Microcirculation and Hyperbaric Oxygen Treatment

The microcirculation is anatomical and consists of arterioles, capillaries, and venules that perform metabolic requirements and oxygen distribution to the tissues. During physiological or pathological stress, it balances between the oxygen delivery and the demand. This delicate balance can play an important role in the progression of critical illnesses and has a role in the development of organ dysfunction. Reduced microvascular perfusion is seen in many diseases, and hyperbaric oxygen treatment (HBOT) has potentially beneficial effects on the microcirculatory environment. It has been shown that HBOT improves microcirculation independent from systemic hemodynamic parameters, which is a key therapeutic target in the critically ill patient. HBOT is emerging as an adjunct to traditional surgery and antibiotic therapy for the special kinds of problematic wounds or purpura fulminans, which are caused by meningococcal sepsis. HBOT also can increase oxygen supply to the ischemic tissue to reduce the extent of irreversible tissue damage in ischemic stroke, femoral head necrosis, diabetic foot ulcer, and carbon monoxide intoxication. In this chapter, we aim to describe microcirculation with its monitoring systems and to show the effectiveness of HBOT in different clinical settings, which are related to microcirculatory dysfunction

Hydrocephaly: Medical Treatment

Hydrocephaly is a prevalent condition in all age groups. At present, the most frequent strategies used to treat hydrocephaly are surgical shunting procedures, which are still associated with multiple complications. The main goal of the medical therapy for the lowering of high ventricular pressure is to avoid shunting or to reduce and decrease intracranial pressure (ICP) until shunt surgery. Medications affect cerebrospinal fluid dynamics by decreasing secretion or increasing reabsorption. Medical treatment for manipulation of water balance or cerebrospinal fluid (CSF) production reduces mortality in both infants and adults with neurological disorders. Medical treatment has an important role in the management of hydrocephaly especially in patients not suitable for shunt and in patients whom the shunt alone is not able to control the hydrocephaly. The treatment is used to delay surgical intervention but is not effective in the long treatment of chronic hydrocephaly