Authors (including presenting author) :
CHAU CWJ
Affiliation :
Hyperbaric Oxygen Therapy Centre, Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital
Introduction :
The first hospital-based Hyperbaric Oxygen Therapy (HBOT) Centre is situated at the Pamela Youde Nethersole Hospital (PYNEH) and service commenced on 28th September 2018. It provides both emergency and elective treatment for patients with indications suitable for HBOT. It provides a 24/7 service with specially trained hyperbaric physician on-call for emergency consultation from all hospitals within Hospital Authority network.
Objectives :
1. Provide emergency and elective service to patients requiring HBOT
2. Enhance smooth logistics in providing service to all the Hospital Authority hospitals
Methodology :
Emergency patients can be consulted through PYNEH operator for hyperbaric physician for consultation 24hourly. Elective patients can be consulted through sending the referral form to the HBOT Centre. The course of HBOT varies according to the indications. For emergency indications, HBOT treatment varies from 1 to 10 sessions per disease. For elective indications, HBOT treatment varies from 20 to 60 sessions per disease. All patients receiving treatments are categorized and recorded. In order to ensure treatment efficacy and safety, patient flow logistics, patient outcome and complications are recorded for future analysis. Time of patient consultation and treatment provided are recorded for future adjustment of manpower.
Result & Outcome :
The HBOT Centre commenced service on 28th September 2018 and statistics of patient admission for treatment up to 31st December 2018 was recorded. There were total 23 patients being treated. 20 out of 23 patients were emergency indications while 3 of them were elective. There were total of 86 treatment sessions provided to these 20 patients, while a total of 20 treatment sessions were provided for elective patients. Out of the emergency patients, 10 were CO Poisoning (COP), 2 were necrotizing soft tissue infection (NSTI), 7 were central retinal artery occlusion (CRAO) and 1 was decompression sickness (DCS). For treatment session done, 22 were COP, 7 were NSTI, 56 were CRAO and 1 was DCS. 14 out of 20 patients were transfer from other HA hospital to PYNEH. For COP, 5 out of 10 patients required intensive unit care. Myringotomy is a standard procedure for intubated patients undergo HBOT. These patients were transferred to either medical department or emergency medical ward once patient was extubated and stable. 1 out of 10 experienced moderate barotrauma of the ear, which required ENT’s consultation and follow up. No other complication was noted. For NSTI, both patients were from PYNEH and had the treatment terminated prematurely due to the first patient succumbed with severe sepsis and the second patient suffered from acute coronary syndrome coincidently. For CRAO, a total of 7 patients were treated in this period, but 2 out of 7 were wrongly diagnosed. As the patient had HBOT treatment once clinically suspected by ophthalmologist. Fundus Fluorescein Angiography was performed in PYNEH in daytime to confirm diagnosis of CRAO. For the remaining 5 patients who had true CRAO, 4 out of 5 has improvement of visual acuity with a subjective improvement from 30 to 70% in VA. The full course HBOT for CRAO was a twice-daily treatment for 5 days (Total 10 session of HBOT). 6 out of 7 patients are referred from hospital other than PYNEH. All patients were treated uneventful. For DCS, 1 patient was treated for 1 session and totally recovered with no relapse. For elective patients, we provided HBOT for 2 orthopedics patients with chronic unhealed wound. Both of the patients were referred from PYNEH orthopedics and still in progress of treatment. One of the patients had done half of the planned sessions and the interim outcome was encouraging with the wound healed more than half of the wound
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