Sabtu, 17 Juli 2010

OHNC - Dr Richard Neubauer - The Recoverable Brain Pt 2

Hyperbaric Oxygen Therapy for neurological disorders

Stroke Recovery and Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Therapy (HBOT) corrects brain-injury.

hyperbaric and autism

Cerebral Palsy Autism Dev. Delays Multiple Sclerosis Stroke TBI & Anoxic BI Down's Syndrome Surgery Osteonecrosis
Hyperbaric Oxygen Therapy and Autism

Craig – Age 23, Cerebral Palsy & Autism

I recommend HBOT unequivocally for anyone with autism and/or cerebral palsy because it has brought me so many wonderful results. After just 40 treatments, my whole body is much more relaxed, my proprioceptive system has turned on, my vision development has jumped ahead – my glasses are half their former prescription – and speech is coming much more easily to me. I am much happier and calmer than before HBOT. Am I recovered? Not yet. But HBOT has greatly enhanced the quality of my life. Thanks, Dave, Lisa, and the rest of the staff!



(This journal has been kept by Ethan's mother, we have not changed it in any way)

My son was diagnosed with severe autistic disorder when he was 2 1/2 years old. We have tried every treatment available for autism, and saw very little improvement over the past 18 months. We started treating him in the hyperbaric chamber in March. We have seen incredible things with this treatment. I wanted to share what all has happened with you. Everything that is reported in this dive log is brand new for Ethan.

3-22-03 (#1 at 1.3)- Did very well in chamber, no problems with ears.

3-24-03 (#2 at 1.3)- Happy today, held hands with Mom in chamber. Susan (para at school) reported he gave her lots of kisses and was happy today.

3-25-03 (#3 at 1.3)- Gave Mom kiss first thing this morning. Elisa (Speech Therapist at school) reported he started saying “w” sound today.

3-26-03 (#4 at 1.5)- Still very happy, whispered something to David (owner of HHI) after dinner. Held hands with Lisa (owner of HHI) during dive.

3-27-03 (#5 at 1.5)- Susan reported he said “I want” twice at school today. Increased babbling noted at home. Sleeping very well and still happy.

3-28-03 (#6 at 1.5)- Rhonda (para at home) reported he said “I wan” 3 times to her today. Also brought her sentence strip with “I want” and “Toy Story 2” and then sat down to watch movie. A few minutes later, he added icon for “blanket” and gave it to her and then got his blanket and returned to movie.

3-31-03 (#7 at 1.5)- Susan sent note home from school that he is very vocal and still saying “I want” with his PECS strip.

4-1-03 (#8 at 1.5)- Following verbal instructions much better. Didn’t want to go to bed, and was up at 5:00 this morning. Gross motor imitation improving.

4-2-03 (#9 at 1.5)- Continues to do very well with imitation. Vocalizations have increased dramatically this week. Increase in chewing noted. Mom told him to “get your bowl and sit at the table” and he did. First time he has ever followed a 2-step command.

4-3-03 (#10 at 1.5)- Imitating consistently touch nose, touch head, wave one hand, wave both hands, clap, high 5, and high 10.

4-4-03 (#11 at 1.5)- Was aggressive after this dive, but skills are remaining consistent.

4-7-03 (#12 at 1.5)- Said “no” over the weekend, said “ball” at school, and discovered bubbles in tubby.

4-13-03- No dives since the 5th due to a cold. Over the weekend, waved responsively with no prompting. Also began removing his pull up to have a bowel movements, seems he now realizes it doesn’t feel good to have poopy pants. We had a team meeting with Molly (his behavior therapist) and she was amazed with his progress. She said “hi Ethan” and he said “hi” right back. She commented that he has shown dramatic improvements since starting treatments. Data shows 6/7 gross motor imitations are now mastered. Adding new ones to work on this week.

4-14-03 (#13 at 1.5)- Still very verbal, especially at school.

4-15-03 (#14 at 1.5)- Susan reported he was doing very well with his workbaskets at school, especially with rolling a ball. He was able to get his backpack off the hook independently for the first time today. Eliza commented “Wow! He’s doing so great!”

4-16-03 (#15 at 1.5)- While working with Agnieszka (au pair at home), Ethan wanted to watch a movie instead. She told him “Touch your nose (and modeled it for him) and then you can go watch your movie.” He followed the instruction and went over to the TV. First time a negotiation has ever worked!!!

4-17-03 (#16 at 1.5)- School sent home a note saying “He said I WANT clear as a bell several times today”. Mom noticed that he is staying by her side when walking to the car after school, even without holding her hand. When she picked him up at school today, he tried to lead her out the door because she was talking to the teachers and he wanted to leave.

4-18-03 (#17 at 1.5)- Nothing new to report after this dive today.

4-21-03 (#18 at 1.5)- Waved spontaneously at several different people over the weekend. Was very aggressive today with biting. Was unable to stay in class today because of it. Took a large bite out of the bus aide this morning. Mom stuck her tongue out at him in the chamber and said “Do this” and he did it twice.

4-22-03 (#19 AT 1.5)- Still slightly aggressive at school this morning, but calm by afternoon. Grabbed Grandma’s hand in the chamber and held it and had her rub his foot during treatment.

4-23-03 (#20 at 1.5)- Took Agnieszka by the hand this morning and led her to the fridge, opened the door, took out what he wanted, handed it to her to get it out for him. Susan reported he was very happy to see her return to school today (she has been out ill for 2 days).

4-24-03 (#21 at 1.5)- Susan reported he began pushing the icon that says “I need to go to the bathroom” at school today, so they took him when he pushed it and he went. At bedtime, Mom said “come on buddy, it’s time to go night night”. He stood up and took her hand and led her to his room and got in bed with no further prompting.

4-25-03 (#22 at 1.5)- Before going into the chamber, Ethan pointed to the TV to let David know he wanted it turned on. This was a first for him!!!

5-6-03 (#23 at 1.5)- Did well in the chamber today.

