Background: As hyperbaric oxygen therapy has been sporadically used in combination with antimicrobial treatment for refractory infections in patients with hematologic malignancies, data on its efficacy and outcomes are limited. Methods: We retrospectively analyzed 55 patients with hematologic malignancies treated with hyperbaric oxygen therapy over a 10-year period at a single tertiary care center and report on patients' clinical features, infection types, treatment responses, and survival outcomes. Results: The most common underlying hematologic malignancy diagnosis was acute myeloid leukemia (30 patients, 55%). The most common hyperbaric oxygen therapy indications were invasive mold disease (IMD) (35 patients, 64%), BK virus-associated cystitis (17 patients, 31%), and bacterial cellulitis (3 patients, 5%). Patients underwent a median of 10 hyperbaric oxygen therapy sessions (range, 1-45). In total, 54 (98%) of the 55 patients were evaluable for response, of whom 32 (59%) patients demonstrated a response, defined as either resolution or stabilization of the infection. Among the 35 patients with IMDs, we found that 11 patients (31%) achieved a complete response, 5 (14%) had a partial response, 6 (17%) had stable disease, and 13 (37%) patients experienced progression of their infection. In contrast, among the 17 patients with BK virus-associated cystitis, 9 patients (53%) had persistent or worsening hematuria. The two evaluable patients with bacterial cellulitis responded with resolution of the infection. We reviewed the status of the hematologic malignancies at the time of hyperbaric oxygen therapy treatment and found that the 21 patients whose hematologic malignancies were in remission tended to have a higher response rate of their infection compared to patients whose hematologic malignancies were not in remission (73% vs. 46% p = 0.057). Despite the response of infections, 1-year mortality in these patients remained high at 76%. Conclusions: Based on our experience, hyperbaric oxygen therapy, in conjunction with appropriate anti-infective therapy and debridement surgery, could benefit selected patients with hematologic malignancies, especially those whose underlying disease is controlled but experience recalcitrant bacterial or fungal infections.
Successful cooperation requires efficient integration of self and other-related information. Whether hyperbaric oxygen intervention improves cooperative performance under high-altitude hypoxic conditions, and whether such effects depend on interpersonal neural coordination, remains unclear. In this randomized crossover study, 62 dyads completed a cooperative task under both hyperbaric oxygen intervention and high-altitude hypoxic conditions while undergoing functional near-infrared spectroscopy (fNIRS) hyperscanning. We examined whether hyperbaric oxygen intervention enhanced cooperative performance and whether this effect was associated with interpersonal trust and inter-brain synchrony (IBS). High-trust dyads exhibited greater hyperbaric-oxygen-related cooperation gains. Increases in medial prefrontal cortex (mPFC) IBS predicted improvements in cooperation success rate and cooperation efficiency, and both associations were moderated by interpersonal trust: positive associations were observed only in high-trust dyads. Pseudo-dyad analyses further indicated that this effect reflected real interpersonal interaction rather than shared task structure. These findings suggest that the cooperative benefits of hyperbaric oxygen intervention are not uniform but depend on interpersonal relationship quality. mPFC IBS may constitute an important neural correlate of hyperbaric-oxygen-related cooperation gains in high-trust dyads.
Introduction Spinal anesthesia (SA) is widely preferred for cesarean sections (CS) due to its association with decreased mortality compared to general anesthesia. This preference applies to urgent clinical situations where prompt delivery is required because of maternal or fetal concerns. To minimize time constraints in these urgent situations, "rapid sequence SA (RSSA)," which involves executing only essential steps and limiting administration attempts, has emerged as a safer and faster alternative. Among the local anesthetics used for spinal anesthesia, hyperbaric bupivacaine and levobupivacaine are widely utilized agents. Methods This prospective, randomized, double-blind clinical study evaluated the effects of a fixed 12.5 mg dose of hyperbaric levobupivacaine (Group B) compared with hyperbaric bupivacaine (Group A) for RSSA in 100 pregnant women undergoing Category 1 or 2 CS. The study protocol, registered with Clinical Trials Registry-India (CTRI) (CTRI/2023/04/051557), omitted opioid use and restricted local anesthetic administration attempts. Results The results indicated that sensory block parameters (onset time, maximum level T4, and regression time) between the groups were comparable, with no statistically significant difference. However, the mean time to achieve motor block onset was significantly faster in Group A (bupivacaine) (172.4 s vs. 214.64 s, p = 0.008). Similarly, motor regression time was significantly longer in Group A. Although overall hemodynamic variables were similar between the groups, hypotension and bradycardia occurred more frequently in the bupivacaine group; however, this difference did not reach statistical significance (p ≥ 0.05). Conclusion In conclusion, both fixed doses of bupivacaine and levobupivacaine are effective and reliable for RSSA in Category 1 and 2 CS. Hyperbaric bupivacaine demonstrated more favorable motor block properties, whereas levobupivacaine was linked to improved hemodynamic stability.
