Efficacy and safety of hyperbaric oxygen treatment to treat COVID-19 pneumonia: a living systematic review update

Sylvain Boet, Cole Etherington, Nibras Ghanmi, Paul Ioudovski, Andrea C Tricco, Lindsey Sikora, Rita Katznelson

Appendix 1. Search Strategies

Ovid MEDLINE(R)
  1. coronavirus/ or betacoronavirus/ or coronavirus infections/ 
  2. (nCoV* or 2019nCoV or 19nCoV or COVID19* or COVID-19* or COVID or SARS-COV-2 or SARSCOV-2 or SARSCOV2 or Severe Acute Respiratory Syndrome Coronavirus 2 or Severe Acute Respiratory Syndrome Corona Virus 2).ti,ab,kf,nm,ot,ox,rx,px.      
  3. ((new or novel or "19" or "2019" or Wuhan or Hubei or China or Chinese) adj3 (coronavirus* or corona virus* or betacoronavirus* or CoV or HCoV)).ti,ab,kf,ot.   
  4. ((coronavirus* or corona virus* or betacoronavirus*) adj3 (pandemic* or epidemic* or outbreak* or crisis*)).ti,ab,kf,ot.     
  5. ((Wuhan or Hubei) adj5 pneumonia).ti,ab,kf,ot.       
  6. or/1-5  
  7. Hyperbaric Oxygenation/      
  8. (Hyperbaric adj5 Oxygen*).ti,ab,kf. 
  9. 7 or 8   14951
  10. 6 and 9
Embase
  1. coronavirus/ or betacoronavirus/ or coronavirus infections/ 
  2. (nCoV* or 2019nCoV or 19nCoV or COVID19* or COVID-19* or COVID or SARS-COV-2 or SARSCOV-2 or SARSCOV2 or Severe Acute Respiratory Syndrome Coronavirus 2 or Severe Acute Respiratory Syndrome Corona Virus 2).ti,ab,kw,hw,fx,ot.  
  3. ((new or novel or "19" or "2019" or Wuhan or Hubei or China or Chinese) adj3 (coronavirus* or corona virus* or betacoronavirus* or CoV or HCoV)).ti,ab,kw,ot.  
  4. ((coronavirus* or corona virus* or betacoronavirus*) adj3 (pandemic* or epidemic* or outbreak* or crisis*)).ti,ab,kw,ot.   
  5. ((Wuhan or Hubei) adj5 pneumonia).ti,ab,kw,ot.      
  6. or/1-5  
  7. hyperbaric oxygen therapy/   
  8. (hyperbaric adj5 (medicine or oxygen*)).ti,ab,kw.   
  9. (high adj3 (tension or pressure) adj3 oxygen).ti,ab,ot,kw.    
  10. or/7-9  
  11. 6 and 10         
 Scopus

( TITLE-ABS-KEY ( ( ncov*  OR  2019ncov  OR  19ncov  OR  covid19*  OR  covid-19*  OR  covid  OR  sars-cov-2  OR  sarscov-2  OR  sarscov2  OR  severe  AND acute  AND respiratory  AND syndrome  AND coronavirus  2  OR  severe  AND acute  AND respiratory  AND syndrome  AND corona  AND virus  2 ) )  AND  TITLE-ABS-KEY ( hyperbaric  AND oxygen* )  OR  TITLE-ABS-KEY ( hyberbaric  AND medicine ) )


Appendix 2. Patient characteristics for all studies included in this living systematic review; BMI – body mass index; COPD – chronic obstructive pulmonary disease; HBOT – hyperbaric oxygen treatment

First author, year

Patients

n

female

n (%)

Age (years)

Mean (SD) or range)

Ethnicity

n (%)

Comorbidities,

n (%)

Cannellotto, 2021

40

14 (35%)

55.2 (9.2)

NR

Obesity 14 (35%)

Hypertension 13 (32.5%)

Diabetes 7 (17.5%)

COPD 2 (5%)

Asthma 2 (5%)

Chronic kidney disease 2 (5%)

Cancer 2 (5%)

Chen, 2020

5

1 (20%)

24−69 (mean 47)

Chinese: 5 (100%)

Hypertension: 1 (20%)

Cardiovascular disease: 1 (20%)

Gorenstein, 2020

80

7 (8.8%)

HBOT:

Median = 58

Range = 30−79

 

Control:

Median = 62

Range = 24−80

White: 23 (28.9%)

Black: 13 (16.3%)

Asian: 7 (8.8%)

Other: 37 (46.3%)

Hypertension: 40 (50%)

Diabetes: 24 (30%)

Cardiovascular disease: 8 (10%)

COPD: 4 (5%)

Guo, 2020

2

0

57 and 64

Chinese: 2 (100%)

Hypertension: 1 (50%)

Diabetes: 1 (50%)

Cardiovascular disease: 1 (50%)

Petrikov, 2021

87

44 (50.6%)

Control:

64.5 (12.7)

HBOT:

58.8 (13.6)

NR

NR

Thibodeaux, 2020

5

4 (80%)

39−63

(median 48)

White: 2 (40%)

Black: 3 (60%)

BMI (Obese): 4(80%)

Hypertension: 4(80%)

Diabetes: 3 (60%)

Zhang, 2020

4

0

56−67

Chinese: 4 (100%)

NR

Zhong, 2020

1

0

87

Chinese

Cardiovascular disease

Chronic obstructive pulmonary disease


Appendix 3. Study characteristics for all studies included in living systematic review; ARDS – acute respiratory distress syndrome; atm abs – atmospheres absolute; CT – computed tomography; FiO2 – inspired fraction of oxygen; HBOT – hyperbaric oxygen treatment; ICU – intensive care unit; NR – not reported; PaO2 – arterial pressure of oxygen; PCR – polymerase chain reaction; SpO2 – peripheral oxygen saturation

 

First author, year, country

Study design, n patients, single or multi-centre

Inclusion criteria

Exclusion criteria

Intervention planned (type of chamber, pressure, duration, frequency)

Control

Cannellotto, 2021, Argentina

Randomised controlled trial, n = 40 (20 per group), multicentre
(n = 3)

“Patients in emergency department or ICU, > 18 years of age, with confirmed diagnosis of COVID-19 by PCR or nasal swab, with pneumonia with oxygen dependence and no previous hospitalisation within the last six months.”

