Could anyone give my any information about the use of the hyperbaric chamber for a severely anemic patient who refuses blood products? Specifically, trauma patients. Are there any current articles about this indication?

EXCEPTIONAL BLOOD LOSS (ANEMIA)

Exceptional blood loss (anemia) occurs when the patients has lost sufficient red cell mass to compromise respiratory requirements and cannot or will not receive transfusions because of medical or religious reasons. The following indications dictate the use of HBO2 for Class IV hemorrhage when the patient cannot accept blood replacement: a) shock, systolic blood pressure below 90 mmHg, or pressure maintained by vasopressors; b) disorientation to coma; c) ischemic gut as demonstrated by a sprue-like diarrhea.

RATIONALE: The intermittent use of hyperbaric oxygen (HBO2) therapy will supply enough oxygen in the severely anemic patient to support the basic metabolic needs of the respective tissues of the body until red blood cells are restored. Most vitally, our brain requires approximately 6 volumes percent of oxygen to support its basic metabolic requirements. HBO2 therapy at 3 ATA will place 6 volumes percent of dissolved molecular oxygen in an intravascular acellular perfusate for the direct use by tissue cells. The HBO2 therapy is continued repetitively as needed and at pressures dictated by clinical response. HBO2 is discontinued when the red blood cells have been replaced in numbers so as to alleviate the above signs and symptoms (a hematocrit of approximately 23%). There is presently no satisfactory blood substitute available to use in exceptional blood loss anemia. Thus, HBO2 is a valuable adjunct when used early in treating acute blood loss in those who cannot or will not receive blood replacement for medical or religious reasons.

Source: Hyperbaric Oxygen Therapy: A Committee Report. Undersea and Hyperbaric Medical Society. 1996 Revision

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You can check Anaesthesia 1999 Sep;54(9):891-895 McLoughlin PL, Cope TM, Harrison JC

Keep in mind that there may be insurance re-imbursement issues.

I believe that Englewood Hospital uses hyperbarics and they may be of further assistance.

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Hyperbaric Oxygen Therapy

The use of increased atmosphere pressure for medical therapy has intrigued many physicians, scientists, and lay persons for hundreds of years. Vague accounts of increased atmosphere pressures used on humans date back to the fifth century BC. Henshaw, a British clergyman, built the first sealed chamber, termed the "Domicilium," in 1662. This chamber compressed air (21% oxygen) for numerous ailments such as inflammation, scurvy, arthritis, and rickets but likely had too little compression to do any physical good.

Following Priestley's discovery of oxygen in the late 1700s, Beddoes developed a pneumatic laboratory enriched with oxygen to treat chronic conditions such as leprosy. In the early 1930s, the Junod reported improvement in patients with cardiorespiratory disorders when treated in 2 atm of pressure in a copper compression chamber. These early reports spawned the creation of a number of "pneumatic institutes" in Europe. These chambers were able to treat up to 10 people at once and reached pressures of 2 or more atm. Compression therapy became the "in vogue" spas of the day. Pneumatic spas came to North America in 1860, with the first compression chamber built in Oshawa, Ontario, Canada.

The French surgeon Fontaine built a mobile compressorized operating suite in 1879. Patients reportedly had better outcomes because of improved oxygenation and decreased postoperative vomiting and cyanosis. Easier reduction of hernias was noted. Corning introduced the therapeutic compression chamber to the US in 1891 to treat nervous and mental afflictions. This chamber was the first operated by electric power.

Orville Cunningham noted 25 years later that patients with certain cardiovascular disorders improved when moved from high altitudes to sea-level altitudes. He discovered this during the Spanish flu epidemic in 1918, which resulted in more than 500,000 deaths. Many of these victims died in a cyanotic state. Under the care of Dr Cunningham, a rather sick resident physician was treated in the compression chamber and recovered completely. Cunningham subsequently built an 88-ft long and 10-ft wide chamber to treat numerous patients, with remarkable success. The credibility of the compression chamber was reinforced during treatment of flu patients. One night when the chamber's power accidentally was shut off, all patients died. At the time, the interpretation credited hyperbaric therapy with keeping the patients alive. When the compression stopped, these patients died. However, the deaths were likely the result of rapid ascent from the compression rather than the secondary effects of the Spanish flu.

In 1928, Mr Timkin, an appreciative patient whose uremic state was resolved after receiving hyperbaric therapies, constructed for Cunningham an enormous 60-ft tall, 6-story hyperbaric hospital that looked like a steel sphere. Conditions such as hypertension, diabetes, syphilis, and cancer were treated here until 1930, when the local medical society closed the hyperbaric hospital for lack of scientific evidence or merit. After 1930, much of the medical or scientific community did not look favorably upon the use of hyperbaric medicine.

