Hyperbaric drugs are medical treatments where ambient pressure greater than atmospheric sea level pressure is a necessary component. Treatment consists of hyperbaric oxygen therapy ( HBOT ), medical use of oxygen at ambient pressure is higher than atmospheric pressure, and therapeutic recompression for disease decompression, is intended to reduce the harmful effects of systemic gas bubbles by physically reducing the size and providing better conditions for removing bubbles and excess dissolved gases.
The equipment required for hyperbaric oxygen treatment consists of pressure chambers, which may be rigid or flexible construction, and a 100% oxygen delivery means. The operation is performed for a predetermined schedule by trained personnel who monitor the patient and can adjust the schedule as needed. HBOT found its early use in the treatment of decompression diseases, and also showed great effectiveness in treating conditions such as gas gangrene and carbon monoxide poisoning. More recent research has examined the possibility that it may also have value for other conditions such as cerebral palsy and multiple sclerosis, but no significant evidence was found.
Therapeutic compression is usually also provided in hyperbaric chambers. This is the definitive treatment for decompression disease and can also be used to treat arterial arterial embolism caused by lung barotrauma from ascent. In an emergency, the diver can sometimes be treated with recompression in the water if no room is available and suitable dive equipment to secure the airway adequately available.
A number of hyperbaric care schedules have been published for years both for recompression therapy and hyperbaric oxygen therapy for other conditions.
Video Hyperbaric medicine
Coverage
Hyperbaric drugs include hyperbaric oxygen treatment, which is the medical use of oxygen at greater pressure from the atmosphere to increase the availability of oxygen in the body; and therapeutic recompression, which involves an increase in ambient pressure on a person, usually a diver, to treat decompression or air embolism by removing bubbles that have formed in the body.
Maps Hyperbaric medicine
Medical use
In the United States, the Undersea and Hyperbaric Medical Society, known as UHMS, include reimbursement approvals for specific diagnoses in hospitals and clinics. The following indications are approved (for replacement) using hyperbaric oxygen therapy as defined by the UHMS Hyperbaric Oxygen Therapy Committee:
- Air or gas embolism;
- Carbon monoxide poisoning;
- Carbon monoxide poisoning is complicated by cyanide poisoning;
- Central retinal artery occlusion;
- Clostridal myositis and myonecrosis (gangrene gas);
- Severe injury, compartment syndrome, and other acute traumatic ischaemia;
- Decompression disease;
- Increased healing of selected problem wounds;
- Diabetic diseases, such as short-term diabetic foot support, diabetic retinopathy, diabetic nephropathy;
- Remarkable blood loss (anemia);
- Sensoryineural hearing loss is suddenly idiopathic;
- Intracranial abscess;
- Mucormycosis, especially rhinocerebral disease in the setting of diabetes mellitus;
- Necrotizing soft tissue infections (necrotizing fasciitis);
- Osteomyelitis (refractory);
- delayed radiation injuries (soft tissue and bone necrosis);
- Skin grafts and flaps (compromised);
- Thermal burns.
Evidence is not enough to support its use in autism, cancer, diabetes, HIV/AIDS, Alzheimer's disease, asthma, Bell's palsy, cerebral palsy, depression, heart disease, migraines, multiple sclerosis, Parkinson's disease, spinal cord injuries, sports injuries,. A Cochrane review published in 2016 has raised questions about the ethical basis for future clinical trials of hyperbaric oxygen therapy, given the increased risk of damage to the eardrum in children with autism spectrum disorders. Despite the lack of evidence, by 2015, the number of people using this therapy continues to increase.
Hearing problems
There is limited evidence that hyperbaric oxygen therapy improves hearing in patients with sudden sensorineural hearing loss who are present within two weeks of hearing loss. There are some indications that HBOT can increase tinnitus that appears within the same time frame.
Chronic ulcer
HBOT in diabetic foot ulcers increases the rate of early ulcer healing but appears to have no benefit in wound healing in long-term follow-up. In particular, there is no difference in the level of major amputations. For venous, arterial, and pressure ulcers, there is no clear evidence that HBOT provides long-term improvement over standard treatment.
Radiation injury
There is some evidence that HBOT is effective for tissue injuries to bone and soft tissue in the head and neck. Some people with head, neck or intestinal radiation injuries show improved quality of life. Importantly, no such effects are found in neurological tissue. Use of HBOT may be justified for certain patients and tissues, but more research is needed to establish the best people to treat and determine the timing of HBO therapy.
