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Jornal Brasileiro de Pneumologia :... Jul 2019
Topics: Adult; Barotrauma; Cocaine-Related Disorders; Humans; Male; Mediastinal Emphysema; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 31365685
DOI: 10.1590/1806-3713/e20190169 -
Critical Care Clinics Oct 2019Anthropogenic disasters may be defined as any disaster caused by human action or inaction. Natural disasters occur without human interference. Injuries caused by... (Review)
Review
Anthropogenic disasters may be defined as any disaster caused by human action or inaction. Natural disasters occur without human interference. Injuries caused by terrorists and related criminal activities may be broadly grouped into 3 categories: blunt, blast, and penetrating trauma. Most terrorist and criminal activities that create a mass-casualty situation are performed using the weapons most readily available, such as firearms or explosives. A consistent pattern, comparing terrorism with interpersonal violence, is the greater severity of impact on the victim.
Topics: Blast Injuries; Critical Care; Disaster Planning; Disasters; Humans; Mass Casualty Incidents; Terrorism; Violence; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 31445611
DOI: 10.1016/j.ccc.2019.06.002 -
Medicina (Kaunas, Lithuania) Jan 2022Dysbarism is a general term which includes the signs and symptoms that can manifest when the body is subject to an increase or a decrease in the atmospheric pressure... (Review)
Review
Dysbarism is a general term which includes the signs and symptoms that can manifest when the body is subject to an increase or a decrease in the atmospheric pressure which occurs either at a rate or duration exceeding the capacity of the body to adapt safely. In the following review, we take dysbarisms into account for our analysis. Starting from the underlying physical laws, we will deal with the pathologies that can develop in the most frequently affected areas of the body, as the atmospheric pressure varies when acclimatization fails. Manifestations of dysbarism range from itching and minor pain to neurological symptoms, cardiac collapse, and death. Overall, four clinical pictures can occur: decompression illness, barotrauma, inert gas narcosis, and oxygen toxicity. We will then review the clinical manifestations and illustrate some hints of therapy. We will first introduce the two forms of decompression sickness. In the next part, we will review the barotrauma, compression, and decompression. The last three parts will be dedicated to gas embolism, inert gas narcosis, and oxygen toxicity. Such an approach is critical for the effective treatment of patients in a hostile environment, or treatment in the emergency room after exposure to extreme physical or environmental factors.
Topics: Barotrauma; Decompression Sickness; Embolism, Air; Humans; Hyperbaric Oxygenation
PubMed: 35056412
DOI: 10.3390/medicina58010104 -
Aerospace Medicine and Human Performance Nov 2022Altitude chambers are used for training aircrews in a hypobaric hypoxic environment to better prepare them for pressurization and oxygen malfunction incidents during... (Review)
Review
Altitude chambers are used for training aircrews in a hypobaric hypoxic environment to better prepare them for pressurization and oxygen malfunction incidents during flights. However, adverse effects may occur during training sessions, with decompression sickness (DCS) being a major concern. The aim of this study was to examine the risks of different adverse effects during altitude chamber trainings (ACT) in the Israeli Air Force (IAF) facility and to compare them to other training facilities. We retrospectively reviewed the records of 1627 individuals in the IAF who were trained in the altitude chamber between 2015 and 2019. Data regarding adverse effects and training safety were extracted. Literature review of altitude chamber trainings was performed and adverse effects rates were compared. There were a total of 91 adverse effects cases in the IAF during the study period. The overall risk rate for an adverse effect was 5.59%. The most common adverse effect was middle ear and sinus barotrauma (69.3% of adverse effects cases), followed by breathing problems (14.3%) and DCS cases (9.9%). Mitigating the risk for DCS should be major concern during ACT. We recommend setting a standard protocol for an ACT which includes a 45-min preoxygenation period, a maximal ascent rate of 3000 ft · min (914 m · min), and setting a maximum altitude of 25,000 ft (7620 m) for fixed-wing trainees.