Supplemental use of oxygen increased with availability after this time. The military soon had an increased interest in underwater activities, and this promoted the use of oxygen and hyperbaric medicine for diving and decompression sickness. Hyperbaric medicine treatments had sound physiologic principles based on known physics of mixed gas when treating decompression sickness.

A flurry of interest in therapeutic hyperbaric medicine was fostered by Dr I. Boerema, who, while in Amsterdam in 1956, reported hyperbaric oxygen (HBO) as an aid in cardiopulmonary surgery, particularly for congenital conditions such as tetralogy of Fallot, transposition of great vessels, and pulmonic stenosis. A colleague of Boerema's, W. H. Brummelkamp, also interested in hyperbaric medicine, discovered in 1959 (and subsequently published in 1961) that anaerobic infections were inhibited by hyperbaric therapy. Meanwhile, Boerema had published an article, "Life without blood," a report of fatally anemic pigs treated successfully with volume expansion and pressurized hyperoxygenation. Boerema often is credited as the father of modern-day hyperbaric medicine.

In 1962, Smith and Sharp reported the enormous benefits of HBO in carbon monoxide poisoning. International interest thus was rekindled, and HBO therapy was thrust into the modern era. Hyperbaric units subsequently were built at Duke University, New York Mount Sinai Hospital, Presbyterian Hospital and Edgeworth Hospital in Chicago, Good Samaritan in Los Angeles, St. Barnaby Hospital in New Jersey, Harvard Children's Hospital, and St. Luke's Hospital in Milwaukee. Further chambers were installed in numerous international sites.

The benefits of hyperbaric medicine subsequently were observed for split-thickness skin graft acceptance, flap survival and salvage, wound re-epithelization, and acute thermal burns. These studies lent credibility to the therapeutic employment of HBO therapy. This fostered the establishment of organized scientific congresses and societies such as the International Congress on Hyperbaric Oxygen and the Undersea Medical Society. Unfortunately, as the availability of hyperbaric medicine chambers increased, the indiscriminate and inappropriate use of the chamber for a variety of medical conditions by practitioners searching for a "cure-all" therapy resulted in a backlash from the scientific society, once again tarnishing the credibility of hyperbaric medicine. As a result, by the late 1970s, the Undersea Medical Society had formulated guidelines for the use of hyperbaric therapy.

Researchers conducting wound-healing studies continued to try to take advantage of the angiogenic properties of increasing oxygen gradients resulting from hyperbaric therapy. Foot wounds from diabetes, radiation ulcers, and other ischemic wounds have been manipulated and successfully treated with HBO. Prospective blinded randomized trials and well-executed laboratory studies continue to further define the role of hyperbaric therapy in medical therapeutics.

In 1989, in recognition of advances in hyperbaric treatments, the American Board of Medical Specialists approved a certification of added competency in Undersea Medicine. The National Board of Hyperbaric Medicine Technology gave its first certification to hyperbaric technicians in 1991. In 1986, the Undersea Medical Society changed its name to the Undersea and Hyperbaric Medical Society.

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Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
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See above posts. This one has been deleted.

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Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
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From a practice perspective: We have several HBO chambers in our Wound Care Dept. During the last 6 years, in this 670-bed Level 1 Trauma center with 100 ICU beds (& high rate of anemia), we used HBO therapy once--on a diverticular bleed patient requiring emergent colon resection with a Hgb of 4. Its affects were temporary (as cited earlier). While it may be a useful adjunct on occasion, we have not found it an essential element for effective bloodless management.

While it may not be used a lot in the bloodless medicine areana, it is sure nice to have as a back up. According to one manual HBO also promotes red blood cells. We had one patient that was transferred to our facility with a hemoglobin of 1.5. The heart was showing some disturbing waves. When we put her in HBO, it gave her body a rest. She also became very mentally clear. It was truly amazing. We have also used the chamber with a sickle cell patient. We used it for the profound anemia, but the patient reported a reduction in pain. Perhaps this arena needs more investigation. Thank you Jan for the history yvette

__________________
Yvette Bunch

ProMedica Health System has 2 individual HBO chambers on The Toledo Hospital Campus. We have used them for exceptional blood loss anemia. True, they're not indicated often but when they are, our team is mighty grateful for those "space tubes" housed in the "bowels of the hospital". Here is contact information in case you want further information. Shirley
Donato Borillo, MD Medical Director, Hyperbaric Medicine 419-291-5823
Brian Sanders, RRT, Manager, Hyperbaric Medicine 419-291-5358

roberto martinez from juarez mex
iam an cht we have 2 multipatient chanber and we have treated some very anemic patient.example 6 year old girl 5.5mg/dl hb 2 weeks of treatment get 10.5mg/dlhb
we are more then happy to share protocolos or answer questions porres34@hotmail.com

Just wondering about HBO for stubborn diabetic ulcers.
I read Medicare will pay for it if the wound does not respond to traditional treatment after 30 days. Has anyone had experience with this modality?
Thank you so much for your time, in advance.