Hyperbaric Medicine Practice 4th Edition

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About the Book

A textbook may sometimes gain the unusual trait of longevity beyond all other books -  it can be revised and remain a primary source ofDr. Harry T. Whelaninformation for generations of students. Hyperbaric Medicine Practice seems destined to become such a book.

This 4^th edition, edited by Harry T. Whelan, pays tribute to its original author, Dr. Kindwall, who died in 2012. It also adds new information of interest to all in the field of diving and clinical hyperbaric medicine. Most chapters have been written or revised by new authors, but many have returned to update their chapters.

New chapters include indications for hyperbaric oxygen treatment subjects recently approved for treatment such as idiopathic sudden sensorineural hearing loss and central retinal vein occlusion. There are also chapters on submarine rescue and problems that pertain to technical and rebreather diving.

This book will be an important addition to the library of physicians in clinical hyperbaric medicine and those involved with divers—recreational, commercial, and military—as well as other professionals who care for them.

- comments by Henry J.C. Schwartz, MD, FACP

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New Information and Updates in the Fourth Edition

Indications for the Use of HBO2

• Completely re-written chapters on basis for HBO2 therapy of Radiation Necrosis and Burns
• New clinical trial data for traumatic brain injuries
• Tabulation of almost all published cases of hyperbaric oxygen used for refractory osteomyelitis and the new CPT codes needed for reimbursements
• Updates on the multiplace hyperbaric chamber with monitoring and provisions for critical care and carbon monoxide emergency
• A new complete description of the multiplace hyperbaric chamber as a medical device
• Improved illustrations and better clarification for the use of hyperbaric oxygen for crush injuries
• Totally new chapter on the role of hyperbaric oxygen for fracture management
• Complications and Contraindications for the Use of HBO2
• Completely re-written chapter on the contraindications and relative risks, and the management recommendations 
• Completely re-written chapter on complications and the management recommendations 
• Updated details on use of medications and indications for myringotomy

The Science of HBO2

• Additional basic science and clinical data regarding HBO2 management of infectious diseases
• Completely re-written chapter on basis for HBO2 therapy of Infectious Diseases
• Updates on mechanism of action of HBO2 and preconditioning
• Added human and animal literature section utilizing hyperbaric oxygen for brown recluse spider bite
• Re-written evidence-based recommendations for use of hyperbaric oxygen for brown recluse spider bite
• New innovative research developed in Brazil when the first lines of hyperbaric medicine therapy history in South America were written.
• Introduces challenging questions to readers including: Should we try HBO2 for Hansen’s disease in present day? Is there any better way to increase oxygen toxicity against Mycobacterium leprae than methylene blue?
• All new hyperbaric oxygen mechanism chapter complimented by exceptionally well-illustrated figures
• New approach to appreciating the mechanisms of hyperbaric oxygen with primary effects that occur immediately and secondary effects that are long standing and generally require repetitive treatments
• In-depth discussion about the physiological, cellular and molecular response to exogenous ketone supplementation and ketogenic diet
• New section on pharmacokinetic disposition of drugs in HBO2
• New section on antibiotic interactions
• Updated literature on pharmacodynamics interactions
• Fully updated discussion on the use of hyperbaric oxygen therapy in pediatrics including risks and benefits, practical considerations, indications and controversies and oxygen administration schedules
• Discussion of latest information on pediatric disease indications for hyperbaric oxygen therapy and current controversies
• Updated recommendations for pediatric psychological preparation and sedation

Wound Care and HBO2

• Evidence-based use of hyperbaric oxygen therapy for diabetic foot ulcer
• New ways of assessing the diabetic foot ulcer and other wounds
• Current updates on clinical application to HBO2 in skin grafts and flaps
• New wound chapter with five strategies that need to be considered for all wounds whether diabetic or not
• Clear and simple algorithms when to use hyperbaric oxygen for wound healing compromised by ischemia-hypoxia
• Presentation of an innovative wound grading score that is user friendly, highly objective and quantifies wounds for Comparative Effectiveness Research of wound products and
• Minimally Important Clinical Improvement

Clinic Administration

• Updated nursing documentation guidelines
• Updated nursing standards of care
• Importance of clinical hyperbaric facility accreditation

Dive Medicine

• In water recompression
• Rebreather and technical diver maladies
• Numerous new and updated chapters on diving, submarine rescue and ocean exploration
• New chapter on growing utilization of closed-circuit rebreathers (CCRs)
• Brand new chapter on closed circuit rebreathers, including a review of physiology and specific risks to divers
• Completely new chapter on diving physics, diving pathology and diving recommendations for pregnancy, elderly and medications
• Discusses the potential use of nutritional ketosis for enhancing the safety and performance while diving and exposed to high partial pressure of oxygen
• Latest information on pathophysiology, clinical presentation and management of arterial gas embolism
• Update on adjunctive therapy for gas embolism

