Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen in a pressurized chamber above 1 atmosphere. HBOT increases the amount of oxygen dissolved in the blood plasma, allowing greater oxygen delivery to tissues. It has been used since the 17th century to treat various conditions and was established as a treatment for decompression sickness in the 1930s. HBOT works by increasing oxygen to tissues through hyperoxygenation and decreasing bubble size through increased pressure. It has multiple mechanisms of action including vasoconstriction, angiogenesis, and collagen formation.
Submental Intubation - (Steps Of The Procedure Explained)Dr Saikat Saha
This presentation shows the steps required in submental intubation and the advantages of the procedure. The author thinks that submental intubation is an effective way to manage airway in cases of panfacial trauma with concomitant naso orbito ethmoidal fractures and skull base fractures.
Submental Intubation - (Steps Of The Procedure Explained)Dr Saikat Saha
This presentation shows the steps required in submental intubation and the advantages of the procedure. The author thinks that submental intubation is an effective way to manage airway in cases of panfacial trauma with concomitant naso orbito ethmoidal fractures and skull base fractures.
Anesthesia complications range from minor to catastrophic.
complications of general anesthesia might be due to difficulty in airway management or ventilation.
Also the complication might be due to cardiac arrhythmias and poor response to anesthetic effect during induction or maintenance or even the emergence from anesthesia.
So, the the systematic response to the effect of the anesthesia may occur at any time during surgery.
Some of the complications:
Hypoxia, arrhythmia, hypotension , hypertension, regurgitation and aspiration, hypothermia hypoglycemia, coronary ischemia, embolism, persistent apnea delayed recovery , and many others.
also regional anesthesia has its complications like nerve injury, post spinal headache.
Toxicity from local anesthesia is one of the important complication might occur during local infiltration.
Anesthesia complications range from minor to catastrophic.
complications of general anesthesia might be due to difficulty in airway management or ventilation.
Also the complication might be due to cardiac arrhythmias and poor response to anesthetic effect during induction or maintenance or even the emergence from anesthesia.
So, the the systematic response to the effect of the anesthesia may occur at any time during surgery.
Some of the complications:
Hypoxia, arrhythmia, hypotension , hypertension, regurgitation and aspiration, hypothermia hypoglycemia, coronary ischemia, embolism, persistent apnea delayed recovery , and many others.
also regional anesthesia has its complications like nerve injury, post spinal headache.
Toxicity from local anesthesia is one of the important complication might occur during local infiltration.
This first part of the presentation gives a brief about the pathophysiology of supplemental oxygen in patients as well as basics of ventilation in the human body.
OXYGEN THERAPY is vast diversified topic.
in the slide share, we have tried to compile all detailed information in brief.
the slides are well versed and all information have been garnered from verified sources.
all recent guidelines, standard textbooks have been referred.
COURTESY- DEPARTMENT OF CRITICAL CARE MEDICINE,
ABVIMS & DR RML HOSPITAL, NEW DELHI.
Oxygen therapy by Dr Arun Gangadharan
This ppt cover basics of oxygen therapy, its indication and the various methods to give oxygen.
Reference- Fishman's Pulmonary Diseases and Disorders
lecture 5: it's good for as to take a breif about how does atmospheric air will pass to our lungs then to blood, for transportation and utilization of oxygen and excretion of carbon dioxide. Many issue are related when gas exchange is performed.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. CONTENTS
• Definitions
• History
• Principles of HBOT
• Physiology
• Mechanism of action
• Dosage and delivery
• Monoplace and multiplace chambers
• Indications
• Contraindications
• Preparations before HBOT
• Negative effects
• Complications
• Applications in dentistry
• Conclusion
• References
3. DEFINITIONs
• HYPER (increase) + BARIC(pressure)
• Hyperbaric oxygen therapy (HBOT) involves the
“intermittent, usually daily, inhalation of 100 percent
humidified oxygen under pressure,greater than 1
atmospheric absolute pressure(ATA).”- Neelima
Malik,3 rd edition.
• The Committee on Hyperbaric Medicine defines HBO
therapy as “A mode of medical treatment in which the
patient is entirely enclosed in a pressure chamber and
breathes 100% oxygen at a pressure >1 atmosphere
absolute (ATA).”
4. •ATA is the unit of pressure
•1 ATA is equal to 760 mm of mercury or pressure at sea level.
