose?
. The incidence of seizure is reported to be 0.01% in treatments at 2.4 ATA.
. Use of pressure at 1.5 ATA does not lead to any oxygen induced-seizures when the duration of treatment was kept below one hour.
. So we used the middle pressure of 1.5 to 2.4 ATA as the testing dose ( 1.9 ATA )
Davis JC, Dunn JM, Heimbach RD ( 1988 ) Hyperbaric medicine; patient
selection, treatment procedures and side effects. In Davis JC, Hunt TK ( eds )
Problem wounds: the role of oxygen Elsevier, New York p

13. Indications of Hyperbaric Oxygen Therapy
Uses of HBO Approved by the Undersea and Hyperbaric Medical Society
(Thom SR : Hyperbaric Oxygen Therapy : A Committee Report,Bethesda,
Undersea & Hyperbaric Medical Society 1996)
K.K.JAIN TEXTBOOK OF HYPERBARIC MEDICINE 5th Revised and Updated Edition P

14. 1. Air of gas embolism
2. Carbon monoxide poisoning and inhalation injury
3. Clostridial myonecrosis (gas gangrene)
4. Crush injury, the compartment syndrome, and other acute traumatic ischemisa
5. Decompression sickness
6. Enhancement of healing in selected problem wounds.

15. 7. Exceptional anemia resulting from blood loss
8. Necrotizing soft tissue infections (of subcutaneous tissue,
muscle, or fascia)
9. Refractory osteomyelitis
10. Radiation tissue damage (Osteoradionecrosis)
11. Compromised skin grafts and flaps
12. Thermal burns
13. Brain abscess
K.K.JAIN TEXTBOOK OF HYPERBARIC MEDICINE 5th Revised and Updated Edition P

16. Contraindications for HBO therapy
1. Absolute
. Untreated tension pneumothorax
2. Relative
1) Upper respiratory infections
2) Emphysema with CO2 retension
3) Asymptomatic air cysts or blebs in the lungs seen on chest X-ray
K.K.JAIN TEXTBOOK OF HYPERBARIC MEDICINE 5th Revised and Updated Edition P

17. Contraindications for HBO therapy
4) History of thoracic or ear surgery
5) Uncontrolled high fever
6) Pregnancy
7) Claustrophobia
K.K.JAIN TEXTBOOK OF HYPERBARIC MEDICINE 5th Revised and Updated Edition P

18. Complications of Hyperbaric Oxygen Therapy
1)Middle ear barotrauma
2)Sinus pain
3)Myopia and cataract
4)Pulmonary barotrauma
5)Oxygen seizure
6)Decompression sickness
7)Genetic effects
8)Claustrophobia
K.K.JAIN TEXTBOOK OF HYPERBARIC MEDICINE 5th Revised and Updated Edition P

19. Middle ear barotrauma Carlson et al 1992
. Frenzel’s maneuver can solve the problem.
. May lead to permanent hearing loss & vertigo.
. Unconscious p’ts. & infants are more likely
. Nasal decongestants for prevention?
( No evidence )
Carlson et al 1992

20. Middle ear barotrauma
. More than 20% centers always do routine prophylactic
myringotomies on intubated p’ts( 30/126) & infants (19/86)
. Less than 50% of the centers never performed the procedures
as routine prophylaxis.
. 33% centers (49/145) routinely administered prophylactic drugs
before HBOT ( topical nasal decongestants: oxymetazoline )
Capes & Tomaszewski 1996

21. Eustachian tube dysfunction
. 87% developed serious otitis media.
. 47% of serious otitis media p’ts required
tympanostomy tubes.
. E - tube dysfunction after first HBOT has high
risk of serious otitis media with subsequent txs.
Fernau et al 1992

22. Incidence of seizure in HBOT?
Wu WH, 2010
0.015%
20664tx.,
1286 case,
2.4ATA
Huang KC, 2006
0.109%,
4638 tx.
240 cases
2.4 ATA
Huang KC, J Trauma. 2006
Oct;61(4):913-7.

23. Hemodynamic changes in HBOT
Cardiac output decreased from to 8.91(min-liter) (64.05%)
Heart rate decreased from to 94.0 (89.78%)
Stroke volume decreased from 133 to 96 (ml) (72.18%)
Elevation of blood pressure
Int Arch Occup Environ Health Mar;74(2):
Carotid body, aortic body: PO2 receptors, carotid sinus(bifucation), aortic sinus(arch): BP receptors

24. HBO vs BLOOD PRESSURE
HBO caused significant elevation in SBP (11%) and DBP (12%) and a decrease in HR (18%) (p <0.001).
Patients with DM and HTN showed higher elevation in SBP and DBP.
HBO caused a marked elevation in SBP and DBP when basal SBP was >140 mmHg.
Critical elevation was obtained when SBP was >160 mmHg.
The use of beta blockers caused significant elevation of blood pressure while reducing HR.
Arch Med Res Nov;37(8):991-7.

25. HBO vs BSL (blood sugar level)
HBO(2) lowered BGL by 23% (p <0.001).
When basal BGL was in the range of mg/dl, it dropped to <100 mg/dl in 31/60 treatment sessions (52%).
When basal BGL was <120 mg/dl it dropped to <70 mg/dl in 8/34 sessions.
There was a possibility of lowered BGL when basal BGL was <170 mg/dl and a marked reduction in BGL occurred when basal BGL was <120 mg/dl.
Arch Med Res Nov;37(8):991-7.

26. HBO vs DM
HBO causes elevation of blood pressure and lowering of HR and BGL (blood glucose level), which were augmented in the presence of HTN, DM, or beta blocker.
The use of beta blockers for the management of HTN should be avoided during HBO therapy.
Arch Med Res Nov;37(8):991-7.

27. Drug effect with HBOT Digitalis: HBOT increase digitalis effection
Insulin: HBOT delay insulin peak level time
Nicotine: increase incidence of seizure
Nitroprusside: vessel dilutation; HBOT: vasoconstriction
Sulfamylon: peripheral vessel dilutation: HBOT: more proximal vessel constriction; leads to higher motality
Thyroid hormone: increase incidence of seizure
Inderal: check heart rate before HBOT
Tenormin: check heart rate before HBOT

28. Conclusion: 1. No lethal complications (2.4 ATA. For 20664 Tx.)
Conclusion:
1. No lethal complications (2.4 ATA. For Tx.)
2. Hx. taking, vital signs, eardrum exam.,CxPA, CBC, and
blood sugar are important before treatment.
3. HBO test dose is useful for reducing complications.

29. 4. For seizure patient treatment, a multiplace chamber equipped with an antechamber is possibly the better facility in consideration of safety.

49. Radiation induced cystitis 96-2-3 96-1-27