HBOT

Hyperbaric chambers, used in hyperbaric therapy (HBOT), are any number of enclosures, which can be pressurized to allow a person inside to experience higher atmospheric pressures than the normal environmental pressures.  For example, a treatment at an elevation of 12,000 feet above sea level using a 4 psi (1.27 ATA) can simulate a decent of ~5,843 feet to 6,157 feet above sea level.

At higher elevations, the barometric pressure is lower.  This decrease of pressure also decreases the oxygenation of blood, and is known as anoxia-where molecules of oxygen exert less pressure on the walls of the alveoli (Dalton's Law). Hyperbaric Oxygen Therapy(HBOT) follows this law.

How does hyperbaric oxygen therapy (HBOT) work?

Hyperbaria - Increased atmospheric pressure as a means of increasing oxygen uptake without an enriched oxygen source.

Hyperoxia - Increased total oxygen content

Hyperbaria is based on the concept of the relationship of gas pressure and uptake in liquids (blood, plasma and tissues).  Henry's Law states that "a gas is dissolved by a liquid in direct proportion to its partial pressure."  For example, at sea level, atmospheric pressure is 760 mm Hg, the oxygen concentration is 21% and the body's oxygen content or partial pressure, pO2, in blood and plasma is ~ 40 mm Hg.

Red blood cells have a limitation as to how much oxygen can bind with hemoglobin. The plasma portion of the blood typically has about a 3% oxygen concentration.

By placing someone in a 3 psi pressure hyperbaric environment, the increase in atmospheric pressure at sea level goes from 760 mm Hg to 915 mm Hg.  This increase in gas pressure, increases the partial pressure of the oxygen gas and thus forces more oxygen to be dissolved in the plasma.  This saturation of oxygen in the blood, due to the Hyperbaric Oxygen Therapy or HBOT, allows the extra oxygen to be diffused or transported to the surrounding body tissues.  Thus, oxygen transport by plasma is significantly increased under hyperbaric therapy (HBOT).  At three atmospheres pressure, enough oxygen can be dissolved in the plasma to support the oxygen demands of the body at rest in the absence of hemoglobin!

Hyperbaric Oxygen Therapy (HBOT) is designed to boost the supply of oxygen to ischemic tissue or to diseased tissues that respond to increased oxygen levels. Increasing the volume of oxygen dissolved in the blood plasma, that is brought about by hyperbaric therapy (HBOT), produces five basic effects:

• Reduction of volume of gas bubbles in the blood
• Vasoconstriction, which reduces edema and secondary hypoxia 
• Restoration of aerobic metabolism to ischemic tissue 
• Detoxification of poisoned tissues 
• Enhanced phagocytosis

Henry's Law- Henry's law states that for a gas-liquid interface the amount of the gas that dissolves in the liquid is proportional to its partial pressure.  So Henry's law helps to predict how much gas will be dissolved in the liquid.  The actual amount also depends on the solubility of the gas as well as its partial pressure.

Dalton's Law-John Dalton observed that the total pressure of a gas mixture was the sum of the pressures of each of the gases if they were to exist on their own.

DOES THE INCREASED PRESSURE CAUSE DISCOMFORT? Hyperbaric treatments are painless, but the patient may experience a sensation of "fullness" in the ears, similar to driving down a mountain, flying, or scuba diving. The "full" feeling occurs as the eardrums respond to the change in pressure. The DR can demonstrates how to relieve this fullness before treatment.

WHAT DOES IT FEEL LIKE? Once a patient is in the chamber and the door is closed, the oxygen begins to circulate. This starts a gradual increase in pressure-called compression. There may be some slight warmth, but that is temporary. The DR. remains by the chamber (and can be reached with the walkie talkie at any time) throughout the treatment to adjust the rate of compression according to patient tolerance and to coach the patient on relieving the "full" sensation in the ears. Compression generally lasts 7-12 minutes depending on how effective one is at clearing their ears. 

