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Hyperbaric oxygen in the critically ill

Section Editor(s): Sevransky, Jonathan E. MD, MHSWeaver, Lindell K. MD, FACP, FCCP, FCCM

doi: 10.1097/CCM.0b013e31821858d1
Concise Definitive Review

Objective: To review aspects of hyperbaric medicine pertinent to treating critically ill patients with hyperbaric oxygen in both monoplace and multiplace chambers.

Data Sources: Literature review of online databases, research repositories, and clinical trial registries.

Results: The search of these resources produced information regarding technical considerations, feasibility, risk, and patient management. Hyperbaric oxygen is used in treating a number of disorders that occur in critically ill patients, including acute carbon monoxide poisoning, arterial gas embolism, severe decompression sickness, clostridial gas gangrene, necrotizing fasciitis, and acute crush injury. Most chambers in the United States treat outpatients with problem nonhealing wounds, and many chambers are not hospital-based. Only a few hyperbaric medicine centers have intensive care unit-level staffing, specialized equipment, a 24/7 schedule, and experience in treating critically ill patients. Not all intensive care unit-related equipment can be subjected to hyperbaric pressurization, and some equipment may increase the risk for fire inside the chamber.

Conclusions: Treating critically ill patients with hyperbaric oxygen requires specialized equipment and personnel with intensive care unit skills and knowledge of the physiology and risks unique to hyperbaric oxygen exposure. Like with all medical interventions, it is important to consider the risk vs. the benefit of hyperbaric oxygen for any given critical care disorder, but hyperbaric oxygen can be delivered safely to critically ill patients. Many critical care environments without present hyperbaric oxygen capability may wish to consider offering hyperbaric oxygen to patients with hyperbaric oxygen-approved indications.

From Hyperbaric Medicine, LDS Hospital, Salt Lake City, UT, Intermountain Medical Center, Murray, UT; and the Department Medicine, University of Utah School of Medicine, Salt Lake City, UT.

This work was supported by Intermountain Healthcare, Inc, a nonprofit system of hospitals and clinics.

The author has not disclosed any potential conflicts of interest.

This work was performed at LDS Hospital, Salt Lake City, UT; and Intermountain Medical Center, Murray, UT.

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© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins