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Pediatric Abstracts
Abstract
Management of intestinal ischaemia, necrotizing enterocolitis and anoxic encephalopathies of neonates with hyperbaric oxygen therapy.
Authors: Sanchez EC, Montes G, Oroz G, Garcia LP
36-42 In: Proceedings of the 25th Annual Meeting of the EUBS on Diving, Hyperbaric Medicine and High Pressure Biology, jointly with the 2nd Annual Meeting of the Israel Society for Hyperbaric and Diving Medicine and Physiology, eds. Shupak A, Lincoln, R, Grossman Y.
1999 Aug 28-Sept 2, Haifa and Eilat, Israel. 279 Pp.
Abstract: The use of hyperbaric oxygen therapy (HB02) is extensive in adults and is gaining popularity in the pediatric patient. Nevertheless, there are very few reports of neonates being treated with HB02, mosts of them from the 60's. This is a prospective pilot study to determine the value of HB02 in the management of intestinal ischernia, necrotizing enterocolitis and anoxic encephalopathy of neonates and to determine the incidence of ocular, pulmonary and CNS oxygen toxicity. Neonates are very special patients to be handled in a hyperbaric chamber, particularly in a monoplace chamber. It is mandatory to have an inside assistant and to do other measures (mentioned above) to provide an adequate inside environment for the neonate. They have a special liability for oxygen toxicity, particularly from the lungs. Nevertheless, they respond very quickly and may require only one treatment to resolve the local ischernic/hypoxic condition and the systemic response (DIC, SIR, or shock) of this event. We believe that the patients treated early (< 6h of the event) reverse dramatically their conditions and HB02 is a safe and cost effective adjunctive treatment. There is a need to undertake large randomized controlled studies regarding the efficacy of HBO in ischernic/hypoxic conditions.
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Abstract
Hyperbaric oxygen therapy in the pediatric patient: the experience of the Israel Naval Medical Institute.
Authors:Waisman D, Shupak A, Weisz G, Melamed Y
Pediatrics 1998 Nov; 102(5):E53
Abstract: The pediatric patient is to be found in hyperbaric facilities throughout the world, receiving hyperbaric oxygen (HBO) therapy for both life-threatening and chronic diseases.
OBJECTIVE: To review the experience accumulated at the Israel Naval Medical Institute in the treatment of pediatric patients.
DESIGN: A retrospective analysis and review of all records of patients younger than age 18 years.
RESULTS: Between 1980 and 1997, 139 pediatric patients age 2 months to 18 years (mean, 7.7 years) received HBO treatment at the Israel Naval Medical Institute. Of the children, 111 (79%) suffered from acute carbon monoxide (CO) poisoning; 13 (9.2%) were treated after crush injury, traumatic ischernia, or compartment syndrome; 4 (2.8%) had clostridial myonecrosis; 1 (0.7%) had necrotizing fasciitis; 5 (3.6%) had refractory osteomyelitis; 2 (1.4%) had suffered massive air embolism; 2 (1.4%) had purpura fulminans; and 1 (0.7%) suffered from decompression sickness. Outcome, judged by neurologic sequelae, mortality, and extent of soft tissue loss and limb amputation, was favorable in 129 patients (93%). Two patients (1. 4%) died, I as a result of CO poisoning and the other, gas gangrene; 2 of the patients in the CO group (1.4%) remained with neurologic sequelae, and 6 patients in the acute traumatic ischernia group (4.3%) underwent limb amputation.
CONCLUSIONS: We had a favorable experience with 129 of a total 139 pediatric patients treated at our facility for the indications listed. A basic knowledge of HBO therapy is needed to refer the pediatric patient for treatment when indicated. The needs of the pediatric patient, especially the critically ill, require specific skills and equipment inside the hyperbaric chamber. Close collaboration between the pediatrician and the hyperbaric medicine physician is essential to ensure adequate care for infants and children.
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Abstract
Brain abscess management by adjuvant hyperbaric oxygenation in a paediatric patient; a case report
Authors: Lampl LA, Ruhr P, Kunz U
In: Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine.
Marroni A, Oriani G, Wattel F, eds.
XXII Annual Meeting of the EUBS, XII International Congress on Hyperbaric Medicine, III Consensus Conference of the ECHM, 1996 Sep 4-8, Milano, Italy; Grafica Victoria, Bologna. 1996, 733 pp.
Abstract: Over the past two decades the mortality rates in patients with intracranial abscess (CA [*] )have shown a clear decline worldwide. The currently published average mortality is 17.3% confirmed even by the latest literature available. This is in contrast to the results from 13 consecutive patients treated by adjunctive HBO in a German series with a resulting 0% mortality, which was confirmed by the data of another 6 patients treated under the same aspects by several centers in the US. Anecdotal case reports may be of limited acceptance with regard to statistical proof. In life threatening disorders of low incidence like ICA, however, the proper documentation of such patient data usually is the only way to gather scientific as well as clinical experience. In this view, the case presented here, of a 9 yearold boy, represents patient no. 14 in a series of vitally endangered ICA patients with a resulting 0% mortality. Based on reproducible and well known therapeutic facts the integration of HBO into the concept of currently accepted brain abscess therapy means a promising protocol, especially in patients in whom the standards are doomed to fail.
