engleski

The role of hyperbaric oxygen therapy in blunt thoracic trauma

BACKGROUND: Hyperbaric oxygen therapy (HBOT) is a way of improving outcomes of conditions and diseases by delivering pure oxygen at greater than atmospheric pressure, and is a primary treatment for decompression disease and air embolism. Blunt trauma to the thorax (BTT) causing cardiac arrest carries a high mortality rate. The increased chances of lung contusion and myocardial depression after BTT, significantly increase the risk of acute respiratory distress syndrome (ARDS) development, which has a fatality rate of 50-75%. Previously, it was documented that survivors had higher concentrations and consumption rates of oxygen. Despite the earlier demonstrated increased survival rates after HBOT exposure in various experimental models of ARDS and BTT, further research has not been conducted. METHODS AND MATERIALS: This is a systematic review article and the pubmed database was primarily used. Using the keywords hyperbaric oxygen therapy and blunt thoracic trauma, two articles were obtained. RESULTS: In 1976, Filipov S. et al., found that HBOT significantly improved the arterial blood oxygen saturation in experimental BTT models. This reduced and/or prevented the development of morphologic changes associated with hypoxia in the early post-trauma period. Recently, Rogatsky G.G. et al., demonstrated a zero percent fatality rate among HBOT treated patients who developed ARDS after severe BTT, and a 77% fatality rate in those treated with conventional methods only. The group treated with HBOT had significantly higher cardiac stroke volume indices (SVI) and PaO2/FiO2 ratios, with p being less than 0.001, in the period when rapid and lethal deteriorating cardiorespiratory parameters developed in the non-survivors. In the initial 24 hours from the moment of trauma, there was a reduction in the mean values of all parameters in all groups. DISCUSSION AND CONCLUSION: Rogatsky G.G. et al. demonstrated that ARDS formation was dependent on both cardiac and pulmonary gas exchange dysfunction following BTT. The highly significant statistical increase in both SVI and PaO2/FiO2 and lack of mortality in the HBOT treated group, suggests that this is the preferred adjuvant therapy for severe blunt thoracic trauma patients. Initially, if cardiac arrest is present, immediate resuscitative field thoracotomy with supportive measures such as the management of hypothermia, coagulopathy, acidosis, and head trauma in the field should be carried out. Any potential pneumothorax, a major contraindication to HBOT, would be eliminated by this method, also. In addition, HBOT should be applied as soon as possible after trauma, to improve the pulmonary and cardiac function before ARDS develops. Other benefits of HBOT in BTT are the recompression of air embolisms, prevention of brain anoxia and ischemic reperfusion injury, increased rates of ROSC return after prolonged hypoxia, and enhanced bone healing. Nature has decreed that proper oxygen concentrations must be present in tissues in order for healing to take place, and oxygen is one of the most essential components of the body’s energy production and construction. The research of HBOT’s role in BTT should be expanded.

hyperbaric oxygen therapy, acute respiratory distress syndrome, blunt, trauma, thorax, stroke volume index, PaO2/FiO2 ratio

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