Contents

Foreword

D. Mathieu

Contributors

Preface

A History of Hyperbaric Medicine xv xi

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 15 W. Welslau

1.2. Biochemistry of Oxygen 25

1.3. Physiologic Effects of Increased Barometric Pressure 31 W. Welslau

1.4. Physiologic Effects of Hyperbaric Oxygen on Oxygen

Transport and Tissue Oxygen Pressure 49

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

1.5. Physiologic Effects of Hyperbaric Oxygen on Hemodynamics and Microcirculation 75

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 103

D. Mathieu, F. Wattel

1.7 Physiologic Effects of Hyperbaric Oxygen on Ischemia Reperfusion Phenomenon 121 S. Van Poucke, P. Jorens, L. Beaucourt

1.8 Physiologic Effects of Hyperbaric Oxygen on Wound Healing Processes 135 J. Niinikoski

1.9 Physiologic Effects of Hyperbaric Oxygen on DNA and DNA

Repair - Genotoxicity of Hyperbaric Oxygen and its Prevention 147

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 163

F. Wattel, D. Mathieu

2.2 Recommended Indications

2.2.1 Dysbaric Illness 173

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

2.2.2 Gas Embolism 217

2.2.3 Carbon Monoxide Poisoning 239 D. Mathieu, M. Mathieu-Nolf, J.C. Linke, R. Favory, F. Wattel

2.2.4 Necrotizing Soft Tissue Infections 263 D. Mathieu, R. Favory, J.F. Cesari, F. Wattel

2.2.5 Intra-Cranial Abscess 291 L. Lampl, G. Frey

2.2.6 Crush Injury and Other Acute Traumatic Ischemia 305

A. Kemmer

2.2.7 Compromised Skin Graft and Flap 329

T.A. Mesimeris

2.2.8 Radio-Induced Lesion in Normal Tissues 363 D. Pasquier, J. Schmutz, E. Lartigau

2.2.9 Non-Healing Wounds 401 D. Mathieu, J.C. Linke, F. Wattel

2.2.10 Persistent Osteomyelitis 429 A. Kemmer, T. Stein, C. Hierholzer

2.2.11 Sudden Deafness 451 A. Barthelemy, M. Rocco

2.2.12 Neuroblastoma 469 A. van der Kleij, P. Sminia

2.3 Optional Indications

2.3.1 Burns 479

2.3.2 Anoxic Encephalopathy 495 F. Wattel

2.3.3 Pleuropulmonary Anaerobic Infections 509 D. Mathieu

2.3.4 Post Vascular Procedure Reperfusion Syndrome and Limb Replantation 521

J. Schmutz

2.3.5 Acute Ischemic Ophthalmological Disorders 527 A. Weinberger, U. Siekmann

2.3.6 Pneumatosis Cystoides Intestinalis 537

J. Niinikoski

2.4 Controversial and Non Indications

2.4.1 Femoral Head Necrosis 547 L. Ditri, M. Montanari,Y. Melamed, D. Reis

2.4.2 Cerebrovascular Incidents (Stroke) 553 F. Cronje, W. Duim, A. Marroni, R. Cali-Corleo

2.4.3 Post-Sternotomy Mediastinitis 567

A. Barthelemy

2.4.4 Sickle Cell Disease 577 H. Medhaoui

2.4.5 Brain Injury and Spinal Cord Injury 585

J. Schmutz

2.4.6 Myocardial Infarction 591

J. Schmutz

2.4.7 Malignant Otitis Externa 597 J. Schmutz

2.4.8 Other Controversial or Non Indications 601

J. Schmutz

Part III: Practice of hyperbaric medicine Editors: J. Kot, A. Kemmer, P. Germonpré

3.1. Hyperbaric Chamber and Equipment 611 J. Kot, R. Houman,P. Müller

3.2. Organization of a Hyperbaric Center 637 J. Kot, Z. Sicko

3.3. Patient Management 651 A. Kemmer, C. Muth, D. Mathieu

3.4. A Cost-Effectiveness Evaluation of Hyperbaric Oxygen

Therapy 671

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

3.5. Education and Training of Hyperbaric Centre personnel 679 J. Desola

3.6. Safety in Hyperbaric Medicine 691 J. Kot, R. Houman,R. Gough-Allen

3.7. Complications of Hyperbaric Oxygen Therapy

3.7.1 Barotraumatism 715 F. Roque, A. Simao

3.7.2 Oxygen Toxicity 731 N. Bitterman, H. Bitterman

3.8. Organisation of Hyperbaric Medicine in Europe 767 D. Bakker,A. Marroni, D. Mathieu

3.9. Research in Hyperbaric Medicine 779 P. Germonpré, D. Mathieu

Annex

List of Hyperbaric Therapeutic Centres in Europe 793

P. Germonpre, J. Kot

Index

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

CONTRIBUTORS

Bakker, Dirk Jan

Beaucourt, Luc

Bitterman, Haim Bitterman, Noemi Boulo, Marie

Cali-Corleo, Ramiro Cesari, Jean-François

Collet, François

Courtière, Alain

Cronje, Frans Desola, Jordi

Ditri, Luciano Duim, Wiebren

Favory, Raphael

Department of Surgery/Hyperbaric Medicine, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands

Centre Hyperbare, Hôpital Sainte Marguerite, Marseille, France

Unit of Hyperbaric Medicine, Department of Emergency Medicine, University Hospital, Antwerp, Belgium

Technion-Israel Institute of Technolog, Haifa, Israel

Technion-Israel Institute of Technolog, Haifa, Israel

Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Calmette, Centre Hospitalier Régional et Universitaire, Lille, France

Head of the Division of Baromedicine at the University of Malta and the Hyperbaric Unit, Malta

Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Calmette, Centre Hospitalier Régional et Universitaire, Lille, France

Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Calmette, Centre Hospitalier Régional Universitaire, Lille, France

Institut de Médecine Navale du Service de Santé des Armées, Toulon Naval, France

Medical Director, Eugene Marais Hospital Hyperbaric Oxygen Therapy Center, Pretoria, South Africa.

