Hyperbaric Oxygen Therapy
Hyperbaric Oxygen Therapy
Hyperbaric Oxygen Therapy
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<strong>Hyperbaric</strong> <strong>Oxygen</strong> <strong>Therapy</strong>Kun-Lun HuangNational Defense Medical CenterInstitute of Undersea and <strong>Hyperbaric</strong> Medicine©Kun-Lun Huang 2000
<strong>Hyperbaric</strong> <strong>Oxygen</strong> <strong>Therapy</strong> -intermittent administration of100% oxygen inhaled at pressuregreater than sea level©Kun-Lun Huang 2000
<strong>Hyperbaric</strong> <strong>Oxygen</strong> <strong>Therapy</strong>Indications - Recompression related‣ Decompression sickness‣ Arterial gas embolism©Kun-Lun Huang 2000
<strong>Hyperbaric</strong> <strong>Oxygen</strong> <strong>Therapy</strong>Indications - <strong>Oxygen</strong>ation related‣ Carbon monoxide poisoning‣ Clostridial myonecrosis‣ Compromised skin grafts and flaps‣ Crush injury, compartment syndrome,and acute traumatic ischemic injury‣ Necrotizing fascitis©Kun-Lun Huang 2000
<strong>Hyperbaric</strong> <strong>Oxygen</strong> <strong>Therapy</strong>Indications - <strong>Oxygen</strong>ation related‣ Exceptional blood loss anemia‣ Intracranial abscess‣ Problem wounds‣ Radiation-induced tissue injury‣ Refractory osteomyelitis‣ Thermal burns©Kun-Lun Huang 2000
A <strong>Therapy</strong> in Search of DiseasesGabb and Robin, Chest 92:1074-1082, 1987©Kun-Lun Huang 2000
A <strong>Therapy</strong> in Search of DiseasesAdequateClinicalTrialsExtensiveFavorable ClinicalExperienceAlternativeForms ofTreatmentDecompression sickness ++ 0Intravascular gas embolism 00±Carbon monoxice intoxication 00+Gas gangrene0 ±+Osteomyelitis 00+Selected mycotic infection 00+Cyanide poisoning 00+Brain edema 0 0+Burns 0 0+Anemia - exceptional blood loss 0 0 ±Enhancement of wound healing 0 0+Radiation necrosis 0 00Gabb and Robin, Chest 92:1074-1082, 1987©Kun-Lun Huang 2000
<strong>Hyperbaric</strong> oxygen therapy -A therapy in search of diseasesGabb and Robin, Chest 92:1074-1082, 1987
Decompression SicknessandAir Embolism©Kun-Lun Huang 2000
Gas Bubble and Tissue Injury©Kun-Lun Huang 2000
Boyle’s LawP 1 V 1 = P 2 V 2if the temperature of a fixed mass ofgas is kept constant, the relationshipbetween the volume and pressure willvary in such a way that the product ofthe pressure and volume will remainconstant.©Kun-Lun Huang 2000
Boyle’s Law
Henry's Law−The amount of a gas that will dissolve ina liquid at a given temperature is directlyproportional to the partial pressure ofthat gas.©Kun-Lun Huang 2000
Blood <strong>Oxygen</strong> ContentO 2 content, ml/dl3025201510500 500 1000 1500 2000PO 2 , mmHgTotalHgb-boundDissolved©Kun-Lun Huang 2000
Carbon Monoxide Intoxication©Kun-Lun Huang 2000
Hgb-O 2 Dissociation CurveO 2 content, ml/dl2220181614121086420NormalCO intoxicationAnemia0 25 50 75 100PO 2 , mmHg©Kun-Lun Huang 2000
Carbon Monoxide and ATP©Kun-Lun Huang 2000
CO EliminationCO-Hgb, % of initial1009080706050403020100Room air100% O 2HBO0 5 10 15 20Time, hour©Kun-Lun Huang 2000
HBO as an Adjunctive <strong>Therapy</strong>• Adjunctive therapy‣ Gas gangrene‣ Problem wounds‣ Chronic refractory osteomyelitis‣ Radiation-induced tissue injury‣ Crush injury with compartment syndrome• Controversial topics‣ Stroke‣ Acute myocardial infarction‣ Global cerebral ischemia/anoxia©Kun-Lun Huang 2000
Blood <strong>Oxygen</strong> ContentO 2 content, ml/dl3025201510500 500 1000 1500 2000PO 2 , mmHgTotalHgb-boundDissolved©Kun-Lun Huang 2000
