Kewal K Jain Textbook of Hyperbaric Medicine Sixth Edition 123 Textbook of Hyperbaric Medicine Kewal K Jain Textbook of Hyperbaric Medicine Sixth Edition Kewal K Jain, MD Basel, Switzerland ISBN 978-3-319-47138-9 ISBN 978-3-319-47140-2 DOI 10.1007/978-3-319-47140-2 (eBook) Library of Congress Control Number: 2016953130 © Springer International Publishing AG 2017 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword to the Third Edition Slowly but surely, hyperbaric medicine is becoming an established treatment modality for a variety of medical disorders, despite the rocky road that it has sometimes had to travel over the years In some ways, I feel that the need for oxygen in medical treatments is akin to man’s basic requirement for water and food, and I also think it is fair to say that the logic and utility of hyperbaric oxygen treatment now seem to be almost as undeniable as these basic requirements are It is certainly the case that, from time immemorial, remedies learned by trial and error have been handed down through the generations—with the result that many roots, berries, fruits, and leaves, as well as special waters containing minerals have been advocated throughout history for their curative powers More recently, however, evidence-based medicine has come to the fore, demanding higher standards of evidence from basic and clinical/research trials and objective statistical results One of the first instances of such objective studies in my lifetime was when Austin Bradford Hill and Richard Doll (Doll 2003) convinced colleagues to allocate patients with pulmonary tuberculosis randomly to prove the efficacy of streptomycin, although their trial followed a tradition started 200 years earlier by Linde, who provided citrus fruits aboard some, but not all ships in the British Navy to test whether they would prevent scurvy (Moberg and Chon 2000) By means of prospective trials, it has been found that various “established” therapies can be detrimental for some diseases, while being clearly beneficial for others This is precisely the case with hyperbaric medicine now: while a hyperoxic environment for newborn babies can lead to retrolental fibroplasia with blindness, there is also convincing evidence that hyperbaric treatments provide clear benefits in diseases such as various neurological disorders, stroke, cerebral ischemia, and wound healing And, of course, those of us who have worked in highaltitude environments know the very short time window during which the human brain can function in hypoxic conditions It never ceases to astonish me what a wide range of effects (beneficial or toxic) a seemingly innocuous substance such as oxygen can have in various circumstances By and large, the experts who have made such superb contributions to the Textbook of Hyperbaric Medicine are the world leaders in their fields With their help, Dr Jain has expanded his already outstanding book into a compendium of multiauthored chapters (containing over 2000 references) covering areas of medicine as disparate as wound healing, gastrointestinal disorders, trauma, and obstetrics Of particular interest in this edition are the extensive discussions of cerebral circulation and its disorders, as well as of stroke, diving accidents, and neurosurgery For an earlier edition, Dr Jain enlisted a remarkable Foreword by Professor Edward Teller (see next page), who began by stating “Hyperbaric medicine is new and controversial” and that we live “in an age that has the habit of treating progress with suspicion,” and then went on to pose the question, “But what is the innovator to do?” He also raised the age-old problem of the ethics of the double-blind trial and cautioned us to be aware of the potential danger of highpressure treatment for too long a period, in the same way that drug treatments at too high dosages bear clear risks The field of hyperbaric medicine has indeed been subject to an at times v vi Foreword to the Third Edition intense debate, but much progress has been made since Professor Teller originally wrote his words (and will, I am sure, continue to be made in the future), on the basis of mutual respect, understanding, and cooperation, while also submitting beliefs to randomized trials Professor Teller wrote then: “It is not entirely impossible that, perhaps sometime in the next decade, professors of medicine will have difficulty in explaining why treatment with oxygen was not widely adopted much earlier.” Reflecting today on these words by an elder statesman whose scientific observations went unheeded early on, we can safely conclude that the uphill battle for acceptance of hyperbaric oxygen as therapy now rests on a solid foundation This solid foundation is described comprehensively and clearly within this outstanding text, in which the assembled experts provide a fair and balanced summary of the literature and evidence And it also means that the “decade of HBO” to which Professor Teller indirectly referred has now come James F Toole, MD Teagle Professor of Neurology Director, Cerebrovascular Research Center Wake Forest University School of Medicine Winston-Salem, NC, USA References Doll R The evolution of the controlled trial The Eighteenth John P McGovern Award Lecture, delivered at the Thirty-third meeting of the American Osler Society, Edinburgh, Scotland; 23 May 2003 Moberg CL, Chon ZA, editors Launching the antibiotic era Personal accounts of the discovery and use of the first antibiotics New York: Rockefeller University Press; 1990 Foreword to the First Edition Hyperbaric medicine is new and controversial Indeed, since it is new, it must be controversial in an age that has the habit of treating progress with suspicion But what is the innovator to do? If he applies a new and safe procedure to patients, and the procedure appears to be successful, his success might well be denigrated as anecdotal Will he be allowed to run a double-blind experiment in which half of the patients are denied the benefits of what appears to be a cure? It is an age-old problem that has grown sharper in the course of time Hyperbaric medicine grew out of the problems encountered by divers exposed to high pressures The treatment of disturbances due to bubbles which develop during rapid decompression was the natural connection between high pressure and medicine This limited application of a medical procedure is, of course, widely accepted But its extension to counteract the damage due to the air bubbles resulting from other causes, such as those accidentally introduced during medical treatment, is less generally recognized What is attempted in this book is a detailed and critical treatment of a large subject If thorough discussion will lead to some consensus, the subject could grow very much larger Indeed, oxygen, which in the form of hyperbaric oxygen (HBO) is called a drug, is the most natural of all drugs The first problem we must face is the danger of high-pressure treatment used at excess pressure for too long a period, or in conjunction with the wrong kind of drug Oxygen indeed has toxic effects Furthermore, the delivery of the pressurized gas to the patient may be mishandled A properly extensive discussion is devoted to such dangers, which are completely avoidable Perhaps the most natural use of HBO is to counteract carbon monoxide poisoning The best known effect of carbon monoxide is to replace oxygen by being more firmly bound to hemoglobin But, of course, high-pressure oxygen can drive out the carbon monoxide and produce a cure in an understandable fashion A little harder to grasp is why pure oxygen at two atmospheres of pressure (which is ten times as concentrated as the natural occurrence) should have any general uses Indeed, under normal circumstances, the hemoglobin in arterial blood is 97 % saturated with oxygen Are we exerting ourselves to supply the remaining %? The answer, of course, is no Oxygen is also soluble in blood At two atmospheres of pressure, oxygen can be dissolved into the plasma at several times normal