Quando indicar a oxigenoterapia hiperbárica?

Fasciite necrotisante após vacina influenza: relato de caso

“…A OHB tem sua indicação -recomendada pelo Conselho Federal de Medicina (CFM) -em infecções necrotizantes de partes moles como a FN 8 . Seu uso consiste em oferecer oxigênio puro (FIO 2 = 100%) em um ambiente pressurizado a um nível acima da pressão atmosférica, habitualmente entre 2 e 3 atm, em câmaras com capacidade para 1 ou mais pacientes 8 .…”

“…Embora esse tratamento possa ser útil para algumas lesões, não existe evidência suficiente para indicar quais os pacientes que dela se beneficiarão e qual o momento adequado para início do tratamento 10 . Além disso, sérios eventos adversos podem ocorrer, como toxicidade pulmonar, neurológica, desconforto e barotrauma auditivos, desconforto em seios da face e alterações visuais transitórias 8 . Dessa maneira, ensaios clínicos randomizados e controlados de alta qualidade devem ser realizados para avaliar os riscos e benefícios, a curto e longo prazo, permitindo, assim, uma decisão clínica mais adequada.…”

Alterações cardiorrespiratórias de pacientes submetidos à oxigenoterapia hiperbárica

“…Hyperbaric oxygen therapy (HBOT) is a therapeutic modality that consists of an offer of pure oxygen (O 2 ) by means of a single fraction of 100% O 2 , in a pressurized environment, a hermetically-sealed chamber with hard walls (hyperbaric chamber), which has a pressure greater than that of the atmosphere, usually between two and three atmospheres. These chambers can accommodate one patient (monoplace) or many patients (multiplace) (1) . "The action of this therapy is complex since it is the result of a series of physiological and pharmacological mechanisms; its "properties contribute to the treatment of several different conditions.…”

“…Nowadays, there are three types of oxygen therapy: Normobaric oxygen -surface or sea level O 2 , in which there is administration of O 2 (24% to 100%), at atmospheric pressure (an atmosphere absolute -ATA); Hyperbaric Oxygen -Inhalation of 100% O 2 at elevated pressures (> than one ATA); and Hypobaric or altitude O 2 -at altitude, due to humans' physiological limitation there is a demand for a concentration of O 2 higher than that inspired at sea level to avoid hypoxia" (2) . "This therapy is indicated for: decompression sickness or gas embolism, traumatic air embolism, gas gangrene, Fournier's gangrene, necrotizing soft tissue infections (fasciitis, myositis, and cellulitis), acute vasculitis triggered by allergic reaction, reaction to medication or biological toxins (3) , radiation injury, acute anemia, acute traumatic ischemia among others (1)(2)(3) .…”

“…Side effects that can be caused due to the application of HBOT are middle ear barotrauma and gas embolism, which is the most severe complication that occurs during decompression (3) , as it can lead to respiratory system toxicity (dry cough, retrosternal pain, hemoptysis, facial discomfort, and pulmonary edema), neurological toxicity (paresthesia and seizure), hearing discomforts, and transient visual changes (1)(2) . Interestingly, the biochemical and cellular effects of HBOT are not completely understood; the excessive exposure of O 2 in the organism was believed to cause the worsening of the lesions, but the beneficial effects of this therapy were mainly observed during reperfusion (8) .…”