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Harch Hyperbarics Testimonials Pt. 1 www.HBOT.com from Griffith Mehaffey on Vimeo.

Derek - A Personal Story & Message

In 2001, 11 years after my discovery with the divers, my wife and I adopted three year old Derek from Romania where he had lived in an orphanage since his birth. As depicted so many times on television, the Romanian facility in which he had been institutionalized was severely understaffed, over-populated, filthy, and lacked resources for improvement. As a result of his living situation and lack of stimulation we expected some developmental and cognitive delays. We were assured by the Romanian orphanage personnel, however, that Derek was "normal" and would quickly catch up to his peers once placed in a loving home with proper attention and nutrition.
When Derek arrived in the United States, a week before his third birthday, he spoke nothing more than animal-like grunts, could barely walk without falling, and was malnourished and underweight. On his third birthday he weighed merely 21 pounds. (Hardly "normal" according to any standard.) In spite of all the love, attention, and nutrition we could offer him, months passed and Derek's progress remained limited. It soon became obvious to me that Derek's difficulties were due to something other than his early childhood deprivations. I began to suspect that Derek's delays were more likely due to some form of early childhood traumatic brain injury.
Like so many of my patients and their parents, Derek, my wife, & I went through what seemed like an endless progression of tests and studies only to be told what we already knew, "Derek is severely delayed." Despite the obvious protein malnutrition and other organic insults, he was classified as "nervous and mental disorder" by our medical insurance, thus not eligible for medical benefits. Like many other neurologically impaired children, MRI of his brain was normal; however, SPECT was not. Additionally, we were told, "Nothing can be done for him. We will just have to wait to see how he develops and grows over time."
At that point, I began Derek's hyperbaric oxygen therapy treatments. Within one month of treating him twice a day, Derek's speech improved dramatically. Words never spoken before seemed to fly out of his mouth without hesitation or struggle. Additionally his problem-solving skills also seemed to improve. It was amazing. My son was now my patient and he was improving.
Before we adopted Derek, after working with brain-damaged children every day, I would go home & thank God for the health of my five (yes, five!) other children. And now, with Derek in our family, I also thank God for hyperbarics. Hyperbarics has very much impacted my life; no longer only professionally, but now & more importantly, personally as well.
Our family celebrates his advancements daily. This is the greatest gift of all; this is what I hope to give to my patients and their families.

fr : Submitted by Juliette Lucari... on Wed, 02/04/2009 - 07:45.  
Harch Hyperbarics Inc
228 Audubon Blvd.
New Orleans, LA 70118
fax (504) 392-4180

di ulas  oleh : dr. Erick Supondha (Hyperbaric & Diving Medicine Consultant)
dokter konsultan ahli kedokteran hiperbarik dan kesehatan penyelaman

Recovering from Trauma

Hyperbaric Oxygen Therapy Denied to Doctor, Embraced by Government
By NHF President Maureen Kennedy Salaman
June 03, 2003

Patty is in critical condition as the paramedics wheel her into the emergency room. Relatives had pulled her out of her running car in a closed garage and her doctors fear the worst. She is in a coma and her CAT scan shows the carbon monoxide has caused extensive brain damage. They have one trick up their sleeve: put her into the hospital's hyperbaric oxygen chamber. In the chamber, Patty is given compressed, richer oxygen that is expected to regenerate the portions of her damaged brain. Hospital technicians explain that as the pressure in the chamber increases, more oxygen is able to get to Patty's brain. Later, her doctor proclaims that Patty is out of her coma and is showing remarkable improvement. This is a true story that was documented by producers of cable television's The Learning Channel, and aired as a segment of their show, "Trauma, Life in the ER."