• Hyperbaric Oxygen Therapy (HBOT) is the use of high
pressure oxygen as a drug to treat basic pathophysiologic
processes and their diseases -
Textbook of Hyperbaric Medicine,3 rd edition
5. HISTORY
• 1662-hyperbaric air was used by Henshaw for
the treatment of “affections of the lung”.
• He built a structure called the domicilium that
was used to treat a multitude of diseases. The
chamber was pressurized with air or
unpressurized using bellows.
6. HENSHAW’S DOMICILIUM
Henshaw IN, Simpson A. Compressed Air as a Therapeutic Agent in the
Treatment of Consumption, Asthma, Chronic Bronchitis and Other Diseases.
1857.
7. • 1775- English scientist named
Joseph Priestly
first discovered oxygen ,
which ultimately would have
had a profound effect on
hyperbaric medicine.
• 1777-Name oxygen was coined by Antoine Lavoisier
• 1789-Unfortunately, Lavoisier and Seguin reported ill-
defined toxic effects of concentrated oxygen, thereby
increasing the hesitation to use hyperbaric oxygen
therapy (HBOT).
8. • 1878 - Paul Bert documented more clearly the
toxic effects of oxygen on the central nervous
system that were manifested as seizures.(Jain KK.
The History of Hyperbaric Medicine).
• 1879-The idea of treating patients under
increased pressure was continued by the French
surgeon
Fontaine, who built a
pressurized, mobile
operating room.
(Kindwall E, Whelan H. Hyperbaric Medicine
Practice. 2nd ed.)
9. • 1928-Dr. Orville Cunningham, a professor of
anesthesia, ran what was known as the "Steel
Ball Hospital.“
10. • The structure, was 6 stories high and 64 feet in
diameter.
• The hospital could reach 3 atmospheres of
pressure.
• The hospital was closed in 1930 because of the
lack of scientific evidence indicating that such
treatment alleviated disease.
• It was deconstructed during World War II for
scrap.
( Reference-Jain KK. The History of Hyperbaric
Medicine.)
11. • 1937- Behnke and Shaw first used hyperbaric
oxygen successfully for the treatment of
decompression sickness sufferred by deep sea
divers.
• In 1950’s: The modern clinical application of
HBO began, in parallel with an increased
understanding of blood gas analysis and gas
exchange physiology.
12. • In 1960’s – 2 institutions preeminently
pursued the clinical aspects of high pressure
oxygenation.
• Dr. Bakers from the University of Amsterdam
developed the use of intermittent HBO, for
the treatment of gas-gangrene.
• Second major focus of interest in this area was
Royal Infirmary of Glassgow, where various
anesthetic and surgical aspects of HBO were
applied and discussed.
13. • 1965: It was first used to assist wound healing when it was
noted that burns of
the victims of
coalmine explosions
treated with HBO2
healed faster.
• Since 1970: Most of the instructional courses, research work and
guidance have been provided by Under seas and Hyperbaric Medical
Society (Headquarters in Kensington, Maryland).
• This medical organization publishes guidelines for hyperbaric
oxygenation every 2-3 years.
14. PRINCIPLES OF HBOT
• based on how gases of different solubilities,
most importantly oxygen, behave under
changing pressures and volumes, within
tissues and fluid -
• Henry’s Law of gas behavior
• Fick’s Law of gas behavior
• Boyle’s Law of gas behavior
15. • Henry’s Law(Edward et al.2010)
“states that the concentration of a dissolved gas
(Concgas) equals the pressure (P) times the
solubility coefficient (Sol) of that gas.”
Concgas=P(sol)
• The 3 main gases of concern in HBOT are oxygen,
carbon dioxide, and nitrogen
Oxygen 0.024
Carbon dioxide 0.57
Nitrogen 0.012
solubility coefficients normal body temperature
16. • Fick’s law (Edward et al,2010)
describes the rate of diffusion of a gas through tissues or
fluids.
• “the gas flow (volume of gas per unit time [Vgas]) through a
tissue or membrane is equal to the area (A) divided by the
thickness (T) multiplied by the diffusion constant (D) times the
difference in partial pressures (P1–P2) of the gas across the
tissue or membrane.”
• The diffusion constant is proportional to the solubility of the
gas (Sol) divided by the square root of the molecular weight
(MW) of the gas.
Vgas =D(P1 - P2)
17. • Boyle’s law (Edward et al,2010)
relates to how volumes of gas behave under pressure.