“Patients unable to give consent, were pregnant or breast feeding, required mechanical ventilation, were unable to maintain prolonged sitting position

(≥ 2 h) or had contraindications for HBOT.”

Monoplace, 1.45 atm abs, 90 minutes, ≥ 5, daily

Standard of care

Chen, 2020, China

Case series,
n = 5, single

Progressive hypoxaemia, moderate-severe ARDS, laboratory confirmed COVID-19

NR

Multiplace 2.0 atm abs for one patient, 1.6 atm abs for four patients, 60-90 min, mean five HBOT sessions (range: 3−8)

None

Gorenstein, 2020, United States

Cohort study with propensity score matching,
n = 80 (20 intervention; 60 control), single

Age ≥ 18, laboratory confirmed COVID-19, SaO2 < 93% on room air

Pregnancy, pneumothorax, positive troponin

Monoplace, 2.0 atm abs, 90 min, once daily for five days

Identified among COVID-19 patients treated contemporaneously at the same hospital using propensity score matching with a 3:1 ratio.

Guo, 2020, China

Case reports, n = 2, single

Laboratory confirmed COVID-19, and one of the following criteria: shortness of breath; respiratory rate ≥ 30 breaths/minute; finger pulse oxygen saturation (SpO2) ≤ 93% at rest state; and P/F ratio (PaO2/FiO2, where PaO2 is the arterial oxygen partial pressure and FiO2 is the percentage of inhaled oxygen concentration) ≤ 300 mmHg

Pneumothorax, bullae or other absolute contraindication to HBOT

Monoplace, 1.5 atm abs, 60 min, once daily for seven days

None

Petrikov, 2021, Russia

Randomised controlled trial, n = 87 (57 HBOT group, 30 control group), single

 

HBOT group divided into two additional subgroups based on start of HBOT after admission:

Group 1 (≤ 7 days): n = 28

Group 2 (> 7 days):

n =  24

Patient admitted to hospital and clinical diagnosis of COVID-19

NR

Monoplace, 1.4−1.6 atm abs, 40 minutes, NR, NR

Standard of care

Thibodeaux, 2020, United States

Retrospective case series,
n = 5, single

Impending respiratory failure, imminent intubation

NR

Type of chamber not reported; 2.0 atm abs, 90 min; Average five

(range 1−6)

None

Zhang, 2020, China

Prospective case series,

n = 4, single

Progressive dyspnoea, lung CT lesion area > 30%, SpO2 < 90% on air, clear consciousness, able to communicate in words and language, minimal education level of junior high

Pneumothorax, pulmonary bullae

Portable monoplace chamber; 1.5 atm abs, 90 min, once daily for seven days

None

Zhong, 2020, China

Case report,
n = 1, single

Critically ill with pneumonia and tracheal intubation, laboratory confirmed positive for COVID-19 from tracheal aspirate

NR

Multiplace chamber, 1.6−1.8 atm abs for 70−100 min, four sessions

None

 


Appendix 4. Risk of bias and GRADE assessments

New studies includes in the updated review

 

First author,
year

Risk of bias arising from the randomisation process

Risk of bias due to deviations from the intended interventions

Risk of bias due to missing outcome data

Risk of bias in measurement of the outcome

Risk of bias in selection of the reported result

Overall risk of bias

GRADE assessment (certainty of evidence)

Cannellotto, 2021

Low risk

Some concerns

Low risk

Low risk

Low risk

Some concerns

 

High

 

Petrikov, 2021

Some concerns

High risk

Low risk

Some concerns

Some concerns

High risk

Moderate

 

5.2 Initial review

 

Newcastle Ottawa Scale Risk of Bias Assessment

 

Selection

Comparability

Outcome/

exposure

Overall quality assessment

GRADE assessment (certainty of evidence)

Gorenstein, 2020

****

**

***

Good

Moderate

 

*risk of bias assessment was not performed in the original review for the 5 case studies.

 

Appendix 5. Results of eight studies included in this living systematic review; CT – computed tomography; HBOT – hyperbaric oxygen treatment; HFOT − high-flow oxygen therapy; NILV − non-invasive lung ventilation; NEWS2 −National Early Warning Score; NR – not reported; OR – odds ratio; SD – standard deviation; PaO2 – arterial pressure of oxygen; SpO2 – peripheral oxygen saturation

First author, year

n patients

Timing of outcome measurement

Number of HBOT sessions received

Results

Clinical outcomes

Biological outcomes

Imaging outcomes

Safety outcomes

Cannellotto, 2021

40

(20 per group)

Within 30 days after admission

Mean 6.2 
(SD 1.2)

Primary outcome: Proportion of patients that recovered from hypoxaemia (SpO2 ≥ 93%):

 

Control group:

Day 3: 1 (8%)

Day 5: 8 (40%)

Day 10:  13 (65%)

Day 15: 16 (80%)

 

HBOT group:

Day 3: 11 (55%)

Day 5: 19 (95%)

Day 10: 20 (100%)

Day 15: 20 (100%)

 

OR for recovery from hypoxaemia (SpO2 ≥93%) for HBOT vs. control group:

Day 3: 23.2 (95% CI 1.6 to 329.6;
P = 0.001)

Day 5: 28.5 (95% CI 1.8 to 447.4;
P < 0.001)

 

Co-primary outcome: Median time to recovery (P < 0.01):

HBOT: median (IQR) 3 (1.0–4.5) days

Control: 9 (5.5–12.5) days

 

Secondary outcomes:

 

Acute respiratory distress
(P = 0.61):

Control group: 3 (15%)

HBOT group: 3 (15%)

 

Mechanical ventilation
P = 0.61):

Control group: 3 (15%)