Dedicated Physician Shut Down, Medical Successes Ignored

David A. Steenblock, M.S., D.O., was the first physician to establish a comprehensive stroke and brain injury rehabilitation facility using HBO therapy and other modalities, with the goal being to repair the damaged brain from stroke and trauma. Practicing out of the Health Restoration Medical Center in Mission Viejo, CA, the reward for his dedication has been that he has been hounded, persecuted, his records confiscated, and family members threatened as the FDA tried to keep him from using the very therapy Charity Hospital in New Orleans now publicly utilizes on national television!
Until Dr. Steenblock's remarkable work no one has paid attention to or studied the repair of the damaged brain. Limbs and motor skills were given extensive therapy, but establishment medicine has contemptuously maintained the position that there was no reversing damage to the brain. Despite their contentions, Doctor Steenblock's success with his patients and his thriving practice demonstrated that brain damage can be reversed, even after years of time.
He told me about one particularly profound case. Dorothy Conforti had had a massive stroke. Her CAT scan showed extensive brain damage. One side of her body was completely paralyzed and she had no control over her bodily fluids or bowels. She could barely see and was unable to communicate. She couldn't feed herself, and she was close to death. Dr. Steenblock treated her in his hyperbaric oxygen chamber for one hour every four hours and three hours of chelation, around the clock. A follow up CAT scan showed the therapy successfully restored 85 percent of the damage to her brain. Today, she is back to normal.

Despite the enormous amount of testimonials from his patients, and incredible successes like Dorothy's, establishment medicine was threatened. Neurologists testified and told their patients that if it was in fact a valid treatment, they would be using it. Dr. Steenblock was savagely attacked with every slander and pressure they could bring against him.
In 1995, the Department of Consumer Affairs approached the National Stroke Association (NSA). They said that hyperbaric oxygen was not only unproven but potentially dangerous. They quoted three references from 1966 to prove their point. Using the NSA's contention, the California FDA and the Department of Consumer Affairs issued a scathing report condemning the use of hyperbaric oxygen for strokes.
Dr. Steenblock looked up their references and found they had nothing to do with hyperbaric oxygen. Nothing. He sued the National Stroke Association. Through utter chicanery, it never got to court. They said it was opinion. The Department of Consumer Affairs used the National Stroke Association's report to retaliate against Dr. Steenblock.
They raided Dr. Steenblock's practice, telling him that if he continued to use his hyperbaric oxygen chambers they would enter his offices at will, anytime they chose, bring bulldozers, drag the chambers out and destroy them.
Led by the California FDA, the Department of Consumer Affairs made good on their threat. On the day they raided his office, he had 21 feeble and very sick patients waiting for treatments. The patients were absolutely up in arms; extremely agitated as the government took away the only help they could find. One became so stressed by the raid that he had a heart attack and died on the spot. At the time, Dr. Steenblock had a doctor assisting him. When the FDA told him they would conduct another raid without notice, he resigned. No doctor will work with Dr. Steenblock under the threat of losing his license to practice.

The government's action has cost Dr. Steenblock one of his practices. He had one medical and one trauma and stroke. He has lost a million dollars and counting. He is stuck with a lease that he is still paying to the tune of a quarter of a million dollars on a medical clinic that he was forced to shut down because the doctor who assisted him quit. His second office is the stroke and trauma center, which is under constant threat. At one time he owned a $450,000 lab, which was closed down by the California FDA. As I write this, Dr. Steenblock, having run out of money to pay attorneys to represent him, is representing himself against the Bureau of Medical Quality Assurance board. This is his fourth hearing.
In the face of all this, I discovered that the Air Force is conducting its own research on using hyperbaric oxygen as medical therapy. A website (www.wpmc1.wpafb.af.mil/pages/hbo/hbo1.htm) from the Wright Patterson Medical Center at Wright Patterson Air Force Base in Ohio states their belief that it is a viable and successful therapy. It states that their Department of Hyperbaric Medicine, 74th Medical Group, is doing extensive research in the medical uses of HBO. One page of the website proclaims:
"The Hyperbaric Medicine Flight team works to improve the health status of our patients through quality hyperbaric medicine consultation and care. We are dedicated to the advancement of the use of clinical hyperbaric medicine through quality research and development of equipment and practices.We are committed to enhancing the understanding of this therapeutic modality through education of health care professionals and the public."
Just above a photo of their chief of medicine is a bold proclamation of their goal:
"To be a leading authority for research, education, and applications of hyperbaric technology and medicine."
Dr. Steenblock has been doing just this for 11 years, under the most adverse circumstances the government, financed by endless funds - ours, could possibly create.
The government medical group's case reports include a 64-year-old diabetic female whose wound infection would not have healed without HBO; a 55-year-old female whose gangrene was completely healed after 37 treatments; and a 52-year-old male whose post-cancer surgery of the mouth resulted in necrosis that was resolved after 91 treatments.

