Hyperbaric oxygen therapy in crush injuries after 17th of August earthquake in Marmara

17 Ağustos Marmara depremi sonrası oluşan ezilme yaralanmalarında hiperbarik oksijen tedavisi

ŞENOL YILDIZ,Sezai ÖZKAN,Kadir DÜNDAR,Hakan Ay,M. Zeki KIRALP,Özcan PEHLİVAN

Abstract

Effectiveness of hyperbaric oxygen therapy in crush injury due to earthquake is not reported yet. In this study, the patients, who developed compartmentsyndrome as a result of crush injury after the Marmara earthquake on August 17, 1999, and who were treated with firstly decompressive fasciotomy and then hyperbaric oxygen therapy, were evaluated retrospectively. After examination and prior treatment on admission,the patients, who had sustained injuries by being compressed under collapsed buildings, were diagnosed with the crush syndrome. On admission, arterial blood gas analysis, whole blood count, biochemical assays, and radiographic and neurological examinations were done. All patients underwent decompressive fasciotomy. Wound cultures were collected from patients and antibiotherapy was started if necessary. Wound cleanings were maintained daily and surgical debridement was performed if needed. Hyperbaric oxygen therapy was performed twice daily at 2,5 Absolute Athmosphere (ATA) by two-hour sessions in postoperative period. Total number and the duration of sessions of hyperbaric oxygen therapy were noted. Fifty two patients were treated with hyperbaric oxygen therapy in postoperative period. Hyperbaric oxygen therapy was provided to all patients in 946 sessions, varying between 3 to 70 sessions per patient. Forty five of 52 patients were recovered without any complication or any sequels. Hemodialysis was performed to 7 patients for acute renal failure, and two of them died during the hyperbaric oxygen therapy due to acute respiratory distress syndrome and sepsis. Hyperbaric oxygen therapy should be considered in the treatment of crush injuries due to earthquakes.

Özet

Deprem sonrası ezilme yaralanmalarının tedavisinde hiperbarik oksijen (HBO2) tedavisinin etkinliği konusunda bir makale yayınlanmamıştır. Bu çalışmada, 17 Ağustos Marmara depremi sonrası hastanemize kabul edilen, ezilme yaralanması sonrası kompartman sendromu gelişen ve dekompressif fasyotomi girişimi sonrasında HBO2 uygulanan hastalar retrospektif olarak incelendi. Depremi müteakip hastanemize kabul edilen 630 hastadan, ezilme yaralanması sonrası kompartman sendromu gelişimi nedeniyle fasyotomi uygulanmış 52' si postoperatif devrede olanlar HBO2 tedavisine alındı. Hastalardan 29' unda alt ekstremitede, 14' ünde üst ekstremitede ve 9' unda hem alt ve hem de üst ekstremitede fasyotomi uygulandı. Bu hastalardan 7'sinde akut böbrek yetmezliği gelişti. İki hasta ise ARDS ve sepsis nedeniyle kaybedildi. Beş hastaya ampütasyon uygulandı, 45 hastanın ezilme yaralanmaları ampütasyon olmaksızın iyileşti. Hiperbarik oksijen tedavisine alınan hastalara, 3 ile 70 seans arasında değişmek üzere toplam 946 seans (1892 saat) HBO2 tedavisi uygulandı. Sonuç olarak, depremler sonrası sıklıkla izlenen ezilme yaralanmasına bağlı gelişen kompartman sendromunda tedavide; fasyotomi, yara debritmanı ve antibiyoterapiye yardımcı olarak HBO2 tedavisinin eklenilmesini önermekteyiz.