levels and can significantly improve tissue oxygenation This is important because hemoglobin, while more eager to take up oxygen, is also more reluctant to part with it The oxygen dissolved in the plasma, having a higher chemical potential, is pushed out from the capillaries and into the surrounding tissue From there, it can spread small distances by diffusion Even in the blood itself, the dissolved oxygen may help the white blood cells in their phagocytic activity Bacteria themselves may react in a variety of ways It appears that many can use oxygen at normal pressures, but are damaged by oxygen at higher pressures In the case of anaerobic bacteria, oxygen can act in a powerful way to stop the infection In combination with other methods, HBO clearly appears effective in cases of gangrene vii viii Foreword to the First Edition But more is involved than the straightforward destruction of the pathogen The natural healing process may also be assisted by the presence of oxygen This obviously should be the case when hyperbaric treatment counteracts on oxygen deficiency Many injuries involve the destruction of capillaries, the means of delivering oxygen Under such circumstances, healing is itself tied to revascularization of the damaged tissue But growth of the requisite capillaries is in turn tied to the oxygen supply This relationship can explain why in the case of many slow healing wounds, HBO seems to have a strong positive effect Very much more can and should be done to extend the study of the speed of healing to the more normal cases In the human body, 20 % of the oxygen consumption occurs in % of the body mass: the brain This is also the region most sensitive to a deficiency of oxygen, which can produce dramatic results Indeed, surgical methods on the carotid artery are often used to relieve oxygen deficiency to the brain It seems logical that in HBO we have a tool that can serve a similar purpose This might be particularly important in the case of stroke, a high-ranking cause of death and disability It is clearly worthwhile to explore whether and to what extent disability can be reduced or avoided by prompt use of hyperbaric treatment If the blood supply to a small region of the brain is reduced, relief might come from the diffusion of oxygen into the ischemic region from neighboring capillaries For all new medical techniques, scientific evidence is demanded Yet medicine is still partly an art, as well as a dramatically advancing science Therefore in the complicated questions of life, disease, and recovery, it is sometimes hard to distinguish between the fight against the causes of a disease and our efforts to aid toward the reassertion of overall health There are good indications that HBO is helpful in many diseases, such as multiple sclerosis and osteomyelitis One may mention these two applications because, in the former, earlier recognition of the disease made possible by the use of magnetic resonance imaging has made early treatment a better possibility and seems to have given a real chance for help from HBO In the latter case, osteomyelitis, the location of the disease is the bone, where oxygen is usually not amply available As members of the scientific community we are all naturally tempted to theorize, as long as a glimmer of a theory might be perceived This book proceeds, however, along strictly step by step empirical lines Case after case, the various pathologies are reviewed In each situation, it is carefully stated to what extent the evidence merely indicates a conclusion and to what extent the conclusion can be proved In the present stage of HBO, it is a certainty that there will be considerable criticism On the other hand, those who disagree are likely at the same time to disagree among themselves I believe that the result will be not only critical reflection, but also more experimentation, more reviews, more understanding, and more progress It is not entirely impossible that, perhaps sometimes in the next decade, professors of medicine will have difficulty in explaining why the treatment with oxygen was not widely adopted much earlier Edward Teller† Formerly Director Emeritus Lawrence Livermore National Laboratories California & Senior Research Fellow Hoover Institution Stanford University, Stanford, CA, USA Preface to the Sixth Edition A quarter of a century has passed since the first edition of the book was published Apart from incorporating new advances since the fifth edition, there was a major reorganization of the book for the new publisher, Springer Of the more than 2500 publications relevant to hyperbaric medicine published during 2009–2015 that were reviewed, approximately 1300 have been selected and added to the bibliography which has been divided and appended at the end of each chapter Several older references have been deleted, whereas others have been retained either for their historical interest or for research that has not been repeated As in previous editions, proportionately more space has been devoted to disorders of the nervous system than other therapeutic areas Nine chapters on new topics have been added to this edition, and two chapters from the first edition were deleted with incorporation of essential information into other chapters With increasing application of biotechnologies to clinical medicine, applications in combination with hyperbaric oxygen have been explored, including a new chapter on personalized hyperbaric medicine There is an increasing integration of multidisciplinary approaches in management of complex disorders, and the role of hyperbaric oxygen in these has been defined Other new chapters include “Nursing in a Hyperbaric Medical Facility,” “Hyperbaric Oxygen Therapy in Military Medicine,” and “Ethics, Standards and Quality Control in Practice of Hyperbaric Medicine.” Finally, I would like to thank Gregory Sutorius, senior editor in Clinical Medicine at Springer, for his encouragement and oversight of this project Diane Lamsback, developmental editor for Springer, has provided invaluable assistance in editing and managing this project Basel, Switzerland K K Jain ix Preface to the Fifth Edition Almost 20 years have passed since the first edition of the Textbook of Hyperbaric Medicine was written, and since the publication of the fourth revised edition in 2004, there has been a considerable increase of research and development in applications of hyperbaric oxygen Of the more than 1200 publications relevant to hyperbaric medicine during 2004–2008, approximately 300 have been selected and added to the list in this book, whilst a corresponding number of older references have been deleted to maintain the bibliography at 2000 entries Several older publications have been retained for their historical interest, and some of these have indeed become classics There is an ever increasing use of hyperbaric oxygen for neurological disorders Other areas of expansion include applications in ophthalmology, and the chapter on this has been rewritten and expanded by Frank Butler and Heather Murphy-Lavoie A new chapter by Alan Wyatt on the role of hyperbaric oxygen in organ transplantation has been added as well as a chapter on the treatment of chronic Lyme disease by William Fife and Caroline Fife Multimodality treatment is required in some complex disorders, and hyperbaric oxygen has been combined with new advances in drug treatment and surgical procedures as well as with complementary medicine techniques such as acupuncture As other new technologies such as those for manipulating stem cells develop, their interaction with hyperbaric oxygen is being studied Hyperbaric oxygen may prove to be a useful adjunct to stem cell-based therapeutics and regenerative medicine I would like to thank the editorial staff at Hogrefe & Huber Publishers, particularly the Publishing Manager, Robert Dimbleby, for their help and encouragement during this revision Basel, Switzerland K K Jain xi 51 Hyperbaric Medicine in Latin America to standardize the treatment protocols which