• “with increasing pressure (P) the volume (V) of a gas
decreases proportionately.”
• Significance-This becomes important when gases are trapped
in various cavities during compression and decompression of
the patient
if there is air trapped
within a body cavity the
volume will contract and
may alleviate some
clinical conditions
when the patient is
decompressed the trapped
gas will expand and may
cause complications.
18. PHYSIOLOGY
• The air that we normally breathe contains 21% O2 at
sea level pressure.
• The tissues that are in need of oxygen obtain it from
the oxygen combined to hemoglobin(oxy Hb)which is
95% saturated.
• Oxygen is needed to provide energy and support
cellular respiration.
19. • Any injury or disease
decreases the body’s ability to transport
oxygen to the tissues,
• Eg – hemolytic anemia, toxin exposure, and
hemorrhage
20. Increases the tissue demands for oxygen
Eg- infections,tissue healing
may increase the distance that the oxygen must travel
from the capillary to reach the cell.
Eg-Edema,decreased perfusion and microthrombosis
21. To brush up ………
• Oxygen is carried by blood mainly in 2 ways-
1. Hemoglobin
2. Plasma
• Hemoglobin carries majority of oxygen
• Plasma carries only minute amounts of
oxygen
22. 100 ml of blood 19ml O2 + Hb
0.32ml in plasma
At the same pressure
100 % O2 inspired O2 + Hb 20ml
Plasma 2.09ml
The higher pressure during
HBO treatment pushes more oxygen
into solution
2ATA pressure
3ATA pressure
4.4 ml/dl
6.8ml/dl
PLASMA
This additional O2 in solution is sufficient to meet tissue needs without
contribution from O2 bound to hemoglobin and is responsible for most of the
beneficial effects of this therapy.
23. MECHANISM OF ACTION
(Bhutani et al,Ind Jr Plastic Surgery,2012)
• 2 primary MOA –
1. hyperoxygenation
2. decrease in bubble size
24. Hyperoxygenation
• an application of Henry's law
• results from an increase in dissolved oxygen in
plasma as a result of increased partial pressure of
arterial oxygen(pO2).
• management of crush injury, compartment
syndrome, flap salvage and acute blood loss
anaemia.
A pressure of 3 ATA results in 6 ml of
O2being dissolved per 100 ml of plasma,
thus rendering as much O2 delivery as by
haemoglobin bound O2.
25. Decrease in bubble size
• application of Boyle's law
• High oxygen (100%) intake saturates the blood
plasma with oxygen.
• volume of a bubble decreases directly in
proportion to increasing pressure and is the
primary mechanism at work in management
of decompression sickness and arterial gas
embolism. (Latham E et al. Hyperbaric oxygen
therapy. eMedicine. Medscape).
27. Vasoconstriction
• Hyperoxia in normal
tissues causes
vasoconstriction which reduces post-traumatic tissue
oedema.
• This contributes to the treatment of crush injuries,
compartment syndromes and burns.
• Vasoconstriction, however, does not cause hypoxia as
this is more than compensated by increased plasma
oxygen content and microvascular blood flow.
28. Collagen formation
Oxygen is vital for
• hydroxylation of lysine and proline residues
during collagen synthesis
• for cross linking and maturation of collagen
which is required for strong wound healing.
• Lack of oxygen is corrected during HBOT,
leading to adequate amounts of mature
collagen formation.
29. Angiogenesis
Hypoxia is a vital stimulant for angiogenesis, but
development of adequate capillary network requires
adequate amounts of tissue oxygen concentration..
This along with fibroblastic proliferation leads to
increased neovascularisation.
HBOT increases the oxygen gradient between the
centre and periphery of the wound, thus creating a
strong angiogenic stimulus.
30. What is hypoxia???
Hypoxia or hypoxiation is a pathological condition in
which
• the body as a whole (generalized hypoxia)
• or a region of body (tissue hypoxia) is deprived of
adequate oxygen supply.
32. • Generalized hypoxia
• occurs in healthy people when they ascend to
high altitude, where it causes altitude sickness
leading to potentially fatal complications:
• High altitude pulmonary edema and high
altitude cerebral edema.
33. • Hypoxia also occurs in healthy individuals when
breathing mixtures of gases with low oxygen
content,
e.g. while diving underwater especially when using
closed-circuit re-breather systems that control
the amount of oxygen in the supplied air.