5-7-03 (#24 at 1.5)- Ethan has been out of the chamber due to a viral infection. This week, a family friend was over to visit and commented, “I can’t believe how much he’s changed. I’ve been here so many times and he’s never even noticed I was in the house. Today he engaged with me like I’ve never seen him do before.” No regression has been noted since out of the chamber, and social interactions have improved this week. This morning, he went to the kitchen and sat at the table until someone came in to help him get breakfast. He took his PECS book and put “I want” “Fruit” and “Cereal” on it and handed it to Agnieszka when she came into the kitchen. Normally, he would have been digging through the fridge or the cabinets for food.

5-8-03 (#25 at 1.5)- Ethan was looking out his bedroom window as Mom and Dad were pulling out of the driveway. He waved to us and pointed at the car. WOW! He has also begun to shut the fridge when he’s done looking in it and the screen door when he walks outside. He has always left them wide open until now.

5-9-03 (#26 at 1.5)- This morning, Agnieszka was gathering her laundry and putting it in her basket. One of the sleeves from her shirt was hanging over the side, so Ethan walked over to it and put it in the basket for her. Big helper!

5-12-03 (#27 at 1.5)- Tonight, Ethan was working on sorting objects, but was very unhappy about the task. Agnieszka told him “If you sort these items, I will turn on the movie for you.” He sorted cars, dolls, and beads without prompting. She turned the movie on for him, and he was happy. He has also begun consistently taking people by the hand, leading them to what he wants, and putting their hands on the item he wants them to give him.

5-13-03 (#28 at 1.5)- Continues to follow directions better. Had a “great day at school” according to Susan.

5-14-03 (#29 at 1.5)- Happy mood today, no biting this week so far.

5-15-03 (#30 at 1.5)- Work with Agnieszka still improving. Requires less instruction for task completion.

5-16-03 (#31 at 1.5)- Very affectionate today. Doesn’t want to let Mom out of his sight. Seeks her out for hugs. Dove at an earlier time today, seemed to be less ancy in chamber for entire dive.

5-19-03 (#32 at 1.5)- This morning, Ethan was standing in the dining room playing appropriately with his toy steering wheel for 5 minutes.

5-20-03 (#33 at 1.5)- When Mom picked Ethan up at school, he was playing by himself with a school bus. He was taking the people out and putting them back in where they belong. Mom said, “Wow! How long has he been playing independently?” Susan said “He does this everyday now.”

5-21-03 (#34 at 1.5)- This morning, Ethan got in bed with Mom. Mom said “hello” and he responded with “hello”.

5-22-03 (#35 at 1.5)- In a great mood today. Had school program, did some of the hand movements with help from his teacher. Much less prompted than ever before.

5-23-03 (#36 at 1.5)- Told Jessica (another Mom) “hi” in the chamber twice today.

5-24-03 (#37 at 1.5)- Molly here this weekend, impressed at how many programs he has mastered at home. Added several new things to try with him. Still following 2 (or more) step commands. Today, he got up from the table with his snack and took it to the living room. Mom said, “Get your snack, go into the kitchen, and sit at the table to eat it.” He did as she asked with no prompting.

5-28-03 through 6-2-03- Mom out of town for the last 3 dives, but 40 have been completed now.

6-1-03- Ethan said “box” after Agnieszka said “sand” while they were playing in the sand box.

6-2-03- Ethan watched “Monsters INC” for the first time. He has only watched the same 5 movies since diagnosis.

6-4-03- Ethan followed Mom from room to room carrying his stacking cups so he could play with them and still be next to her. He also led her to his room (by holding her hand and pulling her) so that she would lay down in bed with him and watch a movie.

6-6-03- Today, Ethan rode his bike independently for the first time. We have been working on transitioning from the tricycle to the bike, but he couldn’t figure out why the brake would engage when he would peddle backwards. He rode 7 feet with no prompting and no braking.

6-10-03- Tonight, Ethan comforted his Dad when he was upset. This the first time he has recognized someone else’s emotional needs.

6-14-03- Mom was talking to a friend who also has a son with autism. He said “I was watching Ethan at the park the other day and would have never known he has autism now.” This meant so much to us coming from the father of an autistic child!

6-17-03- Today Ethan got his haircut. When Mom got home, he immediately walked over to her, took her hand, and rubbed his head with it to show her he got a new haircut.

6-18-03- Today when Ethan was getting off the bus, Katrina (Mom’s best friend) drove by in her car and honked at him and said “hi Ethan”. He stopped, turned around, and waved to her.

6-24-03- Today Ethan’s Dad was putting on his swimsuit to take him to the pool. He got very excited in anticipation of going to the pool. He doesn’t usually show anticipation of activities.

6-30-03 (#41 and #42 at 1.5)- Ethan began his second round today. He dove twice and tolerated it very well. He has been in a great mood all day and has told 3 people “hi”.

7-1-03 (#43 and #44 at 1.5)- Ethan said “wow” tonight while watching fireworks with his family. He also tolerated a new movie for the entire hour during the afternoon dive.

7-2-03 (#45 and #46 at 1.5)- Ethan tolerated a new movie in the morning dive and watched a football game in the second half of the afternoon dive with no problems.

7-3-03 (#47 at 1.5)- Woke up at 5:00 this morning, so he only did 1 dive today. Very sleepy and cranky in the afternoon.

7-4-03- Watched fireworks and said “wow’ again. Very interested in people at the party, swam all day!

7-7-03 (#48 and #49 at 1.5)- Did block imitation correctly for the first time ever!

7-8-03 (#50 at 1.5)- Very cranky this morning when he had to return to school. Cheered up once he was there. In a good mood the rest of the day.

7-9-03 (#51 at 1.5)- This morning Mom got Ethan out of the car to walk into school and he grabbed a hold of her leg and buried his face in it. He held on tight until we got into the classroom. Later this afternoon, Mom started to walk out the front door and Ethan began to cry because he thought she was leaving for work. When Mom walked back into the house, he stopped crying and hugged her. This is the first time he has been upset when Mom leaves since he was diagnosed!

7-10-03 (#52 at 1.5)- This morning, Agneiszka walked into his room and he said “hi” before she did.

