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Mechanical Ventilation in Nontraditional Settings 601

TABLE 18-9 Safety Requirements for Defibrillation in a Multiplace Hyperbaric Chamber

Safety Requirement Notes

Multiplace chamber is compressed with air Room air reduces risk of fire
and F O is kept below 21.5%
2
I
Large adhesive plates are attached to the Flammable materials must not be around
patient’s chest and gel is applied to provide the large adhesive plate
conduction

Transmission cable of large diameter and low Special cable reduces electrical load
resistance goes through the chamber wall during defibrillation
and resides outside the chamber

Defibrillator and switches are located outside Discharge unit outside the chamber
the chamber eliminates electrical discharges inside the
chamber
A three-person team should be available as Designation of special job function en-
follows: (1) one person attaching paddle hances safety in case of emergency
inside the chamber, (2) one person
operating the discharge unit outside the
chamber, and (3) one person activating
water-deluge fire suppression system

Reference: Swanson et al., 1999; Kot, 2005.
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can be done in a multiplace chamber provided that several conditions are met
(Table 18-9).
Most implanted cardiac pacemakers can be used safely in the hyperbaric chamber
Most implanted for pressures below 3 atmospheres (Lafay et al., 2008). It is highly recommended
cardiac pacemakers can be
used safely in the hyperbaric that continuous monitoring of the ECG pattern and a defibrillator be available dur-
chamber for pressures below 3 ing every hyperbaric procedure. For patients who require temporary external pace-
atmospheres.
makers, any untested units should keep the pacemaker unit outside the chamber by
using wires through the chamber wall (Kot, 2005).

MECHANICAL VENTILATION IN HYPOBARIC CONDITION

Conflicts between countries spread the battlefield across the globe. In terms of car-
Transfer of patients to ing for the critically ill patients, it has become inefficient to provide comprehensive
a centralized location neces-
sitates the use of aeromedical critical and surgical care to the wounded at all locations. The current trend is to
evacuation of the wounded, stabilize the wounded and evacuate them to a centralized location for compre-
including those who require
mechanical ventilation. hensive care and rehabilitation. This strategy necessitates the use of aeromedical
evacuation of the wounded, including those who require mechanical ventilation
(Grissom et al., 1997). This section reviews the unique characteristics of mechanical
ventilation in a hypobaric environment.

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