HBOT group: 1 (5%)

Death
(P = 1.0):

Control group: 1 (5%)

HBOT group: 1 (5%)

NR

NR

Ear discomfort

(n = 1)

Chen, 2020

5

Assessed before and after course of HBOT (average of five sessions per patient)

5 (mean)

3−8 (range)

Oxygen saturation (SpO2) increased mean (SD) 73 (6)% to 94 (2)%,
P < 0.05)

 

 

 

PaO2 and SaO2 increased: numbers NR,
(P < 0.05)

 

Lymphocyte count increased, mean (SD): 0.61 (0.35) x 10L-1 to 1.09 (0.24) x 109·L-1 (P < 0.05)

 

C-reactive protein levels decreased: numbers NR

 

D-dimer decreased: numbers NR
(P < 0.05)

 

Fibrinogen decreased: numbers NR
(P < 0.05)

CT improved (qualitatively) 

NR

Gorenstein, 2020

80 (20 HBOT; 60 propensity matched controls)

Assessed at end of study (Patients received up to 5 daily treatments while oxygen still required)

5

In-hospital mortality (primary outcome):

HBOT: two patients (10%) died (none remain hospitalised).

Controls: 13 (22%) died (3 [5%] remained hospitalised at end of study period)

 

Need for mechanical ventilation (secondary outcome):

HBOT: two (10%) patients intubated

Controls: 18 (30%) intubated

 

 

Adjusted sub-distribution hazard ratios:

Inpatient mortality = 0.37
(P = 0.14); Mechanical ventilation = 0.26
(P = 0.046)

 

Secondary outcome of days on mechanical ventilation was not analysed

NR

 

 

NR

Claustrophobia, ear pain (n NR)

Hypoxic arrest in unclear circumstances after patient transfer
(n = 1)

 

Guo, 2020

2

Assessed over 7-day course of HBOT

7

Dyspnoea eliminated immediately after the first HBOT session

 

Respiratory rate decreased daily; no need for mechanical ventilation

 

SpO2 > 93% after the first session and continued to improve

 

 

D-dimers reduced

 

Lymphocyte counts improved

 

Arterial blood gas indices (PaO2, P/F ratio, bicarbonate, lactate) improved

 

Liver function improved

 

Numbers NR for any outcomes

On CT pulmonary inflammation gradually improved

No adverse effects

Petrikov, 2021

87; 57 randomized to HBOT, 30 randomized to control

 

HBOT group divided into two additional subgroups based on start of HBOT after admission: Group 1

(≤ 7 days): 

n = 28

Group 2

(> 7 days): n = 24

Assessed over course of HBOT

(7 sessions)

Mean (SD)

Subgroup 1: 5.1(2.5)

 

Subgroup 2: 4.2 (2.0)

SpO2 increased day 14 from baseline and compared to control
P
< 0.05, mean (SD)

 

Control group:

Day 1: 92.6 (4.2)

Day 3: 90.4 (4.9)

Day 7: 91.3 (4.8)

Day 14: 93.4 (4.7)

 

HBOT subgroup 1:

Day 1: 91.9 (5.3)

Day 3: 91.4 (3.8)

Day 7: 92.1 (3.9)

Day 14: 96.1 (2.8)

 

NEWS2 decreased from  baseline in the HBOT group and compared to control group (P < 0.05),

mean (SD)

 

Control group:

Day 4: 4.7 (2.3) points

Day 10: 4.0 (2.3) points

 

HBOT subgroup 1:

Before: 4.4 (2.2) points

After: 1.2 (1.7) points

 

Ordinal scale for clinical improvement score decreased
(P < 0.05) from baseline in the HBOT group and compared to the control group, mean (SD)

 

Control group:

Day 4: 4.1 (0.7) points

Day 10: 3.9 (0.8) points

 

HBOT subgroup 1:

Before: 4.2 (0.7) points

After: 3.0 (0.6) points

 

Respiratory support, defined as oxygen through the nasal cannula or face mask with a flow of 3–6 l·min-1, in severe cases using HFOT or NILV,

P-value NR:

 

Control group:

Day 4: 10 (33.3%)

Day 10: 8 (26.7%)

 

HBOT subgroup 1:

Before: 9 (32.1%)

After: 0 (0%)

 

Oxygen flow rate 3−6 l·min-1, P-value NR:

 

Control group:

Day 4: 14 (46.7%)

Day 10: 13 (43.3%)

 

HBOT subgroup 1:

Before: 15 (53.6%)

After: 5 (17.9%)

 

No respiratory support required,
P-value NR:

 

Control group:

Day 4: 6 (20%)

Day 10: 9 (30%)

 

HBOT subgroup 1:

Before: 4 (14.3%)

After: 23 (82.1%)

Blood malondialdehyde decreased (HBOT group), mean (SD) from 4.34 (0.52) μmol·l-1 prior to HBOT to 3.98 (0.48) μmol·l-1 at day 7

 

Total antioxidant activity decreased (HBOT group),  mean (SD) from 1.26 (0.28) to 1.21 (0.05) mmol·l-1

 

Open circuit potential of platinum electrode decreased (HBOT group) mean (SD) from -22.78 (24.58) mV to 30.45 (15.32) mV

 

Apoptotic lymphocytes: No significant change

NR

Claustrophobia

(n = 1)

 

 

Pain in the ears

(n = 4)

Thibodeaux, 2020

5

Assessed before and after HBOT  course

Mean 5

Range 1−6

SpO2 improved, mean (SD): 96 (3)% to 96 (1)%

 

All patients recovered without need for mechanical ventilation

 

Respiratory rate decreased, mean (SD): 35.4 (8.5) to 28.0 (7.6)

Inflammatory markers decreased (reported for one patient, NR for four patients)

 

NR

No adverse effects

Zhang, 2020

4

Assessed before and after HBOT course

 

7

SpO2 increased, mean (SD): 86 (5)% to 92 (4)%
(P = 0.042)

6-minute walking distance (m) improved: 272 (62) to 346 (43)
(P = 0.05)

