Introduction & History of Hyperbaric Medicine. Learning without boundaries

Transcription

1 Introduction & History of Hyperbaric Medicine Learning without boundaries

2 Welcome Medical science is expanding rapidly, and within this exciting growth there is advent of many new treatments, technologies, techniques, and procedures. There are also some treatments that have existed for a long time and were poorly understood. However, sustained research and understanding have led to a revival of these treatments and integrated them into mainstream medicine. One such treatment is Hyperbaric Oxygen Therapy (HBOT). We welcome you to this online introductory course in Hyperbaric Oxygen and wish you an enjoyable and productive learning experience Disclaimer: The material in this chapter are compiled from open sources such as the internet and textbooks and we would like to acknowledge these authors (many of whom are unnamed). The LNH site does not claim ownership on these contents. 2

3 Objective By the end of the topic you will be able to Understand the basics of the subject. Describe different modes of administration of hyperbaric oxygen therapy. Understand difference between monoplace and multiplace chambers. List oxygen devices that do not deliver HBOT. Know about the historical phases in the development of HBOT. Briefly know about the future prospects of HBOT. 3

4 Introduction The word hyperbaric literally means high pressure. HBOT is a form of treatment in which a patient is administered 100% oxygen for breathing, inside a special treatment chamber where the ambient pressure is higher than normal atmospheric pressure. HBOT is part of the science of Hyperbaric Medicine, which covers 3 distinct areas as illustrated in the diagram The first 2 areas diving medicine and compressed air work could be defined as Occupational medicine And the third area clinical hyperbaric oxygen therapy ( HBOT) is a clinical application of the experience with the same science The focus of the current learning program is on clinical hyperbaric oxygen 4

5 What is Hyperbaric Oxygen Therapy Definition : The Undersea & Hyperbaric Medical Society has defined Hyperbaric Oxygen as : The intermittent inhalation of 100% Oxygen under a pressure exceeding that of the atmosphere by 1.4 times (1 Atmosphere is the normal room air pressure at sea level = 760 cm Hg) O 2 O 2 Delivered in a specialized chamber via Hood /Mask. During HBO due to higher pressure the Oxygen dissolves more in the liquid part of blood (plasma) and its level increases times of normal level. 5

6 Systemic hyperbaric oxygen administration Systemic Hyperbaric Oxygen is given in specialized treatment chambers which are being used for the treatment of illnesses in divers for many years. HBOT can be carried out in 2 different types of equipment: Monoplace chamber, where only 1 patient can be treated at one time and no attendant is required. Multiplace chamber, where many patients can be treated in the presence of an attendant at any given time. The key difference is that in a monoplace chamber only one patient can be treated at a time, while in a multiplace we can treat many patients at the same time 6

7 Monoplace Chamber HBO therapy can be given in a Monoplace Chamber in which a single patient is placed in a chamber which is then pressurized with 100% oxygen.

8 Multiplace Chamber Multiplace chambers are designed for simultaneous treatment of groups of patients breathing oxygen from masks or hoods. These chambers are usually situated within the hospital settings because of their operating economy and need for internal operators, usually doctors or nurses trained in hyperbaric medicine.

9 Multiplace chamber Easy Seating Arrangement Given that multiple people share a relatively confined