Recovering from Trauma

Despite the darkness thrown onto this dedicated pioneer, Dr. Steenblock, the light of knowledge is reaching the world. The good news is that hyperbaric oxygen, or HBO, is now being recognized as a valuable tool in reversing the effects of trauma. Two factors are involved with HBO: oxygen and pressure. The pressure helps reduce the dangerous swelling that follows trauma to the body. If delivered soon after head or neck injury, damage to the brain and spinal cord can be minimized. Because of HBO's unique ability to deliver oxygen to the brain and other parts of the body, to previously dormant cells, it can be used to minimize the effects of strokes, gangrene, near drowning, extensive blood loss, near hanging, crush injuries, electrocution, burns, edema and serious infections. Anywhere there is a loss of oxygen to a part of the body resulting in tissue damage, HBO can help. Based on what I've read, I believe it is entirely possible that if actor Christopher Reeve had received HBO therapy shortly after his horseback riding accident, he would not have suffered such extensive paralysis.
Every medical trauma unit should have one, and a portable version should be developed. Imagine! At the site of a car crash in which a victim has been pinned inside the car; arms and legs deprived of blood and oxygen, in danger of being amputated as a result, the paramedics can transport him in a hyperbaric oxygen chamber, delivering vital oxygen to those limbs, probably saving them.
In an incredible testimonial to the power of hyperbaric oxygen therapy to heal, a 40-year-old man whose brain was seriously injured in a car crash was brought back to life after doctors had given up all hope. A month in the hospital and after extensive tests, therapies and drugs, the man still did not respond to commands or open his eyes spontaneously. He was in a deep, deep coma, and doctors didn't know if he would ever come out of it. When he was discharged from the hospital, he required total life support. The doctors told his wife she should place him in a nursing home since no further improvement could be made.
Not willing to give up, his wife tried hyperbaric oxygen therapy. Tests before therapy showed extensive brain deficits. After only one treatment, improvement was noted. By the 93rd treatment the man not only had come out of his coma, but could walk, move his arms, understand what was going on around him and speak well. After 188 treatments, tests showed his brain was completely recovered. The man's doctors and therapists were amazed.
A clinical psychologist testified, "During this time the patient has had markedly dramatic improvement in many of his cognitive functions. He has become ambulatory, acquired good communication skills with others again, has become independent once more in his self-help skills, and regained much of his short-term and long-term memory. He seems to have responded to the hyperbaric oxygen treatment programs."
Dr Steenblock conducted a study of his own results. It is most profound because of the number of patients: 50, and the amount of time since their strokes: average 28 months. It showed that no matter how long since the traumatic event, hyperbaric oxygen therapy can still benefit the patient.
He conducted the study with 50 "stable and no longer improving" stroke patients, average age 62 years and, again, average time of 28 months since their stroke. They received HBO therapy for 90 minutes each day, six days a week for 60 treatments, as well as physical therapy for two hours and EEG biofeedback for 30 minutes each day, five days a week. Physical therapists' evaluations and patients' questionnaires were collected prior to and after the program. The therapists' evaluation included range of motion, strength of extremities, bed mobility, bed to chair transfers and body's balance level. By the therapists' evaluations, 100 percent of the patients showed improvements in one or more functions. Of those, 18 percent had mild gain, 48 percent received good gain and 34 percent had excellent gain.
Results from patients' questionnaires showed that 95.83 percent of the patients or their family members believed that the patient experienced one or more improvements in their motor ability, sensitivity to touch and temperature, bladder and bowel control, cognition, memory, speech, sight and hearing. At the conclusion of the program, 29 percent of the patients ranked the program as good, 42 percent ranked it as excellent, and 25 percent reported the program was stupendous.

The Reality of Strokes and Trauma to the Brain

What conventional medicine has failed to realize, and why it has so stubbornly refused to acknowledge the possibility of stroke recovery, is that strokes do not result in the death of brain cells. Dr. Steenblock explains that the traditional concept of infarction, that the brain tissue dies from a blood and oxygen shortage lasting more than a few minutes, is no longer valid. Actually, the death of brain cells occurs only when the flow of blood falls below a certain level (approximately 8-10 ml/100 gr./min.) while at slightly higher levels the tissue remains alive but not able to function. Thus, in acute stroke the affected core brain tissue may die while the more peripheral tissues remain alive for many years after the initial insult. Those brain areas that are injured and are not receiving enough blood flow as a result of stroke or trauma are referred to as "ischemic penumbra," "sleeping neurons," or "dormant" or "idling neurons." These neurons are nonfunctional but anatomically intact and can be regenerated with hyperbaric oxygen therapy, repairing and generating new blood vessels to the injured parts of the brain. It is this reality that allows the open minded physician to realize that HBO can and does work!

