Hyperbaric Chambers

Nature has proven that healing cannot take place without appropriate oxygen levels in the body’s tissues. Many serious health problems stem from or are complicated by tissues having low oxygen levels. In many cases adequate oxygen cannot reach the damaged areas. Without adequate oxygen in the tissues, the body’s natural healing process fails to function properly, and we begin to see damaged tissues, decreased tissue function, slow healing, dry & sagging skin, aging, fatigue, wrinkles, and a variety of other symptoms.
Oxygen given under normal atmospheric pressure is not enough to raise tissue oxygen levels to reverse this lack of oxygen because red blood cells cannot carry and release enough extra oxygen. In order to overcome the oxygen starvation and raise tissue oxygen levels high enough for optimal healing to occur, the oxygen must be delivered under slightly increased atmospheric pressure.
Blood is made up of three main components: White blood cells that help fight infection; red blood cells that carry oxygen; and plasma, which is the fluid that carries both kinds of cells throughout the body.

Normally, only the red blood cells deliver oxygen, via a protein called hemoglobin, to the body’s tissues and cells. A healthy person’s hemoglobin is 97% saturated with oxygen when exposed in our lungs to normal air, or 100% saturated when breathing pure oxygen. Whether breathing air or pure oxygen, the limited number of red blood cells can only deliver a certain level of oxygen to the body’s tissues.

Hyperbaric Oxygen Therapy (HBOT) is a 300 year old medical treatment that consists of administering 100% oxygen at greater than atmospheric (sea level) pressure in order to improve and correct certain medical conditions. The underlying principle of hyperbaric oxygen therapy is quite simple: HBOT saturates the body and its tissues with oxygen so they can function properly.

Oxygen is transported by blood in two ways: Chemically, bound to haemoglobin, and physically, dissolved in plasma. The main effect of HBO is hyperoxia. During this therapy, oxygen is dissolved physically in the blood plasma.

HBOT forces oxygen into the body under pressure, oxygen dissolves into all of the body’s fluids including the blood plasma, the lymph, and the cerebrospinal fluid surrounding the brain and spinal cord. All of these fluids carry the extra oxygen to the tissues and cells of the body, even where circulation is poor or blocked. In short, Hyperbaric Oxygen Therapy (HBOT) works by saturating a person’s blood and plasma with oxygen resulting in increased oxygen delivery to tissues.

The physiological effects of Hyperbaric Oxygen Therapy includes: vasoconstriction and enhanced oxygen delivery, reduction of edema, phagocytosis activation and also an anti-inflammatory effect - enhanced leukocyte function, neovascularization - angiogenesis in hypoxic soft tissues, osteoneogenesis as well as stimulation of collagen production by fibroblasts are known long-term effects.

1.HBOT increases Stem Cell Growth:

According to a study to be published in the American Journal of Physiology-Heart and Circulation Physiology, a typical course of hyperbaric oxygen treatments increases by eight-fold the number of stem cells circulating in a patient’s body. Stem cells, also called progenitor cells are crucial to injury repair.
Stem cells exist in the bone marrow of human beings and animals and are capable of changing their nature to become part of many different organs and tissues. In response to injury, these cells move from the bone marrow to the injured sites, where they differentiate into cells that assist in the healing process.
The movement, or mobilization, of stem cells can be triggered by a variety of stimuli — including pharmaceutical agents and hyperbaric oxygen treatments. Where as drugs are associated with a host of side effects, hyperbaric oxygen treatments carry a significantly lower risk of such effects.

2.HBOT significantly reduces swelling:

Dilation or blood vessel widening following damage to tissue results in decreased blood flow. That increase in blood flow couples with revascular permeability (movement of fluid in and out of blood vessels) to increase protein and fluids outside blood vessels reducing tissue swelling. HBOT significantly reduces swelling, and reduces the pain associated with it.
As the oxygen supply reduces, blood flow increases which will only serve to exacerbate the swelling and impede the inflammatory process that assists the commencement of healing.