Neuro-rehabilitation
In 2012 there is sufficient evidence to support the use of hyperbaric oxygen therapy to treat people with traumatic brain injury. In stroke, HBOT shows no benefit. HBOT in multiple sclerosis has not demonstrated benefit and routine use is not recommended.
A 2007 review of HBOT in cerebral palsy found no difference compared to the control group. Neuropsychological tests also showed no difference between HBOT and room air and based on caregiver reports, those who received room air had significantly better mobility and social function. Children who received HBOT reported experiencing seizures and need a tympanostomy tube to equalize ear pressure, although the incidence is unclear.
Cancer
In alternative medicine, hyperbaric drugs have been promoted as a treatment for cancer. A 2012 article in the journal, Targeted Oncology reported that "there is no evidence to suggest that HBO does not act as a tumor growth stimulator or as a relaptive reinforcement.On the other hand, there is evidence to suggest that HBO may have tumor inhibitory effects on certain cancer subtypes, and we firmly believe that we need to expand our knowledge of the effects and mechanisms behind tumor oxygenation. "However, a 2011 study by the American Cancer Society reported no effective evidence for this purpose.
Migraine
Low-quality evidence suggests that hyperbaric oxygen therapy may reduce the pain associated with acute migraine headaches in some cases. It is not known which person will benefit from this treatment, and there is no evidence that hyperbaric drugs can prevent future migraines. Further research is needed to confirm the effectiveness of hyperbaric oxygen therapy to treat migraine.
Contraindications
Drug toxicology has recently been reviewed by Ustundag et al. and its risk management is discussed by Christian R. Mortensen, given the fact that most hyperbaric facilities are administered by the anesthesiology department and some of their patients are critically ill.
The only absolute contraindication to hyperbaric oxygen therapy is untreated pneumothorax. The reason is the concern that it can develop into tension of the pneumothorax, especially during the decompression phase of therapy, although treatment on oxygen-based tables may avoid that development. COPD patients with large blebs represent relative contraindications for the same reason. Also, treatments can improve Occupational Health and Safety (OHS) problems, which the therapist has encountered.
The following is a relative contraindication - which means that special consideration must be made by a specialist before HBO treatment begins:
- Heart Disease
- COPD with trapped air - may cause pneumothorax during treatment.
- Upper respiratory tract infections - This condition can make it difficult for patients to equate their ears or sinuses, which can lead to so-called ear or squeezing sinuses.
- High fever - In many cases the fever should be lowered before HBO treatment begins. Fever can affect seizures.
- Emphysema with CO 2 retention - This condition can cause pneumothorax during HBO treatment due to rupture of the emphysematous lump. This risk can be evaluated by x-rays.
- The history of chest (chest) surgery - This is rarely a problem and is usually not considered contraindicated. However, there is concern that the air may be trapped in lesions created by surgical scar tissue. This condition needs to be evaluated before considering HBO therapy.
- Malignant Disease: Cancer develops in a blood-rich environment but can be suppressed by high levels of oxygen. HBO treatment in individuals with cancer presents a problem, because HBO both increase blood flow through angiogenesis and also increase oxygen levels. Taking anti-angiogenic supplements can provide a solution. A study by Feldemier et al. and the recent NIH-funded study on Stem Cells by Thom et al., show that HBO is actually useful in producing stem/progenitor cells and malignant processes are not accelerated.
- The middle ear of barotrauma is always a consideration in treating children and adults in a hyperbaric environment because of the need to equalize the pressure in the ear.
Pregnancy is not a relative contraindication to hyperbaric oxygen treatment, although it is possible to dive under water. In cases where a pregnant woman has carbon monoxide poisoning there is evidence that low pressure (2.0 ATA) HBOT treatments are harmless to the fetus, and that the risk involved is greater than the greater risk of untreated CO effects in the fetus (neurologic abnormalities or death.) In pregnant patients, HBO therapy has been shown to be safe for the fetus when administered at appropriate levels and "dose" (duration). In fact, pregnancy lowers the threshold for the treatment of HBO in patients exposed to carbon monoxide. This is due to the high affinity of fetal hemoglobin for CO.
Principles of therapy
Therapeutic consequences of HBOT and recompression results from various effects.