7-11-03 (#53 at 1.5)- Nothing new to report today.

7-13-03- Molly here today for a team meeting. We decided to start some new programs, so we got out the game “Perfection” and were trying to decide if he could put 3 or 4 pieces in if we put in the rest. As we were discussing this, he started grabbing pieces and completed the game completely by himself. WOW!

7-15-03 (#54 at 1.5)- Ethan is now dressing himself without any assistance. Over the weekend, Agneiszka put his pull up on the floor and went upstairs to throw the dirty one in the trash. When she returned to help him, he was already dressed. She didn’t even have to verbally prompt him to put them on!

7-21-03 (#55 and #56 at 1.5)- Mom out of town since last Wednesday. Susan sent home notes twice last week stating, “He is doing great at school”. Is doing much better with potty training, only wet once during the day on average. Laughed out loud when he arrived at the chamber this morning because he was so excited to return to diving. No regressions noted this week.

7-22-03 (#57 at 1.5)- Very hyper and stemming constantly today. Having some regression due to medical treatments. Has not slept through the night in a week. Will remain out of the chamber until next week.

7-28-03 (#58 at 1.5)- Returned to chamber today. Very calm and happy to return. Started blowing bubbles with his saliva this week. Thinks it’s very funny. Is playing independently with his toys in his room instead of constantly watching the TV. Went to the pool tonight, Ethan had a blast. Anticipated splashes when kids would jump in by him and would cover his face when he saw them coming. Very good mood today.

7-29-03 (#59 at 1.5)- Agneiszka asked him to pick out a movie to watch while waiting to get into the chamber. Ethan picked “Shrek” instead of one of his usual movies.

7-30-03 (#60 at 1.5)- Still not sleeping through the night, but in a good mood. Babbling increasing, making new sounds.

7-31-03 (#61 at 1.5)- Para at school sent home note saying “Ethan said I wah mu” for “I want music” today.

8-1-03 (#62 at 1.5)- Today, Aunt Katie was over for lunch. She offered Ethan a chicken strip, and he shook his head and said “no”. She offered him a tater tot, he took it and patted her on the arm as a thank you.

8-4-03 (#63 and #64 at 1.5)- Over the weekend, Ethan got out of the pool and took Agneiszka by the hand. He led her to the bathroom and went potty. YEA! Has finally started sleeping through the night again also.

8-5-03 (#65 at 1.5)- Ethan said “I wan hips” several times today at school for “I want chips”

8-6-03 (#66 at 1.5)- Susan reported they haven’t been pouring water on Ethan at all to get him to go potty.

8-7-03 (#67 at 1.5)- Mom and Dad out of town for this dive.

8-8-03 (#68 at 1.5)- Mom and Dad out of town for this dive.

8-11-03 (#69 at 1.5)- At a birthday party tonight, Ethan put down his food, took Mom by the hand, and hit his pull up. Mom asked if he needed to go potty, and he ran to the bathroom and went potty.

8-12-03 (#70 at 1.5)- Tolerated a new movie for 40 minutes without having a tantrum before real tears appeared.

8-13-03 (#71 and #72 at 1.5)- Saying “k” sound today for first time.

8-14-03 (#73 at 1.5)- Fell asleep in chamber today and woke up very cranky. Had a major tantrum when he had to exit the chamber without watching a movie.

8-15-03 (#74 at 1.5)- Mom and Dad out of town for this dive.

8-18-03 (#75 at 1.5)- This evening, Mom walked into Ethan’s room to check on him. He looked her in the eyes and said “hi” and then returned to playing with his toys.

Autisme dengan hiperbarik oksigen terapi

Terapi Oksigen Tekanan Tinggi

Salah satu pengobatan/ terapi menggunakan oksigen dengan tekanan yang lebih besar dari tekanan yang ada di atmosfer biasa atau sering disebut sebagai Hiperbaric Oxygen Theraphy (HBOT). Penelitian hubungan tekanan oksigen dengan radioterapi pada manusia sudah dimulai sejak tahun 1910 oleh Deche.

TERAPI oksigen hiperbarik lebih familier di kalangan penyelam dan angkatan laut. Terapi yang memanfaatkan oksigen tekanan tinggi itu memiliki beragam manfaat.

Pada prinsipnya, menurut dr Heru Wiyono SpPD, terapi oksigen hiperbarik meningkatkan tekanan oksigen pada jaringan tubuh. Kadarnya lebih tinggi daripada terapi oksigen murni pada tekanan normal. Terapi itu meningkatkan kapasitas transportasi oksigen dalam darah. ''Kadar oksigen dan saturasi meningkat, maka sel-sel yang rusak bisa diperbaiki,'' jelas spesialis penyakit dalam dari RS Spesialis Husada Utama, Surabaya, itu.
Cara Kerja Terapi Oksigen Tingkat Tinggi
Dasar dari terapi hiperbarik sedikit banyak mengandung prinsip fisika. Teori Toricelli yang mendasari terapi digunakan untuk menentukan tekanan udara 1 atm adalah 760 mmHg. Dalam tekanan udara tersebut komposisi unsur-unsur udara yang terkandung di dalamnya mengandung Nitrogen (N2) 79 % dan Oksigen (O2) 21%. Dalam pernafasan kita pun demikian. Pada terapi hiperbarik oksigen ruangan yang disediakan mengandung Oksigen (O2) 100%. Terapi hiperbarik juga berdasarkan teori fisika dasar dari hukum-hukum Dalton, Boyle, Charles dan Henry.
Spoiler for ni alatnya gan....:

Kegunaan HBOT:
1. Meningkatkan sensitifitas efek radioterapi sehingga dapat membantu menekan angka kematian dan meningkatkan angka harapan hidup
2. Meningkatkan sensitivitas sel tumor pada radioterapi. Karena pada kondisi hipoksia sensitifitas sel tumor menurun, sehingga dengan HBOT yang meningkatkan perfusi (Menurut dr Guritno Mantan direktur RSAL Dr Ramelan Surabaya)
3. Bermanfaat pada healing injury post radioterapi
4. Kombinasi antara radiasi baik eksternal atau brachiterapi atau keduanya yang dikombinasikan dengan pemberian HBOT akan meningkatkan radiosensitivitas sel kanker serviks.
5. kehilangan pendengaran yang bersifat sensorineural, terjadi dalam kurun waktu beberapa jam atau hari, biasanya akibat menyelam atau gangguan penyakit lainnya
6. Bahkan di Eropa untuk penderita Autis menggunakan terapi ini dan hasilnya mencengangkan, nih…ada videonya

