Handbook on hyperbaric medicine

HANDBOOK ON HYPERBARIC MEDICINE

Handbook on Hyperbaric Medicine

Edited by

DANIEL MATHIEU

Centre Hospitalier Régional et Université de Lille,

France

A C.I.P. Catalogue record for this book is available from the Library of Congress.

ISBN-10 1-4020-4376-7 (HB)

ISBN-13 978-1-4020-4376-5 (HB)

ISBN-10 1-4020-4448-8 (e-book)

ISBN-13 978-1-4020-4448-9 (e-book)

Published by Springer,

P.O. Box 17, 3300 AA Dordrecht, The Netherlands.

www.springer.com

Printed on acid-free paper

All Rights Reserved

© 2006 Springer

No part of this work may be reproduced, stored in a retrieval system, or transmitted

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Printed in the Netherlands.

or otherwise, without written permission from the Publisher, with the exception

Foreword

D. Mathieu

Contributors

Preface

A History of Hyperbaric Medicine

F. Wattel

Part I

Physical and Pathophysiological Bases of Hyperbaric

Oxygen Therapy

Editors:

B. Ratzenhofer-Komenda, J. Niinikoski, M. Hamilton-Farell

1.1. Physics of Hyperbaric Pressure

1.2. Biochemistry of Oxygen

A. Courtière

1.3. Physiologic Effects of Increased Barometric Pressure

Transport and Tissue Oxygen Pressure

Jüttner, D. Mathieu

1.5. Physiologic Effects of Hyperbaric Oxygen on Hemodynamics

and Microcirculation

D. Mathieu, R. Favory, F. Collet, J.C. Linke, F. Wattel

1.6. Physiologic Effects of Hyperbaric Oxygen on Microorganisms

and Host Defences Against Infection

D. Mathieu, F. Wattel

1.7 Physiologic Effects of Hyperbaric Oxygen on Ischemia

Reperfusion Phenomenon

S. Van Poucke, P. Jorens, L. Beaucourt

1.8 Physiologic Effects of Hyperbaric Oxygen on Wound Healing

Processes

J. Niinikoski

v

1

15

25

31

49

75

103

1.4. Physiologic Effects of Hyperbaric Oxygen on Oxygen

121

135

ix

xi

xv

CONTENTS

D. J. Bakker

W. Welslau

W. Welslau

B. Ratzenhofer-Komenda, R. Favory, W. Welslau, F.M. Smolle-

vi Contents

1.9 Physiologic Effects of Hyperbaric Oxygen on DNA and DNA

C. Muth, M. Gröger, P. Radermacher, G. Speit

Part II: Indications for Hyperbaric Oxygen Therapy

Editors: D. Mathieu, J. Schmutz, F. Cronje

2.1 Methodology for Assessing Hyperbaric Oxygen Therapy in

Clinical Practice

F. Wattel, D. Mathieu

2.2 Recommended Indications

2.2.1 Dysbaric Illness

A. Marroni, F.J. Cronje, J. Meintjes, R. Cali-Corleo

2.2.2 Gas Embolism

2.2.3 Carbon Monoxide Poisoning

D. Mathieu, M. Mathieu-Nolf, J.C. Linke, R. Favory, F. Wattel

2.2.4 Necrotizing Soft Tissue Infections

D. Mathieu, R. Favory, J.F. Cesari, F. Wattel

2.2.5 Intra-Cranial Abscess

L. Lampl, G. Frey

2.2.6 Crush Injury and Other Acute Traumatic Ischemia

A. Kemmer

2.2.7 Compromised Skin Graft and Flap

T.A. Mesimeris

2.2.8 Radio-Induced Lesion in Normal Tissues

D. Pasquier, J. Schmutz, E. Lartigau

2.2.9 Non-Healing Wounds

D. Mathieu, J.C. Linke, F. Wattel

2.2.10 Persistent Osteomyelitis

A. Kemmer, T. Stein, C. Hierholzer

2.2.11 Sudden Deafness

A. Barthelemy, M. Rocco

2.2.12 Neuroblastoma

A. van der Kleij, P. Sminia

2.3 Optional Indications

2.3.1 Burns

P. Germonpré

2.3.2 Anoxic Encephalopathy

F. Wattel

2.3.3 Pleuropulmonary Anaerobic Infections

D. Mathieu

Repair – Genotoxicity of Hyperbaric Oxygen and its Prevention

D. Mathieu, S. Tissier, M.L. Boulo

147

163

173

217

239

263

291

305

329

363

401

429

451

469

479

495

509

Contents vii

2.3.4 Post Vascular Procedure Reperfusion Syndrome and Limb

Replantation