 

Shortness of breath improved

Blood gas analysis indexes improved

CT resolution of inflammation to different degrees

 

NR

Zhong, 2020

1

Assessed before and after HBOT course

4

Oxygenation improved

 

Patient was eventually extubated

CO2 reduced, coagulation normalised,

renal function improved

NR

NR


  

 

 

A prospective single-blind randomised clinical trial comparing two treatment tables for the initial management of mild decompression sickness

Neil Banham, Philippa Hawkings, Ian Gawthrope

Appendix 1 - Vann RD, Denoble PJ, Uguccioni DM, Freiberger JJ, Perkins R, Reed W et al.  Report on decompression illness, diving fatalities and Project Dive Exploration: DAN’s Annual Review.  DAN’s Annual Review of Recreational Scuba Injuries and Diving Fatalities. 2002 Edition. Durham, NC: Divers Alert Network; 2002:35.

 

Arbitrary severity classification

Group symptom 

 (alphabetical order)

 

Reported signs or symptoms

1. Serious neurology

Bladder or bowel

bladder or bowel dysfunction

Coordination

ataxia, ↓coordination, gait

Consciousness

↓consciousness

Hearing

↓hearing, tinnitus

Mental status

dysphasia, ↓memory, mental status, mood, orientation, personality

Reflexes

↓ or ↑reflexes

Strength

hemiparesis, motor weakness, muscle weakness, paraplegia

Vision

↓vision

2. Cardiopulmonary

Cardiovascular

arrhythmia, cardiovascular, palpitations

Pulmonary

cough, haemoptysis, respiratory distress, shortness of breath, voice change

3. Mild neurology

Paresthesia

numbness, numbness & tingling, paresthesia, ↓sensation, tingling, twitching

4. Pain

Pain

ache, cramps, discomfort, joint pain, pain, pressure, sharp pain, spasm, stiffness

5. Lymphatic/skin

Lymphatic

swelling

Skin

burning of skin, itching, marbling, rash

6. Constitutional/ non-specific

Dizziness

dizziness, dizziness/vertigo

Fatigue

fatigue

Headache

headache

Nausea

 

nausea, nausea & vomiting, vomiting

Other

chills, diaphoresis, heaviness, heavy head, light-headedness,

malaise, restlessness

Vertigo

vertigo

Appendix 1: Initial Delphi Survey (English)

Initial Delphi Survey

 

(First page)

Which scenarios in hyperbaric oxygen therapy are relevant to simulation-based education?

Despite the broad implementation of simulation-based education in the majority of healthcare areas, simulation has yet to be used in the context of hyperbaric medicine education.

We are looking for healthcare providers involved in the provision of hyperbaric oxygen therapy (hyperbaric physicians and allied health providers, e.g. Respiratory Therapists or Registered Nurses) to help by completing this online survey.

Learn more about how you can help us develop a simulation-based education curriculum for hyperbaric oxygen therapy to ultimately improve practice and patient safety, and get a chance to win a $200 (CAD) Visa gift card.

 

(Second page)

Your participation in this Delphi survey will help us to determine which scenarios in hyperbaric oxygen therapy should be included in the development of a simulation-based education curriculum.

This questionnaire is the first round of the survey. The number of rounds will be determined based on response agreement, but will most likely involve a total of 2. If you participate in the first round of the survey, you will be asked to participate in all subsequent rounds.

It will take approximately 15 minutes to complete each round. Your participation in this study is completely voluntary. You can choose not to participate, or decide to participate now and then change your mind without loss of any benefit that you are otherwise entitled to. Participation and your individual responses will remain confidential.

If you complete all rounds, you can choose to be entered into a draw for a $200 (CAD) Visa gift card.

By completing this survey, your consent to participate in this study is implied.

 

(Third page)

INSTRUCTIONS:

 

  • Rank the scenarios provided according to how relevant you believe they are for inclusion in the simulation-based curriculum.
  • Answer all questions with a ranking number.
  • A space is also provided for you to include additional comments.

We will also ask you to provide some brief demographic information and to forward the survey link to your colleagues (optional).

Once we have received responses from all participants, we will collate and summarize the findings and develop the second questionnaire. You should receive this within 60 days.

 

(Fourth page)

  1. Please select your profession:
  • Physician
  • Registered Nurse
  • Respiratory Therapist
  • Other (Specify): ___________

 

  1. Are you a trainee?
  • Yes
  • No

 

  1. Please indicate the country in which you are currently practicing: (***DROP DOWN MENU***)
  • Canada
  • United States
  • Afghanistan
  • Albania
  • Algeria
  • Andorra
  • Angola
  • Antigua and Barbuda
  • Argentina
  • Armenia
  • Aruba
  • Australia
  • Austria
  • Azerbaijan
  • Bahamas, The
  • Bahrain
  • Bangladesh
  • Barbados
  • Belarus
  • Belgium
  • Belize
  • Benin
  • Bhutan
  • Bolivia
  • Bosnia and Herzegovina
  • Botswana
  • Brazil
  • Brunei
  • Bulgaria
  • Burkina Faso
  • Burma
  • Burundi
  • Cambodia
  • Cameroon
  • Cabo Verde
  • Central African Republic
  • Chad
  • Chile
  • China
  • Colombia
  • Comoros
  • Congo, Democratic Republic of the
  • Congo, Republic of the
  • Costa Rica
  • Cote d'Ivoire
  • Croatia
  • Cuba
  • Curacao
  • Cyprus
  • Czechia
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • East Timor (see Timor-Leste)
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Ethiopia
  • Fiji
  • Finland
  • France
  • Gabon
  • Gambia, The
  • Georgia
  • Germany
  • Ghana
  • Greece
  • Grenada
  • Guatemala
  • Guinea
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Holy See
  • Honduras
  • Hong Kong
  • Hungary
  • Iceland
  • India
  • Indonesia
  • Iran
  • Iraq
  • Ireland
  • Israel
  • Italy
  • Jamaica
  • Japan
  • Jordan
  • Kazakhstan
  • Kenya
  • Kiribati
  • Korea, North
  • Korea, South
  • Kosovo
  • Kuwait
  • Kyrgyzstan
  • Laos
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libya
  • Liechtenstein
  • Lithuania
  • Luxembourg
  • Macau
  • Macedonia
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Mauritania
  • Mauritius
  • Mexico
  • Micronesia
  • Moldova
  • Monaco
  • Mongolia
  • Montenegro
  • Morocco
  • Mozambique
  • Namibia
  • Nauru
  • Nepal
  • Netherlands
  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • North Korea
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Palestinian Territories
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Poland
  • Portugal
  • Qatar
  • Romania
  • Russia
  • Rwanda
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Vincent and the Grenadines
  • Samoa
  • San Marino
  • Sao Tome and Principe
  • Saudi Arabia
  • Senegal
  • Serbia
  • Seychelles
  • Sierra Leone
  • Singapore
  • Sint Maarten
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Africa
  • South Korea
  • South Sudan
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Swaziland
  • Sweden
  • Switzerland
  • Syria
  • Taiwan
  • Tajikistan
  • Tanzania
  • Thailand
  • Timor-Leste
  • Togo
  • Tonga
  • Trinidad and Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Venezuela
  • Vietnam
  • Yemen
  • Zambia
  • Zimbabwe