<strong>Oxygen</strong> Pressure Gradient2000Carotidbody2000PO 2 , mmHg1000Skin1000Muscle10050BrainHeart10050Artery Tissue capillary VeinClark, 1993, <strong>Oxygen</strong> toxicity.©Kun-Lun Huang 2000
Free <strong>Oxygen</strong> Radicals. -O2e -H 2 OO 2 +O 2H 2 O H . + OHO 2 +2e - + 2H +O 2H 2 O 2©Kun-Lun Huang 2000
<strong>Hyperbaric</strong> <strong>Oxygen</strong>VasoconstrictionReducing edema.O2.O2O 2 O 2O 2.O2NeovasculizationReducing bloodviscosity.O2O 2 O 2.O2.O2.O2O 2©Kun-Lun Huang 2000Enhancing bacteriocidal.O2
<strong>Oxygen</strong> and Host Defense% Original inoculum14012010080604020O 2 , mmHg23232345109150SA + OpsoninSA + PMNSA + Opsonin+ PMN00 60 120Incubation time, minJ Infect Dis 142:915-922, 1980 ©Kun-Lun Huang 2000
Activity of Prolyl HydroxylaseReaction velocity, %Vmax1008060402000 100 200 300<strong>Oxygen</strong> partial pressure, mmHgN Engl J Med 301:13-23, 1979 ©Kun-Lun Huang 2000
<strong>Oxygen</strong> and Wound Healing120AirHBO% Original wound area100806040200-2 0 2 4 6Duration of treatment, weekPlast Reconstr Surg 93:829-834, 1994 ©Kun-Lun Huang 2000
Publications on HBO 2 and Leg Ulcer Since 1960sNonspecificfoot ulcers19%NonrandomizedDM footulcers4%RandomizedcontrolledDM footulcers3%Animal or invitro study36%Reviewarticles andcase report38%76 articles in totalWunderlich et. al., 2000, Diabetes Care 23:1551-1555.
Diabetes Care© 1996 by the American Diabetes Association, Inc.Volume 19(12) December 1996 pp 1338-1343Adjunctive Systemic <strong>Hyperbaric</strong> <strong>Oxygen</strong> <strong>Therapy</strong> in Treatment of SeverePrevalently Ischemic Diabetic Foot Ulcer: A randomized study[Original Article]Faglia, Ezio MD; Favales, Fabrizio MD; Aldeghi, Antonio MD; Calia, PatriziaMD; Quarantiello, Antonella MD; Oriani, Giorgio MD; Michael, Michael MD;Campagnoli, Pietro MD; Morabito, Alberto PhDFrom the Diabetology Center (E.F., F.F., A.A., P.Cal., A.Q.), Niguarda Hospital; the Department of Anesthesia and <strong>Hyperbaric</strong> Medicine (G.O., M.M., P.Cam.), Galeazzi Institute; and the Medical Statistics and Biometrics Institute (A.M.), Milan University, Milan, Italy.Address correspondence and reprint requests to Ezio Faglia, Diabetology Center, Niguarda Hospital, Piazza Ospedale Maggiore, 3 20162 Milan, Italy.Received for publication 1 April 1996 and accepted in revised form 8 August 1996.
Faglia et. al., 1996, Diabetes Care 19:1338-1334.
Faglia et. al., 1996, Diabetes Care 19:1338-1334.
Faglia et. al., 1996, Diabetes Care 19:1338-1334.
HBO and TcPO 2HBO group Non-HBO group P valuen35 33At admission 23.2 ±10.7 21.3 ±10.7At discharge 37.3 ±16.1 26.3 ±13.5Variation 14.0 ±11.85.0 ±5.4 0.002Faglia et. al., 1996, Diabetes Care 19:1338-1334.
HBO and Diabetic UlcerHBO groupNon-HBO groupP valuen 35 33Major amputationsAmputated limbs 3 (8.6) 11 (33.3)Salvaged limbs 32 (91.4) 22 (66.7) 0.016Major amputation/Wagner gradeII 0/4 (--) 0/5 (--)III 1/4 (25.0) 0/8 (--) 0.33IV 2/22 (9.1) 11/20 (55.0) 0.002Minor amputationsForefoot 5 (14.3) 4 (12.1)Toe 16 (45.7) 8 (24.2) 0.61No amputation 11 (31.4) 10 (30.3)Faglia et. al., 1996, Diabetes Care 19:1338-1334.--
HBO and Diabetic UlcerHBO groupNon-HBO groupP valuen 35 33Peripheral BPG 4/35 (11.4) 5/33 (15.1)0.73Major amputation 1/4 (25.0) 1/5 (20.0) 1.00Percutaneous angioplasty 9/35 (25.7) 8/33 (24.2)Major amputation 1/9 (11.1) 3/8 (37.5)Total vascular procedures 13/35 (37.1) 13/33 (39.4)Total major amputations 2/13 (15.4) 4/13 (30.8)1.000.291.000.60Faglia et. al., 1996, Diabetes Care 19:1338-1334.
