The Healing Powers of Hyperbaric Oxygen Treatment

Oxygen is essential to proper healing of bodily tissues, whether it's skin, muscle or
bone. In most cases, the act of breathing combined with a healthy network of veins and
arteries provide enough oxygen for body tissues to heal. However, in certain
circumstances, hyperbaric oxygen treatment is used to substantially increase oxygen
flow within tissues to improve healing.

Patients undergoing hyperbaric treatment are placed in a chamber where 100% oxygen
is circulated. The oxygen is pressurized so that air pressure may be 2-3 times greater
than normal. This allows the lungs and skin to absorb more concentrated oxygen in a
shorter period of time.

Hyperbaric oxygen treatment was originally used to relieve scuba and deep-sea divers
of a dangerous condition called decompression sickness or "the bends." While
ascending from underwater, nitrogen gas bubbles may form in the lungs, tissues and
bloodstream. Blood flow may be blocked, with disastrous results, and blood vessels
may be damaged. Hyperbaric treatment neutralizes the effects of nitrogen.

Today, the Undersea and Hyperbaric Medical Society has approved use of hyperbaric
oxygen for several other conditions besides the bends. The length and number of
treatments depends on the condition and its severity.

Air or Gas Embolism: This is similar to the bends, when air or gas bubbles enter
arteries or veins, reducing blood flow and affecting oxygen circulation.

Carbon Monoxide Poisoning: Carbon monoxide (CO), a colorless, odorless gas, is a

byproduct of combustion. It binds to red blood cells, blocking delivery of oxygen to the
body. Hyperbaric oxygen accelerates the clearance of CO from the body, restoring
oxygen delivery and preventing toxic effects on the central nervous system and blood
vessels.

Gas Gangrene: This bacterial infection eats away soft tissues, releases toxins into the
blood stream and inhibits the body's defense mechanisms. These bacteria prefer low-
oxygen concentrations. High doses of oxygen via hyperbaric therapy inhibit bacteria
and toxin production.

Crush Injuries: Complications of crush injuries, such as from motor vehicle accidents,
falls and gun shots, are very frequent. By increasing oxygen delivery to injured tissues,
hyperbaric treatments reduce swelling, improve healing and help fight infection.

Problem Wounds: Wounds may fail to respond to standard care because of low
oxygen levels and impaired circulation. Foot ulcers in diabetics are one such problem.
By increasing oxygen levels within the wound tissues, hyperbaric therapy promotes
healing.

Anemia/Blood Loss: In cases where a patient can't accept a blood transfusion for
medical or religious reasons, sufficient oxygen delivery (via red blood cells) might be
compromised. Hyperbaric treatment increases the oxygen content of existing red blood
cells.

Intracranial Abscess: A sinus infection or bone infection of the skull may form an
abscess within the skull or brain. Antibiotics may be ineffective and white blood cells
require a minimum oxygen level to kill bacteria. Hyperbaric treatment provides oxygen
for white blood cells and inhibits bacteria that need low oxygen levels to grow.

Soft Tissue Infections: These are serious infections -- in which tissue is dying -- that
may be complicated by conditions such as diabetes or vascular disease. While primary
treatments are removing the infected tissue and administering antibiotics, hyperbaric
oxygen may inhibit bacteria from growing and enhance the ability of white blood cells
to kill bacteria.

Bone Infections: Osteomyelitis, infection of the bone, that does not respond to
standard treatment may benefit from hyperbaric oxygen. It inhibits bacterial growth,
increases the killing power of white blood cells and enhances the effects of some
antibiotics.

Radiation Therapy Complications: Chronic complications of radiation therapy used

to treat cancer may result from scarring and narrowing of the blood vessels. Hyperbaric
treatment allows more oxygen to reach these damaged areas and helps prevent tissue
from dying for lack of blood and oxygen flow. It is most often used in the head and
neck areas.

Skin Grafts: The success of transferred skin grafts or flaps (which might include skin,
deeper tissue, muscle and bone) is largely dependent on sufficient oxygen supply to the
affected area. Hyperbaric treatment can be used to saturate the area with oxygen before
and after grafting.

Burns: Hyperbaric therapy is sometimes used to treat burns to the hands, face or groin
area, or for deep second-degree and third-degree burns that cover more than 20% of the
patient's body. Hyperbaric oxygen reduces swelling, limits progression of the burn
injury (which continues 3-4 days after the initial injury) and may diminish lung damage
from inhalation of heat and smoke.