 

  1. How many post-training years of experience do you have? _____

 

(Fifth page)

  1. Please rate each of the scenarios below in terms of how relevant they are for inclusion in a simulation-based education curriculum for hyperbaric oxygen therapy.

 Please add AND rank any additional scenarios you feel are missing.

 1 indicates least relevant/least likely to benefit from simulation practice and 5 indicates most relevant/most likely to benefit from simulation practice.

 Scenarios should be rated according to the following criteria:

  • The clinical scenario should be either high stakes (i.e. if an optimal course of actions is not implemented in a timely manner, the patient may suffer severe consequences) or lower stakes but with a high potential for becoming critical if the optimal actions are not followed (e.g. intubated and ventilated child who undergoes HBOT);
  • Training on this clinical scenario is best done with the use of a full-body mannequin versus other potential educational modalities. 

 

 

Clinical scenario

Rating

(1=least relevant; 5=most relevant)

 

IF UNABLE TO JUDGE: Please explain why you indicated “unable to judge

 

Cardiac arrest in the hyperbaric chamber.

„ 1 „ 2 „ 3 „ 4 „ 5 „ Unable to judge

 

Seizure in the chamber.

„ 1 „ 2 „ 3 „ 4 „ 5 „ Unable to judge

 

Fire in the chamber.

„ 1 „ 2 „ 3 „ 4 „ 5 „ Unable to judge

 

Pneumothorax in the chamber.

„ 1 „ 2 „ 3 „ 4 „ 5 „ Unable to judge

 

Intubated and ventilated patient in the chamber.

„ 1 „ 2 „ 3 „ 4 „ 5 „ Unable to judge

 

Newborn patient in the chamber.

„ 1 „ 2 „ 3 „ 4 „ 5 „ Unable to judge

 

Panic attack due to claustrophobia in the chamber.

„ 1 „ 2 „ 3 „ 4 „ 5 „ Unable to judge

 

Chest pain in the chamber

„ 1 „ 2 „ 3 „ 4 „ 5 „ Unable to judge

 

Shortness of breath in the chamber

„ 1 „ 2 „ 3 „ 4 „ 5 „ Unable to judge

 

 

  1. If you have any further comments, please list them below:

 

  

PLEASE FORWARD THIS LINK TO YOUR COLLEAGUES: (survey link)

Decompression illness in Finnish technical divers: a follow-up study on incidence and self-treatment

Laura J Tuominen, Sofia Sokolowski, Richard V Lundell, Anne K Räisänen-Sokolowski 

Questionnaire for demographic data

 

1. Research ID

2. Age

3. Height

4. Weight

5. Do you smoke or use other nicotine products?

    • Yes
    • No

6. Have you had a hyperbaric (HBO) treated decompression illness at some point in your diving career?

    • Yes
    • No

7. What is your diving experience in years?

8. What is your number of dives altogether?

9. What has been the deepest dive in your diving career?

10. Main diving system?

    • OC
    • CC

11. Highest certification for cave/mine?

    • Cavern
    • Intro-to-cave
    • Full cave
    • Mine 1
    • Mine 2
    • Other, what?

12. Highest diving certification?

    • MOD1
    • MOD2
    • MOD3
    • Rec Trimix
    • Normoxic Trimix
    • Full Trimix
    • Other, what?

13. Are you an active instructor?

    • Yes
    • No

 


 This questionnaire was filled out every two months. The first period was 1.7.2020-30.9.2020.

 

  1. Research ID?
  2. How many dives have you done to depths from 0-20m?
  3. How many dives have you done to depths from 20-40m?
  4. How many dives have you done to depths from 40-60m?
  5. How many dives have you done to depths from 60-80m?
  6. How many dives have you done to depths over 80m?
  7. How deep has the deepest dive been (in meters)?
  8. What is the total dive time after these two months (in minutes)?
  9. Other comments?

Questionnaire for decompression illness (DCI) symptoms

 

1. Research ID?

2. The date of the event?

3. Diving system used?

    • OC
    • CC

4. Maximum depth of the dive (in meters)?

5. Average depth of the dive (in meters)?

6. Dive time (in minutes)?

7. GF, if known?

8. Gas / diluent?

9. Symptoms (you may choose more than one option)

    • tingling / itching
    • skin rash, heat sensation, swelling
    • joint pain
    • abnormal pain in muscles
    • fatigue
    • headache
    •  vertigo
    • numbness
    • shortness of breath / heavy breathing
    • visual disturbances
    • hearing impairment
    • bladder symptoms
    • verbal disturbances
    • other?

