DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

CENTER FOR
HYPERBARIC MEDICINE
AND ENVIRONMENTAL
PHYSIOLOGY
Richard E. Moon, M.D.,
C.M., M.Sc., FRCP(C),
FACP, FCCP
Medical Director,
HyperbaricCenter
Professor of Anesthesiologyr
of Anesthesiology
Associate Professor of Medicine
The Center
The Center for Hyperbaric Medicine
and Environmental Physiology is a
multi disciplinary organization involved
in clinical treatment of patients with
hyperbaric oxygen, research into oxygen
biology and environmental physiology
(especially diving and altitude
physiology) and provision of information
and medical services for recreational
divers through the Divers Alert
Network.
The Center for Hyperbaric Medicine
and Environmental Physiology
consists of several components. The
F.G. Hall Environmental Laboratory
contains a seven-chamber 254 cu m
complex with a 5,660 cu m compressed
air storage field, three 3 cu m/min air
compressors, a 2,633 cu m liquid oxygen
system, two vacuum pumps, and
a complete gas mixing facility. These
chambers were designed to simulate
environments ranging from an altitude
of 47,000 m (155,000 feet) to a depth
of 1,100 msw (3,600 feet of sea water).
The chambers are outfitted with environmental
control units, which regulate
temperature, humidity, and CO 2 accumulation.
The facility also incorporates
the capability to conduct studies of
subjects immersed in water. Electrical
penetrators are installed, allowing physiological
monitoring of patients undergoing
treatment, human subjects and
experimental animals inside the chambers.
Studies have been performed in
humans incorporating invasive measurement
of arterial and pulmonary
arterial pressures, transcranial Doppler
blood velocity, precordial Doppler
monitoring for vascular bubbles and
in vivo near infrared spectroscopy of
tissue oxygenation. In addition to the
chambers, a human physiology laboratory
is available for human studies at
1 ATA. An electronics shop and
machine shop provide in-house design
and construction facilities.
The Oxygen Transport Laboratory
has facilities for studies of whole animal
and tissues. It incorporates an operating
room and facilities capable of maintaining
anesthetized animals under continuous
monitoring for several days.
It is equipped with an environmental
exposure facility, biochemistry and
molecular biology laboratories and
microscopy and darkroom facilities.
The Divers Alert Network (DAN) is
an organization devoted to promotion
of recreational diving safety via accident
and mortality data collection, research
and education. In addition DAN
provides a 24-hour phone consultation
service for diving accidents (see below).
Clinical Activities
Twenty-four hour coverage is provided
for hyperbaric emergencies and elective
treatment of patients with hyperbaric
oxygen. The call team consists of an
intern, resident or fellow, an attending
physician, a nurse and a chamber operator.
The call schedule also includes
“hotline” coverage of emergency diving
calls from throughout the world.
CLINICAL ACTIVITIES
A total of 200 new patients were evaluated
for hyperbaric therapy in 2000
(6,721 treatment hours). There were an
additional 48 patients evaluated but
who did not receive treatment, including
fitness-to-dive consults and patients
with various wounds for whom hyperbaric
oxygen therapy was not recommended.
New patients included 28
patients with decompression sickness, 5
with air embolism, 29 with carbon
monoxide poisoning and 18 with necrotizing
soft tissue infections. There were
95 emergency hyperbaric treatments.
In addition, 7 therapeutic lung lavages
for patients with pulmonary alveolar
proteinosis were carried out under general
anesthesia inside “C” chamber to.
For this procedure hyperbaric oxygen
provides a convenient mechanism for
treatment of hypoxemia. Non-emergency
conditions treated included
refractory osteomyelitis, threatened
flaps, radiation necrosis and selected
ischemic problem wounds. The service
relies heavily on a computerized database,
designed and maintained by Dr.
Guy Dear, accessible from anywhere
within the Medical Center. All clinical
notes are computer-generated and
accessible via the Duke hospital-wide
computer system.
The following physicians participated
in clinical activities in the
Hyperbaric Center in 2000:
Martha Sue Carraway, M.D.
Department of Medicine
Guy deLisle Dear, M.B., FRCA
Department of Anesthesiology
Richard E. Moon, M.D., C.M., M.Sc.,
FRCP(C), FACP, FCCP
Departments of Anesthesiology and
Medicine, Medical Director
Claude A. Piantadosi, M.D.
Departments of Medicine and
Anesthesiology, Center Director
Bryant W. Stolp, M.D., Ph.D.
Department of Anesthesiology
Edward D. Thalmann, M.D.
Department of Anesthesiology
Since 1986 there have been 14 clinical
fellows in Hyperbaric Medicine.
The training, which has been up to two
CLINICAL ACTIVITIES 55