What is
Hyperbaric Oxygen?
Hyperbaric oxygenation
is the use of I00% oxygen at greater than atmospheric pressure.
It is the same oxygen that we breathe normally
(which is 19-21% of air).
However under pressure, oxygen, a gas, adheres to all of the
laws of physics. When pressure is increased, oxygen will be
dissolved into any body fluid in direct proportion to the
pressure
(Henry's Law).
More oxygen, therefore, may be dissolved in the bone, the urine,
the lymph, especially the blood plasma and the cerebrospinal
fluid
(the fluid- that bathes the entire
central nervous system).
Hyperbaric oxygenation is a method of delivering extra oxygen
into the body. It is not just the increased oxygen that is
important, but that free molecular oxygen is made immediately
available for metabolic use by the mitochondria at the tissue
spaces in the body, where all life takes place.
Normally, in the body, oxygen is delivered to the, tissue spaces
by way of the hemoglobin in the blood. This requires energy to
break off the oxygen molecule from the hemoglobin and to pick up
the carbon dioxide that is returned to the lungs to be exhaled.
This is the basic cycle of life. With Hyperbaric oxygenation, it
is possible to greatly increase the availability of oxygen.
Hyperbaric oxygen has a positive effect on the nervous system in
that it reduces swelling, repairs the blood brain barrier and
stabilizes the cell membrane. It increases the ability of the
phagocytes
(white blood cells)
to clean up damaged areas and over a
long term, it creates a whole new supply of blood vessels called
neo-angiogenesis. Also, it provides a mechanism whereby if there
is hypoxic ischeinic
(severe lack of oxygen)
damaged tissue in the brain that is not adequately supplied by
way of blood, Hyperbaric oxygen may be used immediately to
deliver necessary oxygen to the area for viability, damage
control and healing.
Hyperbaric oxygen is a drug and is administered in a closed
chamber and has a specific dose which relates to the depth of
pressure. This is referred to as the atmospheric pressure
absolute
(ATA).
Sea level is 1.00 ATA, with the partial pressure of 19-21
-percent of O'. The length of time of treatment, the pressure,
the number of treatments per 24 hours and the total number of
treatments all represent the "dose".
There are two types of chambers. One is a monoplace chamber
which is an acrylic tube and compressed with 100% oxygen. There
is no question as to the exact dosage
(ATA)
of oxygen. The other type of chamber is a multi-station chamber
that holds more than one patient. In China, there are chambers
that hold up to 36 patients and they actually perform open heart
surgery within the chamber. This type of chamber, however, is
compressed with air and the delivery of oxygen is either by way
of mask or a hood. In the multi-station chamber employing the
mask delivery, the appropriate dose may not be accurate since
the mask that fits one person may not securely fit another and
there can be leakage of the oxygen, thus the exact pressure may
not be achieved. Also, in some patients with severe head and
facial injuries, masks are impossible. The hood, however, is
more accurate for Hyperbaric oxygenation and fits over the head
with a Velcro strap to seal it around the neck. The monoplace
chamber may be wheeled into an emergency room setting and be
immediately available for use. The multi-station, however,
requires an attendant inside the chamber with the patients and a
technical engineer outside to regulate the pressures.
We are concerned that before this data is totally scientifically
validated, a number of centers may open up purely for financial
purposes. Thus, it is imperative that before you choose a
center, you know:
1)
That they have a
"Medical Director" with an appropriate background in and
knowledge of Hyperbaric medicine, as well as a consultant
knowledgeable in developmental pediatrics
2)
the protocol for
treating the neuroloizically injured child,
3)
Whether the
chamber will accommodate a parent to go in with the child,
4)
The charge per
treatment. The charges may vary from $150-$1,000. per hour.
5)
Membership in an association such as The American College of
Hyperbaric Medicine, the Undersea and Hyperbaric Medical Society
or the newly founded Association of Free-standing Hyperbaric
Centers.
Certain centers may insist upon controlled studies. For the
scientific evaluation of this procedure in the older child,
cross-over double blind studies may be needed. This means that a
group of children will be randomly assigned, one to a chamber
breathing only air
(sham or placebo
treatment)
and another to a
chamber with oxygen. Double blind means that neither the doctors
nor the patients will know which patients are actually receiving
the oxygen treatment until the study and all evaluations are
complete. After a completion of approximately 40 treatments, the
code will be broken. If there is a difference between the two
groups,
(i.e., the results
are more positive with the oxygen),
those who were given the sham treatment will be crossed over and
given the oxygen treatment.
This may be satisfactory for a child several years old, but the
ideal situation would be to take the brain injured newborn from
the delivery room to the Hyperbaric chamber to prevent/repair
the damage immediately. With newer diagnostic techniques such as
transcranial doppler, functional MRI and SPECT scanning, brain
injuries can sometimes be detected at birth. It is at this time
that the patient should be considered for treatment as is done
in Mexico City and has been for many years in Russia and a
British trial published in 1964 in The Lancet.
Under such circumstances that the questions of the ethics of the
double-blind study exist: Should only half the babies be given
the actual treatment if it may safely benefit all of them? This
will be one of the topics for discussion in this program.
The safety record for Hyperbaric oxygen treatment is excellent.
In the United Kingdom, there have been 1.3 million hours of
outpatient Hyperbaric oxygen administered without incident.
Certain outpatient centers insist upon myringotomy, i.e., tubes
put into the ears of the children to equalize the pressure. We
do not feel that this is necessary if the compression and
decompression are appropriately done. In our experience, 1 out
of several hundred children may require this. Ear inspection
prior to and during the course of treatment is mandatory.
Side effects are primarily
( 5% of patients)
sinus squeeze or ear pain - like taking off and landing in an
airplane. Long term treatments in the elderly may have an
acceleration effect on cataract formation. In children, a
transient change may rarely occur in the lens to make them more
nearsighted. This is rapidly fleeting and there is no permanent
sequelae known.
N.B.: Seizure disorder is not a contraindication to
Hyperbaric oxygenation. In China, seizure disorders are treated
with Hyperbaric oxygen. We have treated many cases, and in
certain patients, reduction or discontinuance of ant-seizure
medication was accomplished. Pressures, however, must be begun
at a low pressure 1.25 ATA for thirty minutes and gradually
worked up to 1.5 ATA for one hour twice a day.
It is hoped that as a result of this conference that:
1)
the proper subset
of patients and the timing in which this treatment is most
advantageous will be ascertained,
2)
an appropriate protocol will be
determined,
3)
a database will be
established,
4)
patients will have
an information source and be able to access the website
hopefully for approved centers, i.e., that is those being
members of an association or being guided by a responsible M.D.,
5)
the role of various other modalities in conjunction with
Hyperbaric oxygen in the future will be further evaluated, such
as biofeedback, amino acids, craniosacral therapy, herbal
medications, physical, speech and occupational therapies.
Although the positive evidence is compelling and highly
suggestive, until this is scientifically validated and
appropriately documented, please do not rush into this type of
therapy.
It is hoped that someday, should all of this data be
appropriately evaluated scientifically, that no brain injured
child will ever be denied Hyperbaric oxygenation because of
financial or social reasons.
A special thankyou to
the countless Drs and children whom have made this research
possible. All information contained within these pages are the
sole property of the Dr.s and experts that have spent the
countless hours researching for OUR CHILDREN. Please read each
page of content and please contact your local congressmen and
appropriate government officials today. Thankyou.