CRIS, Hyperbaric Therapy Unit (CRIS-UTH), Dos de maig Hospital, Barcelona, Spain

OTI Medicale, Vicenza, Italy

Medical Director, Life Health Care Group Stroke Therapy Center, Little Company of Mary Hospital, Pretoria, South Africa.

Service d'Urgences Respiratoires, de Réanimation Médicale et de Médecine Hyperbare, Hopital Calmette, Centre Hospitalier Régional et Universitaire, Lille, France

Frey, Günter Germonpre, Peter Gough-Allen, Roly Gröger, Michael

Hamilton-Farell, Martin Hierholzer, Christian Houman, Robert Jorens, Philippe Kemmer, Armin

Kot, Jacek

Lampl, Lorenz Lartigau, Eric Linke, Jean-Christophe

Longobardi, Pasquale Marroni, Alessandro

Mathieu, Daniel

Dept. of Anesthesiology and Intensive Care Medicine, Federal Armed Forces Hospital, Ulm, Germany

Centre for Hyperbaric Oxygen Therapy, Military Hospital Brussels, Belgium

Sea-Long Europe Medical Systems Inc, Plymouth United Kingdom.

Sektion Anaesthesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Ulm, Germany

Whipps Cross University Hospital, Leytonstone, London, United Kingdom

BG Trauma Center, Berufsgenossenschaftliche Unfallklinik, Murnau, Germany

Centre for Hyperbaric Oxygen Therapy, Military Hospital Brussels, Belgium

Department of Intensive Care Medicine, University Hospital, Antwerp, Belgium

Department of Anaesthesia & Intensive Care Medicine, Centre for Hyperbaric Oxygen Therapy, Berufsgenossenschaftliche Unfallklinik, Murnau, Germany

National Center for Hyperbaric Medicine, Institute of Maritime and Tropical Medicine in Gdynia, Medical University of Gdansk, Poland

Dept. of Anesthesiology and Intensive Care Medicine, Federal Armed Forces Hospital, Ulm, Germany

Department of Radiation Oncology, Centre O. Lambret, University od Lille, France

Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Calmette, Centre Hospitalier Régional et Universitaire, Lille, France

Medical Director, Centro Iperbarico, Ravenna, Italy

President and Medical Director, DAN Europe Foundation, Roseto, Italy

Service d'Urgences Respiratoires, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Calmette, Centre Hospitalier Régional et Universitaire, Lille, France

Contributors Mathieu-Nolf, Monique

Mehdaoui, Hossein

Meintjes, Jack

Melamed, Yehuda

Mesimeris, Theodore A.

Montanari, Michele Müller, Peter

Muth, Claude

Niinikoski, Juha Pasquier, David Radermacher, Peter

Ratzenhofer-Komenda, Beatrice Reis, Daniel Rocco, Monica Roque, Filipe Schmutz, Jörg

Centre Anti-Poison, Centre Hospitalier Régional et Universitaire, Lille, France

Criticial care and hyperbaric oxygen therapy unit, University Hospital, Fort de France, Martinique, French West India

Medical Advisor and Senior Lecturer, Department of Community Health, Division of Occupational Health, University of Stellenbosch, South Africa.

Rambam Medical Centre, Orthopedic and HBO Medical Department, Haifa, Israel

Hyperbaric Department, General Hospital St.Paul, Thessaloniki, Greece

OTI Medicale Vicenza, Italy

London Hyperbaric Medicine., Whipps Cross University Hospital, Leytonstone, London, United Kingdom

Sektion Anaesthesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Ulm, Germany

Department of Surgery, University of Turku, Turku, Finland

Department of Radiation Oncology, Centre O. Lambret, University of Lille, France

Sektion Anaesthesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum Ulm, 89073 Ulm, Germany

Dept. of Anaesthesiology and Intensive Care, University Medical School, Graz, Austria

Rambam Medical Centre, Orthopedic and HBO Medical Department, Haifa, Israel

Centro di Medicina Iperbarica, Istituto di Anestesia e Rianimazione, Universita "La Sapienza", Roma, Italy

Centro de Medicina Hiperbarica-Hospital da Marinha, Lisbon, Portugal

SUHMS, Consultant for Hyperbaric Medicine, University of Basel Basel, Switzerland

Sicko, Zdzislaw National Center for Hyperbaric Medicine, Institute of

Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland

Siekmann, Ullrich HBO-Zentrum Euregio and Universitätsklinikum der

RWTH Aachen, Abteilung Anästhesiologie, Aachen, Germany

Simao, Antonio Gata Centro de Medicina Hiperbarica, 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

Society for Diving and Hyperbaric Medicine], Seeboeck gasse 17, Wien, Austria

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