34. • Hypoxia is also a serious consequence of preterm birth in
the neonate.
• The main cause for this is that the lungs of the human
fetus are among the last to develop during pregnancy.
• To assist the lungs to distribute oxygenated blood
throughout the body ,infants at risk of hypoxia are often -
• placed inside an incubator capable of providing continuous
positive airway pressure (also known as a humidicrib).
35. MECHANISM -HYPOXIA
• Hypoxia extends beyond the local wound
environment.
• Reactive oxygen species are produced, including
oxygen free radicals.
• these cause vasoconstriction followed by vasodilatation.
• Endothelial cell damage and release of prostaglandins, pro-
inflammatory cytokines (tumor necrosis factor-α and
interleukin-6) and nitric oxide from vascular endothelium
occurs
36. • capillaries become leaky, interstitial edema
occurs.
• Circulation is further compromised with
compounded injury
• The surgical or medical reestablishment of
interrupted circulation sends blood to the
ischemic area, providing new oxygen substrate
for the formation of more free radicals.
In massive injury the release of inflammatory cytokines and
free radicals escape the normal regulatory mechanisms
and can lead to multiple organ failure. Hence, a long
and catastrophic chain of events can be initiated by O2
deprivation.
37. • HBO exerts both direct and indirect effects against
bacteria.
• Direct bactericidal and bacteriostatic effects occur
through the generation of oxygen free radicals.
• This free radical oxidizes proteins and membrane
lipids, damages DNA, and inhibits metabolic
functions essential for the growth of organisms.
38. •Hypoxia reduces this function.
•Significant reductions in the killing capacity of leukocytes occur
when tissue pO2 falls below 30 mmHg.
•Infected and traumatized tissues often have a partial pressure of
oxygen below this, making them much more susceptible to
infection due to decrease in neutrophil activity.
Indirect effect of HBO in bacterial killing is
through improving leukocytes function and is
regarded as being more significant than the
direct bactericidal and bacteriostatic effects.
Neutrophils require oxygen as a
substrate for microbial killing, after
phagocytosis occurs.
39. Hyperoxia and HBO influence the activity of
some antibiotics, enhancing the effectiveness of
some and inhibiting others.
Physiologic and biochemical effects of hyperoxia:
• Suppression of alpha-toxin production
by Clostridium perfringenes.
• Bacteriostatic for some species of
Escherichia and Pseudomonas and also for a
range of enteric bacteria (Salmonella, Shigella
and Proteus).
40. Improved leukocyte killing activity
Promotion of fibroblast
proliferation, collagen formation,
angiogenesis in problem wounds,
flaps, and irradiated tissues.
Vasoconstriction in normal blood vessels.
Decreased posttraumatic tissue edema.
Reduced half-life of carboxyhemoglobin, improved
dissociation of carbon monoxide from cytochrome-C
oxidase and prevention of neuronal injury in carbon
monoxide poisoning.
41. Mechanism References Clinical Application
Hyperoxygenation
Boerema I
Bassett BE
Bird AD
•DCS
•CO poisoning
•Central retinal artery
occlusion
•Crush
injury/compartment
syndrome
•Compromised grafts and
flaps
•Severe blood loss
anemia
Decrease gas bubble
size
Boyle law •Air or gas embolism
Vasoconstriction
Nylander G
Sukoff MH
•Crush
injury/compartment
syndrome
•Thermal burns
42. Angiogenesis
Knighton DR
Tal S
•Problem wounds
•Compromised grafts
and flaps
•Delayed radiation
injury
Fibroblast
proliferation/collagen
synthesis
Hunt TK
•Problem wounds
•Delayed radiation
injury
Leukocyte oxidative
killing
Mader JT
Park MK
Mandell GL
•Necrotizing soft tissue
infections
•Refractory
osteomyelitis
•Problem wounds
43. Reduces intravascular
leukocyte adherence
Zamboni WA
Thom SR
•Crush
injury/compartment
syndrome
Reduces lipid
peroxidation
Thom SR
•CO poisoning
•Crush
injury/compartment
syndrome
Toxin inhibition Van Unnik A •Clostridial myonecrosis
Antibiotic synergy
Mirhij NJ
Keck PE
Mendel V
Muhvich KH
•Necrotizing soft tissue
infections
•Refractory
osteomyelitis
44. Dosage and Delivery
• All regimens use 100% oxygen
• Pressures are more variable-
Mostly used 2.4 atm
Maximum tolerated is 3 atm
4 atm induces seizures
46. • Dives between 30 and 120 minutes
• May be daily or BID
• Total number varies by indication
• Most treatments include 30 dives
• Optional addition of 10 or more dives are accepted.