The increased overall pressure is the therapeutic value in the treatment of decompression and air embolism because it provides the physical means to reduce the volume of inert gas bubbles in the body; This increased pressure exposure is maintained for a sufficiently long period of time to ensure that most of the bubble gas is reconstituted into the tissue, removed by perfusion and removed in the lungs.
Increased gradient concentrations for the elimination of inert gases (oxygen windows) using high oxygen partial pressures increase the rate of inert gas elimination in the treatment of decompression disease.
For many other conditions, the principle of HBOT therapy lies in its ability to drastically increase the partial pressure of oxygen in body tissues. The partial pressure of oxygen achieved using HBOT is much higher than can be achieved when inhaling pure oxygen under normobaric conditions (ie at normal atmospheric pressure). This effect is achieved by increasing the blood oxygen transport capacity. At normal atmospheric pressure, oxygen transport is limited by the oxygen binding capacity of hemoglobin in red blood cells and very little oxygen is transported by blood plasma. Because red blood cell hemoglobin is almost saturated with oxygen at atmospheric pressure, this transport route can not be exploited any further. The oxygen transport by plasma, however, is significantly increased using HBOT due to higher oxygen solubility when pressure is increased.
One study showed that hyperbaric oxygen exposure (HBOT) may also mobilize stem/progenitor cells from the bone marrow by a nitric oxide-dependent mechanism.
Hyperbaric space
Construction
The traditional type of hyperbaric chamber used for therapeutic recompression and HBOT is a rigid pressure vessel. Such rooms can be run at absolute pressure usually around 6 bar (87 psi), 600,000 Pa or more in special cases. Navy, professional dive organizations, hospitals, and special recompression facilities usually operate this. They range in size from a semi-portable, one-patient unit to a room-sized unit that can treat eight or more patients. Larger units can be rated for lower pressure if they are not primarily intended for the treatment of diving injuries.
Rigid spaces may consist of:
- pressure vessel with display port (window) made of acrylic;
- one or more human hatching entries - small and circular or wheel-in types hatch for patients in gurneys;
- entrance keys that allow human entry - a separate space with two hatches, one out and one into the main room, which can be pressed separately to allow the patient to enter or exit the main room while still pressurized.
- medical volume or low volume airlock service for medicines, instruments and food;
- transparent port or closed-circuit television that allows outdoor medical technicians and staff to monitor patients indoors;
- an intercom system that enables two-way communication;
- an optional carbon dioxide scrubber - composed of a fan which streams gas into space through a lime soda can;
- the outdoor control panel to open and close valves that control airflow to and from the room, and regulate oxygen to the hood or mask;
- excess pressure relief valve.
- a built-in breathing system (BIBS) to supply and dispose of maintenance gases.
- fire suppression system.
Flexible monoplace spaces are available from flexible flexible reinforced flexible reinforced space for transport via truck or SUV, with a maximum working pressure of 2 bar above ambient complete with BIBS allowing full oxygen treatment schedule. to a portable, "soft" exhaled air that can operate between 0.3 and 0.5 bar (4.4 and 7.3 psi) above atmospheric pressure without additional oxygen, and longitudinal zipper closure.
Supply of oxygen
In larger multiplace spaces, patients in the room breathe well from "oxygen caps" - soft, transparent soft plastic veils with a seal on the neck like a space helmet - or a very fitting oxygen mask that supplies pure oxygen and may be designed for immediately discharges the gas released from the room. During the treatment the patients breathe 100% oxygen most of the time to maximize the effectiveness of their treatment, but have periodic "air breaks" as long as they breathe room air (21% oxygen) to reduce the risk of oxygen toxicity. Exhaled maintenance gases should be removed from the room to prevent oxygen buildup, which may pose a risk of fire. Officers can also breathe oxygen some time to reduce the risk of decompression diseases as they leave the room. Pressure inside the chamber is enhanced by opening a valve that allows high pressure air to enter from the storage cylinder, which is filled by an air compressor. The oxygen content of air space is stored between 19% and 23% to control the risk of fire (US Navy maximum 25%). If the room does not have a scrubber system to remove carbon dioxide from the space gas, space must be ventilated in an islutin to keep CO 2 within acceptable limits.
The soft space can be pushed directly from the compressor. or from storage cylinders.