 When the interior of the chamber reaches the prescribed pressure, the sensation of "fullness" in the ears will cease and the patient is free to rest or sleep. The temperature in the chamber remains at room temperature. The patient may also watch TV, listen to music with a battery operated device inside the chamber. Treatment usually lasts one hour.

Near to the end of the treatment, the DR. will gradually decrease pressure that was added at the beginning. This is decompression, which generally lasts 10 to 15 minutes. During decompression, there may be a slight "popping" sensation in the ears as a result of the changing (decreasing) pressure. This "popping" is a normal adjustment, similar to what happens when driving up a mountain or ascending in an airplane. It is usually much easier to equalize ear pressure during decompression than during the compression phase.

ARE THERE ANY NEGATIVE AFTER EFFECTS? Generally patients experience no negative after effects from HBOT. However, some patients report a "cracking" sensation in their ears between treatments as oxygen behind the eardrums is absorbed into the blood stream. This can be relieved in the same manner as clearing the ears during compression and decompression. Also, some patients report feeling light headed for a few minutes immediately following a treatment, but this is brief, and they are quickly able to continue with their normal daily activities such as working or driving.

As with all medical procedures and treatments, some potential after effects may result from exposure to hyperbaric oxygen. These are rare, but will be discussed in detail by the doctor and HBO technician before treatment.

WHAT ARE SOME PREPARATIONS BEFORE HBO THERAPY?

MEDICATIONS: Some medications are not compatible with hyperbaric oxygen therapy. The Dr.M or Dr. Diana will obtain a complete drug history before treatment. Each drug taken will be considered individually in relation to HBOT, and should changes be indicated, the prescribing doctor will be advised.

Some commonly used medications may potentiate side effects from HBOT. They must be limited or substituted with another drug. These include: high doses of aspirin and prednisone (or similar cortisone type drugs), and morphine, or alcohol within 8 hours of treatment.

Special precautions also are required for HBOT patients who are taking insulin, pain medication, tranquilizers, high doses of prednisone and other corticosteroids, and anticoagulants. The doctor or nurse will explain any needed precautions.

Patients will be instructed to take a regimen of high potency nutritional supplements containing vitamin E and other antioxidants during a course of hyperbaric oxygen therapy. A packet of multiple anti-oxidant supplements plus a 100 mg tablet of alpha lipoid acid should be taken twice daily with meals.

COLDS AND OTHER SYMPTOMS: It is important to notify the Doctor should symptoms occur of a cold or the flu, fever, cough, sore throat, runny nose, cold sore, nausea, vomiting, diarrhea, or a generalized ache-all-over feeling. Those types of illnesses are not helped by oxygen, so the HBO treatments may need to be postponed until symptoms have subsided and the doctor allows resumption of HBOT.

SMOKING: Nicotine is another substance that is not compatible with HBOT. Once HBOT has been prescribed, patients should stop the use of tobacco in any form until therapy is complete. This "no smoking" rule applies to cigarettes, pipe tobacco, and cigars, as well as chewing tobacco and snuff. If a person just cannot stop the use of tobacco, HBOT will not be as effective.

COSMETICS: Cosmetics, hair spray, nail polish, perfume, or shaving lotion containing a petroleum, alcohol or oil base are not allowed while in the HBO chamber. However, those products may be reapplied after each treatment. It is important to discuss all skin care products with the Dr.s' Mladenoff so they may assure safety.

CLOTHING: Patients are encouraged to bring shorts and a t-shirt to wear during treatment. No articles containing nylon or polyester can be worn in the chamber. Watches and other jewelry, dentures, contact lenses and other prosthetic devices will also need to be removed before treatment. It is also important that cleanliness be maintained during the course of treatment.

SCHEDULING: The ideal protocol is to schedule treatments on a daily basis. Every effort will be made to consider personal schedules and other activities of daily living. There may be times when an HBOT appointment must be cancelled or postponed due to emergency situations. If, on the other hand, it is not possible to keep an appointment, the clinic should be notified as soon as possible.