title: Safety of hyperbaric oxygen therapy in mechanically ventilated patients.
abstract: BACKGROUND
  To evaluate the epidemiology of patients who require mechanical ventilation during hyperbaric oxygen therapy.
  
  
  METHODS
  One-hundred-fifty patients who required mechanical ventilation during hyperbaric oxygen therapy were prospectively studied during a 6-year period in a French university hyperbaric centre. We analysed the indication of hyperbaric oxygen therapy, agent used for sedation, presence of a chest tube, need for vasopressor agents and tolerance and appearance of side effects. Finally, we compared the outcomes of patients according to the presence or absence of acute respiratory distress syndrome (ARDS).
  
  
  RESULTS
  Eleven children and 139 adult patients were included (n = 150) in the study. In both populations, carbon monoxide poisoning (51%) and iatrogenic gas embolism (33%) were the two main causes of intubation and mechanical ventilation. The combination of midazolam and sufentanil was used in 85 (67%) patients. All of the patients were given a bolus of a neuromuscular blocker during the hyperbaric session, despite the presence of ARDS in 35 patients. Patient-ventilator asynchrony was the most frequent side effect in 6 (5%) patients and was often the consequence of suboptimal sedation. Mortality was higher in the group with ARDS (23%).
  
  
  CONCLUSIONS
  Carbon monoxide poisoning and iatrogenic gas embolism are the two main diseases of the patients who required mechanical ventilation during hyperbaric oxygen therapy in this study. Mechanical ventilation is a safe method for patients during hyperbaric oxygen therapy. Sedation needs to be perfected to avoid patient-ventilator asynchrony.
authors.affiliation: Intensive Care Unit and Hyperbaric Department, CHU Raymond Poincaré, APHP, Garches, France Pôle RUSH, SAMU13, CHU La Timone, APHM, Marseille, France. jacques.bessereau@ap-hm.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Bessereau
authors.forename: Jérôme
authors.initials: J
authors.lastname: Aboab
authors.forename: Thomas
authors.initials: T
authors.lastname: Hullin
authors.forename: Anne
authors.initials: A
authors.lastname: Huon-Bessereau
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bourgeois
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Brun
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
mesh_terms: D000328:Adult; D002249:Carbon Monoxide Poisoning / Q000628:therapy; D015505:Chest Tubes; D002648:Child; D004618:Embolism, Air / Q000628:therapy; D005260:Female; D005602:France; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects* / Q000379:methods; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007049:Iatrogenic Disease; D008297:Male; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D012122:Ventilators, Mechanical / Q000009:adverse effects
chemical_list: D006993:Hypnotics and Sedatives; D014662:Vasoconstrictor Agents
keywords: acute respiratory distress syndrome; critically ill; hyperbaric chambers; hyperbaric oxygen therapy; mechanical ventilation; ventilators