Ni anak bisa "sembuh" setelah dirawat di Stanley Rosenberg Institute

Cara dan penggunaan HBOT

Awal mulai HBOT di Indonesia
Terapi hiperbarik mungkin baru segelintir orang yang mengenalnya. Di Indonesia, pemanfaatna HBOT pertama kali oleh Lakesla yang bekerja sama dengan RS Angkatan Laut Dr. Ramelan, Surabaya, tahun 1960. Hingga saat ini fasilitas tersebut masih merupakan yang paling besar di Indonesia. Sementara di tempat lain telah tersedia pula fasilitas terapi oksigen hiperbarik, diantaranya adalah
1. RSAL Dr Mintohardjo Jakarta, 2. RS. Jakarta 3. RS. Gading Pluit 4. RS THT- Bedah proklamasi BSD, Tangerang
5. RSAL Halong Ambarawa,
6. RSAL Midiato,
7. RSP Balikpapan,
8. RSP Cilacap,
9. RSU Makasar,
10. RSU Manado,
11. RSU Sanglah Denpasar,
12. Diskes Koarmabar.

Contoh Penerapan HBOT:
Pasien Face-off, Lisa, sempat membuat pusing para dokter yang merawatnya karena kecenderungan nekrosis flap hasil pemindahan. Ia akhirnya diterapi HBOT, dan hasilnya cukup baik. Kulit yang sebelumnya ditakutkan akan nekrosis menjadi pulih kembali

Biaya Hiperbarik oksigen terapi (HBOT) Rp 350 000/kali, jika anda ambil paket (10 kali) di RS Jakarta dan anda pengguna kartu kredit man**** akan mendapat discount sebesar 15 %. Jika anda pengguna kartu kredit BI* di RS Gading Pluit anda dapat mencicil selama 6 x dengan bunga 0%.

Hyperbaric oxygen therapy provides a significant increase in tissue oxygenation in the hypoperfused, infected wound

Hyperbaric Oxygen Therapy
The following information is from the
Undersea and Hyperbaric Medical Society, Inc.
10531 Metropolitan Avenue
Kensington, Maryland 20895
In an hypoxic environment, wound healing is halted by decreased fibroblast proliferation collagen production, and capillary angiogenesis (1). Hypoxia also allows growth of anaerobic organisms, further complicating wound healing. Hyperbaric oxygen therapy provides a significant increase in tissue oxygenation in the hypoperfused, infected wound. It influences the rate of collagen deposition, angiogenesis, and bacterial clearance in wounds. The greatest benefits are achieved in tissues with compromised blood flow and oxygen supply.
Diabetic Wounds:
The increased wound oxygen tension achieved with HBO promotes wound healing, increases the host antimicrobial defenses and has a direct bacteriostatic effect on anaerobic microorganisms.
Venous Stasis Ulcers:
HBO therapy has a very limited role. It is only indicated in highly selected patients in the preparation of a granulating bed over debrided venous ulcer for eventual skin grafting. (2)
Pressure Ulcers:
HBO therapy may be useful when underlying osteomyelitis is present or to improve the soft tissue envelope for reconstruction.
Arterial Insufficiency Ulcers:
HBO therapy may be of benefit in selected cases, especially when a wound fails to heal despite maximum revascularization.
HBO treatments are performed at 2.0 to 25 ATA for 90 to 120 minutes of oxygen breathing. The initial treatment schedule is dictated by the severity of the disease process. In the presence of limb-threatening infection after debridement or compromised surgical flaps following amputation the patient should be treated twice daily. When the infection is under control and the soft tissue envelope improves, once daily treatments are adequate.
1. La Van FB, Hunt TK: Oxygen and wound healing, Clinics in Plast Surg 1990; 17 (3): 463-472.
2. Chang N, Goodson WH III, Gottrup F, Hunt TK: Direct measurement of wound and tissue oxygen tension in postoperative patients, Ann Surg 1983; 197:470-478.

Sinergi antara Radioterapi dan Terapi Oksigen Hiperbarik

Pasien Face-off, Lisa, sempat membuat pusing para dokter yang merawatnya karena kecenderungan nekrosis flap hasil pemindahan. Ia akhirnya diterapi HBOT, dan hasilnya cukup baik. Kulit yang sebelumnya ditakutkan akan nekrosis menjadi pulih kembali

Awal mulai HBOT
Terapi hiperbarik mungkin baru segelintir orang yang mengenalnya. Di Indonesia, pemanfaatna HBOT pertama kali oleh Lakesla yang bekerja sama dengan RS Angkatan Laut Dr. Ramelan, Surabaya, tahun 1960. Hingga saat ini fasilitas tersebut masih merupakan yang paling besar di Indonesia. Sementara di tempat lain telah tersedia pula fasilitas terapi oksigen hiperbarik, diantaranya adalah RSAL Dr Mintohardjo Jakarta, RSAL Halong Ambarawa, RSAL Midiato, RSP Balikpapan, RSP Cilacap, RSU Makasar, RSU Manado, RSU Sangla Denpasar, dan Diskes Koarmabar.

Dasar dari terapi hiperbarik sedikit banyak mengandung prinsip fisika. Teori Toricelli yang mendasari terapi digunakan untuk menentukan tekanan udara 1 atm adalah 760 mmHg. Dalam tekanan udara tersebut komposisi unsur-unsur udara yang terkandung di dalamnya mengandung Nitrogen (N2) 79 % dan Oksigen (O2) 21%. Dalam pernafasan kita pun demikian. Pada terapi hiperbarik oksigen ruangan yang disediakan mengandung Oksigen (O2) 100%. Terapi hiperbarik juga berdasarkan teori fisika dasar dari hukum-hukum Dalton, Boyle, Charles dan Henry.

