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.