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KN2-8 33 Davis JC, Heckman JD, DeLee JC, et al. Chronic nonhematogenous osteomyelitis treated with adjuvant hyperbaric oxygen . J Bone Joint Surg 1986; 68A: 1210-17. 34 Mader JT, Admas KR, Wallace WR, et al. Hyperbaric oxygen as adjunctive therapy for osteomyelitis. Infect Dis Clin North Am 1990; 4: 433-440. 35 Depenbusch FL, Thompson RE Hart GB. Use of hyperbaric oxygen in the treatment of refractory osteomyelitis: A preliminary report. J Trauma 1972; 12: 807-812. 36 Bjerknes R, Neslein IL, Myhre K Impairment of rat polymorphonuclear neutrophilic granulocyte phagocytosis following repeated hypobaric hypoxia. Aviat Space Environ Med 1990 Nov;61(11):1007-11. 37 Knighton DR, Halliday B Hunt TK: Oxygen as an antibiotic: a comparison of the effects of inspired oxygen concentration and antibiotic administration on in vivo bacterial clearance. Arch Surg 1986;121: 191-195. 38 Reenstra WR, Buras JA, Svoboda KS. Hyperbaric Oxygen increases human dermal fibroblast expression or EGF-receptors. Undersea Hyper Med 1998 25:54. 39 Bonomo, SR, Davidson, JD, Yu, Y,Xia, Y, Lin, X, Mustoe, TA. Hyperbaric oxygen as a signal transducer: upregulation of platelet derived growth factor-beta receptor in the presence of HBO2 and PDGF. Undersea Hyperb Med 1998 Winter;25(4):211-6. 40 Siddiqui A, Davidson JD, Mustoe TA Ischemic tissue oxygen capacitance after hyperbaric oxygen therapy: a new physiologic concept.. Plast Reconstr Surg 1997 Jan;99(1):148-55 41 Reenstra WR, Buras JA, Svoboda KS. Hyperbaric Oxygen increases human dermal fibroblastic proliferation growth factor receptor number and in vitro wound closure. Undersea Hyper Med 1998 25:53. 42 Sheffied PJ. Measuring tissue oxygen tension: a review. Undersea Hyper Med 1998; 25(3): 179-188. 43 Padberg FT, Back TL, Thompson PN, et al. Transcutaneous oxygen (TcPO2) estimates probability of healing in the ischemic extremity. J Surg Research 1996; 60(2): 365-369. 44 Mars M, Mills RP, Robbs JV. The potential benefit of pre-operative assessment of amputation wound healing potential in peripheral vascular disease. S Afr Med J 1993 Jan;83(1):16-8. 45 Nemiroff PM, Lungu AL. The influence of hyperbaric oxygen and irradiation on vascularity in skin flaps: A controlled study. Surg Forum 1987; 38: 565-567. 46 Manson PN, Im MJ, Myers RA, et al. Improved capillaries by hyperbaric oxygen in skin flaps. Surg Forum 1980; 31: 564-66. 47 Meltzer T, Myers B. The effect of hyperbaric oxygen on the bursting strength and rate of vascularization of skin wounds in rats. Am Surg 1986; 52: 659-62. 48 Wong HP, Zambonis WA, Stephenson LL. Effect of hyperbaric oxygen on skeletal muscle necrosis following primary and secondary ischemia in a rat model. Surg Forum 1996; 47: 705-07. 49 Bowersox JC, Strauss MB, Hart GB. Clinical experience with hyperbaric oxygen therapy in the salvage of ischemic skin flaps and grafts . J Hyperbaric Med 1986; 1:141-49. 50 Champion WM, McSherry CK, Goulian D. Effect of hyperbaric oxygen on survival of pedicled skin flaps. J Surg Res 1967; 7: 583-586. 51 Perrins DJD, Cantab MB. Influence of hyperbaric oxygen on the survival of split skin grafts. Lancet 1967; 1:868-871. 52 Stevens DM, Weiss DD, Koller WA, et al Survival of normothermic microvascular flaps after prolonged secondary ischemia: effects of hyperbaric oxygen. Otolaryngol Head Neck Surg 1996;115(4):360-4. 53 Yamashita, M., Yamashita, M. (2000). Hyperbaric oxygen treatment attenuates cytokine induction after massive hemorrhage. Am. J. Physiol. 278: 811-816. 54 Luongo C, Imperatore F, Cuzzocrea S, et al. Effects of hyperbaric oxygen exposure on a zymosan-induced shock model. Crit Care Med 1998; 26:1972-1976. 55 Cianci P, Lueders HW, Lee H, et al. Adjunctive hyperbaric oxygen therapy reduces length of hospitalization in thermal burns. J Burn Care Rehabil 1989; 10: 432-435. 56 Cianci P, Williams C, Lee H, et al. Adjunctive hyperbaric oxygen in the treatment of thermal burns – an economic analysis. J Burn Care Rehabil 1990; 11: 140-43. 57 Brannen AL, Still J, Haynes M, et al. A randomized prospective trial of hyperbaric oxygen in a referral burn center population. Am Surg 1997; 63: 205-208.