Foreward by Enoch Huang, MD, MPH&TM, FUHM

The second edition of Hyperbaric Medicine Practice (1999) by Kindwall and Whelan was my first hyperbaric textbook, and I recall studying it extensively during my fellowship (and in the years since) to learn as much as I could about my chosen profession. Back then, the contentDr. Enoch Huangleaned a little on the anecdotal side with much less concern about evidence-based medicine and systematic meta-analyses. Much has changed in the last quarter century, as our understanding of hyperbaric oxygen physiology has become more sophisticated, and our need for quality, evidence-based practice recommendations has become more urgent.

The field of hyperbaric medicine has changed as well. More facilities focus on the delivery of hyperbaric oxygen therapy for chronic wound patients rather than the treatment of urgent or emergent indications. The modern hyperbaric practitioner is more likely to come from a field with little primary training in hyperbaric physiology and is more likely to spend only a portion of his or her practice treating patients with hyperbaric oxygen. There is great concern amongst veterans of undersea and hyperbaric medicine that the scope of knowledge of the modern hyperbaric practitioner is focused only on a narrow sector of the field rather than appreciating the complexities and nuances of all of the indications for therapy. While some providers may be interested in learning more about the specialty, opportunities for in-depth education are scarce. Fellowship training is preferable for those who wish to devote themselves to the field, but it is often out of reach for established physicians who find themselves practicing hyperbaric medicine as a second career. It is for this reason that we need resources such as Hyperbaric Medicine Practice to provide a comprehensive approach for educating practitioners on the full breadth and scope of undersea and hyperbaric medicine.

The Undersea and Hyperbaric Medical Society (UHMS) has devoted itself to promoting the scientific study of hyperbaric oxygen therapy and raising the level of knowledge of hyperbaric practitioners, so it is with great pleasure that we welcome Hyperbaric Medicine Practice, 4th edition. This fourth edition includes updates to “classic” chapters, while others have been completely rewritten to address modern-day issues. There are new chapters covering the most recently accepted indications for hyperbaric oxygen therapy while removing some that are less relevant to hyperbaric medicine practice in today’s environment. Overall, the fourth edition of Hyperbaric Medicine Practice is an impressive work that should serve veterans and newcomers of undersea and hyperbaric medicine alike.

-By Enoch Huang, MD, MPH&TM, FUHM President Undersea and Hyperbaric Medical Society

Table of Contents

SECTION ONE Hyperbaric Oxygenation: General Considerations

Chapter 1 Clinical Hyperbaric Facility Accreditation-Process Improvement in Action by W.T. Workman

Chapter 2 Physiologic Effects of Hyperbaric Oxygen by Gerardo Bosco, Enrico M. Camporesi

Chapter 3 Oxygen Toxicity by Heather A. Annis, Aliyah Keval, Harry T. Whelan

Chapter 4 Management of Critically Ill Patients in the Monoplace Hyperbaric Chamber by Lindell K. Weaver

Chapter 5 Multiplace Hyperbaric Chamber by Giacomo Garetto, Gerardo Bosco

Chapter 6 Hyperbaric Nursing by Valerie Messina

Chapter 7 The Use of Drugs Under Pressure by Ryan Feldman

Chapter 8 Myringotomy by Michael E. McCormick, Joseph E. Kerschner

Chapter 9 Contraindications and Relative Risks of Hyperbaric Oxygen Treatment by Phi-Nga Jeannie Le

Chapter 10 Side Effects and Complications: Selected Overview and Brief Guide to Management by Phi-Nga Jeannie Le, John B. Slade Jr, Jason A. Kelly, E. George Wolf

Chapter 11 Pediatric Considerations for Hyperbaric Medicine by Pamela C. Petersen, Michael T. Meyer, Paul A. Thombs 

Chapter 12 Carbon Monoxide by Jillian Theobald

Chapter 13 The Role of Oxygen and Hyperbaric Oxygen Mechanisms by Michael B. Strauss, Lientra Q. Lu

SECTION TWO Disorders Approved for Hyperbaric Treatment

Chapter 14 Idiopathic Sudden Sensorineural Hearing Loss by Tracy Leigh LeGros, Heather Murphy-Lavoie

Chapter 15 Gas Embolism by Richard E. Moon

Chapter 16 Effects of Hyperbaric Oxygen in Infectious Diseases: Basic Mechanisms by Rodney E. Willoughby Jr., Charles C. Falzon, Aliyah Keval, Harry T. Whelan