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Abstract
Hyperbaric oxygen therapy for hepatic artery thrombosis after liver transplantation in children
Authors: Mazariegos GV, O'Toole K, Mieles LA, Dvorchik I, Meza MP, Briassoulis G, Arzate J, Osorio G, Fung JJ, Reyes J
Liver Transpl Surg 1999 Sep;5(5):429
Abstract:Early hepatic artery thrombosis (HAT) after pediatric orthotopic liver transplantation (OLT) can cause significant morbidity and mortality, leading to liver failure or septic complications requiring urgent retransplantation. Experimental evidence that hyperbaric oxygen (HBO) may ameliorate hepatic ischemic reperfusion injury led to this study of HBO in pediatric liver transplant recipients who developed HAT. Children undergoing OLT under primary tacrolimus immunosuppression and University of Wisconsin organ preservation between August 1, 1989, and December 31, 1998, who developed HAT were the basis for this study. Patients who developed HAT between March 1, 1994, and December 31, 1998, were treated with HBO therapy until signs of ischernia resolved (absence of fever, normalizing liver injury test results) or for 2 weeks. The pediatric OLTs personified from August 1, 1989, to February 28, 1994, who developed HAT served as a control group. Primary outcome measures were survival, retransplantation rate, time to retransplantation, incidence of hepatic gangrene, and days to collateral formation. Three hundred seventy five consecutive pediatric patients underwent 416 OLTs between August 1, 1989, and December 31, 1998. Thirtyone patients (7.5%) developed HAT at a mean time of 8.2 days (range, I to 52 days) postOLT. In 17 patients, HBO treatment was begun within 24 hours of HAT or immediately after the revascularization attempt and performed twice daily for 90 minutes at 2.4 atmospheres pressure. Fourteen patients were treated without HBO. None of the HBO treated patients developed hepatic gangrene. Eight HBO patients (47%) were bridged to retransplantation at a mean time of 157 days (range, 3 to 952 days) after initial OLT and all survived. Mean time to retransplant in the control group was 12.7 days (range, I to 64 days). HBO was well tolerated without significant complications. Although there was no significant difference in survival or retransplantation rates, HBO significantly delayed retransplantation, potentially by hastening the development of hepatic artery collaterals.
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Abstract
Effect of hyperbaric oxygen therapy for intractable pediatric postoperative ileus.
Authors: Takao E, Masahiko M, Tadashi M, Tomorou H, Akira S, Hideo S
p. 583 In: Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine. Marroni A, Oriani G, Wattel F, eds.
XXII Annual Meeting of the EUBS, XII International Congress on Hyperbaric Medicine, III Consensus Conference of the ECHM, 1996 Sep 4-8, Milano, Italy; Grafica Victoria, Bologna. 1996, 733 pp.
Abstract: Treatment for intestinal obstruction following pediatric abdominal surgery is extremely difficult, but polysurgery must be avoided. In this study, we evaluated the role of hyperbaric oxygen therapy (HBO) in conservative therapy for intractable postoperative intestinal obstruction.
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Abstract
Hyperbaric oxygen therapy in childhood carbon monoxide poisoning.
Authors:Liebelt EL
Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
Curr Opin Pediatr 1999 Jun;11(3):259-64
eliebelt@welchlink.welch.jhu.edu
Abstract:Hyperbaric oxygen therapy is the administration of 100% oxygen at pressures two to three times ambient pressure, and it significantly increases dissolved oxygen content. Although it has been used successfully to treat decompression illness and arterial air embolism, its role in the treatment of carbon monoxide poisoning remains somewhat controversial. Published evidence and guidelines for the use of hyperbaric oxygen therapy in carbon monoxide-poisoned infants and children are scarce compared with those available for carbon monoxide-poisoned adults. Because of their higher metabolic rates and developing nervous systems, infants and children may be more susceptible to the effects of carbon monoxide and also may warrant special considerations. This review focuses on the unique aspects of carbon monoxide poisoning and hyperbaric oxygen therapy in the fetus, the newborn, the infant, and the child. In addition, it discusses general indications for and special and practical considerations in the use of hyperbaric oxygen therapy in children.
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Abstract
Hyperbaric oxygen treatment during pregnancy in acute carbon monoxide poisoning. A case report.
Authors:Silverman RK, Montano J:
J Reprod Med 1997 May;42(5):309-11
Department of Obstetrics and Gynecology, State University of New York, Syracuse 13210, USA.
Abstract: BACKGROUND: Carbon monoxide poisoning in pregnancy is a relatively rare occurrence, with potentially serious complications for both mother and fetus. Controversy regarding treatment during pregnancy exists primarily due to the concern for oxygen toxicity in the fetus. However, rapid oxygen dissociation and prolonged clearance of carbon monoxide in the fetal circulation emphasize the importance of adhering to aggressive treatment protocols.