Sedangkan prinsip yang dianut secara fisiologis adalah bahwa tidak adanya O2 pada tingkat seluler akan menyebabkan gangguan kehidupan pada semua organisme. Oksigen yang berada di sekeliling tubuh manusia masuk ke dalam tubuh melalui cara pertukaran gas. Fase-fase respirasi dari pertukaran gas terdiri dari fase ventilasi, transportasi, utilisasi dan diffusi. Dengan kondisi tekanan oksigen yang tinggi, diharapkan matriks seluler yang menopang kehidupan suatu organisme mendapatkan kondisi yang optimal.

Terapi oksigen hiperbarik (HBOT) adalah terapi medis dimana pasien dalam suatu ruangan menghisap oksigen tekanan tinggi (100%) atau pada tekanan barometer tinggi (hyperbaric chamber). Kondisi lingkungan dalam HBOT bertekanan udara yang lebih besar dibandingkan dengan tekanan di dalam jaringan tubuh (1 ATA). Keadaan ini dapat dialami oleh seseorang pada waktu menyelam atau di dalam ruang udara yang bertekanan tinggi (RUBT) yang dirancang baik untuk kasus penyelaman maupun pengobatan penyakit klinis. Individu yang mendapat pengobatan HBOT adalah suatu keadaan individu yang berada di dalam ruangan bertekanan tinggi (> 1 ATA) dan bernafas dengan oksigen 100%. Tekanan atmosfer pada permukaan air laut sebesar 1 atm. Setiap penurunan kedalaman 33 kaki, tekanan akan naik 1 atm. Seorang ahli terapi hiperbarik, Laksma Dr. dr. M. Guritno S, SMHS, DEA yang telah mendalami ilmu oksigen hiperbarik di Perancis selama 5 tahun menjelaskan bahwa terdapat dua jenis dari terapi hiperbarik, efek mekanik dan fisiologis. Efek fisiologis dapat dijelaskan melalui mekanisme oksigen yang terlarut plasma. Pengangkutan oksigen ke jaringan meningkat seiring dengan peningkatan oksigen terlarut dalam plasma.

Mekanisme HBOT

HBOT memiliki mekanisme dengan memodulasi nitrit okside (NO) pada sel endotel. Pada sel endotel ini HBOT juga meningkatkan intermediet vaskuler endotel growth factor (VEGF). Melalui siklus Krebs terjadi peningkatan NADH yang memicu peningkatan fibroblast. Fibroblast yang diperlukan untuk sintesis proteoglikan dan bersama dengan VEGF akan memacu kolagen sintesis pada proses remodeling, salah satu tahapan dalam penyembuhan luka.

Mekanisme di atas berhubungan dengan salah satu manfaat utama HBOT yaitu untuk wound healing. Pada bagian luka terdapat bagian tubuh yang mengalami edema dan infeksi. Di bagian edema ini terdapat radikal bebas dalam jumlah yang besar. Daerah edema ini mengalami kondisi hipo-oksigen karena hipoperfusi. Peningkatan fibroblast sebagaimana telah disinggung sebelumnya akan mendorong terjadinya vasodilatasi pada daerah edema tersebut. Jadilah kondisi daerah luka tersebut menjadi hipervaskular, hiperseluler dan hiperoksia. Dengan pemaparan oksigen tekanan tinggi, terjadi peningkatan IFN-γ, i-NOS dan VEGF. IFN- γ menyebabkan TH-1 meningkat yang berpengaruh pada B-cell sehingga terjadi pengingkatan Ig-G. Dengan meningkatnya Ig-G, efek fagositosis leukosit juga akan meningkat. Sehingga dapat disimpulkan bahwa pada luka, HBOT berfungsi menurunkan infeksi dan edema..

Adapun cara HBOT pada prinsipnya adalah diawali dengan pemberianO2 100%, tekanan 2 – 3 Atm . Tahap selanjutnya dilanjutkan dengan pengobatan decompresion sickness. Maka akan terjadikerusakan jaringan, penyembuhan luka, hipoksia sekitar luka. Kondisi ini akan memicu meningkatnya fibroblast, sintesa kolagen, rasio RNA/DNA, peningkatan leukosit killing, serta angiogenesis yang menyebabkan neovaskularisasi jaringan luka. Kemudian akan terjadi peningkatan dan perbaikan aliran darah mikrovaskular. Densitas kapiler meningkat sehingga daerah yang mengalami iskemia akan mengalami reperfusi. Sebagai respon, akan terjadi peningkatan NO hingga 4 – 5 kali dengan diiringi pemberian oksigen hiperbarik 2-3 ATA selama 2 jam. Hasilnya pun cukup memuaskan, yaitu penyembuhan jaringan luka. Terapi ini paling banyak dilakukan pada pasien dengan diabetes mellitus dimana memiliki luka yang sukar sembuh karena buruknya perfusi perifer dan oksigenasi jaringan di distal.

Indikasi-indikasi lain dilakukannya HBOT adalah untuk mempercepat penyembuhan penyakit, luka akibat radiasi, cedera kompresi, osteomyelitis, intoksikasi karbonmonoksida, emboli udara, gangren, infeksi jaringan lunak yang sudah nekrotik, Skin graft dan flap, luka bakar, abses intrakranial dan anemia.

Prosedur pemberian HBOT yang dilakukan pada tekanan 2-3 ATA-90 dengan O2 intermitten akan mencegah keracunan O2. Menurut Paul Bert, efeksamping biasanyaakan mengenai sistem saraf pusat seperti timbulnya mual, kedutan pada otot muka dan perifer serta kejang. Sedang menurut Lorrain Smith, efek samping bisamengenai paru-paru yaitu batuk, sesak dan nyeri substernal.