would allow us to produce multinational multicenter research protocols that could reach statistical significance sooner It is a real challenge to put together so many different countries and come to an agreement on minimum standards for the issues listed above, but it is need for hyperbaric medicine to be accepted and take its place in modern medicine in Latin America In diving medicine, Divers Alert Network (DAN) of Latin America, a branch of IDAN at that moment, set a precedent where it was divided in five areas (Mexico and the Caribbean, Central America, northern part of South America, southern part of South America, and Brazil) and created courses and documents for safety, training, and standardized the management of diving-related accidents The area directors and subdirectors and attending physicians worked as volunteers Many silent heroes gave a lot of their time and knowledge to make this happen Implementation of Minimum Standards and Regulations Although we have standards in the area for multiplace chambers (at least PV), there is a need to extend the existing standard to PVHO and for monoplace chambers A Latin American master document that contains the minimum stan- 625 dards for multiplace and monoplace chambers is very much needed This document would serve as a foundation Currently, most of the existing regulations in the USA are applied in our countries, although we need PVHO and National Fire Protection Association (NFPA), or their equivalent, in the area Hyperbaric chambers in accredited hospitals and clinics have no problems (except for PVHO and NFPA) because they, by law, have to meet certain standards that are generally similar to those in the USA Our real problems are the freestanding chambers that not follow any code or regulation There is not an entity that investigates or regulates this type of freestanding chambers In some countries, the Navy, Labor Department, or other institution regulates all the PV and the activity around them, but this codes or rules are not presently being enforced Our real challenge is to create a document that has the minimum requirements and that states where to get all the related information to upgrade these requirements The second phase would be to try to enforce locally this minimum requirement to standardize the activity in the area The ultimate goal would be that all the area followed the same codes and guidelines, so we can guarantee the safe and ethical use of diving and hyperbaric medicine in Latin America Index A ABEM See American Board of Emergency Medicine (ABEM) ABPM See American Board of Preventive Medicine (ABPM) Acetazolamide therapy, 478 Acetylcholinergic neurons, 140 ACGME accredited fellowship program, 628 ACHM See American College of Hyperbaric Medicine (ACHM) Acute acoustic trauma, 448–453, 458 Acute anemia, 403–404 Acute mountain sickness (AMS), 110 Acute myocardial infarction (MI) cardiac arrhythmias, 381 cardiac resuscitation, 381 chronic ischemic heart disease, 380 diagnostic procedures, 379 HBO and thrombolysis, 379, 380 heart failure, 381 normobaric oxygen, 379 PTCA, 379 Acute obstructive bowel symptoms, 411 Acute pancreatitis animal study, 415 causes, 415 HBO applications, 415 Acute peripheral vascular ischemia, 436 Acute pulmonary oxygen toxicity, 84 Acute severe injury/illness (ASII), 555 Acute stroke, HBO role, 258–266 animal models advantage, 258 hyperglycemia, 261 ischemia/hypoxia, 258–261 MCAO, 258, 261, 262 cerebral ischemia and free radicals, 258 controlled clinical studies, 266 neuroprotective effect, 262 RBC, 257 uncontrolled clinical studies cerebrovascular disease, 262–264 clinical trials, 265 EfHBOT, 266 thrombosis, 264 Acute vision loss, 469 Adenine triphosphate (ATP), 555 Adhesive intestinal obstruction adhesions, 410 clinical trial, 411 decompression therapy, 411 HBO, 411 Adjunctive therapy, 167 Adrenocortical function, 421–422 Advanced Certified Hyperbaric Registered Nurse (ACHRN), 516 Adynamic ileus, 410 Aging brain changes, 505–506 free radicals, 503–504 hypoxia, 504–505 mental function, 506 metabolism, 505–506 morphological changes, 505 oxygen conductance system, 505 theories, 503–505 Air bubbles, 126 Air cysts, 81 Air embolism AGE and VGE, 123 alveolar-capillary disruption, 123 causes, 123, 124 cerebral metabolism, 128 delayed treatment, 131 HBO application, 126–127 hydrogen peroxide poisoning, 130 invasive medical procedures, 129 mechanisms, 124 neurological deficits, 123 obstetrical procedures, 129 spontaneous recovery, 130 treatment, 125, 126 Altitude Mountain Sickness (AMS), 573 Altitude sickness, 103 American Board of Emergency Medicine (ABEM), 621 American Board of Preventive Medicine (ABPM), 621 American College of Hyperbaric Medicine (ACHM), 583, 621 APWCA, 623 CMS, 623 DWLE, 624 functions and goals, 623 Radionecrosis Registry, 624 UHMS, 624, 625 American Diabetes Association, 194 American Osteopathic Board of Preventive Medicine (AOBPM), 621 American Professional Wound Care Association (APWCA), 623 American Society for Mechanical Engineers (ASME), 632 Amino acids, 58–59 Ammonia, 58–59 Ammonia metabolism, 21 Amphotericin B (AMB), 167 Anaerobic cellulitis, 162 © Springer International Publishing AG 2017 K.K Jain, Textbook of Hyperbaric Medicine, DOI 10.1007/978-3-319-47140-2 627 628 Anaerobic glycolysis, 134 Ancillary equipment, 72 Anemia, 533 Anesthesia, 552, 553 cardiovascular effects, 551 central nervous system, 551 historical perspective, 549–550 indications, 550 intravenous anesthesia, 552 middle ear barotrauma, prevention, 553 nitrous oxide (N2O), 551, 552 pharmacokinetics, 552 physiological considerations, 550–552 in pressure chamber airway equipment, 552 monitoring, 553 noise, 552 ventilators, 552, 553 Angiogenesis, 188 Animal experimental studies, 588 Anoxia, 159 Anoxic brain injury, 359 Anterior ciliary arteries, 472 Anterior segment ischemia (ASI), 472, 473 Anticancer agents, 88 Antineoplastic agents, 533 Antioxidants, 90, 91 Antiplatelet drugs, 128 Anxiety reactions, 85 Apligraf (Organogenesis Inc.), 194 APWCA See American Professional Wound Care Association (APWCA) Arterial gas embolism (AGE), 465 Arterial insufficiency, 193 Arteriovenous malformations, 217 Arteritic ischemic optic neuropathy (AION), 474 Ascorbic acid, 60 Asymmetric dimethylarginine (ADMA), 190 Autism spectrum disorder (ASD), 372 B Bacterial gangrene, 162 Bacteriology, 164 Baromedical Nurses Association (BNA), 516, 626 Barotraumatic lesions, 83 Barthel index, 252 Basic fibroblast growth factor (bFGF), 214 Battle casualties, 441 Benign intracranial hypertension (BIH), 369 Biochemical effects of HBO acid-base balance, 20 biomarkers, 20 Bioinformatics, 600 Biological signals, 234 Biomarkers, 588–589, 597, 599 Birth injury, 357 Blood loss, 403–404 Blood volume, 402 Blood–brain barrier (BBB), 45, 124, 228, 346, 347 Bone mineral density (BMD), 440 Brain abscess, 335–336 Brain dysfunction, 235 Brain edema, 229 Brain fibroblastic growth factor (bFGF), 303 Brain imaging, 597 Brain injury, 355, 359, 362 Brain tumors, 334 Index Branch retinal artery occlusion (BRAO), 470, 476, 481 Bronchial asthma, 430 Bronchitis, 430 Brown-Séquard syndrome, 117 C Canadian Neurological Scale (CNS), 253 Cancer, 600 Carbon monoxide poisoning, 133, 135–154, 491 Carbon tetrachloride (CCl4) poisoning, 154, 155 Carbonic anhydrase inhibitors (CAIs), 476 Carboxyhemoglobin (COHb), 134–137, 139–144, 146–153 Carboxymyoglobin (COMb), 134 Carcinoma, 529 bladder, 530 lung, 530 Cardiac arrhythmias, 381 Cardiac pacemakers, 86 Cardiac surgery advantages, HBO, 381, 383 CNS complications, 383–384 HBO preconditioning, 383 IRI, 382 LDH, 382 open-heart surgery, 382 retransfusion, 382 Cardiology, 377–380 HBO clinical application (see Acute myocardial infarction (MI)) Cardioprotection, 383 Cardiopulmonary resuscitation, 557–558 Cardiovascular diseases hyperoxia and atherosclerosis, 375, 376 hypoxia, 375, 376 NBO, 375 risk factors, 375 Cardiovascular disorders, 601 Cardiovascular system, 19–20 Carotid bodies (CBs), 424 Carotid endarterectomy, 337 EC/IC bypass