3.HBOT significantly reduces Edema (Swelling):

The development of edema (swelling) is caused by a number of factors such as an increase in local blood flow and also damage to local blood and lymphatic vessels. The pressure exerted by edema on surrounding structures can compromise circulation. When this pressure approaches or exceeds that in the blood vessels, then blood flow will slow or cease altogether.
Swelling also contributes to tissue hypoxia (a shortage of oxygen in the tissues) by increasing the distance between the capillary (smallest blood vessels) and the cells, which impedes cell function, metabolism and the inflammatory process by increasing the diffusion distance (movement of particles from an area of high concentration to an area of low concentration).
Hyperbaric oxygen therapy is able to combat the increased distance for oxygen diffusion from blood vessel to cells by increasing the oxygen content within the blood which will result in an increased oxygen delivery to cells and tissues, shortening the inflammatory process, thereby speeding the healing and repair of tissues.

4.HBOT significantly shortens the inflammatory process:

The body’s initial response to any injury involves inflammation. Inflammation is the process by which cells such as phagocytes (white blood cells) gain access to the damaged/injured tissues to prevent infection and enable healing to commence. Decreased oxygen supply greatly impacts the inflammatory process as the cells involved in inflammation are oxygen dependent. Should oxygen supply be decreased, the inflammatory process and healing will be impaired.
Increased oxygen availability promotes vasoconstriction when blood vessels in the body become smaller which causes fluid reabsorption and helps reduce edema while keeping the tissue well oxygenated. This supports the cells of the inflammatory process in removing cell debris and micro-organisms that impede infection. White blood cells have an increase in cellular energy that speeds up their activity and reduces the time of the inflammatory process.

5.HBOT improves range of motion:

Following hyperbaric oxygen therapy, swelling is also decreased and resolved more rapidly. As a result, pain will be less allowing for the return of range of motion as the healing process gains momentum and inflammation is decreased.

6.HBOT increases the production of collagen:

Following the initial healing process of the inflammatory response and the prevention or removal of infection, comes the next chapter in tissue/wound healing.
Collagen is the connective tissue developed and laid down by fibroblasts, the repair cells of the body. Collagen acts as a base layer in the healing wound and assists the wound to close and repair. The formation of collagen and hence wound healing/recovery is highly dependent on the presence of adequate amounts of oxygen. The actual production of collagen by fibroblasts is also extremely dependent on oxygen availability.
As hyperbaric oxygen therapy markedly increases the oxygen available within the blood this in turn enables for a cross-linking or strengthening of the tissues, and fibroblasts to produce increased amounts of collagen required for healing of wounds and tissue damage.

7.HBOT increases growth of cells that form reparative tissue (Fibroblastic proliferation):

Clinical research has demonstrated that a number of days following injury there occurs a migration of fibroblasts (connective tissue cells responsible for collagen production) into the area of damage. These cells then divide and replicate producing large amounts of collagen (connective tissue used to repair damage to tissue) that acts as the building block for the healing of tissue and wounds.
The development and migration of fibroblasts is assisted by the influx of oxygen resulting from hyperbaric oxygen therapy, this then supports the development and action of these particular cells which play a vital part in the healing/recovery process.

8.HBOT supports scar tissue rehabilitation:

A decrease in oxygen available to cells such as fibroblasts impairs their action, impacting upon the healing of tissue, causing healing to take longer, and inhibiting the quality of scar tissue developed or rehabilitated, which in turn greatly decreases tissue strength.
Healing occurs both faster and stronger in wounds/injuries that are treated with hyperbaric oxygen therapy due to the demands of oxygen availability by the cells and tissues responsible for the healing process being met.