Chapter 17 Gas Gangrene by Aliyah Keval, Harry T. Whelan

Chapter 18 Selected Aerobic and Anaerobic Soft Tissue Infections by R.A. van Hulst, D.J. Bakker

Chapter 19 Hyperbaric Oxygen in Intracranial Abscess by Lorenz A. Lampl, Guenter Frey, Dietmar Fischer, Enrico Staps

Chapter 20 Hyperbaric Oxygen for the Management of Chronic Refractory Osteomyelitis by Michael B. Strauss, Stuart S. Miller, Lientra Q. Lu

Chapter 21 Strategic Approach to Diabetic Foot and Other Wounds by Michael B. Strauss, Anna M. Tan, Lientra Q. Lu

Chapter 22 Evaluation and Management of the Diabetic Foot Ulcer by Enoch Huang, Marvin Heyboer III

Chapter 23 Adjunctive Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers by Enoch Huang, Marvin Heyboer III

Chapter 24 Fracture Healing and Roles of Hyperbaric Oxygen by Michael B. Strauss, Anna M. Tan, Lientra Q. Lu

Chapter 25 The Microcirculation and Ischemia-Reperfusion: Basic Mechanisms of Hyperbaric Oxygen by Richard C. Baynosa, William A. Zamboni, John Brosious

Chapter 26 The Roles of Hyperbaric Oxygen in Crush Injury and Other Acute TraumaticIschemias by Michael B. Strauss, Lientra Q. Lu

Chapter 27 Hyperbaric Oxygen Use in Exceptional Blood Loss Anemia by Keith W. Van Meter

Chapter 28 Hyperbaric Oxygen in Skin Grafts and Flaps by Jenna Cusic, Chelsea Venditto, Hani S. Matloub

Chapter 29 Radiation Injury to Tissue by Robert E. Marx

Chapter 30 The Use of Hyperbaric Oxygen for Treating Delayed Radiation Injuries in Gynecologic Malignancies by Harry T. Whelan, Chris Kilian

Chapter 31 Adjunctive Hyperbaric Oxygen Therapy in the Treatment of Thermal Burns by Paul Cianci, Ronald M. Sato, Julia Faulkner

SECTION THREE Hyperbaric Oxygen Used in Off-Label Disorders and Investigational Areas

Chapter 32 Off-Label Indications for Hyperbaric Oxygen Therapy by Michael H. Bennett, Simon J. Mitchell 

Chapter 33 Central Retinal Artery Occlusion by Heather Murphy-Lavoie, Tracy Leigh LeGros

Chapter 34 Hyperbaric Oxygen Treatment of Avascular Bone Necrosis of the Femoral Head by Giuliano Vezzani, Gerardo Bosco, Enrico M. Camporesi

Chapter 35 Use of Adjunctive Hyperbaric Oxygen in the Management of Invasive Fungal Infections by Lisardo Garcia-Covarrubias, Diana M. Barratt

Chapter 36 Treatment of the Brown Recluse Spider Bite with Hyperbaric Oxygen Therapy by Matthew Stanton

Chapter 37 Hyperbaric Oxygen in Traumatic Brain Injury by Sarah B. Rockswold, Samuel R. Daly, Gaylan L. Rockswold

Chapter 38 Neurologic Aspects of Hyperbaric Medicine by Ann K. Helms, Charles C. Falzon, Aliyah Keval, Harry T. Whelan

Chapter 39 Hyperbaric Oxygen in the Treatment of Hansen’s Disease by David A. Youngblood, Tomaz A.P. Brito

SECTION FOUR Diving, Submarine Rescue, and Life in the Sea

Chapter 40 Emergency Management of Stricken Divers in Remote Areas by Joseph Dituri, Carla Renaldo

Chapter 41 Ketogenic Diet and Ketogenic Supplementation for Central Nervous System Oxygen Toxicity by Angela M. Poff, Heather A. Annis, Harry T. Whelan, Csilla Ari, Dominic P. D’Agostino

Chapter 42 Submarine Rescue Diving and Hyperbaric Medicine by Joseph Dituri, Harry T. Whelan

Chapter 43 Dive Medicine by Terrance L. Leighton III, Jonathan E. Strain

Chapter 44 Closed-Circuit Rebreathers (CCR) by Derek B. Covington, Charlotte Sadler, Richard L. Sadler

Chapter 45 Maladies Specific to Technical and Rebreather Divers by Carla Renaldo, Joseph Dituri, Brian P. O’Connell

Chapter 46 Ocean Exploration-Living in the Deep Sea by Harry T. Whelan, Terrance L. Leighton III, Heather A. Annis, Joseph Dituri

Index