Page 109 - Hospital Authority Convention 2018

Parallel Sessions

PS3.1 Clinical Application of Hyperbaric Oxygen Therapy 16:15 Theatre 1

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The Clinical Role of Hyperbaric Oxygen Therapy in the 21 Century
Bennett M
University of New South Wales, Australia
Introduction HOSPITAL AUTHORITY CONVENTION 2018
The history of hyperbaric medicine has been a difficult one. From origins in the 19th century “wellness” industry – where
hyperbaric air spas were common throughout Europe and North America - through the enthusiasm of early pioneers who
suggested hyperbaric oxygen therapy (HBOT) could cure a wide range of conditions, to the modern, evidence based
approach, it has been a colourful journey. This presentation will put modern HBOT into its historical context and outline the
likely future for this therapy.
The Modern Context:
In 1973, the Undersea and Hyperbaric Medical Society (UHMS), facing increasing pressure from funders and physicians
outside the field, made the first serious attempt to examine the evidence base for common indications. From a list of more
than 170 conditions examined, sufficient clinical and experimental evidence could be found to support the routine use of
HBOT in only 13. Since then, few new conditions have been added to this list. The latter two decades of the 20th century and
the first years of the 21st century have been ones of consolidation and rationalisation. The field has increasingly been forced
to confront a patchy evidence basis and several modestly powered randomised controlled trials have re-examined all of the
“traditional” indications with mixed results. Hyperbaric physicians have only recently come to a full understanding of the
requirements for acceptance into the contemporary therapeutic arsenal. The primary challenge remains the full integration of
HBOT services into the modern medical system in a rational manner that efficiently utilises a relatively costly resource.

Summary Monday, 7 May 2018
The opportunity in the 21st century is to use both sound clinical and mechanistic arguments to persuade colleagues of
the place of HBOT in their own areas. It is important to encourage participation of a broad range of specialties within the
hyperbaric service in order to achieve this goal.

PS3.2 Clinical Application of Hyperbaric Oxygen Therapy 16:15 Theatre 1

Critical Issues of Hyperbaric Oxygen Treatment for Intensive Care Unit Patients
Yan WW
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong

The common indications of hyperbaric oxygen treatment (HBOT) for intensive care unit (ICU) patients in developed areas are
necrotizing fasciitis, carbon monoxide poisoning, arterial gas embolism and decompression illness. Except for the latter two
indications, which are widely accepted, most indications of HBOT are considered adjunctive therapy or controversial. ICU
doctors should base on its potential benefits and possible risks to decide whether HBOT should be adopted.
For critically ill patients, HBOT is preferably done in multi-place chamber rather than mono-place chamber. Multi-place
chamber enables the healthcare professionals to have direct access to the patients in case complications arise during
treatment.
ICU staff should be familiar with the HBOT preparations. For intravenous infusions, there should not be any air entrainment
inside the tubing. For intravascular pressure monitoring, the volume of air in the pressure bag must be adjusted during
descent and ascent. The battery-run monitoring equipment should not be used inside the chamber because of fire hazard.
For setting up central venous line for the patient, subclavian puncture should be avoided because of its inherent higher risk
of pneumothorax. Water instead of air should be used for endotracheal or tracheostomy tube cuff inflation. For mechanical
ventilator, the set tidal volume and rate may differ under hyperbaric situation. The actual delivered tidal volume must be
monitored by a calibrated spirometer. Hyperbaric ventilator is now available in the market and ventilator settings need not be
adjusted during compression and decompression. All expired gas should be scavenged. Otherwise, the oxygen concentration
inside the chamber would increase and hence a fire risk. For chest drain drainage, air-fluid levels during descent or ascent
must be monitored. Heimlich valve is a handy alternative to underwater seal box or chest bottles. Nasogastric tubes should
be left open to bedside bag.

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