USAF Experience with Hyperbaric Therapy of Altitude Decompression Sickness (1941-1999) William P. Butler, MD, MTM&H, FACS Colonel, USAF, MC, SFS USAFSAM/GE 2602 West Gate Road Brooks AFB, Texas 78235, USA & E. George Wolf, Jr, Colonel (retired) Larry P. Krock, PhD Introduction Davis Hyperbaric Laboratory/USAFSAM 2602 West Gate Road Brooks AFB, Texas 78235, USA Decompression sickness (DCS) is characterized by a plethora of protean symptoms. It can range from mildly annoying to life threatening. Its etiology is tissue and/or vascular bubbles. Indeed, decompression sickness has been a recognized disease since its first report by Triger in 1841. (10) First noted in construction workers laboring in pressurized caissons and later in diving operations, decompression sickness was not even postulated in aviation until 1901 by von Schrotter. (8) Later (1917), Henderson popularized the concept. (11) Over the next forty years some 17,000 cases of altitude DCS were described. At least 743 were considered serious and at least seventeen were fatal. (6) However, altitude decompression sickness was not treated with recompression until Behnke employed it in 1941. (6) Despite his apparent success, supportive care remained the standard. Then, in 1959, under the most extreme of clinical circumstances (DCS shock), Donnell and Norton essentially plucked an aviator from the brink of death with recompression. Thirty-eight hours after entering the chamber the pilot emerged symptom free. (7) This spectacular success launched the research underpinning today’s treatment regimen for altitude decompression sickness. Indeed, this paper describes the USAF treatment effort over the last fifty-eight years. Paper presented at the RTO HFM Symposium on “Operational Medical Issues in Hypo- and Hyperbaric Conditions”, held in Toronto, Canada, 16-19 October 2000, and published in RTO MP-062. 1-1
Page 1 and 2: RTO-MP-062 NORTH ATLANTIC TREATY OR
Page 3 and 4: NORTH ATLANTIC TREATY ORGANIZATION
Page 5 and 6: Operational Medical Issues in Hypo-
Page 7 and 8: Contents Executive Summary iii Synt
Page 9 and 10: Respiratory Changes and Consequence
Page 11 and 12: Introduction Technical Evaluation R
Page 13 and 14: In addition to cabin pressurisation
Page 15 and 16: critical. The so-called technical d
Page 17 and 18: levator veli palatini, like when sw
Page 19 and 20: Present and Future Compromises in A
Page 21 and 22: KN1-3 (RGE) as the safety criterion
Page 23 and 24: Pulmonary Barotrauma KN1-5 Free ven
Page 25 and 26: KN1-7 Future fighter aircraft may w
Page 27 and 28: KN1-9 Figure 1 Cabin Pressurisation
Page 29 and 30: KN1-11 Figure 3 The relationships b
Page 31 and 32: +\SHUEDULF 2[\JHQ $ 6FLHQWLILF 8SGD
Page 33 and 34: KN2-3 recovers spontaneously withou
Page 35 and 36: KN2-5 Hg or less. The attendant hyp
Page 37: KN2-7 8 Tompach PC, Lew D, Stoll JL
Page 41 and 42: Exposure Results and Discussion The
Page 43 and 44: Symptomotology Symptom presentation
Page 45 and 46: Air Force Altitude DCS Treatment Al
Page 47 and 48: References 1. Atlas of Injuries in
Page 49 and 50: Headache and Decompression Sickness
Page 51 and 52: Numerous studies have been done to
Page 53 and 54: 8. Madeline LA and Elster AD. Sutur
Page 55 and 56: Figure 2. Sutural Movement with Spi
Page 57 and 58: Patent Foramen Ovale as a Risk Fact
Page 59 and 60: 90 minutes prior to the start of th
Page 61 and 62: The Relevance of Patent Foramen Ova
Page 63 and 64: In a human population, Glen et al (
Page 65 and 66: Studies evaluating PFO detection me
Page 67 and 68: References 1. O’Rahilly, R., Mull
Page 69 and 70: 55. Giroud, M., Tatou, E., Steinmet
Page 71 and 72: Introduction Altitude DCS Susceptib
Page 73 and 74: Cumulative DCS Incidence, % 100 90
Page 75 and 76: Pharmacological Correction of the H
Page 77 and 78: metabolic regulation remedies [A.S.
Page 79 and 80: asis of these indicators there were
Page 81 and 82: liquidation of energetic debt in mu
Page 83 and 84: Analysis of correlation structures
Page 85 and 86: Interesting data on bemithylum pres
Page 87 and 88: to high altitude hypoxia and allows
Page 89 and 90:
35. Shanazarov, A.S., Ryskulova, G.
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Prognozing of the Resistance to Hyp
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autonomic cardiac control whereas i
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METHOD Subjects 21 male military pi
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mean R-R interval (X), STV, LTV (ms
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• Significant negative correlatio
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DISCUSSION Hypoxic Tolerance Our re
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8. Casa M., Casa H., Pages T., Rama
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66. Sheffield P., Heimbach R. Respi
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Abstract Alternobaric Vertigo: Inci
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12. Nagai H. et al. Effect of incre
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Neuropsychometric Test in Royal Net
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Table 4 Results of neuropsychometri
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Summary: Spanish Navy Up to Date Da
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Hypobaric Training for Royal Air Fo
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c. Fast jet high level. Climb to 18
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Introduction Hypobaric Training Iss
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To be able to tolerate breathing pr
