Vol 68, No 1 (2017)
Original article
Published online: 2017-03-30

open access

Page views 3551
Article views/downloads 5787
Get Citation

Connect on Social Media

Connect on Social Media

Safety of hyperbaric oxygen therapy in mechanically ventilated patients

Jacques Bessereau, Jérôme Aboab, Thomas Hullin, Anne Huon-Bessereau, Jean-Luc Bourgeois, Pierre-Marie Brun, Sylvie Chevret, Djillali Annane
Pubmed: 28357836
IMH 2017;68(1):46-51.

Abstract

Background: To evaluate the epidemiology of patients who require mechanical ventilation during hyperbaric oxygen therapy.

Materials and methods: One-hundred-fifty patients who required mechanical ventilation during hyperbaric oxygen therapy were prospectively studied during a 6-year period in a French university hyperbaric centre. We analysed the indication of hyperbaric oxygen therapy, agent used for sedation, presence of a chest tube, need for vasopressor agents and tolerance and appearance of side effects. Finally, we compared the outcomes of patients according to the presence or absence of acute respiratory distress syndrome (ARDS).

Results: Eleven children and 139 adult patients were included (n = 150) in the study. In both populations, carbon monoxide poisoning (51%) and iatrogenic gas embolism (33%) were the two main causes of intubation and mechanical ventilation. The combination of midazolam and sufentanil was used in 85 (67%) patients. All of the patients were given a bolus of a neuromuscular blocker during the hyperbaric session, despite the presence of ARDS in 35 patients. Patient-ventilator asynchrony was the most frequent side effect in 6 (5%) patients and was often the consequence of suboptimal sedation. Mortality was higher in the group with ARDS (23%).

Conclusions: Carbon monoxide poisoning and iatrogenic gas embolism are the two main diseases of the patients who required mechanical ventilation during hyperbaric oxygen therapy in this study. Mechanical ventilation is a safe method for patients during hyperbaric oxygen therapy. Sedation needs to be perfected to avoid patient-ventilator asynchrony.  

References

  1. Hampson NB. ed. Hyperbaric oxygen therapy: 1999 committee report. Kensington MD, Undersea and Hyperbaric Medical Society 1999.
  2. Tibbles PM, Edelsberg JS. Hyperbaric-oxygen therapy. N Engl J Med. 1996; 334(25): 1642–1648.
  3. Park MK, Myers RA, Marzella L. Oxygen tensions and infections: modulation of microbial growth, activity of antimicrobial agents, and immunologic responses. Clin Infect Dis. 1992; 14(3): 720–740.
  4. Mathieu D, Cojet J, Vinckier F, et al. Red blood cell deformability and hyperbaric oxygen. Med Subaquatique Hyperbar. 1984; 3: 100–104.
  5. Mathieu D, Ratzenhofer-Komenda B, Kot J. Hyperbaric oxygen therapy for intensive care patients: position statement by the European Committee for Hyperbaric Medicine. Diving Hyperb Med. 2015; 45(1): 42–46.
  6. Keenan HT, Bratton SL, Norkool DM, et al. Delivery of hyperbaric oxygen therapy to critically ill, mechanically ventilated children. J Crit Care. 1998; 13(1): 7–12.
  7. Ranieri VM, Rubenfeld GD, Thompson BT, et al. ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307(23): 2526–2533.
  8. Annane D, Troché G, Delisle F, et al. Effects of mechanical ventilation with normobaric oxygen therapy on the rate of air removal from cerebral arteries. Crit Care Med. 1994; 22(5): 851–857.
  9. First European Consensus Conference on Hyperbaric Medicine, Lille (France). http://www.medsubhyp.com/site/conferences_consensus.htm (1994).
  10. Bessereau J, Coulange M, Jacquin L, et al. Endotracheal tube intracuff pressure during helicopter transport. Ann Emerg Med. 2010; 56(5): 583–4; author relply 584.
  11. Lichtenstein DA. Ultrasound in the management of thoracic disease. Crit Care Med. 2007; 35(5 Suppl): S250–S261.
  12. Ding Wu, Shen Y, Yang J, et al. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest. 2011; 140(4): 859–866.
  13. Xirouchaki N, Magkanas E, Vaporidi K, et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med. 2011; 37(9): 1488–1493.
  14. Kindwall EP. The use of drugs under ressure. In: Kindwall EP, Wheelan HT editors. Hyerbaric Medicine Practice, 2nd ed, Best Publishing Co, Flagstaff; 2004. p. : 323–338.
  15. Claudius C, Garvey LH, Viby-Mogensen J. The undesirable effects of neuromuscular blocking drugs. Anaesthesia. 2009; 64 Suppl 1: 10–21.
  16. Moon RE, Camporesi EM. Clinical care in extreme environments: at high and low pressure and in space. In. Miller RD, Churchill Livingstone Edition. Miller’s anesthesia, 7th ed; 2009, Chapter 80.
  17. Blanch PB, Desautels DA, Gallagher TJ. Deviations of function of mechanical ventilators function during hyperbaric compression. Respir Care. 1991; 36: 803–814.
  18. Eskelson MI, Weaver LK, Greenway L. End-tidal CO2 monitoring within the monoplace hyperbaric chamber. Undersea Biomed Res. 1989; 16(Suppl): A13.
  19. Barr J, Fraser G, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41(1): 263–306.
  20. Bessereau J, Tabah A, Genotelle N, et al. Middle-ear barotrauma after hyperbaric oxygen therapy. Undersea Hyperb Med. 2010; 37(4): 203–208.
  21. Bitterman N. CNS oxygen toxicity. Undersea Hyperb Med. 2004; 31(1): 63–72.
  22. Máca J, Jor O, Holub M, et al. Past and present ARDS mortality rates: a systematic review. Respir Care. 2017; 62(1): 113–122.