11 (47) Table 1: Guidelines for Approved Indications for Conducting Hyperbaric Oxygen Therapy (47) Taken from: Undersea and Hyperbaric Medical Society's Hyperbaric Oxygen Therapy Committee Report-2003 • QD = 1 time in 24 hours Hyperbaric Oxygen Therapy • BID = 2 times in 24 hours Hyperbaric Oxygen Therapy • TID = 3 times in 24 hours Hyperbaric Oxygen Therapy Indication Carbon Monoxide Poisoning and Smoke Inhalation Gas Gangrene (Clostridial Myonecrosis) Crush Injury, Compartment Syndrome, and other Acute Traumatic Ischemia Enhancements of Healing in Selected Wounds Necrotizing Soft-Tissue Infections (subcutaneous tissue, muscle, fascia) Osteomyelitis (refractory) Radiation Tissue Damage (osteoradinecrosis) Skin Grafts and Flaps Thermal Burns Treatment Table Treatment Table 5 or Table 6 as recommended by the DMO Treatment Table 5 TID × 1 day then BID × 4-5 days Treatment Table 9 TID × 2 days BID × 2 days QD × 2 days Treatment Table 9 QD or BID Treatment Table 9 BID initially, then QD Treatment Table 9 QD Treatment Table 9 QD Treatment Table 9 BID initially, then QD Treatment Table 9 TID × 1 day, then BID Minimum # Treatments 1 5 3 10 5 20 20 6 5 Maximum # Treatments 5 10 12 60 30 60 60 40 45 While HBOT is indicated for the management of radiation tissue damage the treatment modality, like all treatments, has both relative and absolute contraindications for use. The previously accepted contraindications were, in 2013, revised by the Complimentary Medicine Association (CMA) to 1 absolute and 6 relative contraindications (the absence of these conditions does not (41,42,47) automatically qualify one for treatment) . Absolute contraindication (42) • Untreated pneumothorax Relative contraindications: (42) • Intraventricular external drainage • Fracture of the skull base with cerebrospinal (42) uid leakage • Serious infection of the upper respiratory (42) Tract • High blood pressure (SBP > 180 mmHg, DBP > (42) 110 mmHg) • Patients with chronic obstructive pulmonary (42) disease with CO2 retention (44) • Pregnancy Oxygen Toxicity and Adjusting of Protocols A standard “Table 9” treatment is composed of 3 x 30minute periods of 100% v/v oxygen at a pressure of 2.4 ATA. These episodes of are interrupted by 2 x 5minutes air (21% v/v) breaks, to reduce oxygen (41,42,43) toxicity (as per Figure 1) . As with the addition of time to tables/protocols (i.e: extension of US Navy recompression treatment “Table 6”, due to non-resolution of diving related symptoms), so, might a table be altered to suit both the patients' treatment schedules, facility management as well as to decrease the risk of oxygen toxicity. As such, some HBOT facilities will reduce the 90minute protocol (with two air-breaks, as described above and in Figure 1) to a 60minute protocol with no air breaks at all. This therapeutic reduction in time in turn reduces the risk of CNS toxicity, developing claustrophobia, and allows more time for adjunct treatments to be carried out. The primary advantage of inclusion of HBOT in a treatment regime is that there are minimal to no severe side- (39,41,42,47) effects post treatment . HBOT and Radiation Injury Most studies focusing on CHC and RHC utilised (30,31,40) between 30 to 40 HBOT treatment sessions with a median of 34 treatments. It was however noted that the higher the number of HBOT sessions the greater the opportunity for excellent long-term (46) success/resolution of the injury . Data does however suggest that fewer HBOT sessions, a median of 27 to 40, may sufcient in CHC (35,37,38,45) patients . The elapsed time between the onset of haematuria and the initiation of HBOT is discussed as another success factor for RHC, with shorter pre-treatment intervals (6 to 8 months) (29,34) demonstrating signicantly greater results, whereas the relationship between CHC symptom development and elapsed time to HBOT treatment could not demonstrate a signicant relationship to treatment success (most likely due to the acute nature of CHC). Success is noted in CHC cohorts with intervals ranging from 47 days after the onset of symptoms to up to four months between rst (36) symptoms and the initiation of HBOT . The inuence of patient age, while controversial, does UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
RkJQdWJsaXNoZXIy NTIyOTQ=