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during the change in ambient pressu
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Designing Efficient and Effective,
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The Type II profile involves positi
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Pressurized, Cabin below 10,000 ft
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than 10 minutes at a hypoxia level
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Military Personnel Selection and Di
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expressed by them, are closely inte
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of shortage of blood circulation fu
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The results of the conducted resear
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15-9
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15-11
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In norm there is A > B, and the reg
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Burger, M., 1921, Uber der klinisch
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In: Sbornik nauchno-prakticheskih r
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Templeton, A.W., 1965, Renal Aortog
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Some Psycho-Physiological and Cogni
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Testing in hypobaric chamber condit
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supply immediately recovered. Subje
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The Role of PWC in Declaring a Dive
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Out of 1200 ergometric examinations
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Application of Hypo and Hyperbaric
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evaluation of mountain-climber's hy
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Figure 2 % oxyhemoglobin saturation
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The Effects of Normobaric Hypoxia i
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Memory Scanning Task: Cadets with p
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The statistical analysis of the beh
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ACKNOWLEDGMENTS The authors wish to
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Severe Decompression Illness Follow
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In this set of studies, observation
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pulmonary oedema, a diuretic may be
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Decompression Sickness Research: Ne
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Figure 3. Pigs treated with methano
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Abstract Using “Technical Diving
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ecreational diving training agencie
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After the intermediate or “deco
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include paresthesia, headache, dizz
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practice. Some dives were conducted
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Abstract Into the Theater of Operat
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Procedures: The FCT evaluation init
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The matrix of tests conducted, some
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6. Kennedy, T. Concept of Operation
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The Relevance of Hyperbaric Oxygen
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In reperfusion injury, HBO diminish
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HBO has long been known to favorabl
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3-Nitrotyrosine Predicts Healing in
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corresponded respectively to the si
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that in these diabetic subjects, ne
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Summary Role of a Clinical Hyperbar
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Benefits to the Defence Secondary C
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The study has been deferred due to
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ABSTRACT Incidence of Decompression
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Table 1: Number of Diving Incidents
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Introduction Evaluation of Treatmen
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Table 6A (CF TT6A, initial recompre
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INTRODUCTION Modelling and Validati
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moved to the treatment chamber. Fiv
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Figure 3 The predicted gas in bubbl
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Table 5 shows the same information
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CONCLUSIONS Although it would have
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Respiratory Changes and Consequence
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Table 2 Inspired-expired oxygen dif
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Figure 2 Respiratory patterns, expe
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Apnoea is characteristic of herniat
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Effect of Exercise on Bubble Activi