9.HBOT promotes greater tissue strength:

As the oxygen concentration of the blood increases during hyperbaric oxygen therapy, cells further from blood vessels are more adequately oxygenated. Hyperbaric oxygen therapy allows for increased oxygen availability in more extensive areas enabling fibroblasts to carry out their part of the healing process for tissue damage and injury, more rapidly covering larger areas.
Hyperbaric oxygen therapy saturates the blood plasma with oxygen, this in turn reaches the areas of damage/injury with greater efficiency than red blood cells, providing all cells and tissues with the much needed agent for healing, oxygen. The cells responsible for the development of scar tissue for healing are then able to carry this out more rapidly and the resulting tissue integrity is stronger.

10.HBOT enhances the growth of new blood vessels (Angiogenesis):

Injury or damage to tissues also results in damage and destruction of the supporting blood vessel structures. The healing process is reliant on these structures for supply of the blood containing the cells and nutrients that carry out and enable healing as well as the removal of damaged cells, debris and foreign micro-organisms.
Research has demonstrated that treatment with hyperbaric oxygen therapy significantly increases the number and actual size of blood vessels in damaged tissues and wounds. This allows the healing process to occur faster speeding the recovery of the injury or wound.

11.HBOT increases oxygen levels in tissues (Hyperoxia):

With an increase in oxygen availability resulting from both blood that is highly saturated in oxygen dissolved in the plasma, and an increase in the number of blood vessels due to new vessels being created as well as the healing of damaged blood vessels, tissues and cells become highly saturated in oxygen.

12.HBOT increases oxygen perfusion area around wounds:

Oxygen perfusion around wounds and damaged tissues is greatly increased when the blood supply to these areas possesses greater than normal levels of oxygen within blood plasma as well as carried on red blood cells. The oxygen contained in the blood plasma is more easily accessible than that carried to the tissues and cells of the wound/damaged area on red blood cells, and this method of oxygen supply is less labour intensive and energy taxing.
The cells involved in the healing process are highly dependent on oxygen to carry out their healing function and this increased demand for oxygen in the area around wounds by the increased number of healing cells in that location is met by the increased oxygen saturation of the blood following hyperbaric oxygen therapy.

13.HBOT stimulates new capillary growth:

During the time of injury and damage the microcirculation and the blood vessels of this circulation (capillaries) are vital to the healing process through the supply of nutrients and oxygen and the removal of waste and debris to enable the cells responsible for healing to successfully complete their function.
Growth of new, and repair of damaged capillaries are stimulated within the damaged tissues by hyperbaric oxygen therapy, providing increased oxygen availability to these areas. The increased oxygen supply and increased pressure employed by hyperbaric oxygen supply are both responsible for the stimulation of new capillary growth and the repair of existing capillaries.

14.HBOT improves the survival of tissues in the ‘grey area’ of crush injuries:

The ‘grey area’ of crush injuries can be defined as the area between the tissues that are obviously irreversibly damaged and those tissues that are undamaged. The tissues of the ‘grey area’ benefit greatly from increased oxygen supply, improved circulation and blood supply. These are the aspects that will allow the tissues of the ‘grey area’ to be saved, salvaged and repaired.
Hyperbaric oxygen therapy has been shown to support and maintain tissue oxygenation within the ‘grey area’ resulting in a better outcome for the tissues, wound or injury.

15.HBOT increases production and improves the action of Osteoblasts and Osteoclasts:

Osteoblasts are the cells responsible for bone formation and osteoclasts are the cells responsible for bone reabsorption. Both these cells work together to form bones and control the amount of bone tissue.
The provision of increased levels of oxygen allows for increased production of these cells and enables them to conduct bone repair and formation more adequately through the reduction of edema and growth of new blood vessels in the micro-circulation.

16.HBOT improves bone regeneration for faster recovery:

When the inflammatory process, swelling and edema is rectified more rapidly the repair and regeneration of bone is able to commence sooner.
With the increase in blood supply and oxygen availability, the tissues and cells responsible for bone regeneration are able to carry out their task of healing more efficiently, resulting in accelerated recovery and a better result in the healing tissues.