HBO vs. Vascular ProceduresHBO group Non-HBO group P valuen35 33Total vascular procedures 13/35 (37.1) 13/33 (39.4)Total major amputations 2/13 (15.4) 4/13 (30.8)1.000.60Without vascular procedure 22/35 (62.9) 20/33 (60.6)Total major amputations 1/22 (4.5) 7/20 (35.0)Faglia et. al., 1996, Diabetes Care 19:1338-1334.
Tissue Perfusion and HBO©Kun-Lun Huang 2000
HBO in Chronic Refractory Osteomyelitis- an Adjunctive Treatment©Kun-Lun Huang 2000
Controversial topics
HBO and Traumatic Brain Lesion150SHAM NBSHAM HBOGlucose Utilizationµmol/100g/minLESION NBLESION HBO0
HBO and MCA OcclusionHBO 1.5 ATA 40 min at 1 st , 3 rd hr
C) 1995 American Heart Association, Inc.Volume 26(8) August 1995 pp 1369-1372<strong>Hyperbaric</strong> <strong>Oxygen</strong> in the Treatment of Acute Ischemic Stroke:A Double-blind Pilot Study[Original Contribution]Nighoghossian, N. MD; Trouillas, P. MD; Adeleine, P. MD; Salord, F. MDReceived September 21, 1994; final revision received April 20, 1995; accepted April 26, 1995.From the Department of Neurology, Cerebrovascular Disease and Ataxia Research Center (N.N., P.T.), andDepartment of Anesthesiology (F.S.), NeurologicalHospital, and Laboratoire d'Informatique Medicale, UFR Alexis Carrel (P.A.), Lyon, France.Correspondence to Dr N. Nighoghossian, Service de Neurologie du Pr Trouillas (Urgences Neurovasculaires etCentre de Recherches sur l'Ataxie), HopitalNeurologique, 59 Bd Pinel, Lyon 69003, France.
HBO <strong>Therapy</strong> and AMIAm. Heart J. 1997;134:544-550.
HBO <strong>Therapy</strong> and AMIAm. Heart J. 1997;134:544-550.
Reperfusion Injury% of peak effect1009080706050403020100ECdysfunctionPMNadherenceMPOactivity1 2 3 4 5 6 7Time after reperfusion, hourTissuenecrosis
Controversy in Treating I/R InjuryIschemia/ReperfusionEC dysfunction<strong>Hyperbaric</strong> <strong>Oxygen</strong> <strong>Therapy</strong>EDNO↓⎬Adhesion molecules Inhibition ?PMN adherenceCytotoxic mediatorsFree radicalsFree radicals ↑Tissue injury Tissue protection ?©Kun-Lun Huang 2000
HBO and I/R InjuryICAM-1 flurorescence intensity17515012510075502500 2 4 6 8 10 12 14 16 18 20 22Time, hourHypoxia/HypoglycemiaHBO2.5 ATA, 90 minBuras et. al., 2000, Am. J. Physiol. 278:C292-C302.©Kun-Lun Huang 2000
HBO and I/R InjuryICAM-1 flurorescence intensity2502252001751501251007550250SalineL-NAME 25 uML-NAME 50 uML-NAME 100 uMControl HPx/HGx HPx/HGx/HBO HBOBuras et. al., 2000, Am. J. Physiol. 278:C292-C302.©Kun-Lun Huang 2000
Controversy in Treating I/R InjuryIschemia/ReperfusionEC dysfunctionEDNOInhibitionAdhesion molecules<strong>Hyperbaric</strong> <strong>Oxygen</strong> <strong>Therapy</strong>IncreasePMN adherenceCytotoxic mediatorsFree radicalsFree radicalsTissue injury Tissue protection ?©Kun-Lun Huang 2000
(C) 1999 Lippincott Williams & Wilkins, Inc.Volume 47(2) August 1999 pp 426-435<strong>Hyperbaric</strong> <strong>Oxygen</strong> Treatment: A Brief Overview of a Controversial Topic[Review Article]Sheridan, Robert L. MD; Shank, Eric S. MDFrom the Departments of Surgery (R.L.S.), and Anesthesia (E.S.S.), Massachusetts General Hospital,Massachusetts Eye and Ear Infirmary, and HarvardMedical School, Shriners Burns Hospital (R.L.S.), Boston, Massachusetts.Address for reprints: Robert L. Sheridan, MD, Shriners Burns Hospital, 51 Blossom Street, Boston, MA 02114;email: sheridan.robert@mgh.harvard.edu.
HBO is now more than -A Movie Channel in the CATVA <strong>Therapy</strong> in Search of Diseases©Kun-Lun Huang 2000
©Kun-Lun Huang 2000
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