operation, 336 HBO, 336, 337 Cataract, 464–465 Catecholamines, 422 Ceiling effect, 393 Cell therapy, 255, 590, 600 Centers for Medicare and Medicaid Services (CMS), 623, 625 Central nervous system (CNS), 49, 495 Central retinal artery, 465 occlusion, 466–469 Central retinal vein, 466, 472 occlusion, 474–476 Cerebral anoxia, 300 Cerebral blood flow (CBF), 227, 235–236, 326–328, 330, 340, 505–506 Cerebral edema, 45–46, 229–230, 232 control of, 326 HBO, 336 HBO therapy, 338 and intracranial pressure, 341 neurosurgery, 341 postoperative, 342 vascular occlusion, 337 Cerebral embolism clinical features, 125 diagnosis, 125 pathophysiology, 124–125 Cerebral glucose metabolism, 226 Index Cerebral hemodynamic, 217 Cerebral hypoxia, 46, 47, 229, 292 Cerebral infarction, 241, 248, 257, 258, 265 Cerebral ischemia, 228, 230 DNA damage and repair, 248 gene expression, 248 oxygen free radicals, 246–247 Cerebral malaria, 371 Cerebral metabolism, 21, 56 Cerebral oxygenation, 230 Cerebral palsy (CP) causes of, 355 children with cerebral anoxic injury, 359–360 clinical trials, 358–360 Cornell study, 360 effectiveness studies, 360–361 in HBO, 357–358 in HBOT, 360 hyperbaric oxygen therapy, 365 molecular diagnostic procedures, 366 oxygen therapy in neonatal period, 355–357 postneonatal onset, 361 side effects, 361–362 spastic diplegia, 363, 364 SPECT brain imaging study, 361 TOVA, 361 in utero, 362 Cerebral vasomotor paresis, 229 Cerebrospinal fluid (CSF), 228 Cerebrovascular diseases, 404 Cerebrovascular surgery HBO, 336–341 Certified Hyperbaric Registered Nurse (CHRN), 516 Cervical myelopathy, 334 Chamber claustrophobia, 85 Chandler’s grading system, 218 Chemoradiotherapy (CRT), 219 Chinese hyperbaric chamber, 615 Chronic brain injury, 362 Chronic idiopathic intestinal pseudo-obstruction, 411 Chronic ischemic heart disease, 380–381 Chronic laryngitis, 458 Chronic lyme disease (CLD), 177, 178 Chronic myocardial insufficiency, 384 Chronic obstructive pulmonary disease (COPD), 429 Chronic osteomyelitis, 171, 172 Chronic poststroke stage depression, 257 spasticity management, 256, 257 vascular Dementia, 257 Chronic stable disease, 346 Cilioretinal arteries, 466, 469 Claustrophobia, 85 Clinical trial, HBO defined, 591 ethical aspects, 592 problems, 591, 592 types, 591 Clinically isolated syndrome (CIS), 346 Clinicopathological correlation, 212 Clostridial infections, 165 CMS See Centers for Medicare and Medicaid Services (CMS) CNS drugs anesthetics, 89 ethanol, 89 injuries, 510 629 narcotic analgesics, 89 pentobarbital, 89 scopolamine, 89 stimulants, 89 CNS cochlear microphonics (CM), 450 Coma, 275, 276, 305 Comatose Patients, 233 Comex 30, 113 Compartment syndromes, 437 Compound action potentials (CAP), 450 Compressed air, 72, 74, 76, 77 Computerized tomography (CT), 96 advantages and disadvantages, 236 principles, 236 Congenital malformations, 489–490 Congenital spherocytosis, 404–405 Continuous bladder irrigation (CBI), 74 Controlled trials vs observational studies, 274 Coronary artery bypass graft (CABG), 382 Coronary artery disease, 384 Corticosteroids, 203 Critical limb ischemia (CLI), 386 Crush injuries, 435 compartment syndromes, 437 diagnosis, 434 late complications, 433 pathophysiology, 434 traumatic ischemia, 435, 436 treatment, role of HBO BPI, 435 PtcO2, 435 Cutaneous ulcers, 188 Cyanide poisoning, 147, 153–154 Cystoid macular edema (CME), 476–478 Cytochrome aa3, 555–557, 566, 567 Cytochrome c oxidase, 134 Cytotoxic brain edema, 230 D Decompression illness (DCI), 557, 571 Decompression sickness (DCS), 26, 28–30, 85, 104–108, 546 ATA, 104 altitude, 109–110 blood examination, 112 bone scanning, 112 decompression illness, 104 delayed treatment, 119–120 diagnosis, 111–112 in diving, 108–109 drugs, 118–119 dysbarism, 103 early treatment, 119 electrophysiological studies, 112 emergency management and evaluation, 113 extravehicular activity, 103 facial baroparesis, 117 gas formation, 104 helium and oxygen environment (heliox), 104 imaging, 112 late sequelae, 118 management, altitude, 117 monoplace vs multiplace chambers, 118 neurological, 121 neuropsychological assessment, 113 ocular complications, 111 630 Decompression sickness (DCS) (cont.) oxygen vs gas mixtures, 118 pathophysiology bubble-induced CNS injury, 106–107 changes in blood, 107 DON, 108 free radicals, 108 gas formation, 104–105 pulmonary changes, 106 preventive measurement, 120–121 prognosis, 121 recompression and HBO treatment, 113–116 retinal angiography, 112 risk factors, 120 spinal cord, 117 steady-state conditions, 104 type II, 120 ultrasonic detection, bubbles, 111, 112 X-rays, 112 Decompression syndrome (DCS), 431 Decubitus ulcers HBO role, 199 pathophysiology, 199 Delayed neuropsychiatric sequelae (DNS), 235 Delayed radiation injuries, 218, 219 Dementia causes, 372 defined, 372 Demyelination, 346 Department of Defense (DoD), 329 Department of Veterans Affairs (DVA), 329 Dermatology necrobiosis lipoidica diabeticorum, 206 pyoderma gangrenosum, 206–207 Descemet’s membrane, 465 Diabetes mellitus, 423–424, 491, 601 Diabetic foot infection (DFI), 161, 195 Diabetic macular edema (DME), 479 Diabetic retinopathy (DR), 479, 480 Diabetic ulcer adjuncts to HBO, 194–195 barotrauma rate, 197 clinical use of HBO, 195–196 critical evaluation of HBO, 196 division, 197 HBO role, 194 hyperglycemia, 194 leg amputation rate, 194 treatment, 194, 196–197 Diagnostic equipment ECG and EEG, 73 glucose-monitoring devices, 73 tcpO2, 73 Dichlormethane, 151 Dimethyl sulfoxide (DMSO), 332 Diphosphoglycerate, 134 Diploma course, 585 Disseminated sclerosis, 346 Distal airway epithelial cells, 54 Diver’s headache, 28 Diver’s vertigo, 30 Divers Alert Network (DAN), 633 Diving chambers, 68 Diving medicine, 3–4, 23, 31, 546, 583, 584 gas nuclei elimination, 547 O2 preconditioning, 547 preoxygenation, 547 Index Diving, high-pressure effects central nervous system lesions, 28 headache, 28 hearing and vestibular impairment, 28, 29 microbubble damage in BBB, 28 middle ear damage, 29, 30 peripheral nerve conduction velocity, 28 taste sensation, 30 vertigo, 30 DNA damage, 21 Drug delivery, 600 Drug interactions, 87 Dysbaric osteonecrosis (DON), 25, 108 Dysbarism, 103 Dyspnea, 219 E Ear surgery, 81 ECD SPECT brain imaging, 315 Economic analysis, 196–197 Electron transport system (ETS) ATP, 556 mitochondrial matrix, 556 paramagnetic molecules, 555 Electrophysiological studies, 234–235 Embryonic stem cells (ESCs), 400 Emphysema, 431 Endoscopic retrograde cholangiopancreatography, 130 Endothelial progenitor cells (EPCs), 194 Entrapped intestinal balloons, 415 Enzyme inhibition, 50 Epilepsy, 59 Epinephrine/norepinephrine, 422 Erythropoiesis, 400 Euglobulin fibrinolytic activity (EFA), 19 European Stroke Scale, 253 Eustachian tube, 83 Exercise, 35–38 ammonia metabolism, 37 brain function, 33 effect of HBO blood flow, muscles, 37 skeletal muscle, 37 toxic effects, 38 effects on human body, 34 hyperbaric conditions general effects, 35, 36 lactate production and clearance, 36 hyperbaric environments, 34, 35 hyperoxia, 35 hypoxia, 34 oxygen, 33 Experimental allergic encephalomyelitis (EAE), 347 Extracellular SOD (EC-SOD), 60 Extracranial carotid occlusive disease, 337 Extracranial/intracranial (EC/IC) arterial bypass, 338–341 HBO, 338–339 patients selection, 339–341 Eye diseases central retinal artery occlusion, 466–469 decompression sickness, 465 hyperoxic conditions, 462–463 radiation retinopathy, 469–472 recurrent pterygium/scleral necrosis, 472 Index F Face transplants, 541 Facial palsy, 457 Fetal hypoxia, 490–491 Fibromyalgia syndrome (FMS), 181 Fire safety clinical monoplace chamber, 77 fatal hyperbaric fires, 77 monoplace chamber, 77 multiplace hyperbaric chambers, 77 Flap survival and grafts, 204 animal experiments, 204 clinical applications, 203–204 drugs and biological preparations, 203 Focal hypoxia signals, 346 Food and Drug Administration (FDA), 611–613 Forced vital capacities (FVC), 20 Fournier’s gangrene, 163 Fractures arterial injuries, 440 BMD study, 440 cartilage, 439 HBO treatments, 