17.HBOT helps prevent infection:

Research has demonstrated that having lower oxygen levels in tissues and wounds increases the possibility of infection. Changes in wound and tissue oxygenation impacts greatly upon the wound immune mechanism.
Having an improved or increased tissue oxygen supply reduces the incidence of wound infection as the cells responsible for prevention and recovery from infection are dependent on oxygen, therefore additional oxygen benefits the healing process.

18.HBOT increases white blood cell production:

The major players in the bodies immune response are the white blood cells. Providing the body with increased oxygen availability increases the production of white blood cells providing benefit to the bodies immune response.
High-dose oxygen delivered under pressures greater than sea level (hyperbaric oxygen therapy), stimulates and enables the bodies immune response.

19.HBOT enhances ability of white blood cells to remove bacteria and debris (Leukocyte activity):

Without oxygen or in a hypoxic (shortage of oxygen in the body) environment the function of white blood cells becomes diminished. This in turn provides a significant threat of infection as the bodies immune response is impaired.
Without oxygen or in a hypoxic (shortage of oxygen in the body) environment the function of white blood cells becomes diminished. This in turn provides a significant threat of infection as the bodies immune response is impaired.

20.HBOT potentiates the use of antibiotics:

Research has demonstrated that periods of hyperoxia (increased oxygen levels in tissues) and hyperbaric oxygen therapy has influenced the activity of some antibiotics, enhancing their effectiveness. This enables the presenting infection to resolve quicker.

21.HBOT destroys harmful bacteria (Antimicrobial effect):

Hyperbaric oxygen therapy provides direct bactericidal (substance that kills bacteria) and bacteriostatic (hampers the growth of bacteria) effects against bacteria due to the generation of oxygen free radicals. These free radicals are able to damage the membranes and make up of the bacteria rendering them ineffective or killing them.Anaerobic (without oxygen) organisms find an increased oxygen environment toxic and are unable to survive.

22.Hyperbaric Oxygenation Effects the Blood Flow:

Normal blood flow: There is 21% oxygen in the air that we breathe, and our lungs transfer this oxygen to our red blood cells (via hemoglobin). These oxygen-filled red blood cells are carried around the body by the plasma (fluid), which travels through the blood vessels. The oxygen diffuses into the surrounding tissue ensuring that it is delivered to where it is needed most.

A patient sits or lies in a sealed chamber while the pressure inside is increased to a therapeutically desired level.

Types of Hyperbaric Oxygen Therapy chambers

1.Monoplace Chambers: :

A monoplace chamber is a system that accommodates one patient at a time. The patient lies down on a stretcher which slides into the chamber. Typically the chamber is pressurized with 100% oxygen. The patient receives 100% oxygen by breathing the oxygen inside of the chamber. Monoplace chambers have the capability to be pressurized to 3 ATA.

2.Multiplace Chambers:

A multiplace chamber is a system that can accommodate two or more occupants. Patients can either walk or be wheeled (sitting or lying down) into a multiplace chamber, depending on the size. Typically, an attendant is inside with the patients. The chambers are pressurized with compressed air through a dedicated supply system. 100% oxygen is delivered to the patient via a mask or a hood assembly. Multiplace chambers have the capability to be pressurized up to to 6 ATA.

Compression

Once the patient is situated comfortably inside, the chamber door is sealed and pressurization begins. At any time compression can be slowed or stopped. Compression typically takes about 15 minutes, but can be tailored to each individual patient.

Treatment:

Once at depth, the patient is put on pure oxygen. The chamber will be continuously ventilated to ensure the climate in the chamber is comfortable. Treatment typically takes 90 minutes, but may vary depending on the prescription.

Decompression:

Once the time at the treatment depth is completed, depressurization begins. Air / Oxygen is slowly exhausted out of the chamber; decreasing the pressure and bringing the patient back to the surface. Decompression typically takes 15 minutes.

