Scholars@Duke
John Jacob Freiberger

John Jacob Freiberger

Adjunct Associate Professor in the Department of Anesthesiology
Anesthesiology
john.freiberger@duke.edu
Box 3823 Med Ctr, Durham, NC
0570 CRII DS, Durham, NC 27710

Selected Publications

Prediction of central nervous system oxygen toxicity symptoms using electrodermal activity and machine learning

Journal Article Biocybernetics and Biomedical Engineering · April 1, 2024 Objective: Breathing elevated oxygen partial pressures (PO2) prior to SCUBA diving increases the risk of developing central nervous system oxygen toxicity (CNS-OT), which could impair performance or result in seizure and subsequent drowning. We aimed to st ... Full text Cite

Time-varying Spectral Index of Electrodermal Activity to Predict Central Nervous System Oxygen Toxicity Symptoms in Divers: Preliminary results.

Journal Article Annu Int Conf IEEE Eng Med Biol Soc · November 2021 The most effective method to mitigate decompression sickness in divers is hyperbaric oxygen (HBO2) pre-breathing. However, divers breathing HBO2 are at risk for developing central nervous system oxygen toxicity (CNS-OT), which can manifest as symptoms that ... Full text Link to item Cite

Ultrasound in decompression research: fundamentals, considerations, and future technologies.

Journal Article Undersea Hyperb Med · 2021 It is widely accepted that bubbles are a necessary but insufficient condition for the development of decompression sickness. However, open questions remain regarding the precise formation and behavior of these bubbles after an ambient pressure reduction (d ... Full text Link to item Cite

A fully automated method for late ventricular diastole frame selection in post-dive echocardiography without ECG gating.

Journal Article Undersea Hyperb Med · 2021 Venous gas emboli (VGE) are often quantified as a marker of decompression stress on echocardiograms. Bubble-counting has been proposed as an easy to learn method, but remains time-consuming, rendering large dataset analysis impractical. Computer automation ... Full text Link to item Cite

Sildenafil: Possible Prophylaxis against Swimming-induced Pulmonary Edema.

Journal Article Med Sci Sports Exerc · September 2017 Swimming-induced pulmonary edema (SIPE) occurs during swimming and scuba diving, usually in cold water, in susceptible healthy individuals, especially military recruits and triathletes. We have previously demonstrated that pulmonary artery (PA) pressure an ... Full text Open Access Link to item Cite

Hyperbaric oxygen therapy and osteonecrosis.

Journal Article Oral Dis · March 2017 Osteonecrosis of the jaw may be caused by radiation, medication, or infection. Optimal therapy requires a multimodal approach that combines surgery with adjuvant treatments. This review focuses on the use of adjunctive hyperbaric oxygen therapy for this co ... Full text Link to item Cite

Hypercapnia in diving: a review of CO₂ retention in submersed exercise at depth.

Journal Article Undersea Hyperb Med · 2017 Carbon dioxide (CO₂) retention, or hypercapnia, is a known risk of diving that can cause mental and physical impairments leading to life-threatening accidents. Often, such accidents occur due to elevated inspired carbon dioxide. For instance, in cases of C ... Full text Open Access Link to item Cite

The Dewey monitor: Pulse oximetry can independently detect hypoxia in a rebreather diver.

Journal Article Undersea Hyperb Med · 2017 Rebreather diving has one of the highest fatality rates per man hour of any diving activity in the world. The leading cause of death is hypoxia, typically from equipment or procedural failures. Hypoxia causes very few symptoms prior to causing loss of cons ... Full text Open Access Link to item Cite

Assessment of the interaction of hyperbaric N2, CO2, and O2 on psychomotor performance in divers.

Journal Article J Appl Physiol (1985) · October 1, 2016 Diving narcosis results from the complex interaction of gases, activities, and environmental conditions. We hypothesized that these interactions could be separated into their component parts. Where previous studies have tested single cognitive tasks sequen ... Full text Link to item Cite

Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil.

Journal Article Circulation · March 8, 2016 BACKGROUND: Swimming-induced pulmonary edema (SIPE) occurs during swimming or scuba diving, often in young individuals with no predisposing conditions, and its pathophysiology is poorly understood. This study tested the hypothesis that pulmonary artery and ... Full text Open Access Link to item Cite

Research report: Charcoal type used for hookah smoking influences CO production.

Journal Article Undersea Hyperb Med · 2015 A hookah smoker who was treated for severe carbon monoxide poisoning with hyperbaric oxygen reported using a different type of charcoal prior to hospital admission, i.e., quick-light charcoal. This finding led to a study aimed at determining whether CO pro ... Open Access Link to item Cite

Comparison of complications in free flap reconstruction for osteoradionecrosis in patients with or without hyperbaric oxygen therapy.