10. Possible contributing factors (you may choose more than one option)

    • dehydration
    • ascent rate
    • shortened decos
    • cold or wet
    • tiredness
    • ceiling violation
    • multiple dives a day
    • multiple days of diving (2-3)
    • multiple days of diving (> 4)
    • nothing
    • Other?

11. When did the symptoms start?

12. What did you do after noticing DCI symptoms? You may choose more than one option.

    • nothing
    • used 100% normobaric oxygen
    • hydration orally
    • rest
    • in water recompression
    • recompression in chamber
    • other?

13. What was the outcome after possible treatment?

    • symptoms gone
    • symptoms decreased
    • symptoms remained

14. Additional comments

Inner ear barotrauma and inner ear decompression sickness: a systematic review on differential diagnostics

Oskari H Lindfors, Anne K Räisänen-Sokolowski, Timo P Hirvonen, Saku T Sinkkonen

SDC 1. Details of the preliminary literature search (search date 10/12/2020)

1) PUBMED PRELIMINARY LITERATURE SEARCH: (n = 228)

“Diving” AND “Inner Ear”

-> scanning of:

- titles

- abstracts

- index terms

- keywords

- titles of “similar articles

- titles of “cited articles

 

-> index terms identified:

            - Hearing Loss, Sudden

            - Tinnitus

            - Vertigo

            - Dizziness

-> keywords identified:

            - subaquatic

            - underwater

            - inner-ear

            - perilymph fistula

            - perilymphatic fistula

            - intralabyrinthine membrane tear

            - inner ear hemorrhage

            - cochlear

            - vestibular

            - cochleovestibular

            - vestibulocochlear


SDC 2. Details of the systematic literature search (search date 10/12/2020 & 26/04/2020)

1) PUBMED SYSTEMATIC LITERATURE SEARCH: (n = 182)

"Diving/adverse effects"[Mesh] OR  "Diving/complications"[Mesh] OR  "Diving/epidemiology"[Mesh] OR  "Diving/etiology"[Mesh] OR  "Diving/injuries"[Mesh] OR  "Diving/physiology"[Mesh] OR  "Diving/physiopathology"[Mesh] OR  "Diving/trends"[Mesh] OR subaquatic[tiab] OR underwater[tiab]

AND

"Ear, Inner/abnormalities"[Mesh:NoExp] OR  "Ear, Inner/anatomy and histology"[Mesh:NoExp] OR  "Ear, Inner/diagnosis"[Mesh:NoExp] OR  "Ear, Inner/diagnostic imaging"[Mesh:NoExp] OR  "Ear, Inner/etiology"[Mesh:NoExp] OR  "Ear, Inner/injuries"[Mesh:NoExp] OR  "Ear, Inner/pathology"[Mesh:NoExp] OR  "Ear, Inner/physiology"[Mesh:NoExp] OR  "Ear, Inner/physiopathology"[Mesh:NoExp] OR  "Ear, Inner/surgery"[Mesh:NoExp] OR  "Ear, Inner/therapy"[Mesh:NoExp] OR

"Hearing Loss, Sudden/anatomy and histology"[Mesh:NoExp] OR  "Hearing Loss, Sudden/diagnosis"[Mesh:NoExp] OR  "Hearing Loss, Sudden/diagnostic imaging"[Mesh:NoExp] OR  "Hearing Loss, Sudden/epidemiology"[Mesh:NoExp] OR  "Hearing Loss, Sudden/etiology"[Mesh:NoExp] OR  "Hearing Loss, Sudden/pathology"[Mesh:NoExp] OR  "Hearing Loss, Sudden/physiology"[Mesh:NoExp] OR  "Hearing Loss, Sudden/physiopathology"[Mesh:NoExp] OR  "Hearing Loss, Sudden/surgery"[Mesh:NoExp] OR  "Hearing Loss, Sudden/therapy"[Mesh:NoExp] OR

"Tinnitus/anatomy and histology"[Mesh:NoExp] OR  "Tinnitus/diagnosis"[Mesh:NoExp] OR  "Tinnitus/diagnostic imaging"[Mesh:NoExp] OR  "Tinnitus/epidemiology"[Mesh:NoExp] OR  "Tinnitus/etiology"[Mesh:NoExp] OR  "Tinnitus/pathology"[Mesh:NoExp] OR  "Tinnitus/physiology"[Mesh:NoExp] OR  "Tinnitus/physiopathology"[Mesh:NoExp] OR  "Tinnitus/surgery"[Mesh:NoExp] OR  "Tinnitus/therapy"[Mesh:NoExp] OR

"Vertigo/anatomy and histology"[Mesh:NoExp] OR  "Vertigo/diagnosis"[Mesh:NoExp] OR  "Vertigo/diagnostic imaging"[Mesh:NoExp] OR  "Vertigo/epidemiology"[Mesh:NoExp] OR  "Vertigo/etiology"[Mesh:NoExp] OR  "Vertigo/pathology"[Mesh:NoExp] OR  "Vertigo/physiology"[Mesh:NoExp] OR  "Vertigo/physiopathology"[Mesh:NoExp] OR  "Vertigo/surgery"[Mesh:NoExp] OR  "Vertigo/therapy"[Mesh:NoExp] OR

"Dizziness/anatomy and histology"[Mesh:NoExp] OR  "Dizziness/diagnosis"[Mesh:NoExp] OR  "Dizziness/diagnostic imaging"[Mesh:NoExp] OR  "Dizziness/epidemiology"[Mesh:NoExp] OR  "Dizziness/etiology"[Mesh:NoExp] OR  "Dizziness/pathology"[Mesh:NoExp] OR  "Dizziness/physiology"[Mesh:NoExp] OR  "Dizziness/physiopathology"[Mesh:NoExp] OR  "Dizziness/surgery"[Mesh:NoExp] OR  "Dizziness/therapy"[Mesh:NoExp] OR

inner-ear[tiab] OR “perilymph fistula”[tiab] OR “perilymphatic fistula”[tiab] OR “intralabyrinthine membrane tear”[tiab] OR “inner ear hemorrhage”[tiab] OR cochlear[tiab] OR vestibular[tiab] OR cochleovestibular[tiab] OR vestibulocochlear[tiab]

Filters: English

 

2) MEDLINE SYSTEMATIC LITERATURE SEARCH: (n = 188)

exp Diving/ae, co, in, ph, pp, td [Adverse Effects, Complications, Injuries, Physiology, Physiopathology, Trends] OR subaquatic.mp. OR underwater.mp.