HBOT Meningkatkan Sensitivitas Radioterapi
Penanganan kanker pada umumnya melalui tahapan terapi operasi, radioterapi, kemoterapi dan hormonal. Seiring perkembangan ilmu dan teknologi, oksigen hiperbarik dan herbal merupakan salah satu pilihan untuk meningkatkan sensitifitas efek radioterapi sehingga dapat membantu menekan angka kematian dan meningkatkan angka harapan hidup. Rumkital Dr. Ramelan Surabaya telah memiliki Instalasi Radioterapi dan Oksigen yang merupakan bagian dari unggulan fasilitas kesehatan.

Penelitian hubungan tekanan oksigen dengan radioterapi pada manusia sudah dimulai sejak tahun 1910 oleh Deche. Sedangkan menurut Guritno, yang pada saat diwawancarai masih menjabat sebagai direktur RSAL Dr Ramelan Surabaya, HBOT bermanfaat untuk meningkatkan sensitivitas sel tumor pada radioterapi. Karena pada kondisi hipoksia sensitifitas sel tumor menurun, sehingga dengan HBOT yang meningkatkan perfusi. Dengan demikian akan tercipta kondisi hiperoksia yang menyebabkan sensitifitas sel tumor meningkat. HBOT tentunya juga akan bermanfaat pada healing injury post radioterapi.

Studi dan telaah dilakukan seorang ahli HBOT muda, dr. Arie Widiyasa Sp.OG, Kabag KESLA RSAL Ilyas Tarakan, mengenai pengaruh HBOT terhadap kanker serviks. Kombinasi antara radiasi baik eksternal atau brachiterapi atau keduanya yang dikombinasikan dengan pemberian HBOT akan meningkatkan radiosensitivitas sel kanker serviks. Salah satu modalitas yang dapat dikembangkan saat ini adalah terapi dengan menggunakan oksigen bertekanan tinggi diberikan dengan tekanan 2,0 ATA, 2,4 ATA atau 3 ATA sebanyak 20 – 30 kali dapat dipertimbangkan walau harus tetap mempertimbangkan untung ruginya tindakan tersebut. HBOT dapat memperbaiki sensitivitas sel tumor, meningkatkan persentase angka survival rate, tak jelas dapat mencegah rekurensi atau menurunkan angka kematian. Dengan demikian komplikasi pemberian radioterapi dosis tinggi dapat dicegah sebelum kerusakan menjadi berat dan irreversibel.

Manfaat pada Pasien Post Radioterapi
Dewasa ini terapi radiasi dinilai cukup efektif untuk menangani beberapa kasus kanker yang tidak operable. Namun efek samping radiasi yang bersifat sistemik agaknya sulit untuk dihindari. Contohnya pada radioterapi pelvis yang akan menyebabkan rusaknya epitel, parenkim, stroma, vaskuler rektum dan berujung pada terbentuknya striktur dan fistula. Sayangnya pula terapi yang dilakukan terhadap efek samping tersebut sering tidak berhasil sehingga akan terjadi kerusakan komplek serta terbentuknya mediator yang menyebabkan vasodilatasi, peningkatan permeabilitas pembuluh darah, kemotaksis, demam, rasa sakit dan kerusakan jaringan. American Society for Therapeutic Radiology and Oncology membuat sistem scoring efek samping akut dan efek samping lama.

Menurut Dr. dr. Suyanto Sidik Sp.PD, ahli HBOT dari RSAL Dr. Mintohardjo, radioterapi akan memberikan efek samping seperti rusaknya epitel, parenkim, dan vaskuler dari tubuh. Manifestasi yang paling sering adalah timbulnya struktur dan fistel. Pada umumnya setelah 6 bulan akan terjadi hipoksia, hipovaskuler dan hiposeluler pada jaringan yang terpapar radiasi. Celakanya terapi efek samping ini seringkali gagal karena kerusakan komplek pada jaringan. Terdapat gangguan permeabilitas pembuluh darah, kemotaksis yang disertai manifestasi klinis demam dan nyeri. Terapinya tentu saja adalah dengan meningkatkan aliran darah ke daerah yang hipovaskuler tersebut. Jadi mekanisme penyembuhan luka untuk post radiasi adalah meningkatkan vaskularisasi, memperbaiki fungsi epitel, meningkatkan VEGF, mengatur sintesis dan lisis kolagen. HBOT meningkatkan aktivasi arginin yang berefek pada kolagen sintesis, dan mensupport kontraksi otot.

Sebagai contoh pengobatan HBOT pada injury radiasi dengan proktitis radiasi sebagai model. Efek samping dari terapi radiasi pada karsinoma rongga pelvis adalah proktitis radiasi. Efek samping ini bermanifestasi tergantung dari dosis, fraksinasi, luas dan teknik radiasi. Adanya riwayat radioterapi pelvis biasanya ditandai dengan gejala : sakit perut, diare, anorexia, dan mual. Pada pemeriksaan rekto-sigmoidokopi didapatkan erythema, edema, teleangiektasis, erosi, bahkan ulkus. Pada pemeriksaan PA diketahui adanya sebukan sel radang diikuti gambaran histologik lamina propia terhialinisasi, sub mucosa fibrotik, ektasia vaskuler, nekrosis fibrinoid yang dibandingkan dengan pembuluh darah fibroblas atipik. Gejala yang merupakan manifestasi dari efek samping akut ini biasanya muncul dengan frekuensi 50 – 70 %. Sedangkan efek samping lanjutan umumnya bermanfest dengan sakit perut, tenesmus, dan hematochezia. Gejala efek samping jenis ini biasanya hanya timbul 2,5 – 25 %. Efek yang lebih berat lagi apabila gejala efek samping tersebut disertai dengan diare lendir dan darah.

Pada kanker nasofaring yang mendapat radioterapi, HBOT dapat berguna untuk pencegahan terjadinya mandibular necrosis. Pada kanker leher rahim dan kanker prostat yang mendapat radioterapi HBOT bisa untuk prevensi radiosistitis. Pasien Face-off, Lisa, yang sempat menghebohkan dunia bedah plastik sebelum ini, sempat membuat pusing para dokter yang merawatnya karena kecenderungan nekrosis flap hasil pemindahan. Atas saran Guritno, Lisa akhirnya diterapi HBOT, dan hasilnya cukup baik. Kulit yang sebelumnya ditakutkan akan nekrosis menjadi pulih kembali.