439 hyperoxia, 439 pseudoarthrosis, 440 Free radical scavengers, 88, 91 Frenzel’s maneuver, 83 Frost bite clinical features, 199 laboratory studies, 199 management, 200 pathogenesis, 199 Future medicine, 600, 601 G GABA shunt, 44 Gas gangrene diagnosis, 164 gangrene treatment, 164–165 gas-forming anaerobic organisms, 163 HBO, 165–166 necrotic condition, 163 Gastroenterology, 407–413 acute pancreatitis, 415 entrapped intestinal balloons, 415 IBD (see Inflammatory bowel disease (IBD)) infections (see Gastrointestinal tract infections) intestinal obstruction adhesive intestinal obstruction, 410, 411 adynamic ileus, 410 animals studies, 409, 410 categories, 408 intestinal gas origin, 409 ischemic disorders, 414, 415 PCI (see Pneumatosis cystoides intestinalis (PCI)) peptic ulceration antibacterial effect, 408 clinical assessment, 408 experimental studies in animals, 408 gastric mucosal ischemia, 407 radiation enterocolitis, 413 Gastrointestinal tract infections necrotizing enterocolitis, 413 pseudomembranous colitis, 413 TM, 412 631 Gene expression antioxidant induction, 589 in decompression, 590 human brain, 589 microarray analysis, 589 in stroke, 590 Gene therapy, 255, 256, 600 Genes, 597–598 Geriatrics medical specialty, 503 Glasgow coma scale (GCS), 275, 573 Glasgow outcome scale (GOS), 573 Glaucoma, 481 Global ischemia/anoxia, 274–308 animal studies antiapoptotic effect/neurons preservation, 303 bFGF, 303 gene-signaling trophic effects, 302 HBO therapy, 277–286 microcirculation, 302 neonatal ischemic/hypoxic birth injury, 302 normobaric oxygen (NBO), 304 pregnant uterine harvest/global ischemia model, 302 stem cells, 303 swine study, 302 Van Meter dose–response study, 302 HBO therapy carbon monoxide rat model, 276 characterization, 275 chronic traumatic brain injury rat model, 275 microcirculation, 276 trophic effect, 276 WBCs, 276 human clinical studies acute, 290–295 categories, 304 chronic, 298–301, 307 coma, 305 CSF pressure, 305 HBO, 304, 305 HBOT, 308 heat stroke, 306 hyperacute period, 287–290 intravascular gas, 305 subacute global ischemia/coma cases, 296, 297, 306, 307 TBI patients, 305, 306 Glucocorticoid, 421 Glucose metabolism, 21 Glucose oxidation quotient (GOQ), 225 Glycolysis, 225 Grading of Recommendations Assessment, Development, and Evaluation (GRADE), 196 Gross Motor Function Measure (GMFM), 358, 359, 361 Growth and differentiation factor 15 (GDF15), 54 Gynecology animal experimental studies, 492 clinical applications, 492 H H+ channeling, 556 Haldane effect, 16 Hand transplants, 541 Hansen’s disease, 168–169 HBO life support (HBOLS), 566 HBO preconditioning (HBO-PC), 229 632 HBO therapy, 355–366, 369, 373–374, 591–592 anxiety reactions, 85 ASD, 372 BIH (see Benign intracranial hypertension (BIH)) BNA guidelines, 517 claustrophobia, 85 clinical trials HBO (see Clinical trials HBO) cognitive impairment, 373 contraindications, 81–83, 86 decompression sickness, 85 drug-induced neuropathy, 370 genetic effects, 85 hyperbaric chamber, 86 indications, 81, 82 inflammatory necrotic tissue, 187 intervention, 305, 317 management of neuromuscular disorders muscular dystrophies, 373–374 myasthenia gravis, 374 mental dysfunction, 373 Middle Ear Barotrauma, 83–84 in nonhealing wounds, 193 neurotoxicity, 59 ophthalmological complications, 84 oxygen seizures, 84 patients selection, 86 peripheral neuropathic pain, 370 peripheral neuropathy, 370 plastic surgery, 187 pulmonary complications, 84 surgical procedures, 187 Susac’s syndrome, 371 trigeminal neuralgia, 371 ulcers, 193 vascular headaches, 371, 372 HBO-induced DNA damage, 85 HBO-induced wound healing, 189–190 Head and neck cancer, 529–530 Heart disease, 491 Heart failure, 381 Heat shock protein (HSP), 40, 248 Helium-oxygen mixtures, 119 Hematocrit, 398 Hematuria, 219 Hemiplegics, 234 Hemodialysis, 469, 474 Hemodilution, 128 Hemoglobin, 13, 399 Hemolytic anemia, 404 Hemorheology, 397, 400 Hemorrhagic cystitis and proctitis, 220 Hepatic encephalopathy HBO, 417 MRI diagnosis, 416 treatment, 416 Hepatocellular carcinoma (HCC), 88 Hexamethylpropyleneamine oxime (HM-PAO), 238 High altitude cerebral edema (HACO), 573 High altitude pulmonary edema (HAPO), 573, 574 High pressure water gun injection injury, 437 High-pressure neurological syndrome (HPNS) clinical features, 26 neurotransmitters, 27 pathophysiology, 26, 27 prevention and management, 27, 28 Index HMPAO SPECT brain imaging post near drowning, 312, 313 postinjury, 309 single HBO treatment, 311, 314 HMPAO–SPECT brain imaging, 120 Hospital-based hyperbaric programs, 622 Host defense mechanisms oxygen tension, 159 phagocytic leukocytes, 159 Hydrogen cyanide (HCN), 153 Hydrogen peroxide (H2O2), 50 Hydrogen peroxide poisoning, 130 Hydrogen sulfide (H2S) poisoning, 154 Hydroxocobalamin, 146 Hydroxyethyl starch (HES), 452 Hydroxyl radicals (OH·), 50 Hyperacute and acute studies, 318 Hyperbaric air therapy compressed air, history, hyperbaric chamber, 5, Hyperbaric chambers, 7, 53, 64, 74–78, 110, 117, 120, 553, 575, 615, 617, 619, 620, 631, 633 ancillary equipment, 72 animal experiments, 68–70 cardiopulmonary resuscitation, 73–74 care of tracheotomy, 74 CBI (see Continuous bladder irrigation (CBI)) combined treatment and diver testing, 69 contaminant and value, 76 defibrillators usage, 74 diving medicine, 68 endotracheal tubes, 74 hyperlite 1-man portable, 65 mobile multiplace chamber, 67, 68 model 500A, specifications, 73 monoplace chambers, 63, 64 multiplace chambers (see Multiplace chambers) oxygen masks, 72 patient monitoring devices, 75 pleural suction drainage, 74 portable chamber, 78 pressure usage, 71 regulatory issues FDA classes, 78 GMP regulations, 78 labeling, 78 risk-benefit analysis, 75 safety atmospheric control, 76 breathing control system, 76 fire, 76, 77 operational safety, 75 safety and fire hazard, 605–608 selection, 70 transdermal patches, 74 types, 63, 64 Hyperbaric medicine practice, 79, 187, 516, 584–585 ACHM, 583 air therapy, 4, application of biotechnologies, 588, 589 in bioinformatics, 600 cell therapy, 600 cerebral adverse effects, 546 in China, 615–616 Index diploma course, 585 and diving medicine, 3–4, 584 drug delivery, 600 economic aspects, 586 future needs, 601 in Germany, 618, 619 I/R injury, 546 in Japan, 617, 618 in Latin America, 631 molecular diagnostics, 599 molecular imaging, 599 nanomedicine, 600 nonphysician healthcare personnel, 585 preoxygenation, 546 program outline, 586 remote monitoring, 600 in Russia, 617, 619 sequencing, 599 standards and regulations, 633 training admission requirements, 584–585 examinations, 584–585 training program, 584 Hyperbaric Nursing and Wound Care, 517 Hyperbaric nursing research, 525 Hyperbaric oxygen therapy (HBOT), 133–135, 141, 144–155, 461, 463–470, 472–482, 571, 572, 609, 610 adjuvant to antibiotics, 161 in AIDS, 167–168 case study battered child syndrome, 313, 314 coma treatment, 308, 309 drowning, chronic phase, 311, 312 cell DNA, 212 cerebrovascular diseases, 404 chronic laryngitis, 458 chronic noise exposure, 455 clinicopathological correlation, 212 congenital malformations, 489–490 decompression sickness, dephlogisticated air, 7–9 diving medicine, effectiveness, 347 ethical issue, 605 Facial Palsy, 457 gas gangrene, 572 hearing loss, 453–455 hemoglobin molecule, 399 hemorheology, 400 history, hyperbaric chamber, hyperbaric oxygenation, 348 hypoxia, 348 immune system treatment, 401–402 indications, 616–617 infections treatment, 161–169 inner ear, 455 intravenous high-dosage methylprednisolone, 346 ionizing radiation, 212 leprosy, 168–169 leukocytes, 400 loss of blood, 572 low pressure oxygen, 608 malignant otitis externa, 447, 457–458 mechanism, 178–181 medical registry, 183 633 medicare fraud, 611 Meniere’s disease, 456 military response, 574 Multidisciplinary Healthcare Systems, 601 nanotechnology, 590 neonatology, 491–492 neurological disorders, 401 Neuro-otological Vascular Disturbances, 455–457 off-label use, 604, 605 osteomyelitis, 170–171, 447 otological complications, 457 oxygen carriers, 403 perinatal