J. Schmutz

A. Weinberger, U. Siekmann

2.3.6 Pneumatosis Cystoides Intestinalis

J. Niinikoski

2.4 Controversial and Non Indications

2.4.1 Femoral Head Necrosis

L. Ditri, M. Montanari,Y. Melamed, D. Reis

2.4.2 Cerebrovascular Incidents (Stroke)

F. Cronje, W. Duim, A. Marroni, R. Cali-Corleo

2.4.3 Post-Sternotomy Mediastinitis

A. Barthelemy

2.4.4 Sickle Cell Disease

H. Medhaoui

2.4.5 Brain Injury and Spinal Cord Injury

J. Schmutz

2.4.6 Myocardial Infarction

J. Schmutz

2.4.7 Malignant Otitis Externa

J. Schmutz

2.4.8 Other Controversial or Non Indications

J. Schmutz

Part III: Practice of hyperbaric medicine

3.1. Hyperbaric Chamber and Equipment

J. Kot, R. Houman,P. Müller

J. Kot, Z. Sicko

3.3. Patient Management

A. Kemmer, C. Muth, D. Mathieu

3.4. A Cost-Effectiveness Evaluation of Hyperbaric Oxygen

Therapy

A. Marroni, P. Longobardi, R. Cali-Corleo

J. Desola

3.6. Safety in Hyperbaric Medicine

J. Kot, R. Houman,R. Gough-Allen

547

553

567

577

521

527

537

585

591

597

601

611

637

651

671

679

691

2.3.5 Acute Ischemic Ophthalmological Disorders

Editors: J. Kot, A. Kemmer, P. Germonpré

3.2. Organization of a Hyperbaric Center

3.5. Education and Training of Hyperbaric Centre personnel

Contents

3.7.1 Barotraumatism

F. Roque, A. Simão

3.7.2 Oxygen Toxicity

N. Bitterman, H. Bitterman

3.8. Organisation of Hyperbaric Medicine in Europe

D. Bakker,A. Marroni, D. Mathieu

3.9. Research in Hyperbaric Medicine

P. Germonpré, D. Mathieu

Annex

List of Hyperbaric Therapeutic Centres in Europe

P. Germonpré, J. Kot

Index

715

779

793

viii

731

767

805

3.7. Complications of Hyperbaric Oxygen Therapy

FOREWORD

The Co-operation On Science and Technology (COST) programme is a

European initiative with the objective of implementing and improving

cooperation between European research teams in the fields of Science and

Technology. Thanks to the efforts of our Belgian colleagues, a specific

Action was launched in December 1998 – specifically devoted to Hyperbaric

Oxygen Therapy (Action COST B14). The participants included nineteen

European countries, members, or associates of the European Union. The

main objectives of COST B14 were to expand the knowledge-base for the

rational use of HBO; to issue guidelines for the implementation and

development of clinical HBO centres; and to provide scientifically sound

recommendations for HBO in the treatment of various diseases and

conditions.

This Action has since been completed and the Management Committee

decided to publish this Handbook to introduce the outcome of COST B14 as

well as to incorporate the results of experimental and clinical research

performed over the last 6 years. This Handbook is intended as a reference

document for researchers and clinicians alike – to be used both in the

research laboratory and in everyday hyperbaric clinical practice; it also

provides support material for teachers and will assist students in obtaining

European Committee for Hyperbaric Medicine (ECHM) level II and III

qualifications in hyperbaric medicine.

Contributors to this handbook have to be thanked for their enthusiasm and

efforts. We also wish to express our gratitude to our English reviewers,

Martin Hamilton-Farell and Frans Cronje; to Audrey Degeldere for her

excellent secretarial work; to Springer for its great assistance; and to the

COST secretariat for their strong and continuous support of our efforts.

