Associations of intraoperative end-tidal CO levels with postoperative outcome-secondary analysis of a worldwide observational study.

Background: Patients receiving intraoperative ventilation during general anesthesia often have low end-tidal CO (etCO). We examined the association of intraoperative etCO levels with the occurrence of postoperative pulmonary complications (PPCs) in a conveniently-sized international, prospective study named 'Local ASsessment of Ventilatory management during General Anesthesia for Surgery' (LAS VEGAS).

Methods: Patients at high risk of PPCs were categorized as 'low etCO' or 'normal to high etCO' patients, using a cut-off of 35 mmHg.

Recruitment maneuvers in patients with acute respiratory distress syndrome: a systematic review and metanalysis.

Objective: To systematically review the effects of recruitment maneuvers on patients with acute respiratory distress syndrome.

Methods: This systematic review and meta-analysis using the PICO methodology with keywords (respiratory distress syndrome, recruitment maneuvers, lung recruitment, acute respiratory distress syndrome, alveolar recruitment, and adult acute respiratory distress syndrome). Studies involving patients >18 years, regardless of sex, with acute respiratory distress syndrome, mechanically ventilated for at least 24 h, published in English, Portuguese, and Spanish, with no year restrictions, were included.

High-frequency percussive ventilation in acute respiratory failure.

Introduction: High-frequency percussive ventilation (HFPV) is a ventilation mode characterised by high-frequency breaths. This study investigated the impact of HFPV on gas exchange and clinical outcomes in acute respiratory failure (ARF) patients during spontaneous breathing, noninvasive ventilation (NIV) and invasive mechanical ventilation (iMV).

Methods: This systematic review included randomised and nonrandomised studies up to August 2023.

Five consecutive cases of sensorineural hearing loss associated with inner ear barotrauma due to diving, successfully treated with hyperbaric oxygen.

Introduction: This report describes the outcomes of sensorineural hearing loss (SNHL) due to cochlear inner ear barotrauma (IEBt) in five divers treated with hyperbaric oxygen (HBOT).

Methods: The case histories of five consecutive divers presenting with SNHL from IEBt due to diving, were reviewed. All divers provided written consent for their data to be included in the study.

Recurrent cutaneous decompression sickness in a hyperbaric chamber attendant with a large persistent foramen ovale.

A 41-year-old female nurse had cutaneous decompression sickness on two occasions after acting as an inside chamber attendant for patients receiving hyperbaric oxygen. She breathed air during the treatments at pressures equivalent to 14 and 18 metres of seawater, but each time she decompressed whilst breathing oxygen. Latency was 2.

Anaesthetic and surgical management of gastric perforation secondary to a diving incident: a case report.

Gastric perforation secondary to barotrauma is a rare surgical condition which may manifest as an acute abdomen and potentially lead to complications such as pneumoperitoneum. A 50-year-old, healthy, experienced diving instructor was transported to our emergency department for an acute abdomen and severe dyspnoea after a diving incident. Clinical suspicion combined with computed tomography scanning lead to the diagnosis of linear rupture of the stomach.

Joint position statement on immersion pulmonary oedema and diving from the South Pacific Underwater Medicine Society (SPUMS) and the United Kingdom Diving Medical Committee (UKDMC) 2024.

This joint position statement (JPS) on immersion pulmonary oedema (IPO) and diving is the product of a workshop held at the 52nd Annual Scientific Meeting of the South Pacific Underwater Medicine Society (SPUMS) from 12-17 May 2024, and consultation with the United Kingdom Diving Medical Committee (UKDMC), three members of which attended the meeting. The JPS is a consensus of experts with relevant evidence cited where available. The statement reviews the nomenclature, pathophysiology, risk factors, clinical features, prehospital treatment, investigation of and the fitness for future compressed gas diving following an episode of IPO.

South Pacific Underwater Medicine Society (SPUMS) position statement regarding paediatric and adolescent diving.

