Textbook of Hyperbaric Medicine (eBook)

Table of Contents 8
Foreword 10
Foreword to the Third Edition 11
Preface to the Fifth Edition 13
Preface to the Fourth Edition 13
Preface to the Third Edition 14
Preface to the Second Edition 14
Preface to the First Edition 15
PART I: BASIC ASPECTS 16
History of Hyperbaric Medicine 18
Hyperbaric Therapy and Diving Medicine 19
The Development of Hyperbaric Air Therapy 20
The Development of Hyperbaric Oxygen Therapy 23
Physical, Physiological, and Biochemical Aspects of Hyperbaric Oxygenation 24
Introduction 25
Physiology of Oxygenation 25
Hyperbaric Oxygenation 29
General Effects of HBO on the Healthy Human Body 31
Biochemical Effects of HBO 33
Effect of HBO at Molecular Level 34
Conclusions 34
Effects of Diving and High Pressure on the Human Body 36
Physical Effects of Pressure 37
Effects of Pressure on Various Systems of the Body 37
Effects of High Pressure Environments on the Nervous System 39
Hearing and Vestibular Impairment in Hyperbaric Environments 42
Taste Sensation Under High Pressure 44
Effect of High Pressure on Effect of Drugs 44
Conclusions 44
Physical Exercise Under Hyperbaric Conditions 46
Introduction 47
Exercise Under Hypoxia 47
Exercise in Hyperbaric Environments 48
Exercise Under Hyperoxia 48
Physical Exercise Under Hyperbaric Conditions 49
Conclusions 51
Hypoxia 52
Introduction 53
Pathophysiology of Hypoxia 53
General Impact of Hypoxia 53
Effects of Hypoxia on the Brain 54
Role of HBO in the Treatment of Hypoxic States 60
Possible Dangers of HBO in Hypoxic States 60
Oxygen Toxicity 62
Introduction 63
Pathophysiology of Oxygen Toxicity 63
Pathology of Oxygen Toxicity 64
PulmonaryOxygen Toxicity 66
Oxygen-Induced Retinopathy 67
Factors that Enhance Oxygen Toxicity 67
Central Nervous System Oxygen Toxicity 68
Clinical Monitoring for Oxygen Toxicity 70
Protection Against Oxygen Toxicity 71
Extension of Oxygen Tolerance 72
Conclusion and Directions for Future Research 73
Equipment Used in Hyperbaric Medicine 75
Technique of Hyperbaric Oxygenation 81
Ancillary Equipment 82
Hyperbaric Chambers:Equipment,Technique,and Safety 74
Indications,Contraindications, and Complications ofHBO Therapy 90
Indications 91
Contraindications 91
Complications of Hyperbaric Oxygenation 92
Precautions in Selection of Patients for HBOTreatment 94
Conclusions 95
Drug Interactions with Hyperbaric Oxygenation 96
Oxygen as a Drug 97
Drugs Affecting the Central Nervous System (CNS) 97
Interaction of HBO with Various Drugs 97
Practical Considerations of Drug Administration During HBO Therapy 98
Drugs that Enhance Oxygen Toxicity 98
Drugs that Protect Against Oxygen Toxicity 99
Conclusions 99
PART II: CLINICAL APPLICATIONS 100
Decompression Sickness 102
Introduction 103
Pathophysiology 103
Clinical Features 108
Diagnosis 109
Treatment 110
Management of Neurological Manifestations of Decompression Sickness 112
Risk Factors for DCS 117
Conclusions 117
Cerebral Air Embolism 118
Causes 119
Mechanisms 119
Pathophysiology 119
Clinical Features 120
Diagnosis 120
Treatment 121
Clinical Applications of HBO 122
Ancillary Treatments 122
Hyperbaric Treatment in Special Situations 123
Conclusions 125
Carbon Monoxide and Other Tissue Poisons 126
Classification of Tissue Poisons 127
Carbon Monoxide Poisoning 127
Controversies in the Use of HBO for CO Poisoning 144
Cyanide Poisoning 145
Hydrogen Sulfide Poisoning 146
Carbon Tetrachloride Poisoning 146
Methemoglobinemias 147
Miscellaneous Poisons 147
Conclusions: Poisoning Other than with CO 148
HBO Therapy in Infections 150
Host Defense Mechanisms Against Infection 151
HBO in the Treatment of Soft Tissue Infections 152
HBO in the Management of AIDS 158
Miscellaneous Infections 159
Osteomyelitis 160
HBO Therapy in Chronic Lyme Disease 164
Rationale for Using Hyperbaric Oxygen Therapy 166
Pilot Program at Texas A& M University
Ethical Considerations in Using HBO for Unproven Indications 168
Regulatory Aspects of HBO in Relation to Lyme Disease 169
Conclusions 169
HBO Therapy inWound Healing, Plastic Surgery, and Dermatology 172
Introduction 173