Journal Article Head Neck · December 2014 BACKGROUND: Hyperbaric oxygen (HBO) therapy induces native tissue oxygenation. The hypothesis was patients with mandibular osteoradionecrosis (ORN) and a history of HBO therapy would have less free flap reconstruction complications than patients without HB ... Full text Link to item Cite

Hyperbaric oxygen therapy in necrotising soft tissue infections: a study of patients in the United States Nationwide Inpatient Sample.

Journal Article Intensive Care Med · July 2012 PURPOSE: Necrotising soft tissue infection (NSTI) is a deadly disease associated with a significant risk of mortality and long-term disability from limb and tissue loss. The aim of this study was to determine the effect of hyperbaric oxygen (HBO(2)) therap ... Full text Link to item Cite

What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics.

Journal Article J Oral Maxillofac Surg · July 2012 PURPOSE: This study tested hyperbaric oxygen (HBO) as an adjunct to surgery and antibiotics in the treatment of bisphosphonate-related osteonecrosis of the jaw (ONJ) and evaluated its effects on gingival healing, pain, and quality of life. MATERIALS AND ME ... Full text Link to item Cite

Safe administration of hyperbaric oxygen after bleomycin: a case series of 15 patients.

Journal Article Undersea Hyperb Med · 2012 INTRODUCTION: Supplemental oxygen has been reported to cause pulmonary complications after bleomycin. We describe the safe administration of hyperbaric oxygen (HBO2) after bleomycin in 15 patients. METHODS: Paper and electronic records were reviewed for bl ... Link to item Cite

Risk factors for immersion pulmonary edema: hyperoxia does not attenuate pulmonary hypertension associated with cold water-immersed prone exercise at 4.7 ATA.

Journal Article J Appl Physiol (1985) · March 2011 Hyperoxia has been shown to attenuate the increase in pulmonary artery (PA) pressure associated with immersed exercise in thermoneutral water, which could serve as a possible preventive strategy for the development of immersion pulmonary edema (IPE). We te ... Full text Link to item Cite

Effects of hyperoxia on ventilation and pulmonary hemodynamics during immersed prone exercise at 4.7 ATA: possible implications for immersion pulmonary edema.

Journal Article J Appl Physiol (1985) · July 2010 Immersion pulmonary edema (IPE) can occur in otherwise healthy swimmers and divers, likely because of stress failure of pulmonary capillaries secondary to increased pulmonary vascular pressures. Prior studies have revealed progressive increase in ventilati ... Full text Link to item Cite

Triage and emergency evacuation of recreational divers: a case series analysis.

Journal Article Undersea Hyperb Med · 2010 INTRODUCTION: It is unknown if the benefits of rapid treatment always outweigh the risks of emergency evacuation for recreational divers. To investigate current triage practice, we reviewed a three-year consecutive series of evacuations and analyzed the re ... Link to item Cite

Multimodality surgical and hyperbaric management of mandibular osteoradionecrosis.

Journal Article Int J Radiat Oncol Biol Phys · November 1, 2009 Featured Publication PURPOSE: To elucidate long-term outcomes in 65 consecutive patients meeting a uniform definition of mandibular osteoradionecrosis (ORN) treated with multimodality therapy including hyperbaric oxygen (HBO). METHODS AND MATERIALS: Pretreatment, post-treatmen ... Full text Link to item Cite

Utility of hyperbaric oxygen in treatment of bisphosphonate-related osteonecrosis of the jaws.

Journal Article J Oral Maxillofac Surg · May 2009 Featured Publication Bisphosphonates suppress bone turnover by disrupting osteoclast signal transduction, maturation, and longevity. In some patients, it has been hypothesized that suppressed turnover can impair oral wound healing, leading to a distressing, osteopetrosis-like ... Full text Link to item Cite

Resolution and severity in decompression illness.

Journal Article Aviat Space Environ Med · May 2009 Featured Publication omegaWe review the terminology of decompression illness (DCI), investigations of residual symptoms of decompression sickness (DCS), and application of survival analysis for investigating DCI severity and resolution. The Type 1 and Type 2 DCS classification ... Full text Link to item Cite

Effects of head and body cooling on hemodynamics during immersed prone exercise at 1 ATA.

Journal Article J Appl Physiol (1985) · February 2009 Featured Publication Immersion pulmonary edema (IPE) is a condition with sudden onset in divers and swimmers suspected to be due to pulmonary arterial or venous hypertension induced by exercise in cold water, although it does occur even with adequate thermal protection. We tes ... Full text Link to item Cite

Predictors of increased PaCO2 during immersed prone exercise at 4.7 ATA.

