Hyperbaric Oxygen Therapy

HBOT at Sahaj Hospital

Hyperbaric Oxygen Therapy

"Hyper" means high and "baric" means pressure, so hyperbaric refers to high atmospheric pressure. So, in hyperbaric oxygen therapy (HBOT) the treatment of a patient with pure (100%) oxygen at a greater atmospheric pressure than normal is done.
The tissue physiology and our blood are the limiting factor for oxygenation at normal pressure (i.e. at 1 ATA). At sea level, haemoglobin carries 97 percent of the oxygen, whereas 3 percent is dissolved in the blood plasma. All physiological fluids, including blood, plasma, lymphatic fluid, cerebrospinal fluid, and interstitial fluid, dissolve more readily at greater pressures.
This extra dissolved oxygen in plasma at greater pressure is enough to meet tissue needs without consuming oxygen linked to haemoglobin, and is responsible for the majority of the therapy's positive benefits.

Do You Know?

  • At sea level, 1 atmospheric absolute equals 14.7 pounds / square inch of pressure. In typical circumstances, we breathe around 20% oxygen and 80% nitrogen.

Why is Hyperbaric Oxygen Beneficial?

  • It stimulates new blood vessels growth
  • Arrest certain type of infections and diseases by increasing the oxygenation
  • It improves wound healing
  • Reduces the gas bubble size so that it can be reabsorbed
Oxygen level with hyperbarics | Sahaj Hospital
 

What Hyperbaric Oxygen Does?

  • It reduces edema and swelling
  • Improves the efficiency of leukocytes (WBC) which kills bacteria more effectively
  • Enhances the performance of the antibiotics
  • Fibroblast angiogenesis and proliferation
  • Enhances the proliferation of endothelial cells, thereby reducing the scarring and resolving the bruising
  • Collagen synthesis and cross-linking
  • Improves immune system of the body
  • Reduction in pain and pain cycles due to healing of the nerve endings

Medical Conditions Where it is Showing Benefits

  • COVID and Post COVID recovery
  • In mycosis (fungal infections)
  • Non-healing diabetic wounds
  • Recovery after radiation
  • Poisoning due to carbon monoxide
  • Cyanide poisoning
  • Crush injuries
  • Gas gangrene
  • Decompression sickness
  • Arteries not receiving proper blood flow
  • Skin flaps and grafts (compromised)
  • Osteomyelitis
  • Radiation injury (late/delayed)
  • Necrotizing soft tissue infection
  • Air embolism
  • Chronic infection (actinomycosis)

Mechanisms for HBO Treatment

Oxygenation of ischemic, hypoxic tissue: HBO boosts plasma and tissue oxygen tensions by a factor of ten, allowing tissues to sustain viability in the absence of RBCs.

Neutrophil Oxidative killing: By producing oxygen-dependent superoxides and peroxides, neutrophils restore their ability to destroy germs.

Suppression of multiplication in bacteria: Streptococcus and anaerobes are inhibited by high oxygen pressures.

Augmentation of antibiotic effectiveness: Increased oxygen tension allows oxygen dependent active transport to bring in antibiotics across bacterial cell walls.

Enhanced fibroblast function: Prevents unnecessary cicatrix formation.

Angiogenesis: Increased oxygen tension improves the function of vascular endothelial growth factor and the secretion of fibroblast matrix.

Red Blood Cells
Diffusion of Oxygen | HBOT | Sahaj Hospital
HBOT in Sahaj Hospital
Blood vessels to grow | Sahaj Hospital

Effect of Pressure on Arterial Oxygen

Total pressure Content of oxygen dissolved in plasma (volume percentage)
ATA Breathing Air 100% oxygen
1 0.32 2.09
2 0.81 4.44
3 1.31 6.80
HBOT Therapy in Indore

At 1 ATA

HBOT Treatment in Indore

At 2 ATA

HBOT for Lungs

At 3 ATA

This extra oxygen in solution is virtually enough to meet tissue needs without the help of oxygen linked to haemoglobin, and it is responsible for the majority of the therapy's positive benefits.

Physiologic Basis of Hyperbaric Oxygen Therapy

Hypoxia or lack of oxygenation is the condition which leads to cellular damage during a diseased state. The increase in oxygenation helps in reversing this oxygen deprivation. Tissue breakdown occurs when there is a lack of oxygen, such as during an injury, sickness, or blood clot. Plasma can carry 100 percent oxygen under pressure, which forces more oxygen into the tissues and aids in the formation of new blood vessels.

At sea level pressure, the normal air that we breathe contains 21% oxygen, and the oxygen needs of most of the tissues are met by hemoglobin, which is 95% saturated. In 100 millilitres of blood, 19 millilitres of oxygen are coupled with Hb, and 0.32 millilitres are dissolved in plasma.

