Oxybar Therapy

(HBOT )HYPER BARIC OXYGEN THERAPYDr Faeyz F Orabi MD, PM&R

منظمة الشرقية الغوطة في الضغط عالي األوكسجين بغرفة بالمعالجة تعريفية محاضرةضمان

WHAT IS HBOTWHAT IS HBOT??Hyperbaric oxygen therapy (HBOT) is the inhalation of 100 percent oxygen inside a hyperbaric chamber that is pressurized to greater than 1 atmosphere (atm). HBOT causes both mechanical and physiologic effects by inducing a state of increased pressure and hyperoxia. HBOT is typically administered at 1 to 3 atm. While the duration of an HBOT session is typically 90 to 120 minutes, the duration, frequency, and cumulative number of sessions have not been standardized.


Involves intermittently breathing pure oxygen at greater than ambient pressure

Think of oxygen as a drug and the hyperbaric chamber as a dosing device

Elevating tissue oxygen tension is the primary effectمنظمة الشرقية الغوطة في الضغط عالي األوكسجين بغرفة بالمعالجة تعريفية محاضرةضمان

British physician, Henshaw, in 1662 used a chamber fitted with a large pair of organ bellows, so that air could either be compressed into the chamber or extracted from it.

In this ‘domicilium' increased pressures were used for the treatment of acute disease, and reduced pressures for the treatment of chronic diseases.

Oxygen discovered in 1775


1889 – Moir used hyperbaric 1889 – Moir used hyperbaric therapy to treat workers building therapy to treat workers building railroad tunnels underneath the railroad tunnels underneath the Hudson River. Reduced mortality Hudson River. Reduced mortality rate of decompression sickness rate of decompression sickness from 25% to only 1.6% per year.from 25% to only 1.6% per year.1926 - Six-story “steel ball 1926 - Six-story “steel ball

hospital” in Cleveland, Ohio. The hospital” in Cleveland, Ohio. The facility was capable of treating facility was capable of treating patients in 72 rooms over 12 floors patients in 72 rooms over 12 floors at pressures of 3 atm absolute.at pressures of 3 atm absolute.


..No oxygen? Brain damage in 3-4 minutes.

..No vitamin C? Scurvy in 3-4 months.

..No vitamin D? Osteoporosis in 3-4 years.We can supplement vitamins and

minerals, but…How do you get more

Oxygen?????منظمة الشرقية الغوطة في الضغط عالي األوكسجين بغرفة بالمعالجة تعريفية محاضرةضمان

Room Air 160 mmHg

Lung Capillaries 100 mmHg

Leaving Heart 85 mmHg

Peripheral Arterioles 70 mmHg

Organ Capillaries 50 mmHg

Cells 1-10 mmHg

Mitochondria 0.5 mmHg(0.3% of inhaled oxygen)

Mitochondria is the final

site of energy production


Breathing more oxygen not enough. Breathing more oxygen not enough. Room air contains 21% oxygen, enough to fill most of the

oxygen-binding sites on our red blood cells, carried by hemoglobin.

Breathing even 100% oxygen Breathing even 100% oxygen Fills the few remaining sites on hemoglobin. Increases blood

oxygen by a small percentage. Can be life-saving, especially if blood oxygen levels are low, but results in minimal gains when O2 levels start out normal.

Encourage oxygen to dissolve in serum and plasma by Encourage oxygen to dissolve in serum and plasma by increasing pressure of oxygen.increasing pressure of oxygen.

Pressure is provided by a chamber with above-normal pressure, called a “hyperbaric” oxygen chamber. Patient enters chamber and pressure is slowly increased to a level appropriate for the person’s condition.

HOW TO GET MORE OXYGENHOW TO GET MORE OXYGEN??




RECTANGULAR ROOM


CYLINDRICAL ROOM


Boyle’s Law – pressure and volume inversely proportional under constant temperature

(p 1 v 1 = p 2 v 2)By increasing ambient pressure

to 2 atm, decreases the volume by ½

Therapeutic for bubble forming diseases such as decompression sickness or arterial gas embolism

Henry’s Law – at a given temperature, the amount of gas dissolved in solute is directly proportional to the partial pressure of the gas.A high concentration of oxygen

in the alveolus creates a high concentration in the blood going to the tissues.

Solubility of Gas Solubility of Gas (equilibrium (equilibrium

concentration): C = Kconcentration): C = KHH P Pgasgas



PRESSURIZED OXYGENOxygen% Oxygen

Pressure Capillary Pressure

Normal Air 50 mm Hg pO2

100% O2 1 Atmos .75 mm Hg pO2

100% O2 1.3 Atmos .246 mm Hg pO2

100% O2 1.5 Atmos .437.5 mm Hg pO2


pres

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pres

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O2

O2

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• HypoxiaHypoxia – generates signal to commence wound healing cascade • Hyperbaric Oxygen Hyperbaric Oxygen environment environment augments the signal• ActionAction – HBOT acts as a signal transducer.





WHAT DOES THIS HAVE IN COMMON?


The macrophage is sensitive to variations in levels of oxygen present in the tissues; sensitive to an oxygen gradientPersistent Hypoxia signal results in an attempt , by local tissues to build new blood supply to the affected area.This is how tissues communicate to other neighboring structures, the need for routine tissue repair to commence.


Note that although there may be Note that although there may be insufficient stimulus to initiate the tissue insufficient stimulus to initiate the tissue repair cascade under normal conditions, repair cascade under normal conditions, by increasing the local oxygen delivery by increasing the local oxygen delivery the oxygen gradient is magnified the oxygen gradient is magnified ….resulting in a stronger signal and ….resulting in a stronger signal and augmented repair.augmented repair.



