Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen in a pressurized chamber above normal atmospheric pressure. This increases the amount of oxygen dissolved in the blood and tissues up to 15 times normal levels. The high oxygen levels and pressure have physiological effects that can help treat conditions like carbon monoxide poisoning, gas embolism, and non-healing wounds by promoting angiogenesis and fighting infection. HBOT is administered in multi-place or monoplace chambers and can cause potential side effects from higher pressure and oxygen levels if not done properly.

1. HYPERBARIC OXYGEN THERAPY

4. A patient receives treatment in a state-of-the-art Sechrist Monoplace Hyperbaric Oxygen Chamber.

5. Significant physiological mechanisms, which are activated as a result of hyperbaric oxygenation, explain the many therapeutic results of HBO

12. Problem wounds Delayed radiation injury Fibroblast proliferation/collagen synthesis Problem wounds Compromised grafts and flaps Delayed radiation injury Angiogenesis Crush injury/compartment syndrome Thermal burns Vasoconstriction † Air or gas embolism Decrease gas bubble size DCS/AGE CO poisoning Crush injury/compartment syndrome Compromised grafts and flaps Severe blood loss anemia Hyperoxygenation Clinical Application Mechanism

13. Necrotizing soft tissue infections Refractory osteomyelitis Antibiotic synergy Clostridial myonecrosis Toxin inhibition CO poisoning Crush injury/compartment syndrome Reduces lipid peroxidation Crush injury/compartment syndrome Reduces intravascular leukocyte adherence Necrotizing soft tissue infections Refractory osteomyelitis Problem wounds Leukocyte oxidative killing ‡

22. Multiplace chamber Treat multiple patients at the same time, generally with a nurse or another inside observer who monitors the patients and assists with equipment manipulation or emergencies. Patients in a multiplace chamber breathe 100% oxygen via a mask or close-fitting plastic hood. Multiplace chambers can usually be pressurized to the equivalent of about 6 atmospheres of pressure Rectangular hyperbaric chamber

23. Interior of rectangular chamber

24. Cylindrical multiplace chamber

26. Monoplace chamber

27. Home treatment An example of mild portable hyperbaric chamber. This 40" diameter chamber is one of the larger chambers available for home use. These chambers are often used in a clinical settings, but are also used in homes.

28. Complications

30. Contraindications

31. Discontinue and remove medication Impaired wound healing Sulfamylon Discontinue medication Blocks superoxide dismutase, which is protective against oxygen toxicity Doxorubicin Discontinue medication Blocks superoxide dismutase, which is protective against oxygen toxicity Disulfiram No treatment for extended time from use of medication Impaired wound healing Cisplatin No treatment for extended time from use of medication Interstitial pneumonitis Bleomycin Thoracostomy Gas emboli Tension pneumothorax Pneumomediastinum Untreated pneumothorax Necessary Conditions Prior to HBOT Reason Contraindicated Absolute Contraindications

32. Provide antipyretic Higher risk of seizures High fever Training, PE tubes Barotrauma to tympanic membrane Eustachian tube dysfunction Observation in chamber Loss of hypoxic drive to breathe Chronic obstructive pulmonary disease (COPD) None; HBOT for emergencies only Severe hemolysis Congenital spherocytosis Treatment with benzodiazepines Anxiety Claustrophobia Must be well controlled with medications Air trapping upon ascent leading to pneumothorax Asthma Necessary Conditions Prior to HBOT Reason Contraindicated Relative Contraindications

33. Resolution of symptoms or decongestants Barotrauma Upper respiratory infection (URI) Should be stable on medications; may be treated with benzodiazepines May have lower seizure threshold Seizures None, but HBOT may be used in emergencies Unknown effect on fetus (Previous studies from Russia suggest HBOT is safe.) Pregnancy Ensure company has pressure-tested device and learn to what depth Malfunction or deformation of device under pressure Pacemakers or epidural pain pump Necessary Conditions Prior to HBOT Reason Contraindicated Relative Contraindications

34. Prepared By

35. Fayza Ahmed

36. Ibrahim Moursi

37. Hamdy Sayed

38. Thanks