Even if the pO2 is increased, haemoglobin cannot carry any more oxygen since it is saturated. Under barometric pressures, oxygen is dissolved in plasma, and this dissolved plasma oxygen is supplied to various tissues.

During hyperbaric oxygen therapy, the greater pressure drives more oxygen into solution.

A Very Simple Example Can Explain this Concept

Carbonated soda contains gas bubbles of carbon dioxide. While filling under high pressures, the size of the molecule of the carbon dioxide reduces significantly and dissolves in liquid. And on opening this bottle cap and release of pressure, the size of the bubbles increases, visible to the naked eye. This principle also applies to HBO therapy too. When a person sitting inside the hyperbaric oxygen chamber is provided pure oxygen (100%) at a higher atmospheric pressure, the oxygen molecules reduce in size and dissolve in plasma and other body fluids. The oxygen saturated blood plasma then increases the delivery to the oxygen-deprived tissues and thus improves cellular functionality.

There is an increase in the oxygen-free radical generation due to HBO, this oxidizes the proteins and membrane lipids and inhibits the bacterial metabolic functions.

This therapy is especially effective against anaerobes and leukocytes that kill the bacteria due to the oxygen-dependent peroxidase system facilitated by HBO.

In Wound Healing

In injuries, there is swelling which leads to decreased oxygen and this ultimately leads to tissue death. HBOT breaks this cycle and provides oxygen in surplus to the tissues, which reduces the swelling and reduces tissue damage.

In Reperfusion Injury:

When blood flow to a tissue is interrupted owing to a crush injury, a cascade of events occur, resulting in the release of damaging oxygen radicals. These chemicals induce irreparable damage to the blood arteries, causing them to clamp and stop the flow of blood. Reperfusion damage occurs when blood flow returns to this tissue after a period of hypoxia. HBOT improves the disease and aids in healing by increasing the release of oxygen radical scavengers.

In Improving the Body's Immune System:

HBOT does not allow (impairs) the toxins of certain bacteria and also increases the concentration of the oxygen in the tissues, helping in resisting the infection. It also enhances white blood cells' ability to detect and destroy the invaders.

What Happens Over the Course of Treatment?

What happens over the course of treatment?

Oxygen will be delivered via a comfortable mask allowing you to relax while treatment is in process.

Once you are comfortable inside the chamber, you will feel that oxygen is gradually being forced into this chamber. This is compression.

You will feel pressure on your ears, similar to what you might experience in an airplane.

At the end of the treatment, the face mask is removed and the chamber is decompressed gradually by dropping the pressure inside the chamber.

There is no restriction on conducting normal activities after a session.

Science Behind Hyperbaric Oxygen Therapy

Hyperbaric Therapy Applies the Fundamental Physics Gas Laws:

Air follows following three gas laws:

  • Boyle’s Law (1627-1691)
  • Daltons’ Law (1766-1844)
  • Henry’s Law (1774-1790)
  • There are four basic properties of a gas: pressure (P), volume (V), temperature (T), and amount in moles (n).
  • These properties are interrelated – when one changes it affects the others.
  • The simple gas laws describe the relationships between pairs of these properties.
Hyperbaric Oxygen Therapy at Sahaj Hospital

Boyle’s Law

If P (pressure) increases, V (volume) decreases and vice-versa.
Charles' Law in HBOT | Sahaj Hospital

Charles Law

Temperature and volume of a gas are inversely related. ([P1 V1]/T1 = [P2 V2]/T2) explains the temperature increase when the vessel is pressurized and the decrease in temperature with depressurization.
Volume versus Temperature- HBOT | Sahaj Hospital

Molecular View

The volume of a balloon expands when it is moved from an iced to a boiling water bath because the gas particles inside the balloon travel faster (because of the increased temperature) and take up more space.

Dalton’s and Henry’s Law

The partial pressures of O2 and N2 in the body fall as ambient pressure falls (altitude), and fewer O2 and N2 molecules dissolve into the blood.

When ambient pressure increases (hyperbarism), the partial pressures of O2 and N2 in the body increase, and more O2 and N2 molecules dissolve into the plasma.

    Dalton’s Law:

  • PT = P1 + P2 + P3 + …… Pn
  • Where P is the pressure
  • PT = pressure exerted by gas equals the sum of all the Pgas of the constituent gases:
  • It means, increasing the proportion of oxygen in the inhaled gas mixture increases its partial pressure, thereby more dissolution of oxygen in the blood plasma.
  • Air at sea level is 21% oxygen.
  • - HbO2 treatments use FiO2 100%.

    Henry’s law:

  • Amount of gas dissolved in a liquid at a given temperature is a function of the partial pressure of the gas in contact with the liquid, and the solubility of the gas in that particular liquid.
  • Simplified: As a gas's partial pressure above the surface of a liquid rises, more of the gas dissolves into the liquid.
  • More oxygen is dissolved in the blood when the partial pressure of oxygen is increased.
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