Smaller "monoplace" rooms can only accommodate patients, and no medical staff can enter. Space may be pressurized with pure oxygen or compressed air. If pure oxygen is used, oxygen masks or respiratory masks are not needed, but the cost of using pure oxygen is much higher than using compressed air. If compressed air is used, then a mask or oxygen cap is required as in a multiplace space. Most monoplace spaces can be equipped with a breathing system for air breaks. In low-pressure soft rooms, maintenance schedules may not require air breaks, since the risk of oxygen toxicity is low due to the partial pressure of oxygen used (usually 1.3 ATA), and short treatment duration.
For patients who are vigilant and cooperative, air breaks provided by masks are more effective than replacing space gases because they provide faster gas change and more reliable gas composition during rest and maintenance periods.
Treatment
Initially, HBOT developed as a treatment for dive disorders involving gas bubbles in the tissues, such as decompression and gas embolism, is still considered the definitive treatment for this condition. This space treats decompression and gas embolism by increasing pressure, reducing the size of the gas bubble and increasing the transport of blood to the downstream network. After bubble removal, the pressure is gradually reduced back to atmospheric levels. Hyperbaric space is also used for animals, especially horse races where recovery is very valuable to its owners. It is also used to treat dogs and cats in pre and postoperative care to strengthen their systems before surgery and then accelerate postoperative healing.
Protocol
Emergency HBOT for decompression disease follows the treatment schedule listed in the treatment table. Most cases use recompressions of up to 2.8 bar (41 psi) absolute, equivalent to 18 meters (60 feet) of water, for 4.5 to 5.5 hours with pure oxygen breathing victim, but take an air break every 20 minutes to reduce oxygen toxicity. For very serious cases due to deep dives, treatment may require a room capable of a maximum pressure of 8 bar (120 psi), equivalent to 70 meters (230 ft) of water, and the ability to supply heliox as breathing. gas.
US Navy treatment charts are used in Canada and the United States to determine duration, pressure, and respiratory gas from therapy. The most commonly used tables are Table 5 and Table 6. In the UK, tables of Royal Navy 62 and 67 are used.
The Undersea and Hyperbaric Medical Society (UHMS) publishes a report that collects the latest research findings and contains information on the duration and pressure suggested from long-term conditions.
Outpatient and outpatient clinic care
There are several portable room sizes, which are used for home care. This is usually referred to as a "mild personal space hyperbaric," which is a reference to lower pressure (compared to hard space) of the soft-side room.
In the US, this "light private hyperbaric space" is categorized by the FDA as a CLASS II medical device and requires a prescription to buy one or take care. The most common (but not FDA-approved) choice of some patients choosing is to obtain an oxygen concentrator which usually provides 85-96% oxygen as a respiratory gas.
Oxygen is never fed directly to the soft space but rather introduced through the line and mask directly to the patient. FDA-approved oxygen concentrators for human consumption in restricted areas used for HBOT are regularly monitored for purity (1%) and flow (10 to 15 liters per minute outflow pressure). The audible alarm will sound if its purity has dropped below 80%. Personal hyperbaric space uses a 120 volt or 220 volt outlet.
Possible complications and concerns
There are risks associated with HBOT, similar to some dive disorders. Pressure changes can cause "extortion" or barotrauma in the tissues around the air trapped inside the body, such as the lungs, behind the eardrum, within the paranasal sinuses, or trapped under dental fillings. Inhaling high-pressure oxygen may cause oxygen toxicity. Temporary blurred vision may be caused by a swelling of the lens, which usually disappears within two to four weeks.
There are reports that cataracts can develop following HBOT.
Pressure effect
Patients in the room may feel discomfort in their ears because of the difference in pressure between the middle ear and the atmosphere of space. This can be reduced by cleaning the ears using Valsalva maneuver or other techniques. Continuous increase in pressure without equalization can cause the eardrum to rupture, resulting in severe pain. As indoor pressure increases, the air can become warm.
To reduce the pressure, the valve is opened to allow air out of the room. As the pressure falls, the patient's ears may "squeak" when the pressure inside the ear is attached to the chamber. The temperature in the room will fall. The speed of pressurization and despressurization can be tailored to the needs of each patient.