Wound Healing 173
Wound Healing Enhancement by Oxygen 174
Role of HBO in NonhealingWounds and Ulcers 177
HBO as an Aid to the Survival of Skin Flaps and Free Skin Grafts 185
HBO as an Adjunct in the Treatment of Thermal Burns 187
Applications of HBO in Dermatology 190
HBO Therapy in the Management of Radionecrosis 192
Introduction 193
Radiation Physics 193
Radiation Biology 193
Radiation Pathology 193
HBO Therapy for Radionecrosis 194
Management of Osteoradionecrosis 195
Management of Radionecrosis of CNS 197
Management of Radionecrosis of Soft Tissues 199
Effect of HBO on Cancer Recurrence 201
Conclusions 202
The Use of HBO in Treating Neurological Disorders 204
Effect of HBO on the Blood-Brain Barrier 207
Effect of HBO on Oxygen Tension in the Cerebrospinal Fluid 207
Rationale for the Use of HBO in Neurological Disorders 208
Indications for the Use of HBO in Neurological Disorders 211
Diagnostic Procedures Used for Assessing the Effect of HBO 212
Use of HBO in Miscellaneous Neurological Disorders 216
Neurological Disorders in Which HBO Has Not Been Found to Be Useful 217
The Role of Hyperbaric Oxygenation in the Management of Stroke 220
Introduction 221
Epidemiology of Stroke 221
Pathophysiology of Stroke 222
An Overview of the Conventional Management of Stroke 233
Role of HBO in the Management of Acute Stroke 236
HBO as a Supplement to Rehabilitation of Stroke Patients 244
Conclusions 247
HBO Therapy in Global Cerebral Ischemia/Anoxia and Coma 250
Introduction 251
Pathophysiology 251
Rational Basis of HBO Therapy 252
Review of Animal Experimental Studies 253
Review of Human Clinical Studies 270
Case Studies 274
HBO Therapy in Neurosurgery 290
Introduction 291
Role of HBO in the Management of Traumatic Brain Injury 291
Role of HBO in the Management of Spinal Cord Injury 295
HBO as an Adjunct to Radiotherapy of Brain Tumors 298
Role of HBO in the Management of CNS Infections 299
Role of HBO in Cerebrovascular Surgery 300
Conclusions 304
HBO Therapy in Multiple Sclerosis 306
Introduction 307
Pathogenesis 307
Rationale for HBO Therapy 307
Clinical Trials of HBO in Multiple Sclerosis 308
Conclusions 313
HBO in the Management of Cerebral Palsy 314
Causes of Cerebral Palsy 315
Oxygen Therapy in the Neonatal Period 315
Treatment of Cerebral Palsy with HBO 316
HBO Therapy in Headache 326
Introduction 327
Vascular Headaches 327
Epidemiology of Vascular Headache 327
Mechanisms of Vascular Headache 327
Commonly Used Anti-Migraine Drugs 328
Nonpharmacologic Approaches 328
Rationale for Use of HBO in Migraine 328
Use of Oxygen in Migraine Treatment 329
Use of HBO for Treatment of Cluster Headache 331
Conclusions 332
HBO Therapy in Cardiovascular Diseases 334
Introduction 335
Pathophysiology 335
Hyperbaric Oxygenation in Cardiology 335
HBO in Shock 342
HBO in Peripheral Vascular Disease 344
HBO Therapy in Hematology and Immunology 354
Introduction 355
Effect of HBO on Red Blood Cells 355
Effect of HBO on Leukocytes 357
Effect of HBO on Platelets 357
Effect of HBO on Stem Cells 358
Effect of HBO Treatment on the Immune System 358
Effect of HBO Treatment on Plasma and Blood Volume 359
Clinical Applications of HBO in Disorders of the Blood 360
HBO Therapy in Gastroenterology 362
Introduction 363
HBO in Peptic Ulceration 363
Clinical Assessment of HBO in Gastric and Duodenal Ulcer Patients 363
HBO in the Treatment of Intestinal Obstruction 364
Experimental Studies in Animals 365
HBO Therapy in Adynamic Ileus 365
HBO in Adhesive Intestinal Obstruction 366
HBO in Chronic Idiopathic Intestinal Pseudo-Obstruction 366
HBO in Inflammations and Infections of the Gastrointestinal Tract 366
HBO in Pneumatosis Cystoides Intestinalis (PCI) 367
HBO in Ischemic Disorders of the Intestine 368
Use of Hyperbaric Therapy in Removal of Entrapped Intestinal Balloons 368
HBO in Acute Pancreatitis 369
HBO in Diseases of the Liver 369
Conclusions Regarding the Use of HBO in Gastroenterology 371
HBO and Endocrinology 372
Introduction 373
Thyroid Glands 373
Epinephrine/Norepinephrine 373
Glucocorticoid Receptors 373
Adrenocortical Function 373