Let Me Count The Ways

There are many ways in which HBO benefits the patient. It reduces edema by about 50 percent. In acute burns it reduces fluid requirements by 35 percent in the first 24 hours. It reduces white cell adhesion to capillary walls. In about 15 treatments, red blood cell flexibility is doubled. White blood cell killing of aerobic bacteria and some fungi is greatly enhanced at high oxygen pressures, helping to control osteomyelitis and necrosis. Extremely important is its stimulation of new capillary and collagen formation in radiated tissue, normalizing tissue oxygen tensions to permit surgery, healing, and even bone grafting. Finally, it increases tissue levels of superoxide dismutase, which counters the formation of free radicals after injury, resulting in better tissue survival.
The Committee on Hyperbaric Oxygenation of the Undersea and Hyperbaric Medical Society (UHMS), which has cognizance over this field, currently has approved 14 disorders for treatment in the chamber.
HBO was first used for gas gangrene by Brummelkamp in 1965 in Holland and thousands of patients have been treated with HBO for this disorder worldwide. The best evidence comes from a U.S. Air Force study carried out by researchers at the School of Aerospace Medicine. They demonstrated that if HBO is used for gangrene within 24 hours of the time of diagnosis, the overall mortality rate, when combined with surgery and antibiotics, is six percent. This is compared to a 14 percent mortality rate without HBO.
Entirely too common is the loss of limbs by the diabetic patient. Oriani reported a 10-year experience that showed 80 percent salvage in a group of diabetics suffering limb-threatening lesions that received HBO, versus 40 percent in controls. Multiple other retrospective studies involving approximately 500 patients have been consistent and indicate a 70-90 percent success rate, with success defined as the avoidance of amputation and, in many cases, complete wound healing. Not uncommon is an amputation rate of 12.5 percent in a treated group versus 40 percent in a control group.
One of the biggest problems in treating gangrenous lesions is the education of referring physicians. Surgeons tend to operate on their patients before sending them for hyperbaric treatment. It is inadvisable to put a patient on the operating table when he is in severe septic shock and then to administer an anaesthetic while delaying hyperbaric treatment. While the patient is in surgery, the organisms have several hours to cause further deterioration. The surgery before hyperbaric treatment severely compromises that patient's prognosis. Gangrene can kill within six hours of diagnosis so a three hour delay while doing a massive debridement is counterproductive. Re-education of surgeons in this regard is urgently needed. When this knowledge permeates the surgical community, patients will benefit greatly.
Hyperbaric oxygen is of value when blood transfusion cannot be carried out. This situation occurs in Jehovah's Witnesses who refuse transfusions or any form of blood product. Another rare situation is where the patient has severe hemolysis and it is impossible to type and cross match blood for transfusion.
HBO's ability to stimulate new capillary and collagen formation in the skin means postoperative recovery can be enhanced. Whether by trauma, illness or cosmetic surgery, postoperative patients can see faster recovery times with less residual scarring.
Research has shown that survival can be more than doubled in severely burned patients treated with hyperbaric oxygen compared with controls. In a small series of severely burned patients, it was found that the hospitalization costs were lessened by approximately $92,000 per patient when hyperbaric oxygen was used. There also was less than half as much grafting. There have been anecdotal reports showing dramatic relief of sickle cell crisis with hyperbaric oxygen. Original work done at Duke University showed that sickle cell forms of the erythrocyte were markedly reduced under hyperbaric conditions.
There have been anecdotal reports of patients with cerebral abscess who have recovered following HBO treatment. Prior to being placed in the chamber, they were pursuing a downhill course and were nearly moribund. Similarly, the Russians have done a study of peritoneal abscesses which has shown enhanced survival in humans. There are also animal studies which show hyperbaric oxygen to be of benefit.
One study found 20 patients with Bell's Palsy were cleared up in 15 days or less with twice daily treatments at 2.8 atmospheres absolute (ATA) for one hour. This rapid remission is unheard of in the usual clinical case.
It has been found that in the case of leprosy, the Mycobacterium leprae is sensitive to high partial pressures of oxygen. It has been reported that six treatments carried out over a three-day period have produced permanent remission. Since leprosy is a tremendous financial burden in much of the world, further research must be carried out to bring hyperbaric oxygen to the rescue in this disorder.
Dr. Steenblock sees HBO benefitting autistic children, by its ability to repair damaged brain blood vessels, stimulate growth hormones, detoxify and heal the damaged brain, pancreas and intestinal tissues and decrease the hyperexciteability of these children. Treatments twice a day have proven successful for the correction of chronic chemical allergies, as well as patients suffering from multiple sclerosis, says Dr. Steenblock.
In 1971, Dr. George Hart published a case study in which a Naval Officer partially paralyzed from a stroke showed good improvement after 15 HBO sessions. This was followed by a month with no HBO, and no change in the patient's condition. After the next series of HBO treatments, the officer was able to return to full duty. His study of 40 stroke patients after HBO therapy showed 27 percent experienced significant improvement, 53 percent had moderate improvement and 20 percent had no improvement. Dr. Steenblock has seen improvement in stroke patients who have been paralyzed for as long as 15 years.
It should be obvious by now that establishing HBO therapy for early trauma treatment and recovery should made a priority in every trauma unit and hospital as soon as possible. The evidence is irrefutable that HBO has the potential to not only allow us to recover from trauma with few lasting effects, but reverse disabilities and help us live our lives again free from their constraints. It is with great satisfaction, especially now that I've seen the remarkable benefits of HBO therapy for myself, that I am witness to this explosion of research and acknowledgement that it is a credible, valuable and attainable medical therapy.
I urge you to write the health committee and Bureau of Medical Quality Assurance. Send this article to friends and loved ones who might benefit from Dr. Steenblock's modalities. Politicians don't see the light, they feel the heat. Send this article to your congressman and senators and state legislators. Tell them we want the freedom to choose to save our own lives.