Hyperbaric Oxygen Treatment

Although Hyperbaric Oxygen Therapy (HBO) sounds highly technical, the concept is rather
simple. Originally developed to treat deep-sea divers who suffer from the “bends,” HBO not
only reduces air bubbles caused by diving accidents, but increases the amount of oxygen
carried to body tissue through the blood stream.
Hyperbaric, made up of hyper meaning “excessive,” and baric meaning “atmospheric
pressure,” refers to “excessive pressure.” Oxygen administered at an atmospheric pressure
greater than normal delivers between 10 and 15 times the oxygen received by breathing
normally. Under pressure, oxygen acts as a medication that can increase the ability of white
blood cells to kill bacteria, inhibit the production of toxins, reduce tissue swelling from poor
circulation, stimulate the growth of capillaries, terminate deterioration of cells and even
maintain oxygenation of tissue without the presence of the key oxygen carrying element in
blood, hemoglobin.

THE HISTORY OF HBO

Hyperbaric chambers have been in use for centuries, as early as 1662. However, hyperbaric
oxygen therapy has been used clinically since the mid 1800's.
HBO was tested and developed by the U.S. Military after World War I. It has been used safely
since the 1930's to help treat deep sea divers with decompression sickness.
Clinical trials in the 1950's uncovered a number of beneficial mechanisms from exposure to
Hyperbaric oxygen. These experiments were the forerunners of contemporary applications of
HBO in the clinical setting.
In 1967, the Undersea and Hyperbaric Medical Society (UHMS) was founded to foster the
exchange of data on the physiology and medicine of commercial and military diving. The
Hyperbaric Oxygen Committee was developed by the UHMS in 1976 to oversee the ethical
practice of hyperbaric medicine.
Today, there are thirteen reimbursable indications approved by the UHMS as primary or
adjunctive treatment modalities. HBO has proved to be life and limb saving, as well as cost
effective and therapeutic in a variety of clinical conditions.

HBO
HBO is the therapeutic use of oxygen at pressures greater than 1 atmosphere,Pressures during
HBO therapy usually are expressed in multiples of atmospheric pressure absolute (ATA).
One ATA equals 760 mmHg or 101.32kpa.
HBO therapy conducted under pressure between 2-3 ATA.

INDICATIONS

Carbon Monoxide (CO) Poisoning

When a patient inhales a lethal amount of carbon monoxide, the CO migrates directly into the
tissues where it attaches to and alters proteins. These alterations do not become toxic until the
tissues have an inadequate supply of oxygen. Administering oxygen at normal atmospheric
pressure does not terminate this process. However, HBO therapy at pressures greater than 2
atmospheres stops cell deterioration.

Soft-tissue Infections
HBO has also been proven to fight infection from bacteria that need oxygen to survive.
Although it may seem that raising oxygen levels would promote the growth of these bacteria,
the reverse is true. Simply stated, white blood cells kill bacteria with an “explosion” of oxygen.
When oxygen levels are lower than normal due to poor circulation, white blood cells are not
strong enough to produce this explosion. HBO not only restores oxygen to the normal level,
but “super charges” these cells by delivering oxygen under greater than normal pressure.
Diabetic Ulcers of the Leg and Foot and Other Hard-to-Heal Wounds HBO therapy’s role in
stimulating capillary growth and increasing the white blood cells capacity to kill bacteria make it
an effective aid in the treatment of diabetic ulcers and other hard-to-heal wounds. Diabetics
are especially susceptible to these ulcers and circulation, low oxygen stream and addition to
increasing the amount of oxygen carried to tissues, HBO therapy also increases glucose and
reduces lactose levels, making blood cells more flexible. This allows blood to flow more freely
through smaller blood vessels in the body’s extremities.

Osteomyelitis
Chronic bone infections that resist treatment carry high medical costs over the years. In
combination with a comprehensive regiment of cleansing, isolation of infection, bone and
muscle grafting and antibiotics, HBO can speed the healing process and may also reduce the
likelihood of reinfection.

Traumatic Crush Injury

A number of factors contribute to tissue death due to traumatic crush injury. Although a
surgeon can repair large blood vessels, crushed micro-vessels (capillaries) cannot be mended.
In addition, the affected area may swell, limiting circulation even further. As the oxygen level
drops in the tissue, the cells lose their consistency and their ability to regenerate. HBO sends
oxygen to greater volumes of tissue, promoting new cell growth. It is vital that crush injury
patients receive HBO therapy early, perhaps even before surgery is scheduled.