Prostaglandins 373
Testosterone 374
Clinical Applications 374
Conclusions 375
HBO and Pulmonary Disorders 376
Introduction 377
Lung Mechanics and Pulmonary Gas Exchange 377
PulmonaryOxygen Toxicity 377
Clinical Applications 378
Contraindications 380
Conclusions 380
HBO Therapy in Pediatric Surgery 382
Introduction 383
Hyperbaric Chambers for Children 383
Technique of Hyperbaric Oxygenation in Children 384
Efficacy of HBO in Surgical Disorders of Children 386
Conclusions 389
Hyperbaric Oxygenation in Traumatology and Orthopedics 390
Introduction 391
Crush Injuries 391
Traumatic Ischemia 392
Peripheral Nerve Injuries 394
Fractures 396
Traumatic Amputations and Reimplantations of Body Parts 397
Role of HBO in Battle Casualties 398
Effect of HBO on Osteogenesis 398
HBO for Treatment of Osteonecrosis (Aseptic Necrosis) 398
Rheumatoid Arthritis 401
Conclusions 401
HBO Therapy in Otolaryngology 402
Introduction 403
Tinnitus 403
Sudden Deafness 404
Acute Acoustic Trauma 406
Miscellaneous Disturbances of the Inner Ear 409
Neuro-otologicalVascular Disturbances 410
Menière’s Disease 410
Facial Palsy 411
Otological Complications of HBO Therapy 412
Miscellaneous Conditions in Head and Neck Area 412
Conclusions 412
HBOTherapy and Ophthalmology 414
Introduction 415
Review of Pertinent Anatomy and Physiology of the Eye 415
Adverse Effects of Hyperoxia 417
Ocular Contraindications to HyperbaricOxygen Therapy 419
Pre-HBOT Ocular Examination 420
HBO in the Treatment of Diseases of the Eye 420
Emergency HBO in Patients with Acute Vision Loss 434
Conclusions 435
Hyperbaric Oxygenation in Obstetrics and Neonatology 436
Introduction 437
HBO and Risk of Congenital Malformations 437
Role of HBO in Obstetrics 437
Use of HBO for Medical Conditions in Pregnancy 438
Applications of HBO in Neonatology 439
Conclusions 439
Hyperbaric Oxygenation in Geriatrics 440
Introduction 441
Physiology of Aging 441
Changes in the Brain with Aging 442
Applications of HBO in Geriatrics 443
Conclusions 444
HBO as an Adjuvant in Rehabilitation and Sports Medicine 446
Introduction 447
Role of HBO in Rehabilitation 447
HBO for Treatment of Sports Injuries 448
HBO as an Adjunct to Sports Training 448
Future Prospects 449
The Role of HBO in Enhancing Cancer Radiosensitivity 450
Introduction 451
Clinical Studies of HBO as Radiation Sensitizer 453
Combination of Other Methods with HBO and Irradiation For Cancer 455
Conclusions 456
HBO Therapy and Organ Transplants 458
Introduction 459
Lung Transplants 459
Pancreas Transplants 460
Renal Transplants 460
Liver Transplants 460
Miscellaneous Transplants 461
Clinical Application 461
Conclusions 461
Anesthesia in the Hyperbaric Environment 462
Historical Perspective 463
Present Indications 463
Physical Considerations Concerning Anesthetic Gases Under Pressure 463
Physiological Considerations 464
Practical Aspects of Anesthesia in the Pressure Chamber 465
Conclusions 467
HBO in Emergency Medicine 468
Introduction 469
Indications for Emergency Use of HBO 470
Use of HBO in Cardiopulmonary Resuscitation (CPR) 474
Case Studies of Medical Emergencies Treated with HBO 477
Potential Future Uses of HBO Therapy in Emergency Medicine 496
Hyperbaric Medicine as a Specialty: Training, Practice, and Research 498
Introduction 499
Relation of Hyperbaric Medicine to Other Medical Specialties 499
Training in Hyperbaric Medicine 499
Practice of Hyperbaric Medicine 500
Research in Hyperbaric Medicine 501
Conclusions 503
The Future 503
Hyperbaric Medicine in the United States 506
Introduction 507
Hyperbaric Medicine in Japan 510
History of Hyperbaric Medicine in Japan 511
Indications for HBO Approved by the JSHM 511
Distribution and Number of Hyperbaric Chambers in Japan 511
Current Status of Research and Academic HBO Centers in Japan 512
Cost-Benefit Issues of HBO Therapy in Japan 512
Future Prospects 513
Hyperbaric Medicine in the Rest of theWorld 514
Introduction 515
Hyperbaric Medicine in Germany 515
Hyperbaric Medicine in China 515
Hyperbaric Medicine in Russia 516
Appendix: Diagnostic Imaging and HBO Therapy 520
Bibliography 536