REFERENCES

"Adjunctive Hyperbaric Oxygen Therapy Reduced Length of Hospitalization in Thermal Burns," Cianci P., et al, Journal of Burn Care & Rehabilitation, v. 19, p. 432-435, 1989.
"Autism Due to Stress and Mineral Deficiencies," Steenblock, David. A., M.S., D.O., Health Restoration Medical Center press release, 1999.
"Blood Cell Deformability and Hyperbaric Oxygen," Mathieu D, et al, Med Subaquatique Hyperbar, v. 3, p. 100-104, 1984.
"Chronic Non-hematogenous Osteomyelitis Treated with Adjuvant Hyperbaric Oxygen," Davis, J. C., et al, Journal Bone Joint Surg., v. 68, p. 1210-1217, 1986
"Clinical Hyperbaric Medicine," Kindwall, M.D., Eric P., http://www.etcusa.com/clinical.htm.
Diabetes Spectrum, v. 10, n. 2, p. 118-123, 1997.
"Effects of Hyperbaric Oxygen on Post-bur Plasma Extravasation," Wells C.H., Hinton, J. G., In: "Hyperbaric Oxygen Therapy," Davis, J. C., Hunt, T. K., editors, Undersea Medical Society, Bethesda, MD., p. 259-265, 1977.
"Effects of Hyperbaric Oxygen on Oedema Formation After a Scald Burn," Nylander G., et al, Burns, v. 10, p. 193-196, 1984.
"Effects of Hyperbaric Oxygen on Adenosine Triphosphate in Thermally Injured Skin," Stewart R. J., et al, Surgical Forum, v. 39, p. 87-90, 1988.
"Gas Gangrene: Review and Update," Heimbach, R.D., HBO Review, v. 1, p. 41-61, 1980.
"Hyperbaric Oxygen For the Treatment of Closed Head Injury," Neubauer, Richard A., M.D., Southern Medical Journal, v. 87, n. 9, p. 933-936, September 1994.
"Hyperbaric Oxygen Therapy for Necrotising Fasciitis Reduced Mortality and the Need for Debridements," Riseman, J. A., et al, Surgery, v. 108, p. 847-50, 1990.
"Hyperbaric Oxygen for Treatment of Stroke and Traumatic Brain Injuries," Steenblock, David A., Journal of Naturopathic Medicine, v. 8, n. 1, p. 61-67.
"Hyperbaric Oxygen in the Treatment of Bell's Palsy," Racic, G.P., et al, Proceedings of the Annual Scientific Meeting of the European Undersea and Biomedical Society, Gothenberg, 1985.
"Metabolic Effects of Hyperbaric Oxygen in Post-ischemic Muscle," Nylander G, et al., Plastic Reconstructive Surgery, v. 79, p. 91-96, 1987.
"Morphological Analysis of the Microcirculation During Reperfusion of Ischemic Skeletal Muscle and the Effect of Hyperbaric Oxygen," Zamboni W. A., et al, Plastic Reconstructive Surgery, p. 1110-1123, 1993.
"Oxygen Therapy and Diabetic Gangrene: a Review of 10 Year's experience," Oriani G., et al, Proceedings of the Joint Meeting on Diving and Hyperbaric Medicine.
"Problem Wounds in Oral and Maxillofacial Surgery: The Role of Hyperbaric Oxygen," Marx, R. E., et al. In: Davis, J. C. , Hunt, T. K., editors, "Problem Wounds: the Role of Oxygen," Elsevier Science Publishing, New York, p. 65-125, 1988.
fr : By NHF President Maureen Kennedy Salaman
June 03, 2003

