HYPERBARIC OXYGEN THERAPY – HBOT
The most important is that HBOT is a natural medical treatment based on the combined action of oxygen and pressure. The concept of this therapy implies that the person inhales 100% pure oxygen under pressure above atmospheric pressure (1.5 to 3 ATA). The therapeutic goal is the increase of the dissolved quantity of O2 in patient’s blood. In general, hyperbaric treatments are provided over a period between 60 and 120minutes.
A LITTLE BIT OF PHYSICS
The mechanisms of HBOT can be explained by the three physical laws as described below.
The law of Boyle-Mariotte defines that at constant temperature; the volume (V) of a gas is inversely proportional to the pressure (P). In other words, the product P x V is a constant.
Pa x Va = Pb x Vb
When the pressure increases from 1 ATA to 2 ATA, the volume of the gas decreases by 50%, while an equivalent increase from 4 ATA to 5 ATA. This causes a change of only 5% of the initial volume. This is essential in the treatment of gas embolism because it reduces the volume of gas bubbles in the bloodstream of the patient.
Dalton’s law shows that the pressure of a gas mixture can be considered as the sum of the pressure of each gas component (PP partial pressures).
PPgaz1 + PPgaz2 + …+ PPgazn = Pmixed
To increase the oxygen partial pressure, we can either increase the concentration of oxygen (up to 100%) and/or the pressure of the mixture. The following table shows some cases.
Henry’s law states that at a given temperature, gas will dissolve in liquids in proportion to the partial pressure of each gas.
Cgaz = PPgaz / Hgaz (H is the Henry’s constant of the related gas)
Therefore, the more the partial pressure of oxygen increases, the more the amount of oxygen dissolved in blood is important.
With these laws, we can calculate the amount of oxygen absorbed by the body during hyperbaric treatments.
As we all know, oxygen is essential to the functioning of the human body. Ambient air is composed of approximately 21% of oxygen. It is absorbed during the breathing cycle through the lungs, it passes into the blood and it is then distributed to the whole body. Oxygen is carried in the blood in two forms:
– In combination with hemoglobin in the form of oxyhemoglobin
– Dissolved in plasma
At atmospheric pressure (1 ATA), the quantity of oxygen transported as oxyhemoglobin is the largest, while the dissolved form is low, respectively 19.7 ml / 100 ml of blood and 0.285 ml / 100ml of blood. However, the physiological significance of dissolved oxygen is important. It’s under this form that oxygen is spread to the tissues and provides cell supply.
HBOT essentially increases the amount of dissolved oxygen in plasma. This amount can be given by Henry’s Law. The following table shows the evolution in the amount of dissolved oxygen. At 3 ATA and 100% O2, this amount can reach 6 ml / 100 ml of blood. Under these conditions, the amount of dissolved oxygen is sufficient to cover the total needs of the body.
This therapy saturates the blood plasma with oxygen, making the cell osmosis process less energy consumption and allows the penetration of oxygen directly to the cells.
MECHANISMS OF ACTION
HBOT is a proven treatment. The UHMS defines hyperbaric oxygen (HBO2) as an intervention in which an individual breathes near 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure.
In April 2005, the Undersea and Hyperbaric Medical Society (UHMS) recognized the effectiveness of this therapy for 14 medical conditions listed below.
- Embolism (air bubbles or gas in the blood that can reach the brain or lung);
- Carbon monoxide poisoning (inhalation of smoke or exhaust gas);
- Gas gangrene;
- Crush injury, Compartment syndrome and other acute traumatic ischemias (where blood flow is reduced or stopped, as frostbite);
- Decompression sickness;
- Arterial insufficiencies : enhancement of healing in selected problem wounds such as diabetic foot ulcers;
- Severe anemia (blood loss);
- Intracranial abscess (pus in the brain);
- Necrotizing soft tissue infections (flesh-eating disease);
- Osteomyelitis (infection of the bone);
- Delayed radiation injury (radiation burns that appears after cancer therapy);
- Compormised grafts and flaps;
- Acute thermal burn injury (caused by fire or electric heat sources);
- Idiopathic Sudden sensorineural hearing loss.
HBOT is a new specialty of 50 years and we are far from having explored all the possibilities of this treatment. For more information on recognized indications, please visit the websites of the UHMS, Health Canada.
Note: contraindications exist. Seek the advice of your physician or hyperbaric specialist.
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