14 HBO Therapy in Chronic Lyme Disease (S. 149-150)

Introduction

Lyme disease and its longer-term sequitur, chronic Lyme disease, is one of the most challenging arthropod-borne infectious diseases to diagnose, study, and treat. Although named after the town in Southwest Connecticut in the United States where epidemiological cluster investigations were performed in the mid 1970s, the European medical literature predating this period suggests there was considerable knowledge of this disease prior to this date. In Europe and the United States, the disease is caused by the spirochete Borrelia burgdorferi, although several other Borrelia species have been identified as causative organisms in various parts of the world (Krupka et al 2007).

The spirochete is primarily tick-borne, the most common vector being the Ixodes genus, although its presence in mosquito genera has also been reported (Halouzka et al 1999, Zakovská et al 2002). In the United States, 23,000 individuals were bitten by Borrelia-infected Ixodes ticks in 2005, which makes Lyme disease the most common arthropod-borne infectious disease in that country (Centers for Disease Control and Prevention [CDC], 2007).

Following the tick bite, an erythema migrans or “bull’seye” rash typically develops several days or weeks later, which is capable of expanding until it can measure 30 cm across. An array of flu-like symptoms appears weeks to months thereafter, the most common of which are joint swellings akin to arthritis. Unfortunately, as many as half of bitten individuals do not notice the bite, and the rash itself may not appear bull’s-eye-shaped, nor appear at all in many cases (Edlow 2002, Stricker &, Phillips 2003). Although diagnostic tests are very specific (99%–100%), and thus good for surveillance, they have relatively poor sensitivity (50%–75%) (Stricker 2007), thus, diagnosis is made clinically.

CDC recommends a 2-tiered approach of ELISA or immunofluorescence as a screening test, followed by Western blotting for confirmation if the test is positive. Prompt treatment with 14 to 30-day courses of antibiotics cures the infection in80%-90%of infected individuals(Marques 2008, Smith et al 2002). The most appropriate choices are doxycycline or ceftriaxone for adults and amoxicillin for children, although it should be stressed that other antibiotics may be better suited to different Borrelia species.Our knowledge of the efficacy of antibiotic treatment is far from adequate (Dinser et al 2005, Smith et al 2002).

Chronic Lyme Disease Despite antibiotic therapy, a minority of patients do not respond or continue to report ongoing symptoms, such as fatigue, myalgia, arthralgias, sleep disturbances, cognitive disorders, and depression (Marques 2008), and herein lies a controversy. One school of thought, endorsed by the Infectious Diseases Society of America (IDSA) (Wormser et al 2006), maintains that in patients properly treated with antibiotics, such symptoms are not caused by the persistence of the organism, but are due to the presence of preexisting conditions, such as fibromyalgia or chronic fatigue syndrome, or the presence of chronic inflammatory states induced by the Borrelia species.