Decompression illness treated at the Geneva hyperbaric facility 2010-2016: A retrospective analysis of local cases.

INTRODUCTION: The Geneva hyperbaric chamber is the main treatment centre for decompression illness (DCI) in Switzerland. The characteristics, symptomatology, treatment and short-term outcome of divers treated at this chamber have not previously been investigated. METHODS: This was a retrospective study of patients treated with hyperbaric oxygen (HBO) for DCI from 2010 to 2016. Data were analysed to provide a description of the cases and statistical analysis for possible factors associated with an unfavourable outcome. RESULTS: One hundred and thirty-five patients were treated for DCI. Ninety-two were included in the study. Sixty-four presented with neurological and 28 with mild DCI. One hundred and thirty-five patients were treated for DCI. Ninety-two were included in the study. Sixty-four presented with neurological and 28 with mild DCI. Patients with mild DCI mainly had musculoskeletal symptoms (79%). Patients with neurological DCI mainly had spinal (55%), followed by vestibular (36%) symptoms. Arterial gas embolism was diagnosed in 30% of cases. Diving depths ranged between 15 and 142 metres, and dive times between two and 241 min. Median time to treatment was 6 h. Patients with neurological DCI had a high rate (25%) of persisting deficits after treatment. Older age was associated with an unfavourable outcome in univariate but not in multivariate analysis. No adverse effects of HBO were observed. For spinal DCI, a high Boussuges score was associated with persisting deficits after treatment. CONCLUSIONS: Our findings are consistent with other series. Severe DCI was associated with a high rate of persisting deficits. No single factor was associated with a negative outcome. A Boussuges score > 7 had sensitivity of 90% and positive predictive value 53% for predicting an unfavourable outcome in spinal DCI.

Can preventive hyperbaric oxygen therapy optimise surgical outcome?: A systematic review of randomised controlled trials.

BACKGROUND: A primary underlying cause of postoperative complications is related to the surgical stress response, which may be mitigated by hyperbaric oxygen therapy (HBOT), the intermittent administration of oxygen at a pressure higher than the atmospheric pressure at sea level. Promising clinical studies have emerged suggesting HBOT's efficacy for reducing some postoperative complications. Notwithstanding, the effectiveness (if any) of HBOT across a range of procedures and postoperative outcomes has yet to be clearly quantified. OBJECTIVE: This systematic review aimed to summarise the existing literature on peri-operative HBOT to investigate its potential to optimise surgical patient outcome. DESIGN: A systematic review of randomised controlled trials (RCTs) with narrative summary of results. DATA SOURCES: MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were searched without language restrictions through to 19 June 2018. ELIGIBILITY CRITERIA: Studies were included if they involved patients of any age undergoing any surgical procedure and provided with at least one HBOT session in the peri-operative period. Two independent reviewers screened the initial identified trials and determined those to be included. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs. RESULTS: The search retrieved 775 references, of which 13 RCTs were included (627 patients). Ten RCTs (546 patients) reported treatment was effective for improving at least one of the patient outcomes assessed, while two studies (55 patients) did not find any benefit and one study (26 patients) found a negative effect. A wide range of patient outcomes were reported, and several other methodological limitations were observed among the included studies, such as limited use of sham comparator and lack of blinding. CONCLUSION: Peri-operative preventive HBOT may be a promising intervention to improve surgical patient outcome. However, future work should consider addressing the methodological weaknesses identified in this review. TRIAL REGISTRATION: The protocol (CRD42018102737) was registered with the International ProspectiveRegister of Systematic Reviews (PROSPERO).

Successful Lung Transplant After Prolonged Extracorporeal Membrane Oxygenation (ECMO) in a Child With Pulmonary Hypertension: A Case Report.

INTRODUCTION: The use of extracorporeal membrane oxygenation (ECMO) is considered a risk factor for, or even a potential contraindication to, lung transplantation. However, only a few pediatric cases have been described thus far. CASE PRESENTATION: A 9-year-old boy with idiopathic pulmonary arterial hypertension developed cardiac arrest after the insertion of a central catheter. ECMO was used as a bridge to lung transplantation. However, after prolonged resuscitation, he developed medullary ischemia and medullary syndrome. After 6 weeks of ECMO and triple combination therapy for pulmonary hypertension, including continuous intravenous prostacyclin, he was weaned off support, and after 2 weeks, bilateral lung transplantation was performed. At 4 years post-transplant, he has minimal problems. The medullary syndrome has also alleviated. He is now back to school and can walk with aids. CONCLUSIONS: Increasing evidence supports the use of ECMO as a bridge to LT, reporting good outcomes. In the modern era of PAH therapy, it is feasible to use prolonged ECMO support as a bridge to lung transplant, with the aim of weaning off this support; however, its use requires more experience and knowledge of long-term outcomes.