(2004-08-24 07:23:27 Kapten Laut (K) Dr. Danny Dana )

Pengobatan Hiperbarik Oksigen (HBO) untuk pertama kalinya di gunakan untuk menanggapi penyakit dekompresi/ Decompression Sickness (Behke and Shaw, 1937). Suatu penyakit yang di alami oleh penyelam dan pekerja tambang bawah tanah akibat penurunan tekanan (naik ke permukaan) secara mendadak. Saat ini pemakaian HBO selain untuk penyakit akibat penyelaman juga di Indikasikan (bermanfaat) untuk berbagai penyakit klinis (lihat tabel III).
Perlu disadari bahwa penggunaan HBO yang bermanfaat bagi beberapa macam penyakit, ternyata menjadi Kontraindikasi (pantangan) bagi kondisi dan jenis penyakit tertentu. (Lihat daftar III). Dan dari beberapa penelitian rupanya HBO juga dapat menyebabkan beberapa Komplikasi (efek lanjutan) tertentu. (Davis, Dunn and Heimbach, 1988).
Indikasi, kontra indikasi dan komplikasi merupakan konsekuensi pemakaian HBO. Konsekuensi ini diharapkan dikenal betul oleh kolega sejawat para klinikus dan rekan perwira kesehatan lain yang bekerja pusat pengobatan HBO. Sehingga diharapkan konsumen, calon penderita dan pasien lama yang akan dan sedang menjalani terapi HBO akan mendapat penjelasan yang komprehensif dan Informed Consent yang benar.

Maksud danTujuan
Maksud penulisan ini untuk mengingatkan sekaligus menginformasikan bahwa penggunaan HBO identik dengan penggunaan obat-obatan yang lain. Dimana HBO juga mengandung dosis, indikasi, kontraindikasi, komplikasi dan lain-lain. Sehingga penggunaan HBO harus lebih bijaksana dan lebih waspada.
Tujuan penulisan ini pertama, agar pengobatan HBO dapat digunakan secara rasional dan secara proporsional. Kedua, dengan diketahuinya kontra indikasi (KI) dapat dilakukan langkah-langkah pencegahan/prefentif. Ketiga dengan diketahuinya komplikasi (KO) dapat dilakukan langkah-langkah penatalaksanaannya/ kuratif rehabililatif.

Indikasi HBO
Pada berbagai negara, Amerika Serikat, Perancis, Jepang, Rusia dll. Sudah memiliki standar pengobatan dan protokol penggunaan yang bervariasi satu sama lain. Variasi ini disebabkan tingkatan dan perkembangan IPTEK Kedokteran Hiperbarik berbeda di negara bersangkutan.

Amerika Serikat
(Dari Undersea and Hyperbaric Medical Society, USA 1983)
Tabel III.1

1. Embolisme gas dan udara

2. Keracunan karbonmonoksida (CO Smoke inhalation)

3. Cedera remuk (Crush Injury)

4. Keracunan gas sianida

5. Penyakit dekompresi

6. Meningkatkan penyembuhan luka-luka pada,

a. ulkus diabetikum

b. ulkus stasis venosus

c. ulkus dekubitus

d. ulkus insufisiensi arterial

7. Anemia (Exceptional blood loss)

8. Infeksi jaringan lunak bernekrosis

a. selulitis anaerob krepitan

b. gangrene bakterial progresif

c. fasitis nekrosis

d. Penyakit Fournier

9. Gas gangrene kuman Clostridial

10. Osteomyelitis refrakter

11. Nekrosis karena radiasi

12. Tandur kulit (skin grafts and flaps )

13. Luka baker

Eropa Barat
(Dari European Committee Hyperbaric Medicine, France 1992)
Tabel 111.2. Indikasi

1. Inloksikasi gas CO

2. Embolisme gas arterial

3. Gas gangrene

4. Infeksi berat pada jaringan lunak : gangren diabetik

5. Sindrom kompartemen dan cedera remuk (Compartement Syndrome )

6. Luka bakar dengan inhalasi asap

7. Pasca anoksik encefalopati

8. Tuli mendadak (Sudden deafness)

9. Patologi visual karena gangguan vaskuler


1. Insufisiensi vaskuler kronik

2. Ulkus karena insufisiensi vaskuler/ penyembuhan luka lambat

3. Lesi pada kaki diabetik

4. Tandur kulit

5. Sistitis karena radiasi

6. Osteo radionekrosis rahang bawah

7. Osteo mielitis refrakter

(Dari Japanese Society for Hyperbaric Medicine, Japan 1985)
Tabel III.3 Indikasi Emergensi

1. Intoksikasi gas CO

2. Gas gangren

3. Emboli udara dan Penyakit dekompresi

4. Gangguan vaskuler perifer,

a. luka bakar parah dan sengatan dingin (frost bile)

b. digabung cedera remuk

5. Syok

6. Infark Myocardial dan insufisiensi coroner lain

7. Gangguan kesadaran dan oedema otak

8. Gangguan hipoksia berat pada otak

9. Gangguan obstruktif akut pada arteri retina

10. Gangguan sumsum tulang belakang

11. Ileur paralitik

12. Tuli mendadak

Tabel III.3 Indikasi Non-Emergensi

1. Kanker ganas (Neoplasma malignant) digabung dengan kemoterapi - radio terapi

2. Gangguan sirkulasi perifer

3. Tandur kulit

4. Subacute myelooptico neuropathy

5. Paresis saraf motorik, sebagai sekuele lanjut dari

a. serangan serebro vaskuler

b. kraniotomi

c. cedera parah pada kepala

6. Gejala yang muncul lambat pada keracunan CO

7. Neuropati sumsum tulang belakang

8. Osteomyelitis dan nekrosis karena radiasi

Kontra Indikasi Absolut
Pneumothoraks yang tidak terawat (untreated Pneumothorax)
Kontra Indikasi Relatif

1. Infeksi saluran nafas atas (ISNA)
Faktor predisposisi barotrauma telinga dan Sinus squeeze

2. Gangguan kejang
Belum dapat dipastikan bahwa kasus kejang merupakan KI HBO namun 5% pasien dengan gangguan SSP mengalami kejang saat terapi HBO.