The Management Committee considers this Handbook both a reference and

benchmark – the culmination of the COST B14 action. We hope this

Handbook will be welcomed and avidly used by the international scientific

community.

Prof D. Mathieu

President of the Management Committee

COST B14 Action

Hyperbaric Oxygen Therapy

ix

CONTRIBUTORS

Bakker, Dirk Jan Department of Surgery/Hyperbaric Medicine, University of

Amsterdam, Academic Medical Center, Amsterdam, The

Netherlands

Barthelemy, Alain Centre Hyperbare, Hôpital Sainte Marguerite, Marseille,

France

Beaucourt, Luc Unit of Hyperbaric Medicine, Department of Emergency

Medicine, University Hospital, Antwerp, Belgium

Bitterman, Haim Technion-Israel Institute of Technolog, Haifa, Israel

Bitterman, Noemi Technion-Israel Institute of Technolog, Haifa, Israel

Boulo, Marie Service d’Urgence Respiratoire, de Réanimation Médicale

et de Médecine Hyperbare, Hôpital Calmette, Centre

Hospitalier Régional et Universitaire, Lille, France

Cali-Corleo, Ramiro Head of the Division of Baromedicine at the University of

Malta and the Hyperbaric Unit, Malta

Cesari, Jean-François Service d'Urgence Respiratoire, de Réanimation Médicale

et de Médecine Hyperbare, Hôpital Calmette, Centre

Hospitalier Régional et Universitaire, Lille, France

Collet, François Service d'Urgence Respiratoire, de Réanimation Médicale

et de Médecine Hyperbare, Hôpital Calmette, Centre

Hospitalier Régional Universitaire, Lille, France

Courtière, Alain Institut de Médecine Navale du Service de Santé des

Armées, Toulon Naval, France

Cronje, Frans Medical Director, Eugene Marais Hospital Hyperbaric

Oxygen Therapy Center, Pretoria, South Africa.

Desola, Jordi CRIS, Hyperbaric Therapy Unit (CRIS-UTH), Dos de maig

Hospital, Barcelona, Spain

Ditri, Luciano OTI Medicale, Vicenza, Italy

Duim, Wiebren Medical Director, Life Health Care Group Stroke Therapy

Center, Little Company of Mary Hospital, Pretoria, South

Africa.

Favory, Raphael Service d`Urgences Respiratoires, de Réanimation

Médicale et de Médecine Hyperbare, Hopital Calmette,

Centre Hospitalier Régional et Universitaire, Lille, France

xi

xii Contributors

Germonpre, Peter Centre for Hyperbaric Oxygen Therapy, Military Hospital

Brussels, Belgium

Gough-Allen, Roly

Gröger, Michael Sektion Anaesthesiologische Pathophysiologie und

Verfahrensentwicklung, Universitätsklinikum, Ulm,

Germany

Hamilton-Farell, Martin Whipps Cross University Hospital, Leytonstone, London,

United Kingdom

Hierholzer, Christian BG Trauma Center, Berufsgenossenschaftliche

Unfallklinik, Murnau, Germany

Houman, Robert Centre for Hyperbaric Oxygen Therapy, Military Hospital

Brussels, Belgium

Jorens, Philippe Department of Intensive Care Medicine, University

Hospital, Antwerp, Belgium

Kemmer, Armin Department of Anaesthesia & Intensive Care Medicine,

Centre for Hyperbaric Oxygen Therapy,

Berufsgenossenschaftliche Unfallklinik, Murnau, Germany

Kot, Jacek National Center for Hyperbaric Medicine, Institute of

Maritime and Tropical Medicine in Gdynia, Medical

University of GdaĔsk, Poland

Lampl, Lorenz Dept. of Anesthesiology and Intensive Care Medicine,

Federal Armed Forces Hospital, Ulm, Germany

Lartigau, Eric Department of Radiation Oncology, Centre O. Lambret,

University od Lille, France

Linke, Jean-Christophe Service d'Urgence Respiratoire, de Réanimation Médicale

et de Médecine Hyperbare, Hôpital Calmette, Centre

Hospitalier Régional et Universitaire, Lille, France

Longobardi, Pasquale Medical Director, Centro Iperbarico, Ravenna, Italy

Marroni, Alessandro President and Medical Director, DAN Europe Foundation,

Roseto, Italy

Mathieu, Daniel Service d`Urgences Respiratoires, de Réanimation

Médicale et de Médecine Hyperbare, Hôpital Calmette,

Centre Hospitalier Régional et Universitaire, Lille, France

Frey, Günter Dept. of Anesthesiology and Intensive Care Medicine,

Federal Armed Forces Hospital, Ulm, Germany

Kingdom.

