Wednesday, July 26, 2017

Subacute normobaric oxygen and hyperbaric oxygen therapy in drowning, reversal of brain volume loss: a case report

Title: Subacute normobaric oxygen and hyperbaric oxygen therapy in drowning, reversal of brain volume loss: a case report
Author: Harch P, Fogarty E
Journal: Medical Gas Research, 2017(7)

This article may go over some folks' heads, but it was such an interesting case report I had to share it. This report outlines a case involving a 2 year old girl who was submerged for an estimated 15 minutes in 41F water and underwent 100 minutes of CPR. After 35 days in the hospital she was discharged with apparent severe anoxic brain injury (unresponsive, immobile with legs drawn to chest, constant head shaking). At 55 days post-drowning, Dr Harch (lead author) was consulted to facilitate normobaric and hyperbaric oxygen therapy.

The paper goes on to explain in detail the treatment protocols and subsequent studies done. Here is a summary:


  • Initial normobaric oxygen therapy (2L nasal cannula, 45 min twice a day)
    • Behavioral changes noted within hours
    • Neurologic improvement over next 23 days
      • laughing
      • increased use of extremities
      • oral feeding
      • short speech
  • Hyperbaric treatment started at post-drowning day 78
    • Changes noted within hours
      • decreased tone
      • increased motor activity
      • Increased vocabulary, alertness
    • After 10 sessions patient "near normal, except for gross motor function" per mother
    • After 39 sessions
      • assisted gait
      • speech better than pre-drowning
      • normal cognition
      • discontinued all meds
  • Repeat MRI at post-drowning day 162 showed mild residual injury and some near-complete reversal
Paper Conclusion
"Short duration normobaric oxygen and hyperbaric oxygen therapy in the subacute phase of drowning recovery resulted in video-documented near-complete resolution of severe neurological deficits and near-complete reversal of gray and white matter atrophy on MRI"



This is a fascinating case that sheds light on a therapy that has been described very little with the treatment of drowning patients but had a drastic effect on the outcome of this patient. There is still a long way to go in terms of collecting more cases and usable data, but promising and interesting non the less. Congrats to Dr Harch on a very successful case.


Link:
http://www.medgasres.com/article.asp?issn=2045-9912;year=2017;volume=7;issue=2;spage=144;epage=149;aulast=Harch

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