3. Emfisema dengan retensi C02
Pasien dengan masalah ini dapat berkembang menjadi pneumotoraks sampai terjadinya ruptur bulla emfisematus.

4. Lesi asimtomatik pada paru
Terapi HBO sebaiknya tidak diteruskan jika foto rontgen dada ada gambaran lesi

5. Riwayat pernah bedah thoraks dan telinga
Pasien harus menjalani evaluasi menyeluruh sebelum terapi HBO

6. Demam tinggi
Demam dapat memicu kejang, jika HBO tetap harus dilakukan maka panas badan harus diturunkan

7. Tumor (Malignant Disease)
Masih menjadi kontroversi/perdebatan sehubungan pengaruh HBO terhadap pertumbuhan tumor (El. Torai dkk, 1987) melaporkan 3 kasus carsinoma yang terproliferasi setelah HBO

8. Kehamilan
Percobaan pada hewan membuktikan peningkatan terjadinya cacat bawaan pada janin bila HBO diberikan pada awal kehamilan (orgunogenesis) (Jenings, 1987). Namun jika nyawa si ibu terancam, keracunan gas CO misalnya, terapi HBO harus diberikan.

9. Neuritis opticus
Dikhawatirkan dapat mengalami hilang pandang (loss of vision)

Beberapa KO akibat pengobatan HBO adalah sebagai berikut :

1. Barotrauma telinga
KO HBO yang paling sering terjadi, salah satu penyebabnya adalah penderita gagal/sulit melakukan equalisasi tekanan antara udara telinga tengah dengan udara luar saat terapi HBO. Pemberian obat nasal decongestan akan sangat membantu. Beberapa pasien bahkan perlu miringotomy untuk emergensi saat HBO (Lamm,1987).

2. Nyeri sinus
Sinus adalah rongga-rongga fisiologis disekitar tulang wajah. Hambatan/kebuntuan sinus, sinusitis misalnya, saat penekanan di dalam Chamber akan terasa nyeri. Sinusitis banyak terjadi karena ISNA. Jika hal ini terjadi HBO harus ditunda. Antibiotik dan nasal decongestan bisa diberikan.

3. Miopia dan katarak
Miopia atau rabun jauh merupakan komplikasi yang reversibel, biasanya terjadi saat awal pengobatan HBO. (Anderson, 1978). Sedang katarak merupakan komplikasi akibat pengobatan jangka panjang (Long term exposure) (Palmquist, 1986)

4. Barotrauma Paru
HBO dapat memicu terjadinya robek paru (lung rupture), emboli udara, emfisema mediastinum atau pneumotorak (Unsworth, 1973). Tanda robek paru nyeri dada dan sesak nafas juga diikuti pergeseran trakhea dan pergerakan nafas dada asimetris. Jika hal ini terjadi hentikan HBO dan Torakosentesis.

5. Kejang
Davis, 1988, melaporkan angka kejadian kejang hanya 0,01% dari 28.700 pengobatan pada tekanan 2,4 ATA. Jika tekanan hanya 1,5 ATA selama kurang dari 40 menit, kejang tak akan timbul. Penanganan yang harus dilakukan adalah :

a. lepaskan sungkup 02

b. berikan 60- 120 mg Diazepam

c. tekanan dalam chamber harus tetap

d. penurunan tekanan bisa setelah kejang stop

6. Penyakit Dekompresi
Hal ini terjadi bila penderita dalam chamber melepas sungkup 02/ bernafas udara biasa dan penurunan tekanan yang tiba-tiba terjadi di chamber

7. Klaustrofobia
Suatu bentuk neurosis pada beberapa pasien terutama pada mono place chamber atau multiplace yang sempit. Bantuan Psikiater sangat diperlukan

Pemeriksaan dan Penyaringan
Bagi calon pasien dan pasien lama perlu dilakukan langkah-langkah pemeriksaan dan penyaringan guna menghindari KO dan Kl. Namun langkah di atas untuk kasus-kasus pengobatan HBO terencana/Elective treatment.
Untuk kasus emergensi ini terdapat pengecualian :

a. Pengisian status pasien yang akurat

b. Informed consent yang komprehensif

c. Foto thoraks ( Rontgen )

d. Uji fungsi paru

e. Pemeriksaan gendang telinga

HBO seperti halnya pengobatan lain disamping memiliki manfaat yang begitu besar juga memiliki komplikasi dan kontraindikasi. Hal ini perlu dimengerti rekan kolega, klinikus dan perwira kesehatan hiperbarik agar lebih bijaksana menyikapi HBO. Sikap bijaksana, penggunaan yang proporsional, rasional dan Informed Consent menghindarkan kita dari kemungkinan kesalahan prosedur dan malpraktik.
Ada baiknya bila Perhimpunan Kedokteran Hiperbarik Indonesia (PKHI) mengadakan sarasehan atau seminar guna menyusun indikasi, kontraindikasi, komplikasi khusus untuk standar pemakaian HBO di Indonesia. Mengingat pemakaian HBO di RSAL Dr. Mintoharjo dan LAJ KESLA, Surabaya semakin diminati masyarakat. Hingga saat ini belum ada regulasi baku penggunaan HBO Indonesia.
Sekali lagi tulisan ini bermaksud membuat kita insan hiperbarik TNI AL lebih siaga, waspada dan bijaksana menggunakan HBO. Karena tanpa memahami kontraindikasi dari HBO sulit bagi kita melakukan langkah-langkah antisipasi prevention dan tanpa mempelajari komplokasi HBO sulit bagi kita melakukan langkah penanggulangan/ rehabilitation.©

Hyperbaric Oxygen Therapy for Neurological Conditions. Dr. Lane Scott, PhD.

Hyperbaric Oxygen Therapy for Neurological Conditions. Dr. Lane Scott, PhD.