Tissue Flaps and Grafts

Most tissue flaps and grafts heal readily without HBO. However, when a flap has lost oxygen
and is in danger of becoming unsalvageable, HBO can often sustain the flap until the blood
flow can be restored. HBO therapy can also significantly increase new capillary growth
following surgery.

Bloodless Medicine and Surgery

HBO may also be used prior to and following bloodless surgery to maximize the oxygen
carrying capabilities of the blood. Patients who opt for bloodless medicine and surgery do not
wish to receive blood transfusions to replace blood lost during surgery. Oxygen is normally
carried throughout the body in the red blood cells, which can only be replaced via a
transfusion. The high pressure of the HBO chamber forces oxygen into the plasma, or fluid
component of the blood. This enables oxygen levels in the body to be maintained even when
red blood cells are in short supply.

Radionecrosis
HBO therapy represents a new approach to the treatment of wounds caused by radiation
therapy. Radiation burns differ considerably from normal wounds. When the body is wounded,
the blood flowing from all directions is cut off abruptly, therefore creating a sudden drop in
oxygen pressure and sending a message to the brain to send all the infection fighters and
healing agents. In the case of radiation therapy, the pinpoint center of the area being treated
receives the greatest amount of damage, while the perimeter receives the least. Since the
radiation damage is gradual, the oxygen pressure does not drop abruptly and the brain does
not receive the message to send infection fighting and healing agents. When the oxygen
pressure is increased by nearly 50 times during HBO therapy, the brain can then recognize a
sudden decline in pressure at the wound site, triggering the healing process. This provides new
hope for patients suffering from radiation wounds that are incapable of healing.

Air Embolism (The Bends)

Hyperbaric Oxygen Therapy has been used to treat divers suffering from air embolism or
“bubbles” within the blood stream since the late 1960s. Embolisms can also occur during
surgery. HBO compresses the bubbles to between 1/3 and 1/6 the original size, reestablishing
uninterrupted circulation. In many cases, the success of HBO depends on rapid diagnosis and
treatment.

Gas Gangrene
This familiar disease, caused by loss of blood supply, produces dead tissue accompanied by
gas bubbles infected by bacteria that thrive in the absence of oxygen. These bacteria produce
deadly toxins that rapidly multiply within the tissues of the body. Before Hyperbaric Oxygen
Therapy, the only way to save a patient with gas gangrene from rapid death was to surgically
remove the infected area by amputation or disfiguration. HBO inhibits the production of these
poisonous toxins, stabilizes the patient, controls the infection and reduces the need for
immediate surgery.

Complications and Contraindications of HBO Therapy

Barotrauma
Ear or sinus trauma.
Tympanic membrane rupture.
pneumothorax.

Oxygen toxicity
Central nervous system toxic reaction.
Pulmonary toxic reactions.

Relative Contraindications
Upper respiratory infections.
High fevers .
Emphysema .
Pregnancy.
Malignant disease .

Additional Considerations
High blood pressure .
Asthma.
Diabetes .

THE PROCESS
Therapy is relaxing and painless. The patient lies on a bed enclosed in a clear plastic chamber.
The patient and therapist can see one another and communicate through an intercom. The
pressure is set to the prescribed level and the chamber is filled with oxygen. The patient will
experience a slight sensation of pressure, like that felt in the decent of an airplane. Each
session lasts for up to 90 minutes. For comfort, the patient can watch television or listen to the
radio during treatment.
The individual requirements of the patient dictate the number of hyperbaric oxygen treatments
necessary. For example, treatment for acute carbon monoxide poisoning or bloodless surgery
may require only one treatment, while wound healing may require 30-40 treatments. The
patient’s response to hyperbaric treatment ultimately affects the exact number of treatments

Physiologic Effects of Hyperbaric Oxygen

(HBO)
The Primary Effects
The primary effects of administering oxygen at greater than one atmosphere of pressure are
from the increase in partial pressure of oxygen dissolved in the arterial blood (hyperoxemia)
and from the physical effect of an increased pressure.

