INDEX OF HYPERBARIC INDICATIONS

AIR GAS EMBOLISM

Recompression in a hyperbaric chamber is the treatment of choice for gas embolism of the arterial or venous system. This includes emboli arising from surgery, diagnostic procedures, renal dialysis, gynecologic manipulations, or pulmonary overpressure accidents during scuba diving. Gas embolism is common enough in cardiovascular surgery to earn the statement "air is the bane of cardiac surgery." Treatment must be initiated during the acute period. Results are best if recompression is within minutes after the incident-however, evidence of patients who have recovered with delayed treatment makes recompression mandatory, even in late cases.

RATIONALE: Recompression of gas bubbles in a hyperbaric chamber is the only definitive form of treatment known. Bubbles are compressed, ischemic tissues are oxygenated, and nitrogen is off-loaded. Diving medicine physicians now feel that repeated treatments with hyperbaric oxygen after the initial recompression hasten resolution of residual signs in some cases.

SOURCE: UHMS Publication Committee Report CR(HBO) 1996

CARBON MONOXIDE POISONING AND SMOKE INHALATION; CARBON MONOXIDE COMPLICATED BY CYANIDE POISONING

Treatment should be initiated if possible within 6 hours of exposure in that efficacy seems to diminish markedly after that time. Treatment with 100% oxygen at sea level is indicated for a diagnosis of carbon monoxide poisoning. Hyperbaric oxygen therapy is mandatory for patients with severe poisoning exhibiting alteration in mental status or neurological signs, cardiovascular dysfunction, pulmonary edema,or severe acidosis, irrespective of carboxy-hemoglobin levels.

RATIONALE: Hyperbaric oxygen hastens the dissociation of carbon monoxide from hemoglobin, myoglobin, cytochromes and other hemoproteins (exceeding that possible at 1 atmosphere), as well as providing tissue oxygenation via saturated plasma. Hyperbaric oxygen has been shown to antagonize lipid peroxidation while sea level oxygen has not. Hyperbaric oxygen should be strongly considered for victims of smoke inhalation since they commonly have a combined, synergistic poisoning with carbon monoxide and cyanide. Hyperbaric oxygen may directly reduce toxicity and augment antidote treatment of cyanide. Hundreds of cases reported in the literature have all yielded the same positive results: rapid improvement in symptoms and by a probable reduction of the incidence of late sequelae. Treatment with hyperbaric oxygen must be predicated more on the history and clinical picture than the carboxyhemglobin levels. COHgb levels are useful in confirming carbon monoxide exposure, but unreliable as a prognostic indicator.

SOURCE: UHMS Publication CR(HBO)1996.

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