di ulas ulang oleh : dr. Erick Supondha (Hyperbaric & Diving Medicine Consultant)
dokter konsultan ahli kedokteran hiperbarik dan kesehatan penyelaman

Wound Management Using Hyperbaric Oxygen Therapy (HBOT)

from : Hyperbaric and Diving Medicine Centre, Singapore General Hospital

ditampilkan ulang oleh dr.Erick Supondha

konsultan ahli kedokteran hiperbarik dan kesehatan penyelaman

hyperbaric & diving medicine consultant , Jakarta Indonesia

Wound Management Using Hyperbaric Oxygen Therapy (HBOT)
Dr Kim Soo Joang, Principal Resident Physician, Hyperbaric and Diving Medicine Centre, Singapore General Hospital
IntroductionHyperbaric Centre

Hyperbaric Oxygen Therapy (HBOT) is not a new treatment modality and has been around for more than half a century. In Singapore, the first hyperbaric chamber can be traced back to the Singapore General Hospital, in the 70’s, where it was used by the Orthopaedic Department. However, this was transferred to the Singapore Navy where the bulk of hyperbaric medical work was carried out by the Republic of Singapore Navy until recently. Whilst the application of Hyperbaric Oxygen Therapy in the management of decompression illness is well established, its application for other clinical conditions is less well known. Currently, there are 13 accepted indications for Hyperbaric Oxygen Therapy supported by good evidence.
Indications for Hyperbaric Oxygen Therapy

Approved uses as recommended by the Undersea and Hyperbaric Medical Society. (Hyperbaric Oxygen 2003, Indications and Results. The Hyperbaric Oxygen Therapy Committee Report)
1) Air or gas embolism
2) Carbon monoxide poisoning
3) Clostridial myositis and myonecrosis (Gas gangrene)
4) Crush injury, compartment syndrome and other acute ischaemias
5) Decompression sickness
6) Enhancement of healing in selected problem wounds
7) Exceptional anaemia
8) Intracranial abscess
9) Necrotising soft tissue infections
10) Osteomyelitis (Refractory)
11) Delayed radiation injury (soft tissue and bony necrosis)
12) Skin grafts and flaps
13) Thermal burns

One of the most common indications in clinical practice is enhancement of wound healing in selected problem wounds.

Effective problem wound management requires an integrated multidisciplinary team approach. Hyperbaric Medicine is one important component of this team. When used appropriately, Hyperbaric Oxygen Therapy can be an effective adjunctive therapy for problem wounds.
Hyperbaric Oxygen TherapyWhat is Hyperbaric Oxygen Therapy?

It is a form of therapy where patients breathe 100% oxygen intermittently at pressures greater than sea level. In order to receive oxygen at these pressures, patients will need to be pressurized in a specially designed and built vessel. These vessels can accommodate one or more patients. The vessel is usually compressed with air and the patient breathes 100% oxygen via a transparent hood or mask. Some one-man chambers are compressed with 100% oxygen. By breathing oxygen at high pressures, a large amount of oxygen is carried dissolved in the plasma.

Topical Hyperbaric Oxygen Therapy where oxygen is delivered directly to a wound is not considered Hyperbaric Oxygen Therapy.
How Does Hyperbaric Oxygen Help in Wound Healing?

Wounds without adequate tissue oxygen levels will not heal. Hyperbaric Oxygen Therapy when used appropriately can reverse tissue hypoxia so that wound healing can proceed.