Oxidative stress represents an imbalance between the production of reactive oxygen species and the capacity of antioxidant defense systems to neutralize them. Both acute physical activity and hyperbaric oxygen exposure can influence redox homeostasis; however, their combined effects on systemic and tissue-specific oxidative status and trace element balance remain insufficiently understood. The aim of this study was to investigate the effects of hyperbaric oxygen preconditioning on oxidative stress parameters, antioxidant defense mechanisms, and elemental homeostasis following acute physical activity in previously untrained rats. Male Wistar rats were randomly assigned to four groups: control, physical activity (PA), hyperbaric oxygenation (HBO), and PA following HBO exposure (HBO + PA). Across most measured parameters, no significant interaction between HBO and PA was detected, suggesting that their effects act largely independently. Instead, several significant main effects were identified. In particular, HBO increased erythrocyte count, hemoglobin concentration, and hematocrit, while erythrocyte indices remained unchanged, and were accompanied by increased total protein, albumin, and urea levels. HBO exerted a significant main effect on WBC count, while both HBO and PA were associated with lower lymphocyte counts. Systemic oxidative stress markers showed minimal alterations. An exception was catalase activity, which exhibited significant interaction. Nevertheless, distinct tissue-specific responses were observed. HBO was associated with increased lipid peroxidation in liver tissue, whereas in kidney tissue, HBO reduced lipid peroxidation and attenuated PA-associated depletion of sulfhydryl groups, highlighting organ-dependent redox modulation. Elemental findings further confirmed the predominance of main effects. In kidney tissue, HBO was linked to lower potassium, magnesium, phosphorus, zinc and lead levels, while PA was associated with lower iron and arsenic concentrations, and both interventions contributed to decreased sodium and mercury levels. In liver tissue, both PA and HBO were associated with reduced sodium levels, whereas HBO was associated with lower potassium and PA with higher magnesium concentrations. Phosphorus, manganese, copper, cobalt, and selenium demonstrated significant main effects; however, post hoc analyses did not reveal specific differences between individual experimental groups. Collectively, these findings suggest that short-term HBO and acute PA are associated with distinct organ-specific responses in redox balance and elemental homeostasis, predominantly through independent rather than interactive mechanisms.
Combined spinal epidural anesthesia (CSEA) offers rapid onset and effective postoperative analgesia for lower limb surgeries. Epidural volume extension (EVE), achieved by epidural saline injection following intrathecal administration, influences the cephalad spread of local anesthetic. This study examined the effect of EVE with normal saline on sensory and motor block characteristics following intrathecal hyperbaric levobupivacaine. A total of 100 American Society of Anesthesiologists I-II patients aged 18-60 years were assigned to two groups. Group A received 2.5 ml of 0.5% hyperbaric levobupivacaine intrathecally, while Group B received the same dose followed by EVE with 10 ml of normal saline. Sensory and motor block onset, peak block height, regression characteristics, and epidural supplementation requirement were compared. A peak sensory block height of T10 was achieved in Group A (42%), whereas T8 (46%) was achieved in Group B (P = 0.003). Sensory and motor block onset was significantly faster in Group B (P < 0.001). However, the motor block was longer in Group A (219.30 ± 22.20 min) than in Group B (206.20 ± 22.87 min; P = 0.005). Epidural top-up was numerically more frequent in Group B (18%) compared with Group A (6%), though this difference did not achieve statistical significance (P = 0.08). Adequate intraoperative anesthesia was achieved in all patients with timely epidural supplementation when required. EVE with normal saline in CSEA using intrathecal hyperbaric levobupivacaine results in faster onset and greater cephalad sensory blockade with comparable hemodynamic effects; however, it may be associated with earlier block regression in longer surgical procedures.
