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HYPERBARIC MEDICINE
Hyperbaric Chamber
It is a medical device used to
supply oxygen (O2) at greater
pressure than normal
atmospheric pressure, defined as
1 ATM.
HYPERBARIC OXYGEN THERAPY
Hermetic Cabin: It is pressurized in a stable manner (Treatment Pressure), where the patient remains during the session.
Compressors Cabinet: It enters filtered air into the cabin to reach the treatment pressure by venting in a safe manner.
Oxygen external source:It may be by hub or tank, it supplies high-concentration of O2 to the patient.
COMPONENTS
Increasing the concentration of O2 that
we inhale
Increasing the pressure of the air (environment)
O2 100% HYPERBARIA
blood oxygen (dissolved) reaching tissues little irrigated and producing other
physiological effects
HYPERBARIC OXYGEN TREATMENT (HBOT)
DALTON’s LAW
The pressure of a gas
mixture equals the sum of
the partial pressures of each
of its component gases.
HENRY’s LAW
The gases being dissolved
in liquid when they are
subjected to pressure.
OXYGEN PHYSIOLOGYPhysico-chemical Basis
OXYGEN PHYSIOLOGY
Air at sea level: Normobaria
Partial concentration of O2 : 21%
Atmospheric Pressure : 760 mmHg (1 ATA)
Pp O2 : 0,21 x 760 mmHg = 160 mmHg
Hyperbaria: 1.4 ATA
Partial concentration of O2 : 21%
Pp O2 : 0,21 x (1.4 x760 mmHg ) = 223 mmHg
OXYGEN PHYSIOLOGY
FiO2: (Inspired fraction of O2 - VN: 0,21) VH20: 47 mmHg (inner humidity– Water)PACO2: 40 mmHg (alveolar pressure CO2)CR= 0.8 (respiratory coefficient between CO2 and O2)
alveolar pressure of O2PAO2= (760 – 47) x 0.21 – 40/CR = 100 mmHgPAO2= (760 – 47) x 1 – 40/CR = 663 mmHg
INCREASING THE PRESSURE IN THE ALVEOLI,
DIFFUSION TO THE PLASMA INCREASES
Total O2 and O2 dissolved in ml / dl
HYPERBARIC OXYGEN TREATMENTEssential effect of Hyperbaric Medicine Tissues oxigenation
Basic information about human tissuesAverage density of capillaries~ 600/mm3 Average length of capillary ~ 1 mm It implies that the average separation is ~ 40 µm microns between adjacentcapillariesCapillary density varies considerably among tissues2500-3000/mm3 in the brain, kidneys, liver, and myocardium; 300-400/mm3 in skeletal muscle and < 100/mm3 in the bones, fat, connective tissueMost cells in living tissues are ~ 1-3 cells from a capillary..
Source: Robert A. Freitas Jr., Nanomedicine, Volume I: Basic Capabilities, Landes Bioscience, Georgetown, TX, 1999
O2 DIFFUSION: Krogh’s Model
O2 tissular penetration:pressure into hyperbaric chamber=1.4ATA generates arterial PO2=918mmHg minimal effectivePO2(tissues)=20mmHg penetration radius~75µm (diameter ~150 µm)
Under these conditions, the O2 penetrationinto all cells and tissues is guaranteed
O2 DIFFUSION: Krogh’s Model
1) It sets PO2 radial gradients considering a tissue
cylinder radius (R), O2 consumption (VO2), the
solubility of O2 (α) and O2 diffusion coefficient (D)
2) Sets PO2 at any point r, where c is the capillary
radius and r is the distance from the capillary center
into the cylinder of tissue
PHYSIOLOGICAL EFFECTS
the gradient for O2 pressure between the alveolus and the pulmonary capillary
Oxygen diffussion and tissue penetration
Blood pressure of O2 and the amount of O2 dissolved (independent fromhemoglobin)
AEROBIC METABOLISM
The O2 is an essential element for cell energy production, though cellular
(mitochondrial) respiration.
Through HBOT the O2 is supplied as active ingredient, looking for maximize the tissular
oxygenation and to meet the cellular and metabolic functions.
O2
Enegry production
ATP
FREE RADICALS
Free radicals or reative oxygen species (ROS) are atoms or groups of atoms that have an unpaired electron (e-) in its outer shell. They are highly reactive
Free radicals are physiologically used by our body for multiple functions:
Immune response: against viruses and/or bacteria
Cell proliferation and mitosis
Apoptosis
ROS OXIDATIVE STRESSANTIOXIDANT
DEFENSE
OXIDIZING - ANTIOXIDANT SYSTEM BALANCE
DISBALANCE: ILLNESS
(H₂O₂ -0₂ -OH NO NOO-)
HBOT MECANISM OF ACTIONS
HYPEROXIA
ROS Production
antioxidant system enhancement
Goal: assure the O2 delivery to cells and tissues in order to
meet biochemical, metabolic and physiologic functions
HYPEROXIA – PHYSIOLOGICAL EFFECTSVASOCONTRICTION: Hyperoxia causes vasoconstriction of small arteries reducing theimmflamation and edema. Peripheral vasoconstriction occurs in well-perfused tissues
ANGIOGENESIS: Hyperoxia / normoxia alternation is a significant angiogenic stimulus. Hyperoxia stimulates and promotes the formation of small vessels accelerating thehealing process.
OSTEOGENESIS: Hyperoxia stimulates differentiation of bone-forming cells promotingosteogenesis and bone repair.
CELLULAR IMMUNITY STIMULATION: The poli-morpho nuclears (PMN), a kind a white cells, use free radicals as an anti-bacterial mechanism. O2 improves thismechanism.