Hyperoxemia

• The Alveolar Air Equation is used to calculate the PaO2 at any barometric pressure.
PAO2 = FIO2(Pb - PH20) - (1.25 x PaCO2). It is based on Dalton's Law of Partial
Pressure. Absolute pressure at sea level = 14.7 psi or 760 mmHg. Therefore, 14.7 psi
is one atmosphere. The PAO2 at one atmosphere is .21(760 - 47) - (40 x 1.25) or 100
torr. Arterial PO2 is slightly less than alveolar PO2.
• Dalton's Law - the total pressure of a gaseous mixture is equal to the sum of the partial
pressures of its components.
• Henry's Law - gas enters into physical solution in direct proportion to the partial
pressure exerted by that gas.
100% oxygen at 2 or 3 atmospheres forces enough oxygen to dissolve in the plasma
to meet metabolic needs. Normally the body needs 5.0 vol% of oxygen. 100% oxygen
at 3 atm = 6.5 vol%. 100% oxygen at 2 atm = 4.4 vol%.
• Oxygen Content = O2 combined with hemoglobin + dissolved oxygen.
SaO2(Hgb g% x 1.34) + (PaO2 x .003) = 20.40 vol% breathing air at sea level.
Dissolved oxygen normally contributes 0.30 vol% of the total.

The Physical Effects of Pressure

Compression of gas bubbles in the blood or air pockets in the body occurs from the application
of greater than atmospheric pressure according to Boyle's Law. As the pressure increases, gas
volume decreases. Hyperbarism relieves vascular occlusion in decompression sickness and
traumatic or iatrogenic air emboli. Decompression sickness is not possible breathing 100%
oxygen.

• Boyle's Law - At a constant temperature, the volume of a gas varies inversely with the
pressure to which the gas is subjected.

100% oxygen at 3 atmospheres absolute for 3 hours results in a grand mal seizure. Therefore,
exposure is limited to 90 minutes at 3 atmospheres absolute.
100% oxygen at 2 atmospheres absolute for six hours results in cough, decreased vital
capacity, substernal chest pain, and areas of patchy atelectasis. At 2 atmospheres exposure is
limited to 2 hours

Secondary Effects of HBO

Include: vasoconstriction, neovascularization, and inhibition of the growth of anaerobic
microorganisms.

Vasoconstriction
Peripheral vasoconstriction reduces blood flow to the tissues: brain, kidney, and eye, and
increases peripheral resistance. HBO also reduces cardiac output due to bradycardia. These
combined effects maintain blood pressure. There is no impairment to the tissues since the
elevated PaO2 more than compensates for the reduction in blood flow.
Vasoconstriction has not been found to occur in hypoxic tissues such as chronic skin ulcers,
and therefore, these tissues may receive proportionately more blood flow during HBO. In
addition, the plasma is able to carry dissolved oxygen to areas where red blood cells cannot go
which may also benefit hypoxic tissues. Vasoconstriction may also reduce edema.

Neovascularization
When vasoconstriction significantly reduces blood flow, the tissue becomes hypoxic. All wounds
have areas of hypoxia. Anaerobic metabolism produces lactic acid. Although the mechanism for
neovascularization is not fully understood, hypoxia and high lactate levels stimulate
macrophages to secrete an angiogenesis factor. As long as the exposure to HBO is
intermittent, the regenerating cells receive the oxygen they need, and the macrophages
continue to stimulate the growth of new vessels. Oxygen also improves collagen synthesis by
fibroblasts. HBO has been found to speed the healing of skin grafts/flaps, wounds, burned, and
irradiated tissues.

Inhibition of the Growth of Anaerobic Microorganisms.

The growth of anaerobic, facultative, and aerobic microorganisms is inhibited when the
microbes are subjected to an hyperoxic environment. Although oxygen is toxic to all organisms,
the adverse effects are determined by the duration of exposure, partial pressure of oxygen,
and antioxidant enzyme defenses of the organism. Hyperoxia blocks production of the exotoxin
produced by the Clostridium species which may be why HBO, in conjunction with antibiotics
and surgery, has been beneficial in treating Clostridial myonecrosis

METHODS OF ADMINISTRATION

Hyperbaric oxygen (HBO) therapy is administered through the use of:

• Monoplace Chamber
The monoplace chamber accommodates a single person for each treatment.
During therapy, the cylinder oxygen concentration is kept at 100% .No need for the
patient to wear mask.
No electrical equipment be used , and special ventilators and monitors should be used
due to high oxygen percentage.

• Multiplace Chamber
multiplace chamber, accommodates up to 12 people per treatment plus a nurse,
paramedic or other medical technician to assist with patient needs.
Since patients are directly card for by medical staff inside the tank, multiplace
chambers have air locks that allow entry and egress without altering the pressure.