Hyperbaric Oxygen Therapy (HBOT) - Ohio State University College ...

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Hyperbaric Oxygen Therapy (HBOT) - Ohio State University College ...

Hyperbaric Oxygen Therapy

(HBOT)

Venu Maturi, DDS

Aric Kuehner, Kuehner,

DDS

General Practice Residency,

The Ohio State University College of Dentistry and

University Medical Center

April 19, 2005

Hyperbaric Oxygen Therapy

A Mode of Medical Treatment in which the

Patient is Entirely Enclosed in a Pressure

Chamber and Breathes 100% Oxygen at a

Pressure Greater than 1 Atmosphere Absolute

(ATA).

ATA is a unit of pressure and 1 ATA is equal to 760

mm of mercury pressure at sea level.

Physiological Basis

When we normally breathe air (with 21% O2) at sea level pressure, pressure,

most tissue needs

of Oxygen are met from the Oxygen combined to Hb, which is 95 % saturated.

100 ml blood carries 19 ml O2 combined with Hb and 0.32 ml dissolved dissolved

in

plasma.

At this same pressure if 100% O2 is inspired, O2 combined with Hb Hb

increases to a

maximum of 20 ml and that dissolved in plasma to 2.09 ml.

The higher pressure during hyperbaric oxygen treatment pushes more more

oxygen into

solution.

The amount of O2 dissolved in plasma increases to 4.4 ml/dl at a pressure of 2 ATA

and to 6.8 ml/dl at 3 ATA.

This additional O2 in solution is almost sufficient to meet tissue tissue

needs without

contribution from O2 bound to hemoglobin and is responsible for most of the

beneficial effects of this therapy.

There is really no benefit from the oxygen within the chamber in direct contact with

wounds. This is the reason that dressings are usually left in place place

during the

treatment.

Presentation Outline:

What is Hyperbaric Oxygen Therapy?

Physiology

Advantages and Disadvantages

Indications and Contraindications

Dental Implications

Case Reports

Beneficial Effects

Increased oxygen delivers to the injured tissue

Greater blood vessel formation

Advanced wound healing

Improved infection control

Preservation of damaged tissues

Elimination of toxic substances

Reduce effects from toxic substances

Reduction or elimination of tissue obstruction by

gas bubbles

Total Pressure

ATA

1

1.5

2

2.5

3

Effect of Pressure on Arterial O2

MmHg

760

1140

1520

1900

2280

Content of Oxygen

Dissolved in plasma (vol

%)

Breathing Air

0.32

0.61

0.81

1.06

1.31

100%

Oxygen

2.09

3.26

4.44

5.62

6.80

All values assume arterial pO2 = alveolar O2 and that Hb O2 capacity of blood is 20 vol %

Source: MEDICINE UPDATE, Volume 14, 2004 , The Association of Physicians of India.

Editor Maj Gen S Venkatraman

1


Monoplace chamber

A single patient is placed in a

chamber which is then

pressurized with 100%

Oxygen.

Used to treat stable patients

with chronic medical

conditions.

Administration

Multiplace chamber

Used to treat many patients at

the same time

When treating critically ill

patients who require a medical

attendant within the chamber.

These chambers are

pressurized with compressed

air while the patient breathes

100% Oxygen through special

masks or Oxygen Hoods.

Anxiety or Claustrophobic

patients

Multiplace Chamber

Advantages

HBO is non-invasive non invasive (it is not a surgical procedure)

It has very few side effects

Enhances the natural healing process of your body

Enhances the effectiveness of conventional therapy

Monoplace chamber

Disadvantages

Slight pain in the ears (aural barotrauma) barotrauma)

due to a

blocked Eustachian tube.

Pneumothorax

Air embolism

Transient reversible myopia

Patient may be claustrophobic.

Fire hazard - preventable by strict safety procedures.

2


Indications

Emergency conditions

- Diving related injuries – Decompression

sickness

- Carbon monoxide poisoning

- Air or gas embolism

- Problem wounds and excessive

bleeding

- Crush injuries

Elective surgery

Indications

• Reducing the recovery time after aesthetic

surgery

• Assisting in the recovery for sporting injuries

Dental Implications

Prior to dental extraction/implant placement in a field of

radiation that is known to have received 60 Gy

Active ORN

Osteomylitis

Indications ndications

Permanent or long term problems

- Neurological problems such as swelling

in the brain and spinal tissues

- Infections in bones and muscles e.g.

Osteomyelitis or joint diseases

- Radiation tissue damage

- Diabetic wounds

- Skin grafts, and gangrene

- Motor neuron disorders such as multiple

sclerosis and cerebral palsy

Absolute contraindications

Untreated pneumothorax

Concurrent administration of

disulfuram (Antabuse)

Concurrent administration of

the antineoplastic agents

doxorubicin and cisplatinum

Administration to premature

infants (due to risk of

retrolental fibroplasia).

Contraindications

Relative contraindications

Prior chest surgery

Lung disease

Viral infections

Recent middle ear surgery

Optic neuritis

Seizure disorders

High fever

Congenital spherocytosis

Claustrophobia

The most severe oral complication of radiation

therapy is osteoradionecrosis (ORN).

Each course of radiation causes cumulative,

irreversible damage to the tissue, which

predisposes ORN.

Additional tissue insult, regardless if iatrogenic

or traumatic, can cause tissue death in these

compromised tissues.

The clinical manifestation of ORN is one of "a

persistent, chronically nonhealing bone that

neither produces extensive suppuration or

consistently breaks down in a septic course.

3


The HBO-induced HBO induced angiogenesis may reach 80%

to 85% of the preirradiated vascularity and last

at least 3 years.

The HBO stimulates quiescent fibroblasts in

hypoxic tissues by exposing them to hyperoxic

levels. These fibroblasts lay down a new

collagen matrix which allows angiogenesis. New

capillaries deliver cells, substrate, and oxygen.

This reverses the hypocellular-hypovascular

hypocellular hypovascular-

hypoxic events which lead to ORN

Conclusion

The role of Hyperbaric Oxygen Therapy is

“evidence based” in certain well defined

conditions and the Hyperbaric Chamber is now

an integral part of hospital services. Doctors in

all fields must familiarize themselves with recent

evidence on this mode of therapy, so that their

patients are not denied the gains of this modern

treatment.

Pressure

Duration

Marx Protocol for HBO Therapy

Prophylactic

Active ORN

2.4 Atmospheres

90 min

90 min. at 2.4 atmospheres of pressure of pure oxygen = I Dive

20 dives pre-op; pre op; 10

dives post-op post op

30 dives pre-op; pre op; 10

dives post-op post op

Hyperbaric Case

52 yo male with history of head and neck

cancer and previous radiation therapy

Patient chose not to have teeth extracted

prior to treatment

Presented to clinic with abcessed #17

Because of severity of infection tooth had

to be extracted immediately and then a

hyperbaric course of treatment was started

after the extraction.

Patient continued with a complete course

of hyperbaric treatment, and the healing

was monitored along the way.

4


Extraction site 4 months post-op

3 years post-op post op

Panorex 7 months post-op post op

Patient continued with a complete course

of hyperbaric treatment, 60 dives.

Although healing was slow

osteoradionecrosis is slowly resolving.

5

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