In our case study, we present a patient with postoperative macular edema who received hyperbaric oxygen therapy (HBOT) as adjunctive treatment. Our study aimed to evaluate the potential therapeutic efficacy of HBOT in accelerating the healing process of postoperative macular edema. A 58-year-old healthy male developed blurred vision one week following phacoemulsification with multifocal intraocular lens implantation in the left eye, despite clear optical media. In spite of standard therapy administration (topical corticosteroid and non-steroid anti-inflammatory drug - NSAID), his symptoms persisted, with central retinal thickness measuring 327 μm on postoperative day 35, and visual acuity of 0.4. At this point, while continuing conservative ophthalmic therapy, we initiated adjunctive hyperbaric oxygen therapy, totaling 11 sessions of 2.5 ATA/90 minutes, 100% oxygen breathing, with air breaks every 20 minutes. The patient presented for follow-up examination after the fourth HBOT treatment, reporting significant reduction in subjective complaints of blurred vision. During this examination, visual acuity improved to 0.9. Despite the significant and rapid symptom regression, we continued HBOT treatment to maintain the results and facilitate neuroplasticity and cerebral accommodation. Final optical coherence tomography (OCT) examination was performed one month after completion of HBOT treatment: visual acuity 1.0, macular thickness 267 μm. During hyperbaric oxygen therapy, regression of blurred vision due to postoperative macular edema accelerated significantly, with results objectified by OCT examination that cannot be explained by spontaneous improvement. The application of HBOT in treating macular edema of this etiology may provide significant quality of life improvement in cases where the time factor of recovery is a significant consideration. Orv Hetil. 2026; 167(28): 1120-1126. Esettanulmányunkban posztoperatív maculaoedemában szenvedő beteg túlnyomásos (hiperbárikus) oxigénterápiával (HBOT) kiegészített kezelését mutatjuk be. Vizsgálatunk célja a HBOT potenciális terápiás hatékonyságának értékelése volt a műtét utáni maculaoedema gyógyulási folyamatának gyorsításában. 58 éves, egészséges férfi betegnél bal oldali multifokális műlencse beültetésével járó phacoemulsifikatiós műtét utáni héten zavaró homályos látás alakult ki, tiszta törőközegek mellett. A bevezetett standard terápia (topikális kortikoszteroid és nemszteroid gyulladáscsökkentő – NSAID) alkalmazása mellett a tünet perzisztált, a beteg centrálisretina-vastagsága a posztoperatív 35. napon 327 μm, látásélessége 0,4 volt. Ekkor a szemészeti konzervatív terápiát folytatva, kiegészítő HBOT-kúrát indítottunk, összesen 11 alkalom, 2,5 ATA/90 perc, 100%-os oxigén légzése, 20/5 levegőszünet protokollal. A beteg a negyedik HBOT-kezelést követően soron kívüli kontrollvizsgálatra jelentkezett, szubjektív homályos látási panaszai jelentősen csökkentek. Ezen vizsgálat alkalmával a látásélessége 0,9-re javult. A HBOT-kezelést a nagyfokú és gyors tünetregresszió ellenére folytattuk az eredmény megtartása és a neuroplaszticitás, az agyi akkomodáció facilitálása érdekében. A záró OCT- (optikaikoherencia-tomográfiás) vizsgálat a HBOT-kúra után egy hónappal történt: látóélessége 1,0, a macula vastagsága 267 μm volt. Hiperbárikus oxigénterápia mellett a posztoperatív maculaoedema okozta homályos látási tünet regressziója jelentősen felgyorsult, az eredményt OCT-vizsgálattal objektivizáltuk, amely nem magyarázható spontán javulással. Az ilyen etiológiájú maculaoedema-kezelésben a HBOT alkalmazása jelentős életminőség-javulást jelenthet azokban az esetekben, amelyeknél a szubjektív megélés vagy a gyógyulás időfaktora jelentős tényező. Orv Hetil. 2026; 167(28): 1120–1126.