Sea-Long Europe Medical Systems Inc, Plymouth United

Contributors xiii

Mehdaoui, Hossein Criticial care and hyperbaric oxygen therapy unit,

West India

Meintjes, Jack Medical Advisor and Senior Lecturer, Department of

Community Health, Division of Occupational Health,

University of Stellenbosch, South Africa.

Melamed, Yehuda Rambam Medical Centre, Orthopedic and HBO Medical

Department, Haifa, Israel

Mesimeris, Theodore A. Hyperbaric Department, General Hospital St.Paul,

Thessaloniki, Greece

Montanari, Michele OTI Medicale Vicenza, Italy

Müller, Peter London Hyperbaric Medicine., Whipps Cross University

Hospital, Leytonstone, London, United Kingdom

Muth, Claude Sektion Anaesthesiologische Pathophysiologie und

Verfahrensentwicklung, Universitätsklinikum, Ulm,

Germany

Niinikoski, Juha Department of Surgery, University of Turku, Turku,

Finland

Pasquier, David Department of Radiation Oncology, Centre O. Lambret,

University of Lille, France

Radermacher, Peter Sektion Anaesthesiologische Pathophysiologie und

Verfahrensentwicklung, Universitätsklinikum Ulm, 89073

Ulm, Germany

Ratzenhofer-Komenda, Beatrice Dept. of Anaesthesiology and Intensive Care, University

Medical School, Graz, Austria

Reis, Daniel Rambam Medical Centre, Orthopedic and HBO Medical

Department, Haifa, Israel

Rocco, Monica Centro di Medicina Iperbarica, Istituto di Anestesia e

Rianimazione, Universita "La Sapienza", Roma, Italy

Roque, Filipe Centro de Medicina Hiperbárica-Hospital da Marinha,

Lisbon, Portugal

Schmutz, Jörg

Basel, Switzerland

Mathieu-Nolf, Monique Centre Anti-Poison, Centre Hospitalier Régional et

Universitaire, Lille, France

University Hospital, Fort de France, Martinique, French

SUHMS, Consultant for Hyperbaric Medicine, University of Basel

xiv Contributors

Siekmann, Ullrich HBO-Zentrum Euregio and Universitätsklinikum der

RWTH Aachen, Abteilung Anästhesiologie, Aachen,

Germany

Simão, Antonio Gata Centro de Medicina Hiperbárica, Hospital da Marinha,

Lisbon, Portugal

Sminia, Peter Department Radiation Oncology, division Radiobiology, VU

University Medical Center, Amsterdam, The Netherlands.

Smolle-Jüttner, Freyja Maria Dept. of Surgery, Division of Thoracic Surgery and

Hyperbaric Medicine, University Medical School, Graz,

Austria

Speit, Günter Abteilung Humangenetik, Universitätsklinikum, Ulm,

Germany

Stein, Thomas BG Trauma Center, Berufsgenossenschaftliche

Unfallklinik, Murnau, Germany

Tissier, Stéphanie Service d’Urgence Respiratoire, de Réanimation Médicale

et de Médecine Hyperbare, Hôpital Calmette, Centre

Hospitalier Régional et Universitaire, Lille, France

Van der Kleij, Adrian Department of Surgery/Hyperbaric Medicine, University of

Amsterdam, Academic Medical Center, Amsterdam, The

Netherlands

Van Poucke, Sven Unit of Hyperbaric Medicine, Department of Emergency

Medicine, University Hospital, Antwerp, Belgium

Wattel, Francis Service d'Urgence Respiratoire, de Réanimation Médicale

et de Médecine Hyperbare, Hôpital Calmette, Centre

Hospitalier et Universitaire, Lille, France

Weinberger, Andreas Universitätsklinikum der RWTH Aachen, Abteilung

Augenheilkunde, Aachen, Germany

Welslau, Wilhelm Gesellschaft für Tauch- und Überdruckmedizin [German

Sicko, Zdzislaw National Center for Hyperbaric Medicine, Institute of

Maritime and Tropical Medicine, Medical University of

GdaĔsk, Gdynia, Poland

Society for Diving and Hyperbaric Medicine], Seeboeck gasse

17, Wien, Austria

PREFACE

Dirk Jan Bakker

President of the European Committee for Hyperbaric Medicine.