disturbances, 421 plasma oxygen tension, 347 platelets and coagulation, 400 postconcussive symptoms, 573 pregnancy, 489 radiation physics and biology, 211 RBCs, 397 sham treatment, desperate measures, 609–611 skin and mucous membranes, 213 soft tissue infections treatment, 162 stem cells, 400–401 tank treatment, TBI/PCS, 573 tinnitus, 447–449 toxic effects, UHMS, 604 unit of radiation, endocrine organs, 211–212, 421 VHL, 347 viscosity, 398 Hyperbaric oxygenation (HBO), 20, 70–71, 88–90, 109, 110, 113–117, 119–121, 376–378, 583 aging process, 506 alveolar oxygen pressures, 17 ammonia metabolism, 21 anticancer agents, 88 antimicrobials aminoglycoside antibiotics, 88 carbapenem antibiotics, 88 sulfonamides, 88 arterial O2, 18 blood flow effect, 15 cardiovascular drugs adrenomimetic and adrenolytic blockers, 88 antianginal drugs, 89 digitalis/digoxin, 89 heparin, 89 hypoxia and hyperoxia, 376 CNS anesthetics, 89 ethanol, 89 insulin, 90 Losartan, 90 narcotic analgesics, 89 pentobarbital, 89 practical considerations, 90 reserpine and guanethidine, 90 salicylates, 90 scopolamine, 89 stimulants, 89 theophylline, 90 biochemical effects acid-base balance, 20 biomarkers, 20 634 Hyperbaric oxygenation (HBO) (cont.) capillary level, 14 capillary oxygen pressure drop, 18 cardiovascular system, 19–20 cerebral metabolism, 21 density, 17 enzymes Cyclooxygenase inactivation, 20 Cytochrome Oxidase (CCO), 20 Heme oxygenase (HO), 20 Succinic Dehydrogenase (SDH), 20 Tyrosine hydroxylase, 20 in geriatric patients, 507 glucose metabolism, 21 healthy human body, 19–20 hyperoxia, 19 indications, 506 intracellular pO2, 16 mental function, 506–507 metabolic effects on heart, 376, 377 metabolism, 506 microcirculation, 20 molecular level, 21 myocardial infarction, 377, 378 nervous system, 20–21 oxidative stress, 20 oxygen delivery, 14, 15 pathway, 12 solubility, 17 transport and utilization, 14–15 uptake curve, 18 utilization in cell, 15 oxygen-hemoglobin dissociation curve, 13, 14 oxygen-hemoglobin reaction, 15–16 partial pressures, 17 photoaging, 507–508 physical basics, 11–12 pressure comparison, 17 rehabilitation, 506 respiratory system, 20 retention of CO2, 18 temperature, 17 theoretical considerations, 16–19 tissue oxygen tension, 18–19 transport phase, 12–13 treatments, 508 ventilation phase, 12 Hyperbaric patient education, 517–525 Hyperbaric physicians, 583, 584 Hyperbaric technologies, 585 Hyperbaric treatment cardiovascular surgery, 128–129 cerebral edema, 128 Hyperglycemia, 261 Hyperoxia, 19, 327, 428, 439 Hyperoxic acute lung injury (HALI), 428 Hyperoxic conditions, 462 Hyperoxic myopia, 464 Hyperoxygenated choriocapillaris, 463 Hyperoxygenated choroid, 463 Hyperperfusion, 96, 97 Hyperthermia, 533 Hypothalamo-hypophysio-adrenal system (HHAS), 490 Hypothermia, 60, 129, 498, 533 Hypovolemia, 403–404 Index Hypoxemia, 229 Hypoxia, 42–46, 48, 133–135, 137–141, 146, 147, 151–155, 274, 348, 504–505, 527–528, 597 brain, 42 BBB, 45 brain damage, 46 CBF regulation, 45 cerebral edema, 45, 46 cerebral metabolism, 42–44 electrical activity, 46 GABA Shunt, 44 ischemic–hypoxic disturbances, 45 mental function disturbances, 46 microcirculation disturbances, 45 neurotransmitter metabolism, 44, 45 pyruvate and citric acid cycle, 44 structural changes, 46 cardiovascular system, 41 causes, 41 cellular metabolism, 40 general metabolic effects, 41–42 HBO, 46, 47 carotid body, 48 free radicals, 48 hypoxic states, 48 nitric oxide synthase, 48 HIF, 40 Hsps, 40 oxidative stress, 40 pathophysiology, 39–41 respiratory function, 41 Hypoxia-inducible factor (HIF), 40 Hypoxic brain damage, 46 Hypoxic–ischaemic encephalopathy (HIE) necrotizing enterocolitis, 496–497 newborn, 496 I Idiopathic sudden sensorineural hearing loss (ISSHL), 181, 449 Impairment of consciousness, 304, 307 Inducible nitric oxide synthase (iNOS), 190, 231 Infected wounds, 199 Infertility treatment, 492 Inflammation, 538–539 Inflammatory bowel disease (IBD), 201 Crohn’s disease, 412 oxidative stress biomarkers, 412 ulcerative colitis, 412 Inflammatory processes, 430 Interleukin-10 (IL-10), 232 Intermembrane space (IMS), 555 International Federation of Multiple Sclerosis Societies, 349 Intestinal obstruction adhesive intestinal obstruction, 410, 411 adynamic ileus, 410 animals studies, 409, 410 categories, 408, 409 intestinal gas origin, 409 Intracellular adhesion molecules (ICAM-1), 497 Intracerebral hemorrhage (ICH), 262 Intracranial aneurysms, 337–338 Intraocular pressure (IOP), 463 Intravenous anesthesia, 552 Intravenous perfluorocarbon emulsions, 55 Intrinsic inflammatory disorders, 477–478 Index Ionizing radiation, 212 Ischemia/hypoxia, 275 Ischemia–reperfusion injury (IRI) injury, 382, 546 Ischemic central retinal vein occlusion, 474–476 Ischemic cerebrovascular disease, 249 Ischemic disorders, 414, 415 Ischemic leg pain, 391–393 Ischemic neuropraxia, 117 Ischemic optic neuropathy, 473–474 Ischemic penumbra, 276 Ischemic tissue, 467 J Japanese Society for Hyperbaric Medicine, 618 K Keratometry, 464 Klausenbach Study HBO sessions, 267 outcome, 267, 269 Kreb’s cycle, 555 Kurtzke disability score (KDS), 349 L Lactic dehydrogenase (LDH), 382 Laryngeal cancer, 218 Laser Doppler flowmetry (LDF), 213 Latin America consensus, 632–633 cultures and languages, 631 hyperbaric chambers, 631 meeting, 631 oxygen cylinder, 632 LDH See Lactic dehydrogenase (LDH) Leprosy, 168–169 Leukocytes, 400 Limb reimplantation, 440–441 Lipase sphingomyelinase D, 200 Lipoperoxides, 50 Lipopolysaccharide, 348 Liver disease, 416, 417 effect of HBO animal study, 416 applications, 416 hepatic encephalopathy, 416, 417 normal liver, 416 Liver transplants, 540 Lung injury, 54 Lung mechanics, 428 Lung transplants, 539 Lyme disease vs chronic lyme disease, 175–178 HBOT, 178–183 statistics, 179–180 treatment, 181–183 M Macular hole surgery, 479 Magnetic resonance angiography (MRA), 236 Magnetic resonance imaging (MRI), 20, 94, 96, 345 advantages and disadvantages, 236–237 diffusion-weighted imaging, 237 principle, 236 635 Magnetic resonance spectroscopy (MRS), 145, 346 Malignant disease, 82 Malignant glioma, 530–532 Malignant melanoma, 530 Malignant otitis externa, 172 Mandibular osteoradionecrosis, 215 Market regulations FDC, 611, 612 National Hyperbaric Oxygen Therapy Registry, 612 Matrix metalloproteinases (MMPs), 192 MCAO See Middle cerebral artery occlusion (MCAO) Medicare Administrative Carriers (MACs), 625 MEDLINE, 448 Meniere’s disease, 456 Methemoglobinemias, 134, 154–155 Methionine sulfoxide reductase A (MsrA), 598 Methylene chloride, 151 Metronidazole, 528 Microcirculation, 20 Microembolism, 107, 346 Microvascular occlusion, 212 Middle cerebral arterial blood flow velocity (MCV), 228 Middle cerebral artery occlusion (MCAO), 258 Middle ear barotrauma, 83–84 Middle ear damage in diving, 29–30 Military diving medicine methods, 577 operations, 577 employee’s safety, 577 personnel training, 577 recruitment process, 577 Military medicine, 573 (see also Hyperbaric oxygen therapy (HBOT)) hearing loss and tinnitus, 574 oxygen, 576 spinal cord injury, 574 Military, hyperbaric activities defensive, 576–577 offensive, 575–576 reclamation, 576, 577 research and rescue, 576 seabed inspection, 576 Miscellaneous arteriopathies, 393 Misonidazole, 528 Molecular diagnostics, 596 Mono sclerosis, 346 Monoplace chambers advantages, 63, 64 disadvantages, 64 Gamow bag, 64 oxygen flow mechanisms, 63 MS Therapy Centres, 350 Mucormycosis fungal disease, 167 Multidisciplinary Healthcare Systems, 601, 602 Multiplace chambers advantages, 64 for ICU, 66, 67 mobile multiplace chamber, 67, 68 surgical procedures, 67 Multiple sclerosis (MS), 597 definition, 345 oxygen treatment, 349 patients’ assessment, 351 specific abilities, 351 urinary frequency, 351 Muscular dystrophy, 373–374 Myasthenia gravis, 374 636 Myocardial infarction, 510 Myonecrosis, 163 Myringotomy, 553 N N-acetylcysteine (NAC), 203 Nanobiotechnology, 590 Nanomedicine, 600 National Board of Diving and Hyperbaric Medical Technology (NBDHMT), 516, 625 National