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between medical attendants inside the chamber and the technicians operating the chamber from the outside is the most advanced available. In most hyperbaric chambers, the pressurizing and depres- surizing process is very loud, making it difficult to hear patients speak and to monitor their lungs. HCMC's new cham- ber is quiet, a significant safety advantage allowing effective patient monitoring during treatments. HCMC surveyed most of the chamber manufacturers before selecting Fink Engineering, a small Australian company, to build its chamber. "The quality is incredible," says Dr. Adkinson. "This company makes the most advanced, safe and user-friendly chambers in the world. Unlike other manufacturers, Fink uses the best materi- als — copper, brass and stainless steel. The back of the chamber is a work of art; all of the connections are accessible, so it's very easy to troubleshoot. For patient safety and nursing accuracy, we wanted the headwall for hyperbaric critical care patients to mirror our ICU headwall. To stay within our footprint, we requested doors on the front of the chamber rather than on the ends. We have monitors so patients can be transferred from the ICU without being unhooked from one monitor and re-hooked to another, reducing setup time and the potential for error. Fink did a marvelous job of adapting to our needs." The physiology of hyperbaric medicine is simple; it's used in conditions where tissues do not have enough oxygen. Under normal circumstances, oxygen attaches to hemoglobin and very little oxygen is dissolved in the liquid portion of the blood. In a hyperbaric chamber, at three times normal atmospheric pressure, with the patient breathing 100% oxygen from a ventilator, hood or mask, 20 times more oxygen is dissolved in the liquid portion of the blood. This brings much-needed oxygen to compromised tissues. By fortifying the blood with extra oxy- gen, hyperbaric treatment boosts healing in radiated tissue and diabetic extremity wounds, and aids in the treatment of emergency conditions such as carbon monoxide poisoning, crush injuries, some HCMC's new hyperbaric chamber was constructed in Australia by Fink Engineering. The company's owner, Eric Fink, has been on site to directly supervise the final weeks of the six-month installation and orient the staff. severe infections, and some instances of sudden hearing or sight loss. Over the last five years, awareness has increased among oncologists and head and neck surgeons regarding hyperbaric medi- cine's effectiveness in healing wounds in irradiated tissue and treating patients with, or at risk for, osteoradionecrosis. "Once tissue has been irradiated, wounds in that tissue are very difficult to heal," explains Dr. Adkinson. "Patients who have undergone radiation treatment in the past and need surgery to remove a recurrent cancer frequently need a flap or graft of tissue from another part of the body to cover defects following surgery. These flaps and grafts have a high failure rate because they must heal onto irradi- ated tissue, which is not hospitable. Even when the flap has its own blood supply, it often fails to heal. "In the past, patients failed two or three flap repairs before they were referred for hyperbaric treatment. Now they are referred sooner, in accordance with literature showing that outcomes for surgery in irradiated tissue are best if patients receive hyperbaric treatment before surgery. When the surgery cannot be delayed to give hyperbaric treatment, as when a recurrent cancer must be removed, then the best outcomes are asso- ciated with starting hyperbaric treatment immediately after the surgery, rather than waiting until the wound closure starts to break down." Hyperbaric treatment is also of value in treating conditions, such as crush injury, that result in extensive tissue hypoxia, chronic refractory osteomyelitis and acute thermal burns. Hyperbaric treatment also shows a lot of promise for the treatment of acute head injury. "Hyperbaric medicine is still con- sidered experimental for acute brain injury because large human outcome trials haven't been done," explains Dr. Adkinson. "The physiologic evidence of improvement is very clear. Here at HCMC, Dr. Gaylan Rockswold[M.D.]'s research on patients with acute trau- matic brain injury showed hyperbaric oxygen improved blood flow and oxygen levels in the injured brain and decreased intracranial pressure, and he found these effects lasted for hours after the treatment ended. He and his colleagues also showed that brain metabolism is significantly improved in patients with acute brain injury who receive hyperbaric oxygen within 24 hours of injury. The next step is to look at long-term quality of life. The National Institutes of Health is considering Dr. Rockswold's application for funding for a multi-institutional study focusing on patient outcomes. If the funding is approved, HCMC will be among the study sites." Two of the newest indications for hyperbaric oxygen are sudden idiopathic sensory neural hearing loss and central retinal artery occlusion — sudden onset MDNEWS.COM s MD NEWS Twin Cities | 7 PHOTOS © DAVID GINSBERG, ECLIPSE PRODUCTIONS

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