Hyperbaric oxygen treatment for infants: retrospective analysis of 54 patients treated in two tertiary care centres.

Introduction: We aimed to analyse the outcomes of hyperbaric oxygen treatment (HBOT) and describe difficulties encountered in infants, a rare patient population in this therapeutic intervention, with limited scientific reports. Methods: This was a retrospective analysis of patients 12 months old or younger who underwent HBOT in two different institutions. Demographic data, clinical presentation, HBOT indication, chamber type, oxygen delivery method, total number of treatments, outcome and complications were extracted from clinical records. Results: There were 54 infants in our study. The patients' median age was 3.5 (range 0-12) months. The major HBOT indication was acute carbon monoxide intoxication (n = 32). A total of 275 HBOT treatments were administered, mostly performed in multiplace chambers (n = 196, 71%). Only one patient (2%) required mechanical ventilation. Acute signs were fully resolved in the most patients (n = 40, 74%). No complications related to HBOT were reported. Conclusions: This study suggests that HBOT may be a safe and effective treatment for infants. Paediatricians should consider HBOT when indicated in infants even for the preterm age group.

Hyperbaric oxygen treatment in delayed post-hypoxic encephalopathy following inhalation of liquefied petroleum gas: a case report.

Delayed post-hypoxic encephalopathy can occur after an episode of anoxia or hypoxia. Symptoms include apathy, confusion, and neurological deficits. We describe a 47-year-old male patient who inhaled gas from a kitchen stove liquid petroleum gas cylinder. He was diagnosed with hypoxic ischaemic encephalopathy 12 hours after his emergency department admission. He received six sessions of hyperbaric oxygen treatment (HBOT) and was discharged in a healthy state after six days. Fifteen days later, he experienced weakness, loss of appetite, forgetfulness, depression, balance problems, and inability to perform self-care. One week later, he developed urinary and fecal incontinence and was diagnosed with post-hypoxic encephalopathy. After 45 days from the onset of symptoms, he was referred to the Underwater and Hyperbaric Medicine Department for HBOT. The patient exhibited poor self-care and slow speech rate, as well as ataxic gait and dysdiadochokinesia. Hyperbaric oxygen was administered for twenty-four sessions, which significantly improved the patient's neurological status with only hypoesthesia in the left hand remaining at the end of treatment. Hyperbaric oxygen has been reported as successful in treating some cases of delayed neurological sequelae following CO intoxication. It is possible that HBO therapy may also be effective in delayed post-hypoxic encephalopathy from other causes. This may be achieved through mechanisms such as transfer of functional mitochondria to the injury site, remyelination of damaged neurons, angiogenesis and neurogenesis, production of anti-inflammatory cytokines, and balancing of inflammatory and anti-inflammatory cytokines.

Analysis of the cardiovascular effects of hyperbaric oxygen therapy in diabetic patients.

During hyperbaric oxygen (HBO2) therapy in humans, there are changes in cardiovascular physiology due to high pressure and hyperoxygenation. Peripheral vasoconstriction, bradycardia, and a decrease in cardiac output are observed during HBO2 therapy. These physiological effects of HBO2 therapy on the cardiovascular system are tolerated in healthy people. However, patients with underlying cardiac disease may experience severe problems during HBO2 therapy, such as pulmonary edema and death. In addition, cardiac complications may occur in patients with diabetes mellitus (DM). Therefore, HBO2 therapy may negatively affect cardiovascular physiology in patients with DM. The present study aimed to examine the cardiovascular effects of HBO2 therapy in diabetic patients. The findings of NT-ProBNP, troponin I, and electrocardiography (ECG) of diabetic patients who applied to the Ministry of Health University Gülhane Training Research Underwater and Hyperbaric Medicine Clinic were compared before and after the first HBO2 therapy session. When ECG findings were analyzed at the end of a session of HBO2 exposure, a statistically significant increase was observed in the QTc and QTc dispersion measurements (p≺0.001 and p = 0.02, respectively). In cardiac enzymes, there was a statistically significant increase in troponin I values after an HBO2 therapy session, but no statistically significant change was observed in Pro-BNP (p = 0.009, p = 0.3, respectively). Short-term exposure to HBO2 therapy had statistically significant changes in troponin I, QT, and QTc in patients with DM, which did not reach clinical significance. Despite very little evidence of cardiac dysfunction, we recommend caution in using HBO2 therapy in patients with DM and emphasize the need for further investigation of these measurements.

Does diving deteriorate hearing functions?