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The KISS is an index derived from i
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DISCUSSION: In all group comparison
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Thermography - A Method for the Eva
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level atmospheric pressure O2 parti
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lower extremities cephalic extremit
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1-st group - flying crews We divide
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ABSTRACT Altitude Decompression Sic
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Table 1. Results of validation Prof
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Summary Altitude Decompression Illn
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17 oxygen demand regulator with a p
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During these altitude exposures a n
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Subject Number Subject Number Subje
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that this discrepancy in the incide
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Extrapolation of the data presented
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MITCHELL SJ & LEE VM. (2000) A surv
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Expression of Neuronal and Inducibl
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Experimental procedures Groups of 1
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immunoreactive Purkinje cells were
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Western blotting Cerebral cortical
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certain proteins as substrates for
Page 293 and 294:
Griffiths, T., Evans, M.C. and Meld
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Simon, R.P., Griffiths, T., Evans,
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RESUME Intérêt du caisson d’alt
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3. TYMPANOMETRIE La tympanométrie
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quelconque douleur. Dans ce cas, il
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Altitude DCS Research in Support of
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Altitude, feet X 1000 30 25 20 15 1
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2. POST-LANDING EXERCISE AND RISK O
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addition to observed or reported DC
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% DCS 100 80 60 40 20 0 25,000 30,0
Page 313 and 314:
Modeling Approach for Oxygen Exchan
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The first equation states that the
Page 317 and 318:
may cause the remaining discrepanci
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0 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 F
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Sa (%) Pa (mmHg) 100 80 60 40 V’E
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Sa (%) Pa (mmHg) V’E (L/min) 100
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Changes of Ventilator Generated Vol
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Emergency descent : Oxylog 2000 : C
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&DELQ $OWLWXGH IHHW Table 6 &DELQ D
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The Effect of Increased Full Covera
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assembly incorporating FCAGTs infla
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Following garment fitting, subjects
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Mean CBV (cm/s) 70 60 50 40 30 20 1
Page 339 and 340:
Alveolar Carbon Dioxide Tension Alv
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Phase 2 All experimental exposures
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Diffusion coefficient for carbon mo
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Mean arterial pressure (mmHg) 140 1
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In previous studies (Ernsting, 1966
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Determination of the Most Effective
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Decompression Sickness, Extravehicu
Page 353 and 354:
As a corollary, what about the alle
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Introduction Optimizing Denitrogena
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Cumulative % DCS 100 90 80 70 60 50
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Benefit of Acclimatization to Moder
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. Following completion of the quest
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Discussion This study demonstrated
Page 365 and 366:
12. White, D.P., K. Gleeson, C.K. P
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Introduction: Physiological and Cli
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The steepness of hypoxia-induced de
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RESUME Évaluation d’équipements
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2.1. Règlement TSO-C99 Le règleme
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autre personne s’assure que, sans
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Il est équipé de l’équipement
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REPORT DOCUMENTATION PAGE 1. Recipi
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NORTH ATLANTIC TREATY ORGANIZATION
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