MINISTRY OF HEALTH TRABZON PROVİNCİAL HEALTH DİRECTORATE SBU KANUNİ TRAİNİNG AND RESEARCH HOSPİTAL

MINISTRY OF HEALTH TRABZON PROVİNCİAL HEALTH DİRECTORATE SBU KANUNİ TRAİNİNG AND RESEARCH HOSPİTAL

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Hyperbaric Unit

Updated: 08/10/2019

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WHAT IS HYPERBARIC OXYGEN THERAPY (HBOT)?

Hyperbaric oxygen therapy (HBOT) is a modern and scientific medical treatment method that is performed by making a patient, who is kept under pressure fully, inhale 100% oxygen intermittently in a pressure room.

What is a pressure room? How is HBOT performed?

Pressure rooms are steel cabins that can be pressurized by blowing air into and that allow people inside to inhale 100% oxygen through mask or hood. They can be monoplace or multiplace. In HBOT, most of the patients breathe oxygen under pressure that is 2-2.5 times higher than normal atmospheric pressure. In order for patients to sit comfortably, there are seats in the pressure room. Patients on stretchers can also be treated in recumbent position. HBOT is carried out under supervision of specialist doctor and medical personnel.

How do patients feel during therapy?

In first minutes of therapy called “diving”, patients feel the increase of pressure inside their ears such as during landing in a plane or coming down from high mountains. Patients are informed about how to equalize the pressure inside their ears during increasing pressure. It is generally done by simply swallowing or blowing air after closing nose. This is performed only during diving until treatment pressure is reached. HBOT can be applied to patients of all ages.Patients enter the pressure chamber with special cotton clothes given to them.

How long does the therapy last?

While depending on case, a HBOT session generally lasts 1.5-2 hours. Most of the patients are treated by one session a day. However, the number of sessions per day may increasein some emergency situations. Total number of sessions changes according to the disease.

Are there any side effects of the therapy?

The most observed side effect is that caused by pressure change on ear and sinuses. This is not dangerous and it can be prevented by learning the methods of pressure equalization. Other side effects are rare and include oxygen toxicity, claustrophobia (fear of being trapped in closed spaces), and temporary myopia.

How does HBOT affect?

During HBOT, maximum amount of oxygen is dissolved in plasma of patients and the amount of oxygen reaching tissues increases. By hyperbaric oxygen therapy,

  • The amount of oxygen dissolved in plasma increases
  • Oxygenation of hypoxic tissues is achieved
  • The proliferation of anaerobic bacteria is halted
  • A synergistic effect with some antibiotics is achieved
  • Edema decreases owing to vasoconstriction
  • Cytotoxic effect in carbon monoxide and cyanide poising is inhibited
  • Leukocyte activation in wound area strengthens
  • Angiogenesis (formation of new veins) in wound area is achieved
  • Formation of connective tissue in wound area is stimulated.

    In which diseases is HBOT used?

  • Decompression disease (diver’s palsy)
  • Air and gas embolism
  • Carbon monoxide poising, cyanide poisoning, acute smoke inhalation
  • Gas gangrene
  • Necrotizing infections of soft tissue (subcutaneous, muscle, fascia)
  • Crush injuries, compartment syndrome, and other acute traumatic ischemia
  • Conditions in which wound healing (diabetic or non-diabetic) is delayed
  • Chronic refractory osteomyelitis
  • Excessive blood loss
  • Radiation necrosis
  • Skin flaps and grafts suspected to hold
  • Thermal burns
  • Brain abscess
  • Anoxic encephalopathy
  • Sudden hearing loss
  • Retinal artery occlusion
  • Acute osteomyelitis of head bones, sternum and vertebrae.

Who cannot be treated with HBOT?

HBOT is a reliable therapy method that has a very low risk and a pretty-wide application field. However, applying HBOT to some patients can endanger their lives. The conditions in which HBOT cannot be applied (contraindications) are as follows:

The first condition is pneumothorax in which air enters between lung membrane and lung. HBOT is not applied to these patients until they recover fully.

HBOT may trigger epilepsy seizure. Patients with epilepsy can be treated with HBOT only after their epilepsy is taken under control with medications.

In patients with emphysema, if there is CO2 retention, there may be danger of pneumothorax. Patients who underwent lung surgery are evaluated carefully. If there is compressed gas in surgery area, they are not accepted to therapy.There is concern that HBOT applied during first trimester of pregnancy leads to congenital disorders in baby. However, it was reported that HBOT applied to pregnant women, who were poisoned with carbon monoxide, during early stages of pregnancy did not cause problems. Nonetheless, the characteristics of every pregnancy case should be considered.

Concerning cancer patients, there are people suggesting that HBOT can lead to proliferation of cancer cells. On the other hand, there are researchers suggesting that in oxygen-rich environments cancer cells may be less aggressive and may even be destroyed and that in oxygen-rich environments cancer cells may be more sensitive to chemotherapy. Some researchers also affirm that the absence or lack of oxygen cause cells to become cancerous.

Attention should also be paid to patients with hypertension, asthma, COPD, and diabetes. HBOT may minimally increase tension. The tensions of patients with very high blood pressures should be under control with medications. Patients with acute asthma may be at risk. Every asthma case should be evaluated individually and these patients should be accepted to therapy after asthma is under control. COPD patients with air trapping lesions are under risk. Diabetes patients should also be assessed carefully. Since HBOT can decrease blood sugar, blood sugar is checked before procedure. If it is low, precaution is taken.

Patients with heart failure are under risk. HBOT should not be applied to those with serious heart failure. If patients with peacemakers are to be treated with HBOT, the peacemaker must resist the pressure.