Undersea & Hyperbaric Medical Society ( UHMS ) Approved Indications:

• Acute gas embolism
• Clostridial myositis and myonecrosis (gas gangrene)
• Crush injury, compartment syndrome, and other acute ischemias
• Decompression sickness
• Acute central retinal artery occlusion
• Enhancement of healing in selected problem wounds
• Exceptional anemia
• Intracranial abscess
• Necrotizing soft tissue infections
• Osteomyelitis (refractory)
• Delayed radiation injury (soft tissue and bony necrosis)
• Skin grafts and flaps
• Thermal burns
• Idiopathic sudden sensorineural hearing

FDA (USA) Approved Indications:

• Air Gas embolism
• Acute traumatic ischemia (crush injury, compartment syndrome)
• Burns
• Carbon monoxide poisoning and smoke inhalation
• Diabetic foot ulcers
• Exceptional blood loss
• Decompression sickness
• Gas gangrene
• Necrotizing infections
• Osteomyelitis (refractory)
• Radiation necrosis
• Severe anemia
• Skin grafts and flaps (compromised)
• Wound healing

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Absolute contraindications:

Include untreated pneumothorax and use of bleomycin, disulfiram, doxorubicin and mafenide acetate. Contraindicated drugs must be discontinued before Hyperbaric Oxygen Therapy.
List of a few known contraindication:
1) History of spontaneous pneumothorax.
2) Severe sinus infection.
3) Upper respiratory infection.
4) Asymptomatic pulmonary lesions on chest x-ray.
5) Uncontrollable high fever (greater than 39C).
6) History of chest or ear surgery
7) Congenital spherocytosis.
8) Any anemia or blood disorder (Although HBOT treats different types of anemia.
9) Any convulsive disorder though many patients have seizure disorder and are treated successfully with HBOT.
10) History of optic neuritis or sudden blindness.
11) Middle ear infection.
12) Diabetes mellitus (insulin therapy). Many diabetic wound patients are diabetic and are treated successfully with HBOT.
13) Pregnancy.
14) Nicotine use/addiction.
15) Acute Hypoglycemia (Many patients are treated successfully with HBOT.)
16) Emphysema with CO2 retention.

Relative contraindications

Should be observed with caution or consideration, but do not prohibit. They include seizure disorders, emphysema with carbon dioxide retention, high fever, history of spontaneous pneumothorax, optic neuritis, upper respiratory infection, pregnancy, congenital spherocytosis, implanted pace makers and epidural pain pumps. Cancer Chemotherapy agent doxorubicin (Adriamycin) is thought to become cardio toxic when used concurrently with Hyperbaric Oxygen Therapy. Treating patients with Hyperbaric Oxygen Therapy after doxorubicin is stopped for 2-3 days.

Complications & Precautions

Barotrauma:

Virtually no patients should have barotraumas if each dive should be observed manually, and at the first sign the pressure is adjusted or reversed to relieve any discomfort.

Confinement Anxiety

Oxygen is natural an anti-anxiety agent for patients. A thoruough counseling should remove this condition. Most of the patients get rid of this after the first treatment.

Oxygen Toxicity:

Pulmonary and CNS – 1 in 10,000 people may experience this but no permanent effects result from this occurrence. There are 14 signs that patients display before experiencing oxygen toxicity that the CHT is trained to recognize. It is recommended that the chambers are operated manually, if a patient should start to display symptoms, the pressure is reversed and symptoms are resolved. Oxygen Toxicity occurs in less than 1 in 10,000 treatments. Does not occur if treated with in recommended pressures and limitation in number of treatments.

Myopia:

Minor eyesight changes due to temporary curvature in the lens while undergoing slight pressurization. Gradually reverses after cessation of HBOT when the lens flattens out again.

Precautions to be followed while entering the Hyperbaric Oxygen Therapy Chamber:

Because the chamber is pressurized with 100% oxygen, certain items cannot be taken inside. These include lighters or matches, cigarettes, nylons, wigs, or hair pieces, petroleum jelly, ointments, hearing aids, watches, makeup, lipstick or lip balm, hair spray, hair oil or relaxers, synthetic clothing or hard contact lenses and as advised by your hyperbaric centre safety regulations.