HBOT is carried out in 2 chambers-
1. Monoplace chamber
2. Multiplace chamber
47. Monoplace chambers
•Small and designed to accommodate only one adult individual,
usually in a supine or semi-recumbent position
•pressure capability of 3.0 ATA, and compressed with 100% oxygen
•The high flow oxygen requirement is ideally supplied via a hospital’s
existing liquid oxygen system.
48. •Cost efficient delivery of
HBO2.
• No risk of decompression
sickness.
• Portable, less space, less
equipments, no hood or
mask.
•No risk of iatrogenic
decompression sickness in
patient or staff
Advantages
•Relative patient isolation.
•Associated fire hazard.
• Inability to use certain
diagnostic and/or
therapeutic equipment.
•Limited access to the
patient inside chamber
with only visual and
auditory communication
available to the patient
and observers.
Disadvantages
49. Multiplace chambers
• These units can accommodate between 2 and 18 or
more patients and commonly incorporate a
minimum pressure capability of 6.0 ATA.
50. •Constant patient attendance
and evaluation (particularly
useful in treating evolving
neurological diseases such as
decompression sickness and
cerebral arterial gas embolism).
•Multiple patients treated per
session.
•Greater working pressure.
•Reduced fire risk
•More room available, which
allows medical personnel to
enter to deal with acute
problems, e.g., pneumothorax
•Higher capitalization
requirements.
•risk of cross infection when
used to treat wounds
• Major space requirements;
basement and/or ground
floor level limitations.
•Higher operating costs.
Advantages Disadvantages
51. Other chambers
• Two other types of chambers are mentioned,
although they are not considered HBOT.
1. Topical oxygen, or Topox, is administered
through a small chamber that is placed over an
extremity and pressurized with oxygen.
• The patient does not breathe the oxygen, nor is
the remainder of the body pressurized.
• The patient cannot benefit from most of the
positive effects of HBOT, which are systemic or
occur at a level deeper than topical oxygen can
penetrate
52. • Topox is based on the concept that oxygen
diffuses through tissue at a depth of 30-50
microns.
• This method does not treat DCS, arterial gas
emboli (AGE), or carbon monoxide (CO)
poisoning.
53. 2. portable "mild" hyperbaric chamber
• These soft vessels can be pressurized to 1.5-1.7
atmospheres absolute (ATA).
• They are only approved by the FDA for the treatment
of altitude illness.
• The number of these chambers has increased, as
they are being used more commonly in off-label
indications.
54. INDICATIONS
• According to Undersea and Hyperbaric Medicine Society
(UHMS)-
1.Air or gas embolism.
2. Carbon monoxide poisoning or carbon monoxide poisoning
complicated by cyanide poisoning.
3. Clostridal myositis and myonecrosis (gas gangrene).
4. Crush injury, compartment syndrome, and other acute
traumatic ischemia.
5. Decompression sickness.
6. Enhancement of healing in selected problem wounds;
a. Diabetically derived illness, such as diabetic foot,
diabetic retinopathy, diabetic nephropathy.
55. 7. Exceptional blood loss (anemia)
8. Intracranial abscess.
9. Necrotizing soft tissue infections (necrotizing fasciitis).
10. Osteomyelitis (refractory).
11. Delayed radiation injury (soft tissue and bony necrosis).
12. Skin grafts and flaps (compromised).
13. Thermal burns.
Additional indications recommended by European Concensus
Conference 2004 –
1. Surgery and implant in irradiated tissue(Preventive action)
2. Sudden deafness
3. Neuroblastoma stage IV
4. Post anoxic encephalopathy
5. Limb replantation
56. Figure shows sequential photographs of a 53-year-old male
diabetic suffering from spontaneous gangrene of the thigh
who was managed successfully with HBOT at a tertiary care
hospital of the Armed Forces.