Studies evaluating the hearing function of professional divers have yielded mixed results. In this study, we aimed to observe the effect of diving on hearing function by comparing the audiometry of experienced divers with a non-diver control group. Secondly, we aimed to compare the hearing function among divers according to the diving years and the number of dives in terms of diving exposure. Experienced divers who applied to the University of Health Sciences Gulhane Training and Research Hospital Underwater and Hyperbaric Medicine Department between 2017-2021 for periodic fitness to dive examinations were included in our study. The control group was randomly selected from the non-diver population with similar ages and gender. The audiometry of the control group and the study group was compared. While the control group was found to be better only at 8,000 Hz in the left ear (p = 0.03), there was no difference between the study group and the control group in other frequencies and pure-tone averages. In conclusion, we did not find any evidence regarding the worsening effect of diving on the hearing functions of experienced divers. With the increased awareness of occupational safety in recent years, modern technologies, protective measures, and more conservative diving profiles may have minimized the possible adverse effects of diving on hearing function. Longitudinal studies on hearing functions in the same occupational diver groups should be conducted while observing the effect of different diving profiles and noise exposures.

The outcomes of COVID-19 measures in a hyperbaric oxygen therapy centre during the pandemic.

BACKGROUND: A hyperbaric oxygen (HBO) treatment session carries a high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission since patients stay in a closed area for 2 hours. The primary aim of this study was to evaluate the effects of the preventive measures taken in the HBO centre. MATERIALS AND METHODS: This study evaluated the measures taken during the coronavirus disease 2019 (COVID-19) pandemic for multiplace hyperbaric chamber operated in department (Health Sciences University-Gulhane Research and Training Hospital, Ankara, Turkey) between March 16th, 2020 and December 31st, 2020. The medical records of patients who underwent HBO treatment during this period were evaluated retrospectively. Their demographic attributes, the presence of risk factors, HBO indications, HBO session data, and COVID-19 inquiry forms were analysed. RESULTS: A total of 122 patients underwent HBO treatment, and 150 people were subjected to pressure tolerance test (PTT). No COVID-19 case was treated with HBO in our department. The hyperbaric chamber was operated 608 times in total. Of these, 9.7% (n = 59) procedures were carried out under emergency conditions, and 10% (n = 61) were PTTs. Accordingly, 59.8% (n = 73) of the HBO-treated patients were considered at risk for a severe clinical presentation of SARS-CoV-2. SARS-CoV-2 was detected in 5.7% (n = 7) of the HBO-treated patients during the HBO treatment period. Besides, two inside attendants (14.3%) were diagnosed with COVID-19. There were only two concurrent cases in the same session among SARS-CoV-2 positive cases. The records revealed that these patients were sitting three seats away from each other. Another patient was sitting in between the two infected patients but was not diagnosed with SARS-CoV-2. CONCLUSIONS: There is no clear evidence that these two patients infected each other; on the contrary, since no other patient was infected with SARS-CoV-2 in the same session, we may suspect that the infections were coincidental. The measures taken in our department seem to suffice in preventing in-session transmission of COVID-19 and similar infectious diseases in an HBO centre.

Long-term infant outcomes after hyperbaric oxygen treatment for acute carbon monoxide poisoning during pregnancy.

INTRODUCTION: Carbon monoxide (CO) poisoning in pregnant women is linked to foetal mortality of 36-67%. This study assessed long-term fetal outcomes following hyperbaric oxygen treatment (HBOT) for acute CO poisoning in pregnant women. The effects of clinical severity parameters and pregnancy trimester were also analysed. METHODS: A retrospective review of 28 pregnant patients who received HBOT for acute CO poisoning between January 2013-June 2016 was made. Adverse events, birth week, birth weight-height, birth complications, and the age of crawling, walking independently, talking (first words) of their children were recorded. RESULTS: Twenty-eight singleton pregnancies were included. One fetus was dead before HBOT. Three adverse events were reported: abortion, premature birth, and limb malformation. All remaining patients (n = 24) delivered healthy term infants and reported normal neurophysiological development. At final interview the median age of babies was 34 (8-44) months and none had any diagnosed disease. There was no relationship between clinical severity parameters and long-term outcomes. However, the pregnancy trimester at the time of CO poisoning had a significant relationship to birth weight (P = 0.029). Also, the week of pregnancy at the time of the incident correlated with the age of walking independently (P = 0.043, r = 0.436). CONCLUSIONS: This is the largest relevant series and longest follow-up to date. Adverse outcomes were likely incidental because the mothers' medical histories revealed alternative aetiologies. There was no definite evidence of fetal morbidity or mortality after HBOT in this study. HBOT may improve long-term fetal outcomes after in-utero CO poisoning without complications.

Assisted reproductive treatments with hyperbaric oxygen therapy in male infertility.