Hyperbaric oxygen therapy has been shown to have the following effects:

• Stimulation of angiogenesis
• Enhancement of fibroblast replication and collagen synthesis
• Enhancement of epithelialization
• Reduction of local oedema
• Improved leukocyte killing
• Direct toxic effects on anaerobic bacteria
• Suppression of bacterial toxin production
• Synergism with certain antibiotics
• Prevention of leukocyte mediated post-ischaemic reperfusion injury

For Hyperbaric Oxygen Therapy to be effective there must be adequate blood flow to the wound. Without adequate blood flow, the oxygen carried in the blood and plasma will not be able to reach the site where it is needed most and in some cases revascularization procedures may be required first.
Who Can Benefit From Hyperbaric Oxygen Therapy?

Patients with the following types of wounds may benefit from Hyperbaric Oxygen Therapy:

1) Diabetic lower extremity wounds - failure to heal or improve with conventional management.
2) Venous stasis ulcers – failure to heal or improve with adequate control of oedema.
3) Late radiation injury – wounds that fail to heal or improve with conventional management.
4) Arterial insufficiency ulcers – failure to heal or improve despite maximum revascularisation.
5) Any wound that has failed to heal with conventional management where hypoxia is a contributing factor.

Diabetes Treatment Diabetes Treatment

Patients with problem wounds will undergo a non-invasive test called Transcutaneous Oximetry. This test measures the transcutaneous oxygen tension at the level of the skin and is an indirect measurement of microcirculatory blood flow. A baseline measurement is taken on room air and another while breathing 100% oxygen at sea level.

Patients who have reversible periwound hypoxia are suitable candidates for HBOT. If perfusion is too poor, referral to vascular team is warranted. Patients can be reassessed after vascular intervention if any.

Before a patient is selected for Hyperbaric Oxygen Therapy, an assessment is made to determine the patient’s fitness for exposure to high ambient pressure and high oxygen concentration.

Malignant ulcers are generally not accepted for Hyperbaric Oxygen Therapy.

When skin grafts and flaps are used to cover problem wounds, Hyperbaric Oxygen Therapy can be beneficial in support of compromised skin grafts and flaps.
What is Treatment Like?

Problem wounds usually require 20 to 30 treatment sessions or more depending on response. Each treatment session lasts about 2 hours and the treatment pressure is between 2 to 3 ATA (equivalent to 10 to 20 metres underwater).

The actual treatment can be divided into 3 phases – compression, maintenance of pressure and decompression.

Compression
During this phase, the pressure in the chamber is increased slowly to the treatment depth. There will be a sensation of fullness in the ears similar to that felt during take off and landing in an airplane. Equalization techniques are taught. Patients will feel warm during this phase.

Maintenance of pressure
Once the depth is reached, patients can relax and read a book, or watch a program on the in chamber entertainment system, while breathing oxygen in a transparent hood or mask.

Decompression
Once treatment is completed, patients will be decompressed back to sea level. Again, there will be a sensation of fullness in the ears. It is a normal sensation which will resolve spontaneously. Patients will feel cold during this phase.

Contraindications
The only true absolute contraindication to HBOT is an untreated pneumothorax. Once treated, the patient can proceed with HBOT. Prior exposure to Bleomycin is not compatible with HBOT.

Complications associated with HBOT
• Barotrauma
- Middle ear
- Tooth
- Sinus
- Pulmonary
• Oxygen toxicity
• Temporary worsening of myopia

Serious complications are extremely rare. The most common complaint is ear pain which can easily be managed with no serious consequences.

Diabetes Treatment

For more information, please visit our website:
http://www.sgh.com.sg/MedicalSpecialtiesnServices/SpecialistCentres/HDM/

References

1. Hyperbaric Oxygen 2003. Indications and Results. The Hyperbaric Oxygen Therapy Committee Report. Pg 41 – 55. Enhancement of Healing in selected problem wounds. Robert A. Warriner III and Harriet W. Hopf.
2. Wound Care Practice. Paul J. Sheffield, Ph.D., Adrianne P.S. Smith, M.D., Caroline E. Fife, M.D. Pg 661-684. Hyperbaric Oxygen Therapy Applications in Wound Care. Caroline E. Fife.


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fr : Hyperbaric and Diving Medicine Centre, Singapore General Hospital
hyperbaric & diving medecine consultant, dokter ahli hiperbarik jakarta indonesia