58. Disulfiram
Blocks superoxide
dismutase, which is
protective against
oxygen toxicity
Discontinue
medication
Doxorubicin Cardiotoxicity
Discontinue
medication
Sulfamylon
Impaired wound
healing
Discontinue and
remove medication
59. • Relative
a. Upper respiratory tract infection
b. Chronic pulmonary obstructive disease
c. Congenital spherocytosis
d. Eustachian tube dysfunction
e. Asthma
f. Pregnancy
g. Claustrophobia
h. Seizure disorder
i. Hyperthermia
60. PREPARATIONS BEFORE HYPERBARIC
OXYGEN THERAPY
1. Medication
• The HBO technician will obtain a
complete drug history before treatment
since some medications are not compatible with HBOT.
These include:
• High doses of prednisolone (or similar cortisone type
drugs), and morphine, or alcohol, insulin within 8 h of
treatment.
• Such drugs should be substituted for another drug.
• Patients will be instructed to take a regimen of high
potency nutritional supplements containing vitamin E
and other antioxidants during a course of HBOT
61. 2.Cold and other symptoms
• Patients with the symptoms of
a cold or the flu, fever, cough, sore throat, runny
nose, cold sore, nausea, vomiting or diarrhea are not
helped by oxygen.
• HBO treatments may need to be postponed until
symptoms have subsided.
62. 3.Smoking
• Hyperbaric oxygen therapy
will not be effective in patients
who use tobacco in any form like cigarettes, pipe
tobacco, and cigars, as well as chewing tobacco and
snuff.
4. Cosmetics
• Cosmetics, hair spray, nail polish, perfume, or
shaving lotion containing petroleum, alcohol or oil
base are not allowed while in the HBO chamber.
• It is important to discuss all skin care products with
the HBO technician, so they may assure safety.
63. 5. Clothing (Moon & Grande)
• Patients are provided with
100% cotton gowns to wear
during treatment.
• No articles containing nylon
or polyester can be
worn in the chamber.
64. Negative affects after therapy??
• A “cracking” sensation in their ears
between treatments as a pressure
difference develops between their
middle ear and the chamber atmosphere.
(Lehm JP, Bennett MH. Predictors of middle ear
barotrauma associated with hyperbaric oxygen
therapy.)
• Feeling of light headedness for a few minutes
immediately following a treatment.
65. Potential complications after HBO
1.Oxygen toxicity - Seizures, dry cough, chest
pain or burning.
2.Visual refraction changes - Cataract,
progressive myopia with prolonged number of
treatments.
3. Barotrauma - In ears, sinus, lungs, tooth
caries/fillings.
66. Complication Presentation Treatment
Barotrauma
Middle ear (URI,
Eustachian tube
dysfunction)
Ear pain,
fullness
Muffled hearing
•Autoinflation
technique
•Pseudoephedri
ne/oxymetazoli
ne
•Tympanostomy
tubes
•Wait for URI
resolution
Sinus
Sinus pain or
bleeding
•Oxymetazoline
/pseudoephedri
ne
•Antihistamines
•Steroid nasal
spray
67. Dental Tooth pain
Replacement of
filling or crown
(allows trapped
air bubble to
escape)
Pulmonary
•Dry cough
•Chest pain or
burning
•Decreased vital
capacity
•No breath-
holding
•Thoracostomy (if
pneumothorax)
•Increase
decompression
time
Round or oval window blowout
•Immediate
deafness
•Tinnitus
•Nystagmus,
vertigo, or both
Discontinue
Valsalva
Refer to ENT
69. Oxygen toxicity
CNS (Incidence
0.7 per 10,000
treatments at 2.4
ATA)
Seizure
•Removal from
oxygen source
•Resume HBOT
with shorter
oxygen treatment
periods
•Does not require
medication
•Treat
hypoglycemia if
present
•Treat fever if
present
Pulmonary
•Dry cough
•Chest pain or
burning
•Decreased vital
capacity
•Decrease total
oxygen exposure
time (including
outside HBOT)
70. APPLICATIONS IN DENTISTRY
hyperbaric oxygen therapy is used in
• Osteoradionecrosis
• Osteomyelitis of jaws
• Aggressive periodontitis
• Adjunctive therapy for the placement of the
implants in irradiated jaws.
71. Osteoradionecrosis
complication of the jaws which occurs
after head and neck radiotherapy
Patients are subjected to HBOT to
prevent the necrosis of the bone after
extraction in irradiated patients.