Cost
HBOT is recognized by Medicare in the United States as a replaceable treatment for 14 "approved" UHMS conditions. A 1-hour HBOT session can cost between $ 300 and higher in private clinics, and over $ 2,000 in hospitals. US doctors (either M.D., D.O., D.D.S., D.M.D., D.C., N.D.) can legitimately prescribe HBOT for "off-label" conditions such as stroke, and migraine. The patient was admitted to an outpatient clinic. In the UK most rooms are financed by the National Health Service, although some, such as those run by Multiple Sclerosis Therapy Centers, are nonprofit. In Australia, HBOT is not covered by Medicare as a treatment for multiple sclerosis. China and Russia treat more than 80 diseases, conditions and trauma with HBOT.
Research
The University of Birmingham 2012 guidance for the trust of primary care of the West Midlands and clinical commissioning group concluded "The major research studies investigated the remarkable HBOT efficacy for consistent poor quality of published clinical trials as well as the lack of evidence demonstrating significant health benefits." There is a lack of clinical evidence adequate to support the view that HBOT therapy is efficacious for every indication used.
Aspects studied include radiation-induced hemorrhagic cystitis; and inflammatory bowel disease.
Neurological
Temporary evidence suggests potential benefits for cerebrovascular disease. Clinically published experience and results have promoted the use of HBOT therapy in patients with cerebrovascular injury and focal cerebrovascular injury. However, the strength of clinical research is limited because of the lack of randomized controlled trials.
Radiation wound
A 2010 review of HBOT research applied to wound from radiation therapy reported that, while most studies show favorable effects, more experimental and clinical studies are needed to validate their clinical use.
History
Hyperbaric air
Junod built a room in France in 1834 to treat lung conditions at pressures between 2 and 4 absolute atmospheres.
Over the next century "pneumatic centers" were established in Europe and the United States that used hyperbaric air to treat a variety of conditions.
Orval J Cunningham, an anesthesiology professor at the University of Kansas in the early 1900s observed that people suffering from circulatory disorders are better at sea level than at elevations and this forms the basis for hyperbaric air usage. In 1918 he succeeded in treating patients suffering from Spanish flu with hyperbaric air. In 1930, the American Medical Association forced him to stop hyperbaric treatments, as he did not provide acceptable evidence that his treatment was effective.
Hyperbaric Oxygen
British scientist Joseph Priestley discovered oxygen in 1775. Shortly after his discovery, there were reports of the toxic effects of hyperbaric oxygen on the central nervous system and lungs, which delayed therapeutic applications until 1937, when Behnke and Shaw first used it in the treatment of decompression diseases.
In 1955 and 1956 Churchill-Davidson, in England, used hyperbaric oxygen to increase tumor radiosensitivity, while nl, at the University of Amsterdam, successfully used it in heart surgery.
In 1961 Willem Hendrik Brummelkamp et al. published on the use of hyperbaric oxygen in the treatment of clostridial gas gangrene.
In 1962 Smith and Sharp reported the successful treatment of carbon monoxide poisoning with hyperbaric oxygen.
The Undersea Medical Society (now Undersea and Hyperbaric Medical Society) established the Committee on Hyperbaric Oxygen which has been recognized as an authority on indications for hyperbaric oxygen treatment.
See also
- Undersea and Hyperbaric Medical Society
- South Pacific Pacific Society of Medicine
- Decompression space
- Hyperbaric care schedule
References
Further reading
-
Kindwall, Eric P; Whelan, Harry T (2008). Hyperbaric Medicine Practice (3rd ed.). Flagstaff, AZ: The Best Publishing Company. ISBN: 978-1-930536-49-4. Ã, - Mathieu, Daniel (2006). Handbook on Hyperbaric Medicine . Berlin: Springer. ISBN: 1-4020-4376-7. Neubauer, Richard A; Walker, Morton (1998). Hyperbaric Oxygen Therapy . Garden City Park, NY: Avery Publishing Group. ISBN: 978-0-89529-759-4.
- Jain, KK; Baydin, SA (2004). Hyperbaric textbook (4th ed.). Hogrefe & amp; Huber. ISBN 0-88937-277-2. (6th edition of Springer in media 2016)
- Harch, Paul G; McCullough, Virginia (2010). Oxygen Revolution . Long Island City, NY: Hatherleigh Press. ISBNÃ, 1-57826-326-3.
External links
- Hyperbaric Oxygen Therapy from eMedicine
- The Duke Medical University archive contains a collection of individuals working with hyperbaric drugs
Source of the article : Wikipedia
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