Peripheral neuritis and its related significant complication, neuropathic foot ulcers, often lead to functional impairment and increased risk of lower-limb amputation. Hyperbaric oxygen therapy (HBO) and photobiomodulation therapy in the form of polarized light therapy (PLT) have been independently reported to improve peripheral neuritis and enhance wound healing by improving tissue oxygenation and promoting cellular regeneration. The purpose of this randomized controlled trial was to assess the combined effect of HBO followed by PLT on neuropathic foot ulcer healing and peripheral neuropathy. Forty patients aged from 55 to 70 years old were randomized into two groups: an experimental group (HBO + PLT, n=20) and a control group receiving standard care (n=20). Outcome measures included ulcer volume, transcutaneous oxygen tension (TcPO2), and Michigan Neuropathy Questionnaire (MNQ) scores, assessed at baseline, two weeks, and four weeks. The experimental group demonstrated significant improvements in all outcomes compared to controls. These findings support the combined use of HBO and PLT as an effective adjunctive therapy for neuropathic foot ulcers. Hyperbaric oxygen therapy followed by polarized light therapy significantly enhances TcPO2 and improves peripheral neuropathy outcomes.
Sudden sensorineural hearing loss (SSNHL) is an otologic emergency with a highly variable clinical course. Hyperbaric oxygen therapy (HBOT) has been widely used as an adjunctive treatment; however, its efficacy and determinants of treatment response remain incompletely defined. The aim of this study was to evaluate hearing outcomes in patients receiving HBOT and to assess the association between treatmentrelated factors and audiometric recovery. This retrospective study included 65 patients with idiopathic SSNHL. Pure tone audiometry thresholds were evaluated at baseline, post-treatment, and long-term follow-up when available. Changes were analyzed with the Wilcoxon signed-rank and Friedman tests, and correlations with recovery were assessed using Spearman's analysis. Complete pre- and post-treatment data were available for 65 patients. A statistically significant improvement in hearing thresholds was observed, decreasing from 41.7 ± 21.9 dB at baseline to 31.9 ± 22.1 dB following HBOT (P < .001). Among 19 patients with long-term follow-up, hearing thresholds further improved to 25.9 ± 17.3 dB. A significant difference was observed between baseline and long-term measurements (P = 0.006), although the overall comparison did not reach statistical significance (P = .209). No significant correlations were identified between hearing improvement and the number of HBOT sessions (r = 0.11, P = .387) or treatment delay (r = -0.06, P = .658). Etiological factors observed in the study population included upper respiratory infection (n = 30), acoustic barotrauma (n = 2), trauma (n = 1), and cases with no identifiable cause (n = 32). When analyzed according to etiology, no statistically significant difference in hearing threshold improvement was observed between groups (Kruskal-Wallis test, P = .151). HBOT demonstrated a positive effect on hearing thresholds in patients with SSNHL, with the observed audiological improvements appearing to be sustained at long-term follow-up Cite this article as: Kuduban O, Özkan R. Shortand long-term hearing outcomes after hyperbaric oxygen therapy in idiopathic sudden sensorineural hearing loss. 2026, 58(4), 1486, doi: 10.5152/ eurasianjmed.2026.261486.
Chronic radiation proctitis is a recognized late complication of pelvic radiation therapy and may present with rectal bleeding, urgency, altered bowel habits, ulceration, and transfusion-requiring anemia. Management can be challenging when bleeding persists despite standard endoscopic therapy. We present the case of a 72-year-old man with a history of prostate cancer treated with radiation therapy in 2016 who developed refractory hemorrhagic radiation proctitis in 2023. He initially underwent three sessions of argon plasma coagulation (APC) for rectal bleeding but was later hospitalized with acute blood loss anemia requiring transfusion. Colonoscopy demonstrated post-treatment rectal ulcers with visible vessels, which were treated with bipolar electrocautery. He subsequently received compounded sucralfate enemas with improvement in bleeding, followed by repeat endoscopic treatment of residual radiation proctitis with APC. Due to persistent symptoms, mesalamine suppositories and rectal radiofrequency ablation were used. Ongoing bleeding ultimately prompted referral for hyperbaric oxygen therapy, with completion of 30 sessions over seven weeks and resolution of rectal bleeding. Follow-up flexible sigmoidoscopy showed resolution of radiation proctitis with one clean-based rectal ulcer. Biopsies were negative for cytomegalovirus (CMV), herpes simplex virus (HSV), and dysplasia. This case highlights the stepwise and often multimodal management required for refractory chronic radiation proctitis and supports consideration of hyperbaric oxygen therapy when bleeding persists despite topical and endoscopic interventions.