Necrosis occurs since blood supply is
compromised after radiotherapy
characterized by hypocellularity,
hypovascularity and hypoxia
Mode of action of HBOT
•Increases the oxygen tension in the
region and promotes angiogenesis and
wound healing
72. Osteomyelitis
chronic, unresponsive bone infection
which is caused by bacteria that may
remain dormant for years.
treatment of osteomyelitis is surgical
debridement and antibiotic prophylaxis
main complication in osteomyelitis is
the presence of a barrier between the
host and the infection.
This barrier can be suppuration,
necrotic bone, but it can limit the action
of the host’s immune system.
Mode of action of HBOT
Increases the host response by
favouring the action of inflammatory
cells.
73. Implants in irradiated
bone
Dental implants are directly inserted into the bone which
replaces the missing teeth.
in an individual who has already undergone radiation therapy,
the implant is likely to fail, because the bone formation is
compromised after radiation
In an experimental study done on implants inserted into
irradiated bone, to assess the effects of hyperbaric oxygen
therapy on the capacity of bone formation, hyperbaric oxygen
therapy was found to stimulate effective bone formation .
74. • Implants when placed in the irradiated bone
lead to failure because of increased
susceptibility to infection and compromised
bone formation.
Mode of action of HBOT
• Stimulates effective bone formation and
increases host defense mechanism
75. Periodontitis
• The effect of hyperbaric oxygen on aggressive periodontitis
and subgingival anaerobes in Chinese patients,
documented the effect of hyperbaric oxygen therapy.
• This assessment was done by measuring plaque index,
gingival index, probing depth and attachment loss, two
years after hyperbaric oxygen therapy was indicated.
• It was concluded in this study, that HBO could inhibit the
growth of subgingival obligate anaerobes, facultative
anaerobes and Bacteroides melaninogenicus,
• thus promoting healing of peridontium, which could help
in the treatment of aggressive periodontitis.( Tie-lou Chen,et
al.2012)
76. • The use of hyperbaric oxygen as a adjunct to scaling and
root planning in patients with generalized chronic
periodontitis, is found to improve the clinical parameters
like probing depth and attachment level, thus indicating the
beneficial effects of hyperbaric oxygen on the
periodontium .(Getulio R et al 2010)
• Microorganisms and their toxins affect the periodontium
Mode of action of HBOT
• Inhibits the growth of subgingival obligate anaerobes and
facultative anaerobes and promotes healing of the
peridontium
77. HBO and Periodontitis
Mechanism
• Hyperbaric oxygen therapy showed to increase oxygen
distribution at the base of the pocket which is
deleterious to periodontal pathogens, particularly to
the anaerobic microorganisms.
• HBO increases generation of oxygen free radicals,
which oxidize proteins and membrane lipids, damage
deoxyribonucleic acid and inhibit bacterial metabolic
functions.
• It also facilitates the oxygen-dependent peroxidase
system by which leukocytes kill bacteria.
78. Studies
AUTHOR STUDY
Manhold et al. showed through an experiment that some commercially
available oxygenating agents demonstrated
shorter healing times when applied on inflamed gingiva.
Hirsch et al studied the effect of locally released oxygen on the
development of plaque and gingivitis in man and concluded
that there was no significant effect of oxygen on plaque
formation, crevicular fluid flow, or the number of
gingival bleeding sites.
Schlagenhauf et
al
used repeated subgingival oxygen irrigations in previously
untreated periodontal patients. They concluded that
repeated oxygen insufflations resulted in a significant
clinical improvement of the periodontal baseline conditions
superior to the one found in the control.
79. Gaggl et al. applied localized oxygenation in contrast to systemic oxygen
therapy, to help treat acute necrotizing periodontal diseases. In
both groups of patients, colonization with P. intermedia, T.
forsythia, and T. denticola was initially positive. None of these
microorganisms were completely eradicated in any of the
patients in the group without oxygen therapy within the first 10
days.
Signoretto et al combination of HBO2 and SRP substantially reduced (by up to
99.9%) the Gram-negative anaerobe loads of the subgingival
microflora. In addition, molecular detection of the main
periodontopathogenic bacteria significantly reduced in the
number of dental sites, which harbored them.
Nogueira-Filho et
al.
They concluded that HBOT had a short term beneficial effect on
pocket reduction and bacterial elimination, and may be
considered potential adjunct therapeutic option to improve the
clinical outcomes of scaling in severe cases of chronic
periodontitis.