This paediatric diving position statement was developed from a targeted workshop at the 51st Annual Scientific Meeting of the South Pacific Underwater Medicine Society (SPUMS) on 8 June 2023. It highlights the factors that SPUMS regards as important when undertaking health risk assessments for diving by children and adolescents (defined as aged 10 to 15 years). Health risk assessments for diving should be performed by doctors who are trained in diving medicine and who are familiar with the specific risks which result from breathing compressed gas in the aquatic environment.

Dive medicine capability at Rothera Research Station (British Antarctic Survey), Adelaide Island, Antarctica.

Rothera is a British Antarctic Survey research station located on Adelaide Island adjacent, to the Antarctic Peninsula. Diving is vital to support a long-standing marine science programme but poses challenges due to the extreme and remote environment in which it is undertaken. We summarise the diving undertaken and describe the medical measures in place to mitigate the risk to divers.

Divers treated in Townsville, Australia: worse symptoms lead to poorer outcomes.

Introduction: Hyperbaric oxygen treatment (HBOT) is considered definitive treatment for decompression illness. Delay to HBOT may be due to dive site remoteness and limited facility availability. Review of cases may help identify factors contributing to clinical outcomes.

Trends in competitive freediving accidents.

Introduction: Understanding safety issues in competitive freediving is necessary for taking preventive actions and to minimise the risk for the athletes.

Methods: We analysed occurrence of loss of consciousness (LOC) and pulmonary barotrauma (PBt) in various freediving disciplines in 988 competitions over five years (from 2019 to 2023 inclusive), with 38,789 officially registered performances (starts): 26,403 in pool disciplines and 12,386 in depth disciplines.

Results: Average incident rate in competitive freediving (all cases: LOCs plus PBt, 2019-2023) was 3.

Modelling the risk factors for accidents in recreational divers: results from a cross-sectional evaluation in Belgium.

Introduction: Characterisation of the recreational diving community could help to identify scuba divers at risk for accidents.

Methods: We performed a cross-sectional evaluation in a federation for recreational scuba divers in Belgium (Duiken.Vlaanderen).

Occurrence and resolution of freediving-induced pulmonary syndrome in breath-hold divers: an online survey of lung squeeze incidents.

Introduction: Breath-hold divers occasionally surface with signs of fluid accumulation and/or bleeding in air-filled spaces. This constellation of symptoms, recently termed 'freediving induced pulmonary syndrome', is thought to come from immersion pulmonary oedema and/or barotrauma of descent and is colloquially termed a 'squeeze'. There is limited understanding of the causes, diagnosis, management, and return to diving recommendations after a squeeze.

A Case of Pneumocephalus Due to an Untreated Atrial-Esophageal Fistula Post-Left Atrial Ablation Therapy.

Air embolisms can be caused by trauma, barotrauma, or due to surgical procedures in neurosurgery, vascular surgery, and cardiac surgery. An atrial-esophageal fistula (AEF) is a life-threatening complication that can occur following left atrial ablation therapy, which is used to treat refractory atrial fibrillation (Afib). AEF, if left untreated, can lead to serious neurological complications such as pneumocephalus.

Mine-explosive trauma of the maxillofacial region: current state of the problem and description of a case from practice.

Military conflicts, terrorist attacks and wars around the world pose a wide range of questions to the medical community about providing medical care to military personnel and civilians with mine-explosive trauma, which is characterized by simultaneous damage of various anatomical areas, including the maxillofacial region. The purpose of this work was to describe a case from practice of treating a patient with a mine-explosive trauma, which manifested by a fracture of the right zygomatic-orbital complex and the upper jaw on the right. Using own case from practice, the authors showed that the treatment of patients with mine-explosive trauma of the maxillofacial region is long-term, multi-stage and should take place in a specialized hospital with the involvement of a team of multidisciplinary specialists.

How to minimize mechanical power during controlled mechanical ventilation.