Rhinophyma is a progressive, disfiguring form of rosacea that affects the nasal soft tissues and leads to functional and cosmetic challenges. Surgical excision is the primary treatment, but healing can be complicated by scarring, infection, and graft failure, especially in extensive lesions. Hyperbaric oxygen therapy (HBOT) has been suggested as an adjunctive treatment to enhance healing, reduce inflammation, and improve skin-graft survival. This case series presents three patients with giant rhinophyma who underwent surgical excision, with one requiring a split-thickness skin graft (STSG). Postoperatively, HBOT sessions (90 minutes at 2.4 atmospheres absolute [ATA]) were administered for 5-10 days, depending on the lesion severity. All patients demonstrated excellent healing with complete epithelialization and no evidence of hypertrophic scarring or short-term recurrence. HBOT contributed to faster recovery, improved skin-graft survival, and enhanced cosmetic outcomes. These findings suggest that HBOT is a promising adjunct in the surgical management of rhinophyma, although larger studies are required to validate its efficacy.
Chronic fatigue syndrome (CFS) is frequently accompanied by persistent cognitive deficits and neuroinflammation, yet effective interventions remain limited. Here we tested whether hyperbaric oxygen (HBO) improves CFS-related cognitive impairment in mice and examined a glycerophospholipid-metabolic mechanism. CFS was induced by a 3-week multi-stressor paradigm, and mice received HBO (100% O2, 2.5 ATA, 60 min/session, 4 sessions/week for 3 weeks). HBO improved fatigue-/depressive-like behaviors and rescued spatial and recognition memory. Histology and ultrastructure analyses showed that HBO reduced hippocampal neuronal injury and preserved blood-brain barrier (BBB) integrity, accompanied by decreased pro-inflammatory cytokines and attenuated microglial activation. Untargeted LC-MS metabolomics revealed that HBO partially reversed CFS-associated metabolic shifts and enriched glycerophospholipid metabolism. Hippocampal Western blot further showed that HBO reduced CFS-associated elevation of PLA2G4A signaling. In parallel, PGE2 levels were decreased by HBO and by AACOCF3, supporting a PLA2G4A-related downstream inflammatory lipid mediator axis. In BV2 microglia and in vivo CFS mice, pharmacological PLA2G4A inhibition with AACOCF3 attenuated inflammatory and behavioral abnormalities, and subsequent HBO did not confer additional significant benefit. Together, these data support that HBO alleviates CFS-related cognitive impairment in this model, at least in part, through suppression of neuroinflammation involving a PLA2G4A-linked glycerophospholipid metabolic pathway.
Carbon monoxide poisoning (COP) induces systemic hypoxia and oxidative stress-related injury, leading to myocardial injury and persistent cardiac dysfunction. However, reliable biomarkers for monitoring long-term cardiac sequelae and therapeutic responses remain lacking. Extracellular vesicles (EVs), which reflect the molecular status of their cells of origin, may serve as candidate biomarkers for organ-specific injury. This study investigated whether cardiac EV proteins capture COP-induced myocardial and mitochondrial dysfunction and reflect the therapeutic effects of hyperbaric oxygen (HBO) therapy. A rat model of COP was established with or without HBO treatment. Cardiac function was assessed by echocardiography, and myocardial injury was evaluated using histological, ultrastructural, and biochemical analyses. Cardiac-enriched EVs isolated from ex vivo whole-heart perfusate were used for global proteomic profiling. Candidate differentially abundant proteins were analyzed with emphasis on pathways related to mitochondrial dynamics, mitochondrial energy metabolism, calcium handling, and myocardial contractility. Key EV-associated and tissue proteins were further validated, and selected candidates were examined in serum-derived EVs as preliminary targeted circulating EV validation. COP induced significant cardiac dysfunction, as evidenced by reduced ejection fraction and fractional shortening, together with histological myocardial injury, all of which were attenuated by HBO treatment. Proteomic analysis demonstrated that COP reshaped the cardiac EV proteome in a manner consistent with mitochondrial abnormalities, altered calcium-handling protein profiles, and impaired myocardial contractile function. These EV proteomic alterations were enriched in pathways related to mitochondrial dynamics, calcium signaling, and cardiac contractile regulation. Specifically, COP was associated with dysregulation of mitochondrial dynamics regulators, including optic atrophy type 1 (Opa1) and mitochondrial fission protein 1 (FIS1), as well as calcium-handling proteins such as ryanodine receptor 2 (Ryr2) and phospholamban (Pln). Ultrastructural and biochemical analyses showed mitochondrial cristae disruption, altered mitochondrial fusion-fission protein profiles, mitophagy-related protein changes, and pyroptosis-associated signaling in cardiac tissue following COP, whereas HBO mitigated these abnormalities. Notably, EV-associated Opa1 and FIS1 were associated with COP-related alterations in mitochondrial dynamic balance, whereas EV-associated Ryr2 and Pln were associated with impaired myocardial contractile parameters. Additional analysis of EV proteins related to mitochondrial function and ATP energy production further supported COP-associated mitochondrial energy metabolism-related protein