Undersea and Hyperbaric Medicine

Hyperbaric Medicine Literature Highlights

Presented by Drs. Ceponis and Hickey at the Undersea and Hyperbaric Medical Society
annual scientific meeting in June 2016 in Las Vegas.

Articles Presented at UHMS ASM 2016

 Peter Ceponis, MD, PhD, Dip. Sport Med  



Hampson NB, Piantadosi CA, Thom SR, et al. Practice recommendations in the diagnosis, management and prevention of CO poisoning. Am J Respir Crit Care Med. 2012;186(11):1095-1101.

Clear clinical recommendations for any specialty. Large amount of info in a short paper.

Fedorko et al. Hyperbaric Oxygen Therapy does not reduce indications for amputation in patients with diabetes with nonhealing ulcers of the lower limb: a prospective, double-blind, randomized controlled clinical trial. Diabetes Care. 2016;39:392-399.

Though an RCT, many critical problems with this paper. Poor patient selection (Wagner Gr 2 were half the subjects and they are known not to respond to HBOT); short follow up; incomplete HBOT course; hypothetical amputation endpoint by Vascular Sx assessment of limb photographs; Generally, the results of this article do a disservice to HBOT practitioners if not interpreted with a critical eye.

Stoekenbroek et al. Is additional HBOT cost-effective for treating ischemic diabetic ulcers? Study protocol for the Dutch DAMOCLES multicenter RCT. J Diabetes. 2015;7(1):125-132.

Well-designed RCT. Results pending, so more light will be shed on the diabetic foot ulcer issue. Important in light of Fedorko’s poor study.

Glover et al. Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomized, double blind, sham controlled phase 3 trial. Lancet Oncol. 2016;17:224-233.

RCT with rigorous selection.

But – underpowered; not a representative population of what is referred to HBOT; excessively long time from radiation therapy to HBOT; endpoints were questionnaires, not biological.

Moon et al. Swimming-induced pulmonary edema. Pathophysiology and risk reduction with sildenafil. Circulation. 2016;133:988-996.

Elucidates cardiovascular physiology underlying SIPE. Shows risk reduction with simple medication. HBOT physicians need to be aware of the physiology and how to counsel patients (incl divers, swimmers, triathletes).

Wilkinson et al. Hyperbaric oxygen therapy increases insulin sensitivity in overweight men with and without type 2 diabetes. Diving Hyperb Med. 2015;45(1):30-36.

HBO therapy alters insulin sensitivity in nondiabetics and diabetics. Implications for understanding more about glucose metabolism. Mechanistic insight why HBO may help diabetics.

Jain et al. Hypoxia as a therapy for mitochondrial disease. Science. 2016;352(6281):54-61.

Mice with mitochondrial disease survive better in hypoxia! Potential new treatment that HBOT physicians should be aware of. Are hypobaric chambers, or is living at altitude, better for humans with mitochondrial disease?

Blatteau et al. Xenon blocks neuronal injury associated with decompression. Sci Rep. 2015;5:15093.

Xenon is protective in a neuronal model of DCS. Very basic science, but would be interesting to test in animals/humans (caveat: xenon has been shown to increase bubble size in animal models of AGE).

Wright et al. Cardiac arrest in the hyperbaric environment: key steps on the sequence of care – case reports. Undersea Hyperb Med. 2016;43(1):71-78.

Good template by which to consider how your unit will handle chamber emergencies. Do you have up to date protocols?

Huang et al. 2015. A clinical practice guideline for the use of HBOT in the treatment of diabetic foot ulcers. Undersea Hyperb Med. 2015;42(3):205-47.

An incredible amount of work went into surveying the literature for this CPG. Based on sound methods, HBOT is recommended for Wagner Gr 3 and above diabetic foot ulcers.

Chin et al. Hyperbaric programs in the US: locations and capabilities of treating DCS, AGE and acute CO poisonings: survey results. Undersea Hyperb Med. 2016;43(1):29-43.

Thorough account of as many US chambers as they could find/would respond to their survey. Shocking lack of 24/7 HBOT versus the total number of chambers. Strike against the 9-5 wound care model of HBOT “care”. How do we compensate chambers appropriately for remaining open 24/7 and covering emergent patients?

Papers not presented but were in the talk reference list, also worth reading: 



Alea K. Identifying the subtle presentation of decompression sickness. Aerosp Med Hum Perform. 2016;86(12):1058-62.


Very subtle DCS presentation case. Advocates for neuropsych testing of these patients.

Attanasio et al. Does the addition of a 2nd daily session of HBO therapy to intratympanic steroid influence the outcomes of sudden hearing loss? Acta Otorhinololaryngologica Italica. 2015;35:272-5.

Once or twice daily treatments with HBOT for ISSHL have similar outcomes.

Vera-Cruz et al. HBO therapy improves glucose homeostasis in type 2 diabetes patients: a likely involvement of the carotid bodies. Adv Exp Med Biol. 2016;860:221-5.

HBOT improves oral glucose tolerance test values in diabetics. Should it be used for more than just foot ulcers in that population?

Huang et al. An implantable depot that can generate oxygen in situ for overcoming hypoxia-induced resistance to anti-cancer drugs in chemotherapy. J Am Chem Soc. 2016;138(16):5222-5225.

Implantable oxygen generators (in the mouse)!

Lautridou et al. Effect of simulated air dive and decompression sickness on the plasma proteome of rats. Proteomics Clin Appl. 2016;10(5):614-20.

Search for a DCS biomarker.

Eggert et al. Cost and mortality data of a regional limb salvage and hyperbaric medicine program for Wagner Grade 3 or 4 diabetic foot ulcers.  Undersea Hyperb Med. 2016;43(1):1-8.

Limb salvage programs work and are cost effective.

Hampson et al. Diffusion of carbon monoxide through gypsum wallboard. JAMA. 2013. 310(7):745-6.

CO passes right through gypsum barriers. Need to know to counsel CO-poisoned patients and families



Articles Presented at UHMS ASM 2016 

By Brad Hickey, MD, PhD, MPH, MBA



Madden D, Thom S, Dujic Z. Exercise Before and After SCUBA Diving and the Role of Cellular Microparticles in Decompression Stress. Med Hypotheses. 2016;86:80-84.

Studies demonstrate exercise impacts decompression. A single bout of exercise 2 hours before diving reduces microparticle counts in mice.

Clarke JE. Moving in extreme environments: inert gas narcosis and underwater activities. Extrem Physiol Med. 2015;4:1.

Deep deaths lead to increased risk but working up to deeper depths may reduce risk. Recommend practice of tasks at depth.

Deb SK, Swinton PA, and E Dolan. Nutritional Considerations During Prolonged Exposure to a Confined, Hyperbaric, Hyperoxic Environment: Recommendations for Saturation Divers. Extrem Physiol Med.2016;5:1.

Saturation diving can disrupt physiologic and metabolic homeostasis requiring nutritional strategies

Brubakk AO. Career Perspective: ALF O. Brubakk – looking back to see ahead. Extrem Physiol Med . 2015;4:4.

Multiple insights from an extraordinary diving career




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