BMJ 1994;309:124 (9 July)

Letters

Proposed alternatives are incorrect

EDITOR,--James Watt's suggestion that hyperbaric oxygen would have been at least as efficacious as, and less dangerous than, blood transfusion in the management of a man who refused blood products after suffering extensive orthopaedic trauma1 is erroneous. Hyperbaric oxygen cannot be regarded as a practical alternative to blood transfusion to ensure adequate oxygen delivery for any length of time in such patients.

Oxygen must be given at 3.04 x 105 kPa to supply the body's total demand in the form of dissolved oxygen (60 ml/l).2 This can be achieved only intermittently for short periods, since continuous administration produces oxygen toxicity within hours, manifest by convulsions and serious pulmonary complications (atelectasis, oedema, and fibrosis), and would ultimately be fatal.3 4 In addition, there are practical problems in caring for critically ill patients being given hyperbaric oxygen: the safety of the attenders, who require safe decompression; the increased fire hazard; and the care . . . [Full text of this article]


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Relevant Article

Managing patients who refuse blood transfusions: an ethical dilemma: Major trauma in two patients refusing blood transfusion
S Finfer, S Howell, J Miller, K Willett, and J Wilson-MacDonald
BMJ 1994 308: 1423-26. [Extract] [Full Text]

Rapid Responses:

Read all Rapid Responses

Criticism and Condemnation of Life-Saving Treatment is Incorrect.
Gordon J.G. Ward
bmj.com, 21 Aug 2007 [Full text]
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