OBJECTIVE: This study aimed to analyze the results of hyperbaric oxygen therapy (HBOT) in addition to assisted reproductive technologies in male infertility cases. MATERIAL AND METHODS: Medical records of male infertility patients who had HBOT sessions for any reason between January 1, 2015-December 31, 2019, were analyzed retrospectively. RESULTS: A total of 15 male patients were included. Patients were classified as group 1 [DNA fragmentation (n=5)], group 2 [globozoospermia (n=5)], and group 3 [azoospermia (n=5)]. Round spermatid injection (ROSI), intrauterine insemination (IUI), or intracytoplasmic sperm injection (ICSI) procedures were performed in 10 of the 15 patients. A total of 31 embryos were obtained out of which 19 (61%) were transferred. While a total of 15 embryos were obtained in the globozoospermic group, which was the highest number, 10 were obtained from the azoospermic patients, and 6 from the DNA fragmentation patients (p=0.515). A total of 3 (30%) healthy pregnancies were obtained, overall. The mean sperm count of the patients (n=9) before HBOT was 8.4±11.1 mil/mL, while it was found to be 15.7±15.0 mil/mL after HBOT (azoospermic patients were not included). The TESE results were analyzed for azoospermic patients; positive changes were observed in 4 patients (80%). On the other hand, there was an improvement in 50% of group 1 according to sperm DNA fragmentation after HBOT (p=0.500). CONCLUSION: While a total of 15 embryos were obtained in the globozoospermic group, which was the highest number, 10 were obtained from the azoospermic patients.. Further studies should be conducted on HBOT and male infertility.

The changes in pulmonary functions in occupational divers: smoking, diving experience, occupational group effects.

BACKGROUND: Diving challenges the respiratory system because of the pressure changes, breathing gases, and cardiovascular effects. We aimed to analyse the long term effect of occupational diving on pulmonary functions in terms of diving experience (year), smoking history, and occupational groups (commercial divers and SCUBA instructors). MATERIALS AND METHODS: We retrospectively analysed respiratory system examination results of the experienced occupational divers who were admitted to the Undersea and Hyperbaric Medicine Department for periodic medical examination between January 1, 2013 and February 28, 2019. RESULTS: Sixty-four divers applied to our department. Candidate divers were not included in our study. The mean diving experience (year) was 13.6 ± 7.3. None of the divers complained of pulmonary symptoms. Pulmonary auscultation and chest radiography were normal in all cases. In divers with 20 years or more experience, the FEV1/FVC ratio and FEF25-75(%) was significantly lower (p < 0.001, p < 0.05, respectively). In addition, there was a statistically significant negative correlation between FEV1/FVC ratio and FEF25-75(%) and diving experience (year) (p < 0.05, r = -0.444, p < 0.05, r = -0.300, respectively). As the diving experience increase per 1 year, the FEF25-75(%) value decreases by 1.04% according to linear regression analyses. However, smoking and occupational groups did not show any significant influence on pulmonary function test parameters. CONCLUSIONS: Occupational diving seems to create clinically asymptomatic pulmonary function test changes related to small airway obstruction after long years of exposure.

Early treatment response predicts outcome in patients with idiopathic sudden sensorineural hearing loss treated with hyperbaric oxygen therapy.

Hyperbaric oxygen (HBO2) therapy is used in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). Some patients, however, do not benefit from HBO2 therapy despite several weeks of treatment. We hypothesized that early treatment response could predict treatment failure. We conducted a retrospective chart review and identified patients diagnosed with ISSNHL and recorded the pure tone average (PTA) levels prior to, after the first week and at completion of HBO2 therapy. Early treatment response (ETR) was assessed after the first week of HBO2 therapy, and an increase ⟨10 decibels (dB) in mean PTA level was defined as a negative ETR. Factors associated with no recovery were determined using logistic regression analysis. Overall, 39 patients (22 males; mean age (±SD) 41.9 ±14.3 years) were assessed. At treatment completion, the improvement in hearing was 'very substantial' (≥20 dB) for 21 patients (53.8%), 'substantial' (10-19 dB) for eight (20.5%), 'minimal' (⟨10 dB) for five (12.8%) and absent for five (12.8%) patients. After the first week of HBO2 therapy, 18 (46.2%) patients displayed negative ETR. Multivariate logistic regression analysis revealed 'negative ETR' as the only significant predictor of treatment failure (odds ratio (95% confidence interval): 6.98 (1.59-30.61), p=0.010) in patients with ISSNHL treated with HBO2. In conclusion, we found that patients who fail to benefit from an initial set of HBO2 sessions were less likely to benefit from additional HBO2 sessions. Further prospective studies are necessary to confirm our findings.