. By exposing the patient to 100% oxygen and higher atmospheric pressure, HBOT provides many benefits, including:Increasing the amount of oxygen intake to cellsAiding in circulationIncreasing the diameter of blood vesselsAssisting in cleansing the patient’s body of toxinsEnhancing white blood cell actionRejuvenating skin cellsIncreasing energyIncreasing endurance


THE FULL LIST OF FDA-APPROVED HYPERBARIC OXYGEN THERAPY TREATMENTS:Air or gas embolismCarbon monoxide poisoningEnhancement of healing in diabetically derived illness such as diabetic foot, diabetic retinopathy, diabetic nephropathy

Exceptional blood loss (anemia) Intracranial abscessClostridal myositis and myonecrosis (gas gangrene)

Crush injury, compartment syndrome, and other acute traumatic ischemiasمنظمة الشرقية الغوطة في الضغط عالي األوكسجين بغرفة بالمعالجة تعريفية محاضرةضمان

http://www.hyperbariccentersoftexas.com/hbot-orthopedic-conditions

THE FULL LIST OF FDA-APPROVED HYPERBARIC OXYGEN THERAPY TREATMENTS: Decompression sickness Necrotizing soft tissue infections (necrotizing fasciitis)

Osteomyelitis (refractory) Delayed radiation injury (soft tissue and bony necrosis)

Skin grafts and flaps (compromised) Thermal burns Actinomycosis Cyanide poisoning Delayed radiation injury (soft tissue and bony necrosis)منظمة الشرقية الغوطة في الضغط عالي األوكسجين بغرفة بالمعالجة تعريفية محاضرةضمان

--OFF-LABEL-- STUDIED USES OF HBOT

Cerebral Palsy (Montgomery, 1999; Collet 2001; Marois; 2006)

Amyotrophic Lateral Sclerosis (Steele, 2004)Complex Regional Pain Syndrome (Kiralp, 2004)Fetal Alcohol Syndrome (Stoller, 2005)Ischemic Brain Injury (Neubauer, 1992; Neubauer,

1998)Traumatic Midbrain Syndrome (Holbach, 1974)Closed Head Injury (Rockswold, 1992)Lupus (Wallace, 1996)Stroke (Nighoghossian, 1995)Myocardial Infarction (Shandling, 1997) منظمة الشرقية الغوطة في الضغط عالي األوكسجين بغرفة بالمعالجة تعريفية محاضرة

ضمان

Recent studies suggest low oxygen state after a Recent studies suggest low oxygen state after a stroke, cerebral stroke, cerebral palsy, autism, or chronic viral infections. palsy, autism, or chronic viral infections. Some of the cells around the area of injury are still alive - not Some of the cells around the area of injury are still alive - not sufficient oxygen to function well. Not dead, but too little oxygen to sufficient oxygen to function well. Not dead, but too little oxygen to do their jobs. do their jobs. Thousands of people are affected every year by an event or Thousands of people are affected every year by an event or condition that causes some body tissues to live in a perpetually-low condition that causes some body tissues to live in a perpetually-low oxygen state. Can be improved with acceptable blood flow, oxygen oxygen state. Can be improved with acceptable blood flow, oxygen saturation.saturation.••Limb reattachmentLimb reattachment••Radiation therapyRadiation therapy••Head injuryHead injury••Surgical woundSurgical wound••Skin graft Skin graft ••Plastic surgeryPlastic surgery••Severe burnsSevere burns••Carbon-monoxide poisoningCarbon-monoxide poisoning


Barotrauma (2%)Sinus squeezeSerous otitisClaustrophobiaReversible myopiaSeizures (0.01 – 0.03%)


Ruptured eardrum risk.Dropped lung (pneumothorax).Diabetic retinopathy.Cataracts.Cancer?Seizures




Some conditions are served better with:Immediate use following acute eventImmediate use following acute event,

Stroke, Head Injury, Heart AttackOngoing use to treat chronic conditionOngoing use to treat chronic condition,

Autism, Lyme Disease, Multiple SclerosisTemporary use to improve isolated condition.

Plastic Surgery, Wound Healing, Sports Injury


SPORTS INJURIESSPORTS INJURIES Shown to reduce recovery time for soft-tissue injuries and bone fractures. Reduces swelling and pain Prevents Hypoxia of the traumatized tissues Speeds up the healing of tissues, ligaments and fractured bones Reduces scar tissue formation and damage Helps return players to the game sooner. Professional NBA, NHL and NFL teams use hyperbaric oxygen chambers for treating their players.In the various studiesIn the various studies, the location of the injury seemed to have an influence on the effectiveness of treatment. After being exposed to HBO, for example, injuries at the muscle belly seem to have less benefit than areas of reduced perfusion such as muscle–tendon junctions and ligamentInjuries studies involving bones, muscles and ligaments with HBO Injuries studies involving bones, muscles and ligaments with HBO treatment seem promisingtreatment seem promising. However, they are comparatively scarce and the quality of evidence for the efficacy of HBO is low


HBOT indications will become better defined with perfection of the techniques for direct measurement of tissue oxygen tensions and intramuscular compartment pressures. Despite evidence of interesting results when treating many cases these treatments are multifactorial and are rarely published. Therefore, there is a need for larger samples, randomized, controlled, double-blind clinical trials of human and animal models in order to determine its effectiveness


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