Journal Article J Appl Physiol (1985) · January 2009 Featured Publication During diving, arterial Pco(2) (Pa(CO(2))) levels can increase and contribute to psychomotor impairment and unconsciousness. This study was designed to investigate the effects of the hypercapnic ventilatory response (HCVR), exercise, inspired Po(2), and ex ... Full text Link to item Cite

Decompression illness diagnosis and decompression study design.

Journal Article Aviat Space Environ Med · August 2008 Featured Publication Full text Link to item Cite

Hyperbaric oxygen treatment and bisphosphonate-induced osteonecrosis of the jaw: a case series.

Journal Article J Oral Maxillofac Surg · July 2007 Featured Publication PURPOSE: Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) is an emerging problem with few therapeutic options. Our pilot study of BP-ONJ investigated a possible role for hyperbaric oxygen (HBO(2)) therapy. PATIENTS AND METHODS: A total of 16 p ... Full text Link to item Cite

First aid normobaric oxygen for the treatment of recreational diving injuries.

Journal Article Undersea Hyperb Med · 2007 Featured Publication INTRODUCTION: First aid oxygen (FAO2) has been widely used as an emergency treatment for diving injuries, but there are few studies supporting its efficacy. METHODS: 2,231 sequential diving injury reports collected by the Divers Alert Network (DAN) Injury ... Link to item Cite

Influence of bottom time on preflight surface intervals before flying after diving.

Journal Article Undersea Hyperb Med · 2007 Featured Publication Previous trials of flying at 8,000 ft after a single 60 fsw, 55 min no-stop air dive found low decompression sickness (DCS) risk for a 11:00 preflight surface interval (PFSI). Repetitive 60 fsw no-stop dives with 75 and 95 min total bottom times found 16:0 ... Link to item Cite

A comparison of hyperbaric oxygen versus hypoxic cerebral preconditioning in neonatal rats.

Journal Article Brain Res · February 23, 2006 Featured Publication The potency of hyperbaric preconditioning (HBO-PC) is uncertain compared to well-validated ischemic or hypoxic models and no studies have directly compared HBO-PC to hypoxic preconditioning (HPC). We subjected rat pups to unilateral carotid cauterization f ... Full text Link to item Cite

Carbon monoxide actuates O(2)-limited heme degradation in the rat brain.

Journal Article Free Radic Biol Med · December 1, 2004 Featured Publication The biochemical paradigm for carbon monoxide (CO) is driven by the century-old Warburg hypothesis: CO alters O(2)-dependent functions by binding heme proteins in competitive relation to 1/oxygen partial pressure (PO(2)). High PO(2) thus hastens CO eliminat ... Full text Link to item Cite

Consensus factors used by experts in the diagnosis of decompression illness.

Journal Article Aviat Space Environ Med · December 2004 Featured Publication INTRODUCTION: The diagnosis of decompression illness (DCI) is entirely based on clinical findings and DCI experts are rare. Of all the chambers reporting to Diver's Alert Network (DAN), 86% see less than 10 cases per year. Simulated diving injury cases (vi ... Link to item Cite

Superoxide dismutase responds to hyperoxia in rat hippocampus.

Journal Article Undersea Hyperb Med · 2004 Featured Publication The brain's anti-oxidant response to highly elevated oxygen (O2) partial pressures is poorly understood. In this study we hypothesized that hyperbaric O2 (HBO2) would stimulate superoxide dismutase (SOD) transcription in the oxidative stress-sensitive rat ... Link to item Cite

The relative risk of decompression sickness during and after air travel following diving.

Journal Article Aviat Space Environ Med · October 2002 Featured Publication BACKGROUND: Decompression sickness (DCS) can be provoked by post-dive flying but few data exist to quantify the risk of different post-dive, preflight surface intervals (PFSI). METHODS: We conducted a case-control study using field data from the Divers Ale ... Link to item Cite

Private demand for a HIV/AIDS vaccine: evidence from Guadalajara, Mexico.

Journal Article Vaccine · June 7, 2002 Featured Publication The private demand for a hypothetical vaccine that would provide lifetime protection against HIV/AIDS to an uninfected adult was measured in Guadalajara, Mexico, using the concept of willingness to pay (WTP). A 91-question survey instrument was administere ... Full text Link to item Cite

Alprazolam withdrawal presenting as delirium after cardiac surgery.

Journal Article J Cardiothorac Vasc Anesth · April 1991 Featured Publication Full text Link to item Cite

CLINICAL-APPLICATIONS OF PROSTAGLANDINS FOR THE ANESTHESIOLOGIST

Journal Article SEMINARS IN ANESTHESIA · June 1, 1988 Link to item Cite

An unusual presentation of an airway tear.

Journal Article Anesthesiology · August 1984 Featured Publication Full text Link to item Cite