Topics: Humans; Aerospace Medicine; Decompression Sickness; Altitude; Retrospective Studies; Barotrauma
PubMed: 36309795
DOI: 10.3357/AMHP.6048.2022 -
Journal Francais D'ophtalmologie Jun 2021
Topics: Blast Injuries; Humans; Retina
PubMed: 33622548
DOI: 10.1016/j.jfo.2020.09.018 -
Internal and Emergency Medicine Oct 2021
Topics: Barotrauma; Diving; Humans; Male; Middle Aged; Treatment Outcome
PubMed: 33765301
DOI: 10.1007/s11739-021-02709-9 -
The Journal of the Acoustical Society... Nov 2019Blast-induced tinnitus is a prevalent problem among military personnel and veterans, as blast-related trauma damages the vulnerable microstructures within the cochlea,... (Review)
Review
Blast-induced tinnitus is a prevalent problem among military personnel and veterans, as blast-related trauma damages the vulnerable microstructures within the cochlea, impacts auditory and non-auditory brain structures, and causes tinnitus and other disorders. Thus far, there is no effective treatment of blast-induced tinnitus due to an incomplete understanding of its underlying mechanisms, necessitating development of reliable animal models. This article focuses on recent animal studies using behavioral, electrophysiological, imaging, and pharmacological tools. The mechanisms underlying blast-induced tinnitus are largely similar to those underlying noise-induced tinnitus: increased spontaneous firing rates, bursting, and neurosynchrony, Mn++ accumulation, and elevated excitatory synaptic transmission. The differences mainly lie in the data variability and time course. Noise trauma-induced tinnitus mainly originates from direct peripheral deafferentation at the cochlea, and its etiology subsequently develops along the ascending auditory pathways. Blast trauma-induced tinnitus, on the other hand, results from simultaneous impact on both the peripheral and central auditory systems, and the resultant maladaptive neuroplasticity may also be related to the additional traumatic brain injury. Consequently, the neural correlates of blast-induced tinnitus have different time courses and less uniform manifestations of its neural correlates.
Topics: Acoustic Stimulation; Animals; Behavior, Animal; Blast Injuries; Connectome; Disease Models, Animal; Evoked Potentials, Auditory; Tinnitus
PubMed: 31795642
DOI: 10.1121/1.5132551 -
The Cochrane Database of Systematic... Mar 2021High-flow nasal cannulae (HFNC) deliver high flows of blended humidified air and oxygen via wide-bore nasal cannulae and may be useful in providing respiratory support... (Meta-Analysis)
Meta-Analysis
BACKGROUND
High-flow nasal cannulae (HFNC) deliver high flows of blended humidified air and oxygen via wide-bore nasal cannulae and may be useful in providing respiratory support for adults experiencing acute respiratory failure, or at risk of acute respiratory failure, in the intensive care unit (ICU). This is an update of an earlier version of the review.
OBJECTIVES
To assess the effectiveness of HFNC compared to standard oxygen therapy, or non-invasive ventilation (NIV) or non-invasive positive pressure ventilation (NIPPV), for respiratory support in adults in the ICU.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane COVID-19 Register (17 April 2020), clinical trial registers (6 April 2020) and conducted forward and backward citation searches.
SELECTION CRITERIA
We included randomized controlled studies (RCTs) with a parallel-group or cross-over design comparing HFNC use versus other types of non-invasive respiratory support (standard oxygen therapy via nasal cannulae or mask; or NIV or NIPPV which included continuous positive airway pressure and bilevel positive airway pressure) in adults admitted to the ICU.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures as expected by Cochrane.
MAIN RESULTS
We included 31 studies (22 parallel-group and nine cross-over designs) with 5136 participants; this update included 20 new studies. Twenty-one studies compared HFNC with standard oxygen therapy, and 13 compared HFNC with NIV or NIPPV; three studies included both comparisons. We found 51 ongoing studies (estimated 12,807 participants), and 19 studies awaiting classification for which we could not ascertain study eligibility information. In 18 studies, treatment was initiated after extubation. In the remaining studies, participants were not previously mechanically ventilated. HFNC versus standard oxygen therapy HFNC may lead to less treatment failure as indicated by escalation to alternative types of oxygen therapy (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.45 to 0.86; 15 studies, 3044 participants; low-certainty evidence). HFNC probably makes little or no difference in mortality when compared with standard oxygen therapy (RR 0.96, 95% CI 0.82 to 1.11; 11 studies, 2673 participants; moderate-certainty evidence). HFNC probably results in little or no difference to cases of pneumonia (RR 0.72, 95% CI 0.48 to 1.09; 4 studies, 1057 participants; moderate-certainty evidence), and we were uncertain of its effect on nasal mucosa or skin trauma (RR 3.66, 95% CI 0.43 to 31.48; 2 studies, 617 participants; very low-certainty evidence). We found low-certainty evidence that HFNC may make little or no difference to the length of ICU stay according to the type of respiratory support used (MD 0.12 days, 95% CI -0.03 to 0.27; 7 studies, 1014 participants). We are uncertain whether HFNC made any difference to the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO/FiO) within 24 hours of treatment (MD 10.34 mmHg, 95% CI -17.31 to 38; 5 studies, 600 participants; very low-certainty evidence). We are uncertain whether HFNC made any difference to short-term comfort (MD 0.31, 95% CI -0.60 to 1.22; 4 studies, 662 participants, very low-certainty evidence), or to long-term comfort (MD 0.59, 95% CI -2.29 to 3.47; 2 studies, 445 participants, very low-certainty evidence). HFNC versus NIV or NIPPV We found no evidence of a difference between groups in treatment failure when HFNC were used post-extubation or without prior use of mechanical ventilation (RR 0.98, 95% CI 0.78 to 1.22; 5 studies, 1758 participants; low-certainty evidence), or in-hospital mortality (RR 0.92, 95% CI 0.64 to 1.31; 5 studies, 1758 participants; low-certainty evidence). We are very uncertain about the effect of using HFNC on incidence of pneumonia (RR 0.51, 95% CI 0.17 to 1.52; 3 studies, 1750 participants; very low-certainty evidence), and HFNC may result in little or no difference to barotrauma (RR 1.15, 95% CI 0.42 to 3.14; 1 study, 830 participants; low-certainty evidence). HFNC may make little or no difference to the length of ICU stay (MD -0.72 days, 95% CI -2.85 to 1.42; 2 studies, 246 participants; low-certainty evidence). The ratio of PaO/FiO may be lower up to 24 hours with HFNC use (MD -58.10 mmHg, 95% CI -71.68 to -44.51; 3 studies, 1086 participants; low-certainty evidence). We are uncertain whether HFNC improved short-term comfort when measured using comfort scores (MD 1.33, 95% CI 0.74 to 1.92; 2 studies, 258 participants) and responses to questionnaires (RR 1.30, 95% CI 1.10 to 1.53; 1 study, 168 participants); evidence for short-term comfort was very low certainty. No studies reported on nasal mucosa or skin trauma.