Fire Protection Association (NFPA) fire safety code, 607, 633 National Hyperbaric Oxygen Therapy Registry, 612 Necrobiosis lipoidica diabeticorum, 206 Necrotizing enterocolitis, 413, 496–497 Necrotizing fasciitis (NF), 162 Neonatal brain injury, 355 Neonatal ischemic/hypoxic birth injury, 302 Neonatal patients hyperbaric chamber, 499 hypothermia and oxygen toxicity, 499 ischemia–reperfusion injuries, 499 lesions, 499 Nervous system, 20–21, 26 HPNS (see High-pressure neurological syndrome (HPNS)) neuropsychological effects, 25–26 nitrogen narcosis, 26 Neurological disorders, 510, 600–601 BBB, 228 CBF, 226–228 cerebral metabolism, 225 GOQ, 226 HBO treatment, 228 HBO-PC, 229 hyperbaric chamber, 233 hypoxia and ischemia, 225 neuroprotection, 230 OHCob, 226 Neurological indications, 233 Neuronal nitric oxide synthase (nNOS), 50, 56 Neuropathology, 59 Neuroprotection, 230–232 cell therapy, 255 gene therapy, 255, 256 oxygen carriers, 255 Neuroprotective agents, 230 Neurosurgery, 129 Neurotransmitters, 56 Neurotrophic factors (NTFs), 248 Neutrophils, 106, 108, 346 New York University Medical Center, 349 Nicotinamide, 203 Nitric oxide synthase (NOS), 55, 189–190 Nitrogen dioxide poisoning, 431 Nitrogen narcosis, 26 Nocardia asteroides, 167 Nonarteritic ischemic optic neuropathy (NAION), 473, 474 Noncardiac pulmonary edema, 106 Non-Hb hemoproteins, 134 Nonhealing wounds, 188–189, 213 Nonischemic CRVO, 476 Nonsteroidal anti-inflammatory agents (NSAIDs), 477 Normobaric oxygen (NBO) therapy, 146–154, 191, 375, 583 Normobaric vs hyperbaric oxygen, 55 Nosocomial infections, 169 Index NTFs See Neurotrophic factors (NTFs) Nuclear transcription factor kappa B (NFkB), 496 Nursing plan of care BNA Certification Board, 516 HBO application, 515, 516 hyperbaric medicine, 515, 516 ICU nurses, 515 Nationally Recognized Certification exam, 516 nursing textbook, 517 process, 517 O Obstetrics experimental studies, 490 fetal hypoxia, 490–491 threatened abortion, 490 Ocular blood flow occlusion, 462 Ocular contraindications, 465 Ocular injury, 469 Ocular oxygen tension, 462 Oedema, 345, 347, 348 Ophthalmological complications, HBO, 84 Ophthalmology, 466 Optic neuritis, 82, 346, 347 Opt-out model, 537 Organ storage process, 542 Organ transplantation clinical applications, HBO, 542 delayed graft function, 540 face transplants, 541 hand transplants, 541 HBO, 538 inflammation, 538–539 ischemia-reperfusion injury, 538 kidney transplant, 537 liver transplants, 540 lung transplants, 539 opt-out model, 537 organs and tissues, 541 pancreas transplants, 539 renal transplants, 540 Osteomyelitis, 169, 170 jaw, 172 sternum, 172 Osteonecrosis causes, 441, 442 chest wall, 216 diagnosis, 442 HBO, 443, 444 surgical procedures, 442 temporal bone, 216 Osteopontin (OPN), 341 Osteoradionecrosis, 214–221 basic studies, 214–215 mandible, 215–216 vertebrae, 216 Outer surface protein A (OspA), 176 Oxidative stress, 20 Oxygen as antibiotic, 159–160 carriers, 255, 403, 533 conductance system, 505 inhalation, 512 masks, 72 seizures, 84 Index Oxygen toxicity, 90, 91, 597–598 aerosol therapy, 60 ammonia and amino acids, 58–59 antioxidative defense mechanisms, 62 ascorbic acid, 60 brain and seizures, 59 cerebral metabolism, 56 chemiluminescence index, 61 clinical monitoring, 59–60 CNS, 49 cytochrome c, 60 distal airway epithelial cells, 60 factors, 55–56 free radical mechanisms, 50 free radical scavengers, 61 HBO neurotoxicity, 59 hyperbaric oxygen (HBO), 49 hyperoxic injury, 60 hypothermia, 60 magnesium sulfate suppresses, 60 mammalian cell lines, 62 medicine, 49 molecular basis, 62 neuropathology, 59 neurotransmitters, 56 normobaric vs hyperbaric oxygen, 55 oxygen-induced retinopathy, 55 pathology, 50, 53, 54 prevention/treatment, 60 pulmonary, 54–61 ROS, 50 signs and symptoms, CNS toxicity, 52, 59 vitamin E (tocopherol), 60 Oxygen transport and utilization, 14–15 Oxygen utilization in cell, 15 Oxygen-Hemoglobin Dissociation Curve, 13–14 Oxygen-induced retinopathy, 55 Oxygen-induced seizures, 59 P Painless vision loss, 466, 469, 481 Panama Canal, 631 Pancreas transplants, 539 Paraplegics, 233–234 Paraquat poisoning, 431 Pars plana vitrectomy (PPV), 476, 477 Pathogenesis, 164 Patient monitoring devices, 75 Pattern shift visual evoked potential (PSVEP), 144 Penicillin, 165 Penicillin-G, 166 Penile amputation, 441 Penumbra zone, 246 Peptic ulceration antibacterial effect, 408 clinical assessment, 408 experimental studies in animals, 408 gastric mucosal ischemia, 407 Perfluorochemicals, 533 Perinatal brain injury, 355 Perineal Crohn’s disease (CD), 201 Peripheral blood mononuclear cells (PBMCs), 85 637 Peripheral nerve injuries, 438, 439 HBO applications, 439 edema, 438 gait analysis, 438 nerve regeneration, 438 pinch-reflex test, 438 Peripheral neuropathy, 370 Peripheral vascular disease (PVD), 388, 510–511 causes, 385 clinical and laboratory assessment, 387 clinical applications, HBO, 390, 391 HBO, 389 hyperbaric therapy, 390 ischemia causes, 386 limb ischemia, 386 management, 388 drug therapy, 388 exercise therapy, 388 surgery, 388 surgical procedures, 388 NBO, 389 skeletal muscles, biochemical changes, 386, 387 surgery, 393 symptom, 386 Perivenous syndrome (PS), 108 Personal transfer chamber (PTC), 562 Personalized hyperbaric medicine Ayurvedic practices, 595 clinical application, 596 constitutional picture, 595 economical aspects, 598 hypoxia, 597 imaging, 597 molecular diagnostics, 596 pharmacogenomics, 595 prescription, 595 sequencing, 596–597 SPECT, 595 Pharmacogenomics, 595 Photoaging, 507–508 Photodynamic therapy, 534 Phycomycotic fungal infections, 167 Physical therapy, 509 Placental growth factor (PlGF), 401 Plasma, 402 Platelets and coagulation, 400 Pneumatosis cystoides intestinalis (PCI), 413–414 Pneumatosis intestinalis clinical study, 414 normobaric oxygen therapy, 414 PCI, 413 Pneumothorax (PTX), 84, 431 Positron Emission Tomography (PET), 145, 237 Post-concussion syndrome (PCS), 327, 329, 573 Postoperative anterior segment ischemia, 472–473 Postoperative complications cerebrovascular surgery, 336 intracranial aneurysms, 337–338 Posttraumatic stress disorder (PTSD), 327, 573 Precision medicine, 595 Preconditioning, 546 PregnancyHBO therapy, 491 638 PregnancyMEDLINE, 491 Pregnant uterine harvest/global ischemia model, 302 Pre-HBOT ocular examination, 465 Preoxygenation, 545–547 Pressure and action of drugs, 30–31 Pressure effect on human body, 25–29 ammonia metabolism, 24 blood cells and platelets, 24 cardiovascular system, 25 endocrine system, 25 hematological and biochemical effects, 23–24 nervous system effects (see Nervous system) physical effects, 23 respiratory system and blood gases, 24 skeletal system, 25 Pressure ulcers, 199 Pressure vessels (PV), 632 Pressure vessels for human occupancy (PVHO), 632 Priapism, 404 Primary percutaneous transluminal coronary angioplasty (PTCA), 379 Proctitis, 220 Proliferative vitreoretinopathy, 480 Prostaglandins, 422 Protein methionine sulfoxide (PMSO), 598 Protoporphyrin IX-triplet state lifetime technique (PpIX-TSLT), 16 Pseudoarthrosis, 440 Pseudomembranous colitis, 413 Pseudomonas aeruginosa, 172 Psoriasis, 207 Psychological stress, 190 PTCA See Primary percutaneous transluminal coronary angioplasty (PTCA) Pulmonary barotrauma, 84, 106, 129 Pulmonary complications, HBO, 84 Pulmonary disorders arterial hemodynamics, 427 respiratory insufficiency, 429 Pulmonary edema, 430–431 Pulmonary embolism, 430 Pulmonary gas exchange, 428 Pulmonary oxygen toxicity, 428 Pulmonary symptoms, 103 Purpura fulminans, 207 Pyoderma gangrenosum, 206–207, 478 Q Quality measures, 624, 625 R Radiation Biology, 212 Radiation effects bone, 213 nervous system, 212 Radiation encephalopathy, 217 Radiation enterocolitis, 413 Radiation injuries, 214 Radiation myelitis, 216 Radiation retinopathy (RR), 469, 471, 472 Radiation sensitizing agents, 533 Radiation therapy, 218 Radiation-Induced Hemorrhagic Cystitis, 219–220 Radiation-induced necrosis (RIN), 217 Index Radiation-induced optic neuropathy (RION), 217 Radionecrosis, 211–214 