Oxybar Therapy, Idenitifation, indication, contraindication

1. )HBOT) HYPER BARIC
OXYGEN THERAPY
Dr Faeyz F Orabi MD, PM&R

2. 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.

3. 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 effect

4.  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

5. 1889 – Moir used hyperbaric1889 – Moir used hyperbaric
therapy to treat workers buildingtherapy to treat workers building
railroad tunnels underneath therailroad tunnels underneath the
Hudson River. Reduced mortalityHudson River. Reduced mortality
rate of decompression sicknessrate of decompression sickness
from 25% to only 1.6% per year.from 25% to only 1.6% per year.
1926 - Six-story “steel ball1926 - Six-story “steel ball
hospital” in Cleveland, Ohio. Thehospital” in Cleveland, Ohio. The
facility was capable of treatingfacility was capable of treating
patients in 72 rooms over 12 floorspatients in 72 rooms over 12 floors
at pressures of 3 atm absolute.at pressures of 3 atm absolute.

6. ..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?????

7. 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

8.  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% oxygenBreathing 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 byEncourage 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??

11. RECTANGULAR ROOM

12. CYLINDRICAL ROOM

13. 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 (equilibriumSolubility of Gas (equilibrium
concentration): C = Kconcentration): C = KHH PPgasgas

15. PRESSURIZED OXYGEN
Oxygen% Oxygen Pressure Capillary Pressure
Normal Air 50mm Hg pO2
100%O2 1Atmos. 75mm Hg pO2
100%O2 1.3Atmos. 246mm Hg pO2
100%O2 1.5Atmos. 437.5mm Hg pO2

16. pressurepressure
O2absorptionO2absorption

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

21. WHAT DOES THIS HAVE IN COMMON?

22. The macrophage is sensitive to
variations in levels of oxygen
present in the tissues; sensitive to
an oxygen gradient
Persistent 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.

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

25. . By exposing the patient to 100% oxygen and higher atmospheric
pressure, HBOT provides many benefits, including:
Increasing the amount of oxygen intake to cells
Aiding in circulation
Increasing the diameter of blood vessels
Assisting in cleansing the patient’s body of toxins
Enhancing white blood cell action
Rejuvenating skin cells
Increasing energy
Increasing endurance

26. THE FULL LIST OF FDA-APPROVED HYPERBARIC OXYGEN THERAPY
TREATMENTS:
Air or gas embolism
Carbon monoxide poisoning
Enhancement of healing in diabetically
derived illness such as diabetic foot, diabetic
retinopathy, diabetic nephropathy
Exceptional blood loss (anemia)
Intracranial abscess
Clostridal myositis and myonecrosis (gas
gangrene)
Crush injury, compartment syndrome, and
other acute traumatic ischemias

27. 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)

28. --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)

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

30. Barotrauma (2%)
Sinus squeeze
Serous otitis
Claustrophobia
Reversible myopia
Seizures (0.01 – 0.03%)

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

34. Some conditions are served better with:
Immediate use following acute eventImmediate use following acute event,
Stroke, Head Injury, Heart Attack
Ongoing use to treat chronic conditionOngoing use to treat chronic condition,
Autism, Lyme Disease, Multiple Sclerosis
Temporary use to improve isolated condition.
Plastic Surgery, Wound Healing, Sports Injury

35. 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 ligament
Injuries studies involving bones, muscles and ligaments withInjuries studies involving bones, muscles and ligaments with
HBO treatment seem promisingHBO treatment seem promising. However, they are

36. 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

37. Thank You