AUTHORS' CONCLUSIONS
HFNC may lead to less treatment failure when compared to standard oxygen therapy, but probably makes little or no difference to treatment failure when compared to NIV or NIPPV. For most other review outcomes, we found no evidence of a difference in effect. However, the evidence was often of low or very low certainty. We found a large number of ongoing studies; including these in future updates could increase the certainty or may alter the direction of these effects.
Topics: Acute Disease; Adult; Barotrauma; Bias; Critical Care; Hospital Mortality; Humans; Intubation; Length of Stay; Masks; Nasal Mucosa; Noninvasive Ventilation; Oxygen Inhalation Therapy; Patient Reported Outcome Measures; Pneumonia; Randomized Controlled Trials as Topic; Respiration, Artificial; Respiratory Insufficiency; Treatment Failure
PubMed: 33661521
DOI: 10.1002/14651858.CD010172.pub3 -
Heart (British Cardiac Society) Jun 2022As the popularity of scuba diving increases internationally, physicians interacting with divers in the clinical setting must be familiar with the cardiovascular stresses... (Review)
Review
As the popularity of scuba diving increases internationally, physicians interacting with divers in the clinical setting must be familiar with the cardiovascular stresses and risks inherent to this activity. Scuba presents a formidable cardiovascular challenge by combining unique environmental conditions with the physiologic demands of underwater exercise. Haemodynamic stresses encountered at depth include increased hydrostatic pressure leading to central shifts in plasma volume coupled with cold water stimuli leading to simultaneous parasympathetic and sympathetic autonomic responses. Among older divers and those with underlying cardiovascular risk factors, these physiologic changes increase acute cardiac risks while diving. Additional scuba risks, as a consequence of physical gas laws, include arterial gas emboli and decompression sickness. These pathologies are particularly dangerous with altered sensorium in hostile dive conditions. When present, the appropriate management of patent foramen ovale (PFO) is uncertain, but closure of PFO may reduce the risk of paradoxical gas embolism in divers with a prior history of decompression sickness. Finally, similar to other Masters-level athletes, divers with underlying traditional cardiovascular risk should undergo complete cardiac risk stratification to determine 'fitness-to-dive'. The presence of undertreated coronary artery disease, occult cardiomyopathy, channelopathy and arrhythmias must all be investigated and appropriately treated in order to ensure diver safety. A patient-centred approach facilitating shared decision-making between divers and experienced practitioners should be utilised in the management of prospective scuba divers.
Topics: Decompression Sickness; Diving; Embolism, Paradoxical; Foramen Ovale, Patent; Humans; Prospective Studies
PubMed: 34670825
DOI: 10.1136/heartjnl-2021-319601 -
Undersea & Hyperbaric Medicine :... 2022Divers are regularly exposed to a unique and changing environment that dentists must consider when treating such patients. This review focuses around two case studies... (Review)
Review
Divers are regularly exposed to a unique and changing environment that dentists must consider when treating such patients. This review focuses around two case studies encountered in naval dentistry: (i) diving barotrauma (pressure-induced injury related to an air space); and (ii) scuba diving mouthpiece-related oral conditions. Each condition is described by its effect on the oral cavity and in particular the teeth. Then we generally review the latest literature on the different effects of scuba diving on the diver's head, face and oral regions and emphasize methods of dental disease prevention, diagnostic tools and treatment guidelines.
Topics: Barotrauma; Diving; Humans; Military Dentistry
PubMed: 36001570
DOI: 10.22462/05.06.2022.11