larynx, 218–219 Radiopharmaceutical, 93, 94 Radiosensitivity, 212, 528–529, 532 Radiotherapy, 528, 532 Rankin scale, 252 Reactive oxygen species (ROS), 50, 556 Recompression, 107–113, 116–119, 121 Red blood cells (RBCs) CO2 and H2O, 397 deformability, 397–398 erythropoiesis, 400 hemoglobin, 399 oxygen exchange, 398–399 stored blood, 399 structure and biochemistry, 399 Red cell infusion, 533 Refractory pseudomonas keratitis, 478 Regenerative medicine, 590, 600 Regional cerebral blood flow (rCBF), 56 Regulation of hyperbaric medicine codes, 632 health, 632 insurance, 632 labor, 632 Rehabilitation, HBO role acute myocardial infarction, 510 advantages, 510 CNS injuries, 510 indications, 509, 510 ischemic leg pain, 511 limb amputees, 511 myocardial ischemia, 511 neurological disorders, 510 paraplegia, 511 peripheral vascular disease, 510 physical therapy, 509 stroke, 511 traumatic brain injury, 511 Renal transplants, 540 Reperfusion injury, 247–248, 274 Repetitive transcranial magnetic stimulation (rTMS) therapy, 449 Research animal experimental studies, 588 application of biotechnologies, 588, 589 in hyperbaric medicine, 587, 588 Respirators and ventilators, 72 Respiratory insufficiency, 429 Respiratory system, 20 Retina, 462 Retinal artery occlusions, 470–471 Retinal blood supply, 462 Retinal injury, 467 Retinal oxygen toxicity, 463–464 Retinitis pigmentosa (RP), 479 Retinopathy, 464 Retinopathy of prematurity (ROP), 356, 357 Retrolental fibroplasia, 55, 355–357, 464 Reversible ischemic neurological deficit (RIND), 338 Rheumatoid arthritis clinical applications, 445 HBO therapy, 444 inflammatory process, 444 Rhinocerebral mucormycosis, 167 Robotics, 600 Index S Safety and fire hazard clinical hyperbaric chambers, 606 FDA labeling requirements, 606 fire causes, 606 NFPA, 606 UHM, 608 Salmonella abortus, 348 Scleroderma, 207, 208 Sechrist monoplace hyperbaric chamber, 64, 65 Secondary keratoendotheliosis, 480 Seizure disorders, 82 Seizures control, 128 Self-contained breathing apparatus (SCUBA), 106 Sequencing, 596–597 Shock cardiogenic shock, 385 oxygen delivery , blood, 384–385 pathophysiology, 384 traumatic and hypovolemic, 385 Shock lung, 431 Sickle cell disease, 480 Single photon emission computerized tomography (SPECT), 145, 237–238, 359–367 Sinus Pain, 84 Skin flaps animal experimental studies, 202–203 ischemic injury, 201 myocutaneous flap, 202 pedicle graft, 201 split skin grafting, 201 tissue hypoxia, 202 Social media, 600 Soft tissue gas, 165 Soft tissue infections, 162, 163 Soft tissue necrosis, 218 Somatosensory-evoked potentials (SSEPs), 331, 334 Spasticity, 357–360, 362 SPECT brain function imaging, 94, 95 case studies, 95 HBOT, 95 hyperbaric oxygen therapy, 95 stroke, 94, 95 clinical utilization, 94 heads imaging, 95 image comparison, 94 radioisotope, 96 SPECT brain imaging, 318 Spider bite animal experimental studies, 200 antivenom, 200 Loxosceles reclusa, 200 treatment, 200–201 vesicle formation, 200 Spinal cord injury (SCI), 231, 330–334, 342, 348, 574 Spinal cord symptoms, 103 Spinal epidural abscess, 334 Sports injuries, 511–512 Sports training, 512–513 Squamous cell carcinoma, 221 Standard cortisone treatment (SCT), 449 Stem cells, 400–401 Stem cells and HBO, 591 Stereotactic radiosurgery, 217 Steroids, 128 639 Stroke, 244–248, 252–255, 267, 336–341 acute ischemic stroke, 253 concomitant disorders, 254 medical emergency, 254 medical therapies, 253, 254 rehabilitation, 253, 254 surgical therapies, 254 causes, 243, 244 cerebral infarct, 244, 246 cerebral ischemia, 246, 247 complications, 250 definition, 241 diagnosis, 251, 252 effects of HBO, 269, 270 epidemiology, 242 glutamate, 246 ischemia brain changes, 244, 245 cerebral metabolism, 246, 247 neuroprotective agent (see Neuroprotection) pathogenesis cytokines and adhesion molecules, 248 DNA damage, 248 gene expression, 248 HSP, 248 NTFs, 248 pathophysiology, 243 recovery, 249, 250 rehabilitation (see Klausenbach study) reperfusion injury, 247 risk factors, 242–248 scales Barthel index scores, 252 CNS, 253 European Stroke Scale, 253 NIH, 252 Rankin scale, 252 UNSS, 252 spasticity and dementia, 251 stages, 244, 245 symptoms, 244 vascular dementia, 251 Stroke rehabilitation, 511 Subjects somatosensory evoked potentials (SSEP), 234 Submarine medicine rescue operations, 577 submarines’ rescue, 577 transfer under pressure, 578 Sudden deafness acute acoustic trauma, 450 causes, 449 clinical studies, 452–453 cortilymph pO2, 449 experimental studies, 450–452 hair cells, 449 HBO, 449 treatment, 449 Superoxide dismutase (SOD), 54 Surface equivalent fraction of inhaled oxygen (SEFIO2), 557 Susac’s syndrome, 371 Synthetic biology, 600 T Temporal bone, 216 Temporal visual field defects (TVFD), 479 640 Testosterone, 422 The MS National Therapy Centres, 349 The Undersea and Hyperbaric Medical Society (UHMS), 196 Thermal burns, 206 cellular elements, 204 clinical application, 205, 206 experimental studies, 205 pathophysiology, 204 polymorphonuclear neutrophilic leukocytes, 204 vascular permeability, 204 Thoracic surgery, 81 Thyroid disease, 423 Thyroid glands, 421 Tinnitus, 447–449 Tissue oxygen tensions, 190, 191 Tissue poisons, 133, 134 Tolerance to oxygen adaptation, 61 drugs, 61 interruption of exposure, 61 newborn mammals, 61 Topical application by a small hyperbaric chamber (TOPOX), 191, 192 Toxemias, 491 Toxic amblyopia, 478, 479 Toxic brain injury, 359, 362 Toxic epidermal necrolysis, 207 Toxic megacolon (TM), 412, 413 Transcutaneous oximetry (TcPO2), 213 Transcutaneous oxygen monitor (TCOM), 498 Transcutaneous oxygen pressure (tcpO2), 73, 190 Transportable recompression rescue chamber (TRRC), 120 Transverse myelitis, 346 Traumatic brain injury, 355, 362 HBO, 328 Traumatic brain injury (TBI), 226, 304, 325–331, 334, 341, 342, 573 Traumatic ischemia amputation, 436 causes, 435 HBO treatments, 436 transcutaneous oxygen, 436 Traumatology definition, 433 Treatment of ulcers, 188 Tuberculosis, 169 Tumor radiosensitivity, 529, 531 Type I DCS, 108, 110, 112, 113 Type II DCS, 108–111, 113, 118, 120 U Ulcers, 193 Undersea and Hyperbaric Medical Society (UHMS), 82, 495, 604, 621 Undersea and Hyperbaric Medicine (UHM), 583, 608, 628 Undersea Medical Society (UMS), 621 Unidentified bright objects (UBOs), 345 Index Unified neurological stroke scale (UNSS), 252 Unit pulmonary toxic dose (UPTD), 54 United States, hyperbaric medicine ABEM, 621 ABPM, 621 ACHM, 621 hospital-based hyperbaric programs, 622 UHMS, 621, 622 UNSS See Unified neurological stroke scale (UNSS) Urine methylguanidine (MG), 20 Uveitis, 480 V Vacuum-assisted closure (VAC), 437 Vascular dementia, 251 Vascular endothelial growth factor (VEGF) expression, 192, 203, 356, 574 Vascular headaches, 371 Vascular pathologies, 391 Vasoconstriction, 126 Vasodilators, 533 Venous ulcers pathophysiology, 197 treatment, 197–198 Vestibular symptoms, 103 Viral infections, 601 Vision factors, 462 loss, 467–469, 473–476, 481, 482 process, 462 Visual-evoked response (VER), 463 Vitreoretinopathy, 480 Von Hippel Landau protein (VHL), 347 W White matter hyperintensities (WHMs), 345 Whole body irradiation, 212 Wound Care and Hyperbaric Medicine Program, 627 Wound healing adjuncts to HBO, 192–193 angiogenesis, 188 cell types, 188 clinical applications, 191–193 experimental studies, 189 nitric oxide, 189–190 nonhealing wounds, 188–189 oxygen role, 188 psychological stress, 190 rationale of using oxygen, 189 X Xanthine-oxidase-derived reactive oxygen species, 140 .. .Textbook of Hyperbaric Medicine Kewal K Jain Textbook of Hyperbaric Medicine Sixth Edition Kewal K Jain, MD Basel, Switzerland ISBN 978-3-319-47138-9... diving medicine and the other forms of HBO therapy © Springer International Publishing AG 2017 K. K Jain, Textbook of Hyperbaric Medicine, DOI 10.1007/978-3-319-47140-2_1 K. K Jain The Development of. .. publications include 27 books such as Oxygen in Physiology and Medicine, Textbook of Gene Therapy, The Handbook of Nanomedicine, and Textbook of Personalized Medicine Prof Jain, in addition to his