remodeling. Targeted analysis of serum-derived EVs further showed that selected calcium-handling proteins, including Ryr2 and Pln, were detectable in circulating EVs and exhibited COP-associated changes consistent with cardiac tissue alterations. These findings support selected cardiac-enriched EV proteins as candidate molecular readouts of COP-associated myocardial, mitochondrial, and contractile abnormalities. Cardiac EV proteomic remodeling reflects COP-associated mitochondrial and contractile abnormalities and captures the therapeutic effects of HBO. These findings identify cardiac-enriched EV proteins as candidate molecular readouts of myocardial injury and treatment response, providing a cardiac-enriched EV discovery framework for future blood-based biomarker development. The observed alterations in mitochondrial dynamics-, mitochondrial energy metabolism-, and calcium-handling-related proteins provide hypothesis-generating insight into molecular pathways associated with COP-induced cardiac dysfunction. Further validation using circulating EV proteomics, biomarker classifier analyses, and dedicated redox proteomics will be required to establish clinical utility and redox-regulated mechanistic relevance.
The initial injury from TBI damages brain tissue, disrupting blood flow and causing the brain to experience hypoxia. Hypoxia contributes significantly to the persistence of neuroinflammation and the progression of secondary brain injury, ultimately leading to long-term neurological deficits. Hyperbaric oxygen (HBO) therapy is a potential intervention to mitigate hypoxia. In our earlier work, we demonstrated that HBO treatment effectively reduced brain hypoxia in rat models, as indicated by decreased levels of hypoxia-inducible factor (HIF)-1α. Building on these findings, this study aims to investigate the impact of HBO therapy on neuroinflammatory responses following TBI. A total of 44 rats were randomly assigned to 11 groups: one control group, one TBI group, three normobaric groups, three 2 ATA HBO treatment groups, and three 3 ATA HBO treatment groups. Following TBI induction, the treatment groups received six sessions of 1-hour HBO exposure, administered every 12 h. Brain tissue was harvested on days 3, 7, and 14 post-TBI for analysis. Neuroinflammation was evaluated by measuring NF-κB, NLRP3 and caspase-1 expressions, as well as COX-2 activity. The percentage of intact neurons was assessed by hematoxylin-eosin (HE) staining. On days 3, 7, and 14, both the 2 ATA and 3 ATA HBO groups exhibited a trend toward reduced NF-κB protein levels and COX-2 activity compared to the normobaric groups. In contrast, elevated mRNA and protein levels of NLRP3 and caspase-1 were observed in both HBO-treated groups. Moreover, the 2 ATA and 3 ATA HBO groups showed significantly higher percentages of intact neurons than the normobaric groups at all three time points, suggesting a neuroprotective effect. These findings suggest that acute-phase HBO treatment after TBI is associated with suppression of the NF-κB/COX-2 inflammatory pathway while simultaneously enhancing NLRP3 inflammasome expression. This differential regulation may contribute to the observed neuroprotective effect.
This article provides an overview of the main study designs for hyperbaric oxygen therapy (HBOT) clinical research. Based on study objectives, study types and use cases across different phases and settings are described, including before-and-after studies to detect early signals and feasibility, randomized controlled trials, including pragmatic RCTs, to confirm causality, multicenter stratified or adaptive designs to optimize protocols, and real-world studies to evaluate real-world effectiveness, safety, adherence, and health economic outcomes. To improve comparability and reproducibility, the following key elements are also proposed: the use of a pre-specified, pooled set of intervention parameters in each study (pressure, session duration, frequency, and overall course), the establishment of consistent and feasible inclusion and exclusion criteria, and the creation of a multilevel outcomes framework focusing on objective clinical endpoints and patient-reported outcomes, including specific safety and adherence monitoring. To overcome common challenges in HBOT research-protocol heterogeneity, blinding difficulties, interindividual variability in responses, and limitations in evidence synthesis-the article recommends standardized multicenter templates, stratified randomization, a predesigned statistical analysis plan, and mechanisms for data registration and sharing to enable cross-study pooling and long-term follow-up. Finally, a stepwise research pathway is proposed that begins with signal detection and confirmatory studies, progresses through parameter optimization and practice expansion, and ultimately leads to the creation of standardized clinical pathways and generalizable results. The goal is to provide a concise, practical methodological reference for proposal writing, funding applications, and implementation planning, thereby supporting more rigorous HBOT research in neurorehabilitation, tissue repair, chronic disease management, and healthy aging, particularly where current evidence remains exploratory or heterogeneous. This article is not intended as a systematic review of HBOT efficacy; instead, it is positioned as a narrative methodological review that uses current evidence limitations to inform trial design, feasibility assessment, interpretation, and transparent reporting.