AND

Ear, Inner/ab, ah, di, dg, in, pa, ph, pp, su [Abnormalities, Anatomy & Histology, Diagnosis, Diagnostic Imaging, Injuries, Pathology, Physiology, Physiopathology, Surgery] OR

Hearing Loss, Sudden/di, dg, ep, et, pa, pp, su, th [Diagnosis, Diagnostic Imaging, Epidemiology, Etiology, Pathology, Physiopathology, Surgery, Therapy] OR

Tinnitus/di, dg, ep, et, pa, ph, pp, su, th [Diagnosis, Diagnostic Imaging, Epidemiology, Etiology, Pathology, Physiology, Physiopathology, Surgery, Therapy] OR

Vertigo/di, dg, ep, et, pa, ph, pp, su, th [Diagnosis, Diagnostic Imaging, Epidemiology, Etiology, Pathology, Physiology, Physiopathology, Surgery, Therapy] OR

Dizziness/di, dg, ep, et, pa, pp, su, th [Diagnosis, Diagnostic Imaging, Epidemiology, Etiology, Pathology, Physiopathology, Surgery, Therapy] OR

OR inner-ear.mp. OR perilymph fistula.mp. OR perilymphatic fistula.mp. OR intralabyrinthine membrane tear.mp. OR inner ear hemorrhage.mp. OR cochlear.mp. OR vestibular.mp. OR cochleovestibular.mp. OR vestibulocochlear.mp.

Additional limits: English

 

3) SCOPUS SYSTEMATIC LITERATURE SEARCH: (n = 455)

TITLE-ABS-KEY ( ( diving  OR  subaquatic  OR  underwater )

AND

 ( "inner ear"  OR  "inner-ear"  OR  "hearing loss"  OR  "tinnitus"  OR  "vertigo"  OR  "dizziness"  OR  "perilymph fistula"  OR  "perilymphatic fistula"  OR  "intralabyrinthine membrane tear"  OR  "inner ear hemorrhage"  OR  "cochlear"  OR  "vestibular"  OR  "cochleovestibular"  OR  "vestibulocochlear" ) )

AND  ( LIMIT-TO ( SUBJAREA ,  "MEDI" ) )

 AND  ( LIMIT-TO ( LANGUAGE ,  "English" ) )


 

SDC 3. Publications included in the final systematic review.

a) publications with inner ear barotrauma patients

Study details

n of patients

Eichel BS, Landes BS. Sensorineural hearing loss caused by skin diving. Arch Otolaryngol. 1970;92(2):128-31. PMID:5428306.

2

Soss SL. Sensorineural hearing Loss with diving. Arch Otolaryngol. 1971;93(5):501-4. PMID:5554886.

3

Freeman P, Edmonds C. Inner Ear Barotrauma. Arch Otolaryngol. 1972;95(6):556-63. PMID:4666425.

5

Freeman P, Tonkin J, Edmons C. Rupture of the round window membrane in inner ear barotrauma. Arch Otolaryngol. 1974;99(6):437-42. PMID: 4829762.

2

Tonkin JP, Fagan P. Rupture of the round window membrane.  J Laryngol Otol. 1975;89(7):733-756. PMID:1176821.

2

Caruso VG, Winkelmann PE, Correia MJ, Miltenberger GE, Love JT. Otologic and otoneurologic injuries in divers: clinical studies on nine commercial and two sport divers. Laryngoscope. 1977;87(4 Pt 1):508-21. PMID:300136.

1

Molvaer OI, Natrud E, Eidsvik S. Diving injuries to the inner ear. Arch Otorhinolaryngol. 1978;221(4):285-8. PMID:727987

9

McNicoll WD. Traumatic perforation of the tympanic membrane with associated rupture of the round window membrane. J Laryngol Otol. 1978;92(10):897-903. PMID:712222.

1

Pullen FW, Rosenberg GJ, Cabeza CH. Sudden hearing loss in divers and fliers. Laryngoscope. 1979;89(9 Pt 1):1373-7. PMID: 481042.

5

Gray RF, Barton RP. Round window rupture. J Laryngol Otol. 1981;95(2):165-77. PMID:7462785.

2

Parell GJ, Becker GD. Conservative management of inner ear barotrauma resulting from scuba diving. Otolaryngol Head Neck Surg. 1985;93(3):393-7. PMID:3927237.

14

Shupak A, Doweck I, Greenberg E et. al. Diving-related inner ear injuries. Laryngoscope. 1991;101(2):173-9. PMID:1992269.

5

Pullen FW. Perilymphatic fistula induced by barotrauma. Am J Otol. 1992;13(3):270-2. PMID:1609857.

2

Parell GJ, Becker GD. Inner ear barotrauma in scuba divers: a long-term follow-up after continued diving. Arch Otolaryngol Head Neck Surg. 1993;119(4):455-7. PMID:8457309.

20

Nakashima T, Yanagita N, Yamakawa K, Naganawa S. Inner ear barotrauma: computed tomographic evaluation. Clin Otolaryngol Allied Sci. 1995;20(6):544-6. PMID:8665716.

4

Whinney DJ, Parikh AA, Brookes GB. Barotraumatic fracture of the stapes footplate. Am J Otol. 1996;17(5):697-9. PMID:8892563.

1

Sheridan MF, Hetherington HH, Hull JJ. Inner ear barotrauma from scuba diving. Ear Nose Throat J. 1999;78(3):181,184,186-7 passim. PMID: 10188355.

3

Shupak A, Gil, A, Nachum C et. al. Inner ear decompression sickness and inner ear barotrauma in recreational divers: a long-term follow-up. Laryngoscope. 2003;113(12):2141-7. PMID:14660917.

