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 mmHgPAO2=(760*1.4 - 47) x 1 - 40/CR = 919 mmHg

INCREASING THE PRESSURE IN THE ALVEOLI,

DIFFUSION TO THE PLASMA INCREASES

O2 blood content

Hyperbaric effect on oxygen dissolved:

1. Normobaric air (21% O2 1 ATA 97% Hb): 0.3ml/dl dissolved oxygen2. Hyperbaric oxygen (100% 1.4 ATA 100%Hb): 2.4ml/dl dissolved oxygen

HYPEROXIA: Increases 8 fold dissolved oxygen amount (independently on Hb) O2 immediately and fully available for cell intake

HYPERBARIC OXYGEN TREATMENTEssential effect of Hyperbaric Medicine Human tissues oxigenation

Capillary density varies considerably among tissues (in average ~ 600/mm3 ) 2500-3000/mm3 in the brain, kidneys, liver, and myocardium; 300-400/mm3 in skeletal muscle < 100/mm3 in the bones, fat, connective tissue

Average separation between adjacent capillaries is ~ 40 µm microns

Most 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

PO2 gradients in vessels explain radial (a) and

longitudinal (b) variations of PO2. Allows to

calculate PO2 at different distances from

capillar center or arterial end: PO2 drops to

cylinder perimeter and to venous end.

ARTERIAL END

VENOUS END

a.radial

L

L

O2 DIFFUSION: Krogh’s Model

O2 tisular penetration:

pressure into hyperbaric chamber=1.4ATA generates arterial PO2=918mmHg minimal effective PO2 (tissues) = 20mmHg * penetration radius ~75µm (Distance at which PO2 = 0mmHg: 96µm)

The O2 diffusion distance rises with risingsource PO2

Under100% O2 at 1.4ATA, the O2 penetrationinto all cells and tissues is guaranteed

* *

918mmHg

PHYSIOLOGICAL EFFECTS

the gradient for O2 pressure between the alveolus and the

pulmonary capillary

Oxygen diffussion and availability in the tissues

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

HYPERBARIC OXYGEN

GENERATES A STRONG HYPEROXIA

TRIGGERS PHYSIOLOGICAL BENEFITS

VASOCONSTRICTION

ANGIOGENESIS

OSTEOGENESIS

CELLULAR IMMUNITY

PERIPHERAL AXONAL

REGENERATION

COLAGEN SYNTHESIS

OXIDATIVE STRESS AND IMMFLAMATORY RESPONSE

CEREBRAL BLOOD FLOW INCREASE AND

REDISTRIBUTION

STEM CELLS

INCREASED SUCCESS IN FLAPS AND GRAFTS

HYPEROXIA - PHYSIOLOGICAL EFFECTS

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. Hyperoxiastimulates and promotes the formation of small vessels accelerating the healing 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 this mechanism.

PERIPHERAL AXONAL REGENERATION STIMULATION:

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 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.

GREATER SUCCESS OF FLAPS AND GRAFTS:

HYPEROXIA – PHYSIOLOGICAL EFFECTS

OXYGEN DOSE

The therapeutic effect of hyperoxia is determined by

the oxygen dose, in turn the dose of oxygen

depends on:

% of O2

Chamber pressure

Session time

Session frecuency

Number of total sessions

1 weekly session

3 weekly sessions

4 weekly sessions

2 weekly sessions

5 weekly sessions

HOW IS THE TREATMENT INDICATED?

Sessions.

10 sessions blocks, according to patient conditions and physician’s criteria.

Session duration.

The average time is 60 minutes. In acute patients could be performed 90 minutes, up to 2

times a day.

Frequency.

The physician must indicate: number of daily sessions, weekly frequency 1 to 6 and time

session.

HBOT: INDICATION – CLINICAL MEDICINE

Fibromyalgia

Chronic fatigue

Migraine y Headaches

Tinnitus

Elderly

Sleep apnea

Crohn’s disease

Adjuvant treatment to reduce inflammation and edema, relieve pain, improveperfusion, energy efficiency and life quality.

HBOT: INDICATION – TRAUMATOLOGY

Pre and post-surgery

Bacterial Progressive gangrene

Acute Traumatic Ischemia

Ligament and tendon injuries

Osteomyelitis

Non-unions

Spinal cord injury

Adjuvant treatment to accelerate healing and recovery, reduce inflammation and edema, relieve pain, reduce infection and amputation risk and improve life quality.

HBOT: INDICATION – SPORTS MEDICINE

Training

Injuries (tendon, ligaments and

muscle)

Recovery after exercise

Chronic and Subacute Fatigue

Syndrome

Adjuvant treatment to prepare athletes during training, improve energy efficiency, shorten recovery, prevent fatigue and improve injuries and trauma rehabilitation.

HBOT: INDICATION – NEUROLOGY

Stroke

Parkinson disease

Multiple Sclerosis

Spinal cord injury

Migraine

Autism spectrum disorder

Cerebral Palsy

Adjuvant treatment to reduce edema, redistribute blood flow and improve cerebral oxygenation, reduce stiffness, tremors and spasticity, improve cognitive function, neuroprotection and life quality.

HBOT: INDICATION – WOUNDS

Wounds

Ulcers - Diabetic foot

Venous ulcers

Post-surgical Wounds

Burns

Abscess

Sores

Flaps and grafts

Adjuvant treatment to reduce inflammation and edema, accelerate healing and recovery,

decrease infection and amputation risk, and improve life quality.

HBOT: INDICATION – RHEUMATOLOGY

Fibromyalgia

Rheumatoid arthritis

Arthrosis

Bone marrow edema

Bone necrosis

Osteomyelitis

Adjuvant treatment to accelerate recovery, relieve pain, reduce inflammation and edema, decrease infection risk and improve life quality.

HBOT: INDICATION – ONCOLOGY

Tumors

Radio-necrosis and radio-therapy

Adjuvant treatment to enhance radio and chemo-therapy sensitization, control tumoral

growth, relieve pain, prevent and recovery of radio-necrosis and improve life quality.

EVIDENCE AND PRESENTATION OF CASES

Several trials, case series and case reports highlight efficacy

of HBOT as successful treatment for different diseases.

*Shai Efrati et al, Plos One 2013

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 after 10 sessions at 1.3

ATA.

Heuser et al, 2000

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

HYPERBARIC TREATMENT WITH REVITALAIR 430 CHAMBERS

In daily use we verify the therapeutic efficacy of HBOT, like the cases of wounds we just

saw. To generate more evidence in this and other pathologies through clinical trials, we

first thoroughly study its effect on healthy volunteers:

Treatment at 1.4ATA does not modify the biochemical parameters of acute phase

inflammation and oxidative stress in healthy volunteers

Significant increase of antioxidant enzyme suggests the effect of hyperoxia

The fluctuations of biochemical parameters at 10 and 20 sessions are kept within

reference values: physiological response was conserved in healthy volunteers

Treatment is safe and well tolerated, with no adverse effects

TO CONCLUDE:

The strong HYPEROXIA increases oxygen volumedissolved in blood plasma. This greater O2 diffusionreaches less irrigated tissues

The hiperoxia produces a wide range ofPHYSIOLOGICAL BENEFITS to the body.

HYPERBARIC TREATMENT: Patient breathes highdoses of O2 in a hyperbaric enviroment

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