Poststernotomy deep sternal wound infection (DSWI), mediastinitis, and sternal osteomyelitis are uncommon but serious complications of cardiac surgery. Hyperbaric oxygen therapy (HBOT) has been used as an adjunct in selected complex infections, but its incremental role within contemporary cardiac-surgery pathways is uncertain. We conducted a scoping review according to JBI guidance and PRISMA-ScR reporting standards. MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched from 1 January 1999 to 2 June 2026. We included adult and pediatric clinical sources and relevant experimental mediastinitis models. Two reviewers independently screened sources and charted data. Design-matched appraisal tools were used only to contextualize methodological limitations. Because populations, infection phenotypes, cointerventions, comparators, and endpoints differed substantially, findings were stratified and synthesized narratively; no meta-analysis was performed. Eleven sources met the inclusion criteria: six adult cohorts/series, one pediatric cohort, two single-patient reports, and two MRSA rat models (179 adults in cohorts/series, 53 pediatric patients, two additional adult single-patient reports, and 103 animals). These sources represent distinct evidence strata and were not interpreted as one clinical entity. HBOT was always embedded within multimodal care, including surgery, antibiotics, NPWT, and/or reconstruction. Only two small adult studies provided direct nonrandomized HBOT-versus-non-HBOT comparisons. Li et al. compared sequential treatment eras and was analyzed separately. The evidence cannot isolate an incremental HBOT effect. Evidence for adjunctive HBOT remains sparse and highly heterogeneous. Current studies do not establish a causal or incremental benefit beyond surgery, source control, antibiotics, NPWT, and reconstruction. HBOT should not be routinely adopted or allowed to delay definitive surgical management. Its role, if any, is limited to carefully selected adjunctive use within multidisciplinary pathways and prospective evaluation.
Hyperbaric oxygen therapy (HBOT) has been used in ischemic and inflammatory conditions due to its ability to enhance tissue oxygenation and support wound healing. Filler-induced vascular occlusion (FIVO) is a rare but potentially devastating complication of dermal filler injections that may result in skin necrosis or vision loss. HBOT has been increasingly reported as an adjunctive intervention in FIVO, but its reported use has not been systematically summarized. To summarize the existing literature on HBOT use in FIVO, describe reported clinical contexts and treatment parameters, and identify gaps in current knowledge. This scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A comprehensive search of PubMed, MEDLINE, Embase, and Google Scholar identified case reports, case series, experimental studies, and reviews describing FIVO cases managed with HBOT. Articles published in English or Spanish between January 2011 and May 2025 were included. Data were synthesized descriptively. Twenty-four studies met inclusion criteria, consisting primarily of case reports and small case series. HBOT was most often used as an adjunct to established therapies, including hyaluronidase, antiplatelet agents, vasodilators, and thrombolytic therapy. Reported HBOT protocols varied substantially, with treatment pressures of 2.0 to 3.0 atmospheres absolute and session durations of 60 to 120 minutes. Outcomes were heterogeneous and frequently confounded by multimodal management. HBOT has been reported as an adjunctive intervention in selected cases of FIVO, but evidence remains limited to low-level observational data, highlighting the need for standardized protocols and prospective studies.