[Carbon monoxide poisoning: an update for 2009]. / L'intoxication au monoxyde de carbone en 2009.

Carbon monoxide (CO) is the leading cause of death by poisoning in developed countries. In 2006, 23 deaths and more than 130 hospitalisations related to CO poisoning have been reported in Switzerland. Impairment in oxygen transport through competitive antagonist action on hemoglobin is well known. Other mechanisms, in particular CO induced mitochondrial dysfunction, participate in CO toxicity. CO intoxications carry a high risk of immediate mortality and long-term neuropsychiatric or cardiac sequelae which justify the need of early diagnosis and treatment. Administration of supplemental oxygen is the cornerstone of treatment of CO poisoning. Hyperbaric oxygen therapy must be considered for the treatment of severe intoxications.

Mechanical support availability in pediatric cardiac surgery: program size should not matter.

Intractable heart failure may require Extracorporeal Life Support (ECLS) techniques for rescue therapy. Nevertheless, in many small to middle-sized centers in Europe, this valuable resource is not available. In our University pediatric intensive care unit 0.9% of 1360 open-heart surgical patients required mechanical assistance over the latest 9 years with a survival rate of 69.2% and low residual morbidity. This favorable overall outcome suggests that regardless of the program size, it is possible to ensure the availability of efficient mechanical assistance that appears to be fundamental in a center performing surgery for complex congenital or acquired cardiac diseases.

Effect of cardiopulmonary bypass and aortic clamping on functional residual capacity and ventilation distribution in children.

OBJECTIVE: To characterize factors that contribute to lung function impairment after cardiopulmonary bypass, we assessed functional residual capacity and ventilation homogeneity during the perioperative period in children with congenital heart disease who are to undergo surgical repair. METHODS: Functional residual capacity and lung clearance index were measured by using a sulfur hexafluoride washout technique in 24 children (aged 0-10 years). Measurements of functional residual capacity and ventilation distribution were performed after induction of anesthesia, at different stages of the surgical procedure, and up to 90 minutes after skin closure. Anesthesia was standardized, and ventilator settings, including the fraction of inspired oxygen, were kept constant throughout the study period. RESULTS: Sternotomy and retractor insertion led to a significant increase in functional residual capacity (mean [SD], 24% [14%]), followed by a similar percentage decrease in the resting volume after a significant reduction in pulmonary blood flow during cardiopulmonary bypass with aortic clamping. Although reestablishing pulmonary blood flow increased functional residual capacity (10% [6%]), chest closure led to a decrease in functional residual capacity of 36% (14%) that only slightly improved during the first 90 minutes after surgical intervention. Changes in lung clearance index were affected conversely compared with changes in functional residual capacity at all assessment times. CONCLUSIONS: These results confirmed that chest wall condition and pulmonary circulation affect lung volumes and ventilation homogeneity. Although opening of the chest wall improved alveolar recruitment and ventilation homogeneity, blood flow appeared essential for alveolar stability, presumably by exerting a tethering force caused by the filled capillaries on the alveolar walls and therefore contributing to an increase in resting lung volume.

Optimization of power wheelchair control for patients with severe Duchenne muscular dystrophy.

The extended survival of patients with Duchenne muscular dystrophy (DMD) achieved by the introduction of mechanical ventilation is raising new quality-of-life issues. We evaluated passive range of wrist extension, key pinch strength, and power wheelchair driving in 84 patients. The 47 drivers with restricted driving abilities were older than the 37 unrestricted drivers (27.2+/-5.0 y vs. 22.8+/-3.8 y) and had worse upper limb performance. By multiple logistic regression, only key pinch was significant ( R(2) = 0.224, P = 0.02. Eighteen restricted drivers were reassessed after having swapped a conventional joystick for another control system (mini-joystick, isometric mini-joystick, finger joystick, or pad) and having moved the position of the tested control system so that the patient could use it with different fingers, his chin or his mouth. All of them regained the ability to drive unrestricted. Adults with DMD gradually lose their ability to drive with a conventional joystick but can regain unrestricted driving with alternative control systems.