Department of Surgery/Hyperbaric Medicine, University of Amsterdam, Academic

Medical Center, Amsterdam, The Netherlands

On the second day of my surgical residency in the end of 1968, under

professor Boerema in the “Wilhelmina Gasthuis” in Amsterdam, I found

myself in the hyperbaric chamber, supervising the treatment of a patient with

gas gangrene.

When I witnessed the sudden awakening of a very serious victim of

carbon monoxide poisoning, in the middle of the night two nights later, I

was definitively won over to the side of Hyperbaric Medicine.

These, together with palliative surgical procedures in small children

(until 1972), were practically the only indications we had at that time.

The role of hyperbaric oxygen was investigated in many different

diseases, and also experimentally; but these three were the most successful

clinical indications (besides decompression illness and gas emboli).

A lot has changed since then. Many supposed indications have come and

disappeared again; a few have stayed and proved to be successful, and new

indications have been found. The situation in Europe was that every

physician with a chamber at his or her disposal treated the indications he or

she believed in and had experience with. Every four, and subsequently three,

years we gathered at the hospital or university of one of our colleagues and

discussed what we had done in the previous years. This was established as

the International Congress on Hyperbaric Medicine (ICHM) in 1963. A great

deal of scientific and clinical work was done; and the Proceedings of these

Congresses are witness thereof. If you take the opportunity to read these

books carefully, you will be surprised by the good scientific work that was

done in those days. It is a pity that much of it has been forgotten or

duplicated in later years.

xv

An example of the thoroughness of the work is that in almost every

animal experiment a control group was included; this, unfortunately, was

lacking in most clinical series. The reason was that “experience-based” and

xvi Preface

“consensus-based” medicine were the rule rather than the exception. Many

of the young investigators who presented their work later became giants in

their respective medical fields.

This is the reason that the International Congress on Hyperbaric

Medicine is looking for funds to reprint these old Proceedings.

The Undersea Medical Society (UMS later the UHMS, Undersea and

Hyperbaric Medical Society, established in 1967) was the first society that

selected a Hyperbaric Oxygen Therapy Committee, to identify and classify

the various clinical indications on the basis of the scientific evidence that

existed. The first Committee Report was published in 1977 and many

followed in later years. Gradually, over the years, the insurance companies

took these reports as a guide for payment for the treatment of patients with

the recommended indications.

The situation in Europe at that time was that we followed more or less

the indications from the UHMS Committee Report. The contacts between

the different hyperbaric centres were rare and restricted to the occasional

symposium or congress.

Contacts with the Soviet Union and the far east were, if they existed,

extremely rare. Also the different languages were a big problem (Russian

and Chinese for example).

An example of this is the Proceedings of the VIIth International Congress

on Hyperbaric Medicine, held in Moscow in 1981, which were published in

1983 completely in Russian without any translation.

This situation changed in 1989 when the necessity of founding a

committee, with the goal of raising the quality and profile of Hyperbaric

Medicine, emerged during an informal discussion in Milan. The three editors

of this new book were all present on that occasion, as was the author of this

Preface.

The first informal meeting took place in November 1989; and this date

can be considered the initiation of the European Committee for Hyperbaric

Medicine (ECHM).

The first Plenary Meeting with all diving and hyperbaric representatives

from the different European countries took place in Amsterdam in August

1990, during the Joint Meeting on Diving and Hyperbaric Medicine (of the

International Congress, the Undersea and Hyperbaric Medical Society, and

the European Undersea and Biomedical Society, EUBS).

The official founding of the ECHM took place again in Milan, in 1991.

The goals for the Committee were defined as:

1). Studying and defining common indications for hyperbaric therapy;

research and therapy protocols; common standards for therapeutic and

technical procedures; equipment and personnel; cost-benefit and cost￾effectiveness criteria.