CASE: A 22-year-old employee at an office undergoing repairs on the heating and ventilation systems presented with neurologic symptoms, tachycardia, tachypnea, signs of preterm labor and a carboxyhemoglobin level that was mildly elevated. Fetal monitoring demonstrated a reactive nonstress test with mild to moderate repetitive variable decelerations. The patient underwent hyperbaric oxygen treatment, with complete resolution of her neurologic symptoms, tachycardia and tachypnea as well as fetal variable decelerations. She was additionally treated with intravenous magnesium sulfate tocolysis, with cessation of contractions. The patient subsequently delivered at term; the viable infant had no sequelae of in utero carbon monoxide poisoning.
CONCLUSION: This case supports previously published recommendations for treating acute carbon monoxide poisoning during pregnancy with hyperbaric oxygen. As more cases are gathered, a more widely accepted set of standards can be established.
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Abstract
Acute carbon monoxide intoxication and hyperbaric oxygen in pregnancy.
Authors: Elkharrat D, Raphael JC, Korach JM, Jars-Guincestre MC, Chastang C, Harboun C, Gajdos P
Service de Reanimation Medicale, Hopital Raymond Poincare, Garches, France.
Intensive Care Med 1991;17(5):289-92
Abstract: Modalities of oxygen therapy for pregnant women intoxicated with carbon monoxide (CO) are ill defined. Hyperbaric oxygen (HBO) is presumed to be hazardous to the pregnancy. On the other hand CO entails anoxic injuries in the mother and fetus. We have entered 44 pregnant women who sustained an acute carbon monoxide poisoning at home, into a prospective study in order to assess HBO tolerance. They were treated within 5.3 3.7 h (range: 1-12) of the intoxication with a combination of 2 h of HBO at a pressure of 2 atmospheres absolute (ATA) and 4 h of normobaric oxygen, irrespective of the clinical severity of the intoxication and of the age of pregnancy. Six patients were lost to obstetric follow-up. Only 2 patients sustained a spontaneous abortion: 1 within 12 h and 1 within 15 days of the intoxication. Thirty-four women gave birth to normal newborns. Finally 1 elected to undergo abortion for reasons unrelated to the intoxication and 1 gave birth to a baby with Down's syndrome. There is no evidence that HBO was involved with either abortion of our study. We conclude that HBO may be carried out in pregnant women acutely intoxicated with carbon monoxide.
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Abstract
Should hyperbaric oxygen be used to treat the pregnant patient for acute carbon monoxide poisoning? A case report and literature review
Authors: Van Hoesen KB, Camporesi EM, Moon RE, Hage ML, Piantadosi CA
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710.
JAMA 1989 Feb 17;261(7):1039-43 Erratum in: JAMA 1990 May 23-30;273(20):2750
Abstract: Carbon monoxide (CO) is the leading cause of death due to poisoning. Although uncommon, CO poisoning does occur during pregnancy and can result in fetal mortality and neurological malformations in fetuses who survive to term. Uncertainty arises regarding the use of hyperbaric oxygen (HBO) as a treatment for the pregnant patient because of possible adverse effects on the fetus that could be induced by oxygen at high partial pressures. While the dangers of hyperoxia to the fetus have been demonstrated in animal models, careful review of animal studies and human clinical experience indicates that the short duration of hyperoxic exposure attained during HBO therapy for CO poisoning can be tolerated by the fetus in all stages of pregnancy and reduces the risk of death or deformity to the mother and fetus. A case is presented of acute CO poisoning during pregnancy that was successfully treated with HBO. Recommendations are suggested for the use of HBO during pregnancy.
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Abstract
Hyperbaric oxygen and the pediatric patient: case presentation and technical aspects.
UHMS Gulf Coast Chapter Annual Scientific Meeting conjoint with UHMS Associates & Baromedical Nurses Association, 2000 Oct 12-14; San Antonio, Texas.
Abstract: BACKGROUND: Experience with chronic administration of hyperbaric oxygen therapy to paediatric patients is rare. Many chambers avoid treating the paediatric population due to potential complications of therapy.
MATERIALS AND METHODS: Observation and literature review.
DESCRIPTION OF RESULTS: Treatment of a three year old patient in the chamber required the following special accommodations: Certifying both parents fit to dive, special TcP02 measurement techniques, hood fit, one on one nursing care, valsalva techniques, certification of toys for chamber use, evaluation of potential hazards, and team approach to care. Complications included a minor suction injury, difficulty with descent and objections from other adult occupants.
CONCLUSIONS: Treating paediatric patients with hyperbaric oxygen requires planning of time and resources. A team approach to care is essential. Risks for complications appear no greater than that for adults.
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© Copyright 2007 Hyperbaric Medical Center of New Mexico
The information provided by Hyperbaric Medical Center of New Mexico does not constitute a medical recommendation. It is intended for informational purposes only, and no claims, either real or implied, are being made.
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