Chen et al. concluded that HBO2 inhibits the growth of subgingival obligate
anaerobes and facultative anaerobes and B. melaninogenicus thus
promoting healing of peridontium, which will be of help in the
treatment of AgP.
80. HBO and Implant
Mechanism
• The exact mechanisms at the cellular level where
HBO2 act remain obscure.
• It has been recently shown that HBO2 and basic
fibroblast growth factor (bFGF) acts synergistically in
irradiated bone.
• Factors that could be involved in bone protection by
bFGF and HBO2 are bone marrow radioprotection,
induction of oxygen radical scavengers and
production of different cytokines.
81. • Hyperbaric oxygen and bFGF can also enhance the level of
insulin-growth factor, which is known to promote
proliferation and differentiation of bone.
• They could also affect bone progenitor cells by promoting
DNA synthesis, stimulating enzymes involved in bone
formation or affect membrane receptors.
• HBO2 has furthermore been shown to affect the interface
between the titanium implant and bone, which could be
different from cellular effect.(Johnson k et al,1993.)
• Oxygen under hyperbaric conditions could thus play a role
in osseointegration by affecting bone cell metabolism,
implant interface and capillary network in the implant bed.
82. Biological effect on periodontium
• Animal studies showed that HBO can increase the amounts
of opened blood vessels, and increase the gingival blood flow
and blood current velocity, decrease the blood
concentration.
• HBO may regulate the microcirculation by changing the
opened blood vessels and endoepithelial cell metabolism.
• The value of PGE2 in alveolar bone and gingiva reduce
markedly after HBO exposure in experimental periodontitis.
• HBO is effective in treating periodontitis after periodontal
flap surgery.(Lai SP, Huang F. Observation of the therapeutic
effects of hyperbaric oxygen on periodontitis after
periodontal flap surgery. )
83. CONCLUSION
HBOT was started as a treatment modality for
management of decompression sickness and, with the
passage of time, its scope has gradually increased to
include numerous indications.
Hyperbaric oxygen has been successfully used in several
medical applications.
The therapeutic effect is related to elevated partial
oxygen pressure in the tissues.
Dental patients too could be benefited with this
treatment approach along with the advancement in the
medicines and technical equipment’s used in the patient
care.
84. • Hyperbaric oxygen therapy can be used as an
adjunct to SRP to treat moderate-to-severe
periodontitis.
• It has been shown to decrease load of anaerobic
microbes and thus significantly improve
periodontal health.
• However, further advancement should be made
to use this therapy routinely in clinical practice.
• Consideration must be given to both the benefits
and the risks of a therapy when contemplating its
application in any clinical situation.
85. REFERENCES
• Hyperbaric Oxygen Therapy – Can It Be the New Era in Dentistry? Divya Devarajand D.
Srisakthi
• www.mayoclinic.org/testsprocedures/hyperbaric-oxygen-therapy/about/pac-20394380
• Hyperbaric Oxygen Therapy, Medscape
• Hyperbaric oxygen and wound healing Sourabh Bhutani,Guruswamy Vishwanath
• Hyperbaric oxygen therapy. Part 1: history and principles Melissa L. Edwards, DVM,
DACVECC
• Applications of hyperbaric oxygen therapy in dentistry: A mini review Nalini Jain, D.
Deepa
• Biological effec ts of hyperbaric oxygen in human severe periodontitis,T chen Y zhou
• Hyperbaric oxygen therapy in periodontal diseases Swapna A. Mahale, Pankaj K.
Kalasva, Sunil Vinayak Shinde
• Microbiological evaluation of the effects of hyperbaric oxygen on periodontal disease
Caterina Signoretto, Franco Bianchi, Gloria Burlacchini, Pietro Canepari
• Role of hyperbaric oxygen therapy in the treatment of periodontitis Ravi Prakash Popat,
Parita Ravi Popat1
• Neelima Malik 3° edition
• Internet sources
Editor's Notes
From this, it is evident that carbon dioxide is 24 times more soluble than oxygen and 48 times more soluble than nitrogen and that oxygen is twice as soluble as nitrogen
Since inspired air is 21% oxygen and atmospheric pressure is 760 mmHg (at sea level), the partial pressure of oxygen is 0.21 x 760 mmHg = 160 mmHg. As air moves into the alveoli, water vapor and carbon dioxide are added, and that reduces the partial pressure of oxygen to about 100 mmHg in the alveolar gas.