Operational use and patient care in the monoplace hyperbaric chamber.

The author has made an attempt to describe presently available monoplace chambers, provide codes for their appropriate use in hospitals, and emphasize chamber safety. If appropriate safety precautions are not strictly adhered to, catastrophic accidents may occur, and have occurred. Critically ill patients may have indications for HBO and, indeed, can be treated with HBO in the monoplace chamber. This requires strict attention to detail and an understanding of critical care medicine as well as hyperbaric medicine. To facilitate care of these patients within the monoplace chamber several modifications have been implemented. Complete pulmonary and arterial hemodynamic monitoring, transcutaneous and laser Doppler monitoring, as well as vasopressors, sedation, paralysis, and mechanical ventilation can be supplied to patients treated with HBO within a monoplace chamber (Fig. 19). Suction within the monoplace chamber can be accomplished by adapting existing hospital equipment. Likewise, air breaks can be provided to all patients in the monoplace chamber, including those who are intubated and mechanically ventilated. These modifications have been presented here. Hemodynamic and intravenous access to the critically ill patient is important. Physiologic pressures, ECG, and typical intravenous setups have been described. Several techniques that the author has have personally found helpful have also been provided. The final section of this article presents clinical observations in a few critically ill patients. These anecdotes were only included to try to stimulate thought and hopefully an interchange of ideas that may help us deal more effectively with the management of these patients. This article also raises the question of what is the optimal arterial partial pressure of oxygen as opposed to merely treating the HBO patient with a standard protocol, particularly if the patient has a significant right-to-left shunt (anatomic or physiologic). It is hoped that further discussion, thought, and research can help elucidate answers to these questions.