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There is a high risk of inadequate block with spinal anesthesia for postpartum tubal ligation that could be related to inadequate intrathecal dosing. This study aimed to investigate the association between intrathecal bupivacaine dose and inadequate blocks and to assess factors associated with inadequate blocks. Patients undergoing a postpartum tubal ligation between 2003 and 2025 with spinal anesthesia with hyperbaric bupivacaine were included in this retrospective cohort study. Cases were grouped according to bupivacaine dose as low (7.5-9.75 mg), middle (10.5-12 mg), and high (≥13.5 mg). The primary outcome was the occurrence of an inadequate block, defined as supplementation with intravenous analgesics, or failed block with repeat neuraxial anesthesia or conversion to general anesthesia. Data were analyzed using Kruskal-Wallis and Fisher's exact tests and multivariable logistic regression. An inadequate block occurred in 132/594 (22.2%) patients: 3/14 (21.4%, low dose), 95/336 (28.3%, middle dose), and 34/244 (13.9%, high dose). Inadequate blocks were less likely with ≥13.5 mg bupivacaine vs. 10.5-12 mg [OR 0.48, 95% CI (0.26 to 0.86); P = 0.015], and with more recent years since start of the study [0.95 (0.9 to 1); P = 0.029]. Longer surgical duration [(1.03 (1.01 to 1.04); P < 0.001] and higher intrathecal fentanyl dose [1.03 (1 to 1.05); P = 0.043] were associated with increased odds of inadequate block. Intrathecal hyperbaric bupivacaine at a dose ≥13.5 mg was associated with lower odds of inadequate anesthesia for postpartum tubal ligation compared with 10.5-12 mg in the context of an evolving institutional practice.
Enhanced recovery after surgery (ERAS) is a current concept in surgery that has excellent short-term outcomes. Currently, no standardized ERAS protocol exists for total hip replacement (THR). So, we conducted this study to assess the efficacy of ultrasound-guided erector spinae plane block (ESPB) with dexmedetomidine as an additive in comparison with intrathecal morphine (ITM) for ERAS after THR in Cairo University hospitals. Our randomized controlled study included 70 patients. The patients were randomly allocated to the M group or E group. M group patients received 5 mL of subcutaneous lidocaine 1% and then 3.5 mL of hyperbaric bupivacaine 0.5% with 0.1 mg of morphine in 0.25 mL of normal saline intrathecally. E group patients received ESPB with dexmedetomidine as an additive on the side of surgery and then 3.5 mL of hyperbaric bupivacaine 0.5% with 0.25 mL of normal saline intrathecally. The primary outcome was the time of the first successful walking trial for 10 steps with a walker. Secondary outcomes were postoperative pain score, total morphine consumption, duration of hospital stay, patient satisfaction, and incidence of complications (hypotension, bradycardia, pruritus, nausea, vomiting, and urine retention). The mean time of a successful walking trial with a walker of the E group was 12.69 ± 2.42 h which is decreased significantly in comparison to the M group (19.71 ± 3.11 h), with a mean difference of 7.0 (95% CI 8.81-5.2) hours, with a very large effect size (Cohen's d = 2.51), and p value < 0.001. The mean number of failed walking trials in the E group (1.11 ± 0.4 trials) decreased to a statistically significant value in comparison to the mean number of failed walking trials in the M group (2.29 ± 0.52 trials), with a mean difference of 1.18 (95% CI 0.96-1.4) trials, and p value < 0.001. Duration of hospital stay after surgery was, on average, 33.9% lower in E group in comparison to M group (1.66 ± 0.59 and 2.51 ± 0.51 days, respectively) with a large effect size (Cohen's d = 1.54) and p value < 0.001. There was no significant difference regarding the mean time of the first morphine dose in M and E groups (16.8 ± 4.78 h and 18.86 ± 4.63 h, respectively) and p value = 0.072. Total morphine consumption in the first 24 h was insignificantly higher in the M group than in the E group (7.36 ± 2.97 mg and 5.76 ± 2.88 mg, respectively), with a mean difference of -1.6 (95% CI -2.99 to -0.2) mg and p value = 0.025. The patient satisfaction score was better in the E Group than in the M Group. The number of patients with complete satisfaction was more in the E group (24 [68.6%]) than in the M group (10 [28.6%]) and p value < 0.001. The rate of complications was higher in the M Group than in E Group (56.19% vs. 22.86%, respectively, with an odds ratio of 4.01 (95% CI, 1.43-11.25) and p value = 0.008. ESPB with dexmedetomidine as an additive enhances early mobilization after THR better than ITM with about a 34% decrease in the duration of hospital stay and a lower rate of complications. Trial Registration: ClinicalTrials.gov Protocol Registration and Results System: NCT06621849.