STIMULATES COLLAGEN SYNTHESIS: Hyperoxia stimulates collagen synthesis and fibroblasts proliferation, which are the cells that produce collagen, the key substance for wound healing and tissue repair process.
REGULATES OXIDATIVE STRESS AND IMMFLAMATORY RESPONSE: Hyperoxia acts on regulators and mediators of the inflammatory response and decreases oxidative stress producing anti-inflammatory effects with cell damage reduction.
STIMULATION IN STEM CELLS: Hyperoxia stimulates differentiation and release of stem cells, contributing to tissue repair process and formation of new blood vessels.
CEREBRAL BLOOD FLOW INCREASE AND REDISTRIBUTION: A greater O2 availability in the brain contributes to reduce inflammation and led to greater O2 absorption at cellular level, improving treatment and rehabilitation for patients who have suffered from strokes, brain paralysis, autism spectrum disorders and neurological diseases.
HYPEROXIA – PHYSIOLOGICAL EFFECTS
HOW IS THE TREATMENT INDICATED?
Sessions.
At least 10 to 20 sessions are generally indicated, according to patient conditions.
Session duration.
The average time is 60 minutes but it is effective from 45 minutes onwards. In acute
patients is performed 90 minutes to 2 times a day.
Session/episodes cycle.
It is the number of sessions. It must indicate: total number, number of daily sessions, and
weekly frequency 1 to 6 and time session.
Period intercycles
It is the indicated rest between episodes.
HBOT: INDICATION – CLINICAL MEDICINE
Fibromyalgia
Chronic fatigue
Migraine y Headaches
Tinnitus
Elderly
Reduces inflammation and swelling, relieves pain and improves tissue perfusion
HBOT: INDICATION – TRAUMATOLOGY
Trauma
Pre and post-surgery
Bacterial Progressive gangrene
Acute Traumatic Ischemia
Ligament injuries
Osteomyelitis
Accelerates the recovery and the healing, reduces inflammation and swelling, stimulates the immune response and improves tissue perfusion
HBOT: INDICATION – SPORTS MEDICINE
Training
Injuries
Recovery after exercise
Chronic and Subacute Fatigue Syndrome
Accelerates the recovery, reduces fatigue and improves tissue perfusion.
HBOT: INDICATION – NEUROLOGY
Stroke
Parkinson
Multiple Sclerosis
Alzheimer's disease
Improves cerebral oxygenation, benefits neuroprotection and reduce spasticity
Hyperbaric Oxygen Induces Late Neuroplasticity in Post Stroke Patients
- Randomized, Prospective Trial
Shai Efrati1,2,3*, Gregori Fishlev1, Yair Bechor1, Olga Volkov3,4, Jacob
Bergan1, Kostantin Kliakhandler5,
Izhak Kamiager3,6, Nachum Gal1, Mony Friedman1, Eshel Ben-
Jacob2,5,7, Haim Golan3,4
Hyperbaric Oxygen Induces Late Neuroplasticity in PostStroke Patients -Randomized, Prospective Trial
A normal adult and healthy
brain should be fundamentally
yellow in the SPECT scanner.
Green indicates reduced blood
flow and oxygen. Blue and
violet represent a significant
reduction of blood flow in the
brain.
HBOT: INDICATION – WOUNDS
Wounds
Ulcers - Diabetic foot
Venous ulcers
Post-surgical Wounds
Burns
Promotes rapid healing, stimulates angiogenesis and synthesis of collagen,
reduces inflammation and swelling, triggers the immune system and improves
tissue perfusion.
Patient: Male,
Age: 60 years.
Pathology: Right leg – Ischemic ulcer/ rheumatoid arthritis
Number of sessions: 40
Patient: Male,
Age: 60 years.
Pathology: Right leg – Ischemic ulcer/ rheumatoid arthritis
Number of sessions: 40
Patient: Male
Age: 27 years old.
Pathology: Arterial venous fistula.
Number of sessions: 34
Patient: Male
Age: 27 years old.
Pathology: Arterial venous fistula.
Number of sessions: 34
Patient: Male.
Age: 60 years
Pathology: post- heart surgery injury
Number of sessions: 35
Patient: Male.
Age: 60 years.
Pathology: Right Leg. Necrosis, circulatory failure.
Number of sessions: 40
Patient: Male.
Age: 5 years
Pathology: Arterial venous malformation
Number of sessions: 70
Patient: Male.
Age: 70 years.
Pathology: Diabetic ulcer.
Number of sessions: 70
Patient: Female.
Age: 90 years.
Pathology: Bedsore
Number of sessions: 35
Patient: Female
Age: 60 years.
Pathology: Pyoderma gangrenosum
Number of sessions: 40
Patient: Female.
Age: 11 years.
Pathology: Trauma.
Number of sessions: 40
Patient: Woman.
Age: 70 years old.
Pathology: Lip melanoma (2015).
Number of sessions: 20
Patient: Male.
Age: 90 years old.
Pathology: Venous insufficiency
Number of sessions: 20
Patient: Male.
Age: 90 years old.
Pathology: Venous insufficiency
Number of sessions: 20
Absolute Untreated pneumothorax Lung Bula / Bulla
Relative Perforated eardrum Oncology treatment (Bleomycin, Cisplatin, Disulfiram, Doxorubicin) Pacemaker
Special Care HBOT produces slightly hypoglycemic. Nasal congestion. Claustrophobia. VAS pathology (Vascular Autonomic Signal) HBOT can cause mild hypertension. It is negative inotropic.
CONTRAINDICATIONS
MUCHAS GRACIAS.