High intrapulmonary pressures, large tidal volumes, and elevated respiratory rates during controlled mechanical ventilation can lead to barotrauma, volutrauma, and atelectrauma. Mechanical power-defined as the product of the pressure-volume integral and respiratory rate-consolidates these three risk factors into a single, intuitive parameter. Several studies have demonstrated that higher mechanical power correlates with an increased risk of lung injury and mortality, prompting the suggestion that mechanical power should be minimized.

A case of spontaneous pneumomediastinum in a triathlete.

Spontaneous pneumomediastinum is an infrequent condition typically secondary to smoking, illicit drug use, or asthma. The condition often follows barotrauma or bronchial hyperactivity, causing alveolar destruction and air trapping within the mediastinum. Rarely, it may present following strenuous exercise, particularly in tall, thin males, resembling the presentation of pneumothorax.

A fish-friendly axial flow pump turns out to be eel safe, roach unfriendly and bream unsafe.

Additional and refurbished pumping stations are required to mitigate the intensifying occurrence of droughts and floodings. These installations negatively impact threatened freshwater fish populations due to the increased risk of injury and mortality when fish pass through them. Fish-friendly pumping installations have been proposed as a potential solution to reduce these risks.

Temporal changes of neurobehavior in rats following varied blast magnitudes and screening of serum biomarkers in early stage of brain injury.

Blast neurotrauma has been linked to impairments in higher-order cognitive functions, including memory, attention, and mood. Current literature is limited to a single overpressure exposure or repeated exposures at the same level of overpressure. In this study, a rodent model of primary blast neurotrauma was employed to determine the pressure at which acute and chronic neurological alterations occurred.

Characteristics of Side Effects in Non-Emergency Indications Using Computer-Controlled Pressurized Monoplace Hyperbaric Chambers: A Retrospective Multicenter Study.

Hyperbaric oxygen therapy (HBOT) involves inhaling nearly 100% oxygen in a pressurized environment and is commonly used to treat various diseases and injuries. Despite its well-known safety, HBOT is associated with side effects, with frequent middle ear barotrauma (MEB) and oxygen toxicity. Understanding the characteristics and risk factors associated with these side effects is critical for improving patient compliance and treatment outcomes.

Comment on Loddé et al. Does Decreased Diffusing Capacity of the Lungs for Carbon Monoxide Constitute a Risk of Decompression Sickness in Occupational Divers? 2023, , 6516.

This letter addresses errors in the statistical analysis found in a paper addressing pulmonary diffusing capacity and decompression sickness. Our re-analysis could not confirm any of the significant statistical contrasts described for the bubble data, invalidating the speculation on the relationships between bubble scores and decompression sickness.

[Gunshot and Blast Injuries from a Trauma Surgery Perspective].

The severity and extent of gunshot and blast injuries are often misjudged due to a lack of specialist knowledge. The aim of this article is to outline the characteristics of gunshot and blast injuries, including emergency diagnostics and initial surgical treatment.Due to multiple high-energy penetrating injuries, barotrauma, or blunt trauma, affected patients are usually polytraumatized, with multiple organ damage and an average Injury Severity Score (ISS) of > 36.

[Thoracoabdominal Trauma Caused by Blast and Gunshot Injuries].

In Germany, blast and gunshot injuries are uncommon but complex injury entities. Due to the global political situation, terrorist attacks, accidents, or acts of violence, these injuries are potentially part of the reality of care for every anaesthetist, surgeon, and emergency physician. In principle, this type of injury should be treated in a trauma centre with appropriate expertise, but the knowledge of basic treatment principles is necessary for all practitioners.

[Preclinical Treatment of Gunshot and Blast Injuries in Germany].

Gunshot and blast injuries are extremely rare in the emergency services. However, in the context of the increasing threat of terrorist attacks, the possibility of these traumas is also coming into focus. This article provides an overview of the various entities and the corresponding treatment principles for penetrating injuries.