9

Edmonds C. Inner ear barotrauma: a retrospective clinical series of 50 cases. SPUMS Journal. 2004;34:11-4.

50

Shupak A. Recurrent diving-related inner ear barotrauma.  Otol Neurotol. 2006;27(8):1193-6. PMID: 16983314.

3

Duplessis C, Hoffer M. Tinnitus in an active duty navy diver: a review of inner ear barotrauma, tinnitus, and its treatment. Undersea Hyperb Med. 2006;33(4):223-30. PMID:17004408.

1

Klingmann C, Praetorius M, Baumann I, Plinkert P. Barotrauma and decompression illness of the inner ear: 46 cases during treatment and follow-up. Otol Neurotol. 2007;28(4):447-54. PMID:17417111.

26

Foster PK. Autologous intratympanic blood patch for presumed perilymphatic fistulas. J Laryngol Otol. 2016;130(12):1158-1161. PMID:27894373

1

McIntire S, Boujie L. Inner Ear Barotrauma After Underwater Pool Competency Training Without the Use of Compressed Air Case and Review. J Spec Oper Med. 2016;16(2):52-6. PMID:27450603.

1

Morvan JB, Gempp E, Riviere D, Louge P, Vallee N, Verdalle P. Perilymphatic fistula after underwater diving: a series of 11 cases. Diving Hyperb Med. 2016;46(2):72-5. PMID:27334993.

11

 


 

SDC 3. Publications included in the final systematic review. 

b) publications with inner ear decompression sickness patients

 

Study details

n of patients

Farmer JC, Thomas WG, Youngblood DG, Bennett PB. Inner ear decompression sickness. Laryngoscope. 1976 Sep;86(9):1315-27. PMID: 957843

23

Caruso VG, Winkelmann PE, Correia MJ, Miltenberger GE, Love JT. Otologic and otoneurologic injuries in divers: clinical studies on nine commercial and two sport divers. Laryngoscope. 1977 Apr;87(4 Pt 1):508-21. PMID:300136

8

Reissman P, Shupak A, Nachum Z, Melamed Y. Inner ear decompression sickness following a shallow scuba dive. Aviat Space Environ Med. 1990 Jun;61(6):563-6. PMID:2369397

1

Shupak A, Doweck I, Greenberg E et. al. Diving-related inner ear injuries. Laryngoscope. 1991 Feb;101(2):173-9. PMID:1992269

4

Nachum Z, Shupak A; Spitzer O, Sharoni Z, Doweck I, Gordon CR. Inner ear decompression sickness in sport compressed-air diving.  Laryngoscope. 2001 May;111(5):851-6. PMID:11359165

29

Klingmann C, Knauth M, Ries S; Kern R, Tasman AJ. Recurrent inner ear decompression sickness associated with a patent foramen ovale. Arch Otolaryngol Head Neck Surg. 2002 May;128(5):586-8. PMID:12003593

1

Wong R, Walker M. Diagnostic dilemmas in inner ear decompression sickness. SPUMS J. 2004; 34(1): 5-10.

8

Smerz RW. A descriptive epidemiological analysis of isolated inner ear decompression illness in recreational divers in Hawaii. Diving Hyperb Med. 2007;37(1):2-9.

28

McGeoch G. Two divers with acute vertigo and loss of balance. SPUMS J. 2007; 37(1): 40-41.

1

Brookler KH. Dizziness in a SCUBA diver. Ear Nose Throat J. 2009 May;88(5):916-20. PMID:19444787

1

Dan-Goor E, Eden J, Wilson SJ, Dangoor J, Wilson BR. Benign paroxysmal positional vertigo after decompression sickness: a first case report and review of the literature. Am J Otolaryngol. Nov-Dec 2010;31(6):476-8. PMID:20015792

1

Klingmann C. Inner ear decompression sickness in compressed-air diving. Undersea Hyperb Med. Jan-Feb 2012;39(1):589-94. PMID:22400449

34

Verrecchia L, Gennser M, Tribukait A, Brantberh K. Superior vestibular dysfunction in severe decompression sickness suggests an embolic mechanism. Aviat Space Environ Med. 2012 Nov;83(11):1097-100. PMID:23156099

1

Ignatescu M, Bryson P, Klingmann C. Susceptibility of the inner ear structure to shunt-related decompression sickness. Aviat Space Environ Med. 2012 Dec;83(12):1145-51. PMID:23316542

33

Gempp E, Louge P. Inner ear decompression sickness in scuba divers: a review of 115 cases. Eur Arch Otorhinolaryngol. 2013 May;270(6):1831-7. PMID:23100085

115

Wilson CM, Sayer MD. Cerebral arterial gas embolism in a professional diver with a persistent foramen ovale. Diving Hyperb Med. 2015 Jun;45(2):124-6. PMID:26165536

1

Guenzani S, Mereu D, Messersmith M, Olivari D, Arena M, Spano A. Inner-ear decompression sickness in nine trimix recreational divers. Diving Hyperb Med. 2016 Jun;46(2):111-6. PMID:27334999

9

Azzopardi CP, Caruana J, Matity L, Muscat S, Meintjes J. Increasing prevalence of vestibulo-cochlear decompression illness in Malta - an analysis of hyperbaric treatment data from 1987-2017. Diving Hyperb Med. 2019 Sep 30;49(3):161-166. PMID:31523790

99

 

Diving and Hyperbaric Medicine is indexed on MEDLINE, Science Citation Index Expanded (SciSearch®) and Embase/Scopus and complies with the International Committee of Medical Journal Editors (ICMJE) Recommendation for the Conduct, Report, Editing and Publication of Scholarly Work in Medical Journals.
Articles from 2017 are deposited in PubMed Central

Diving and Hyperbaric Medicine Journal
Department of Anaesthesiology
University of Auckland
Private Bag 92019, Auckland 1142
New Zealand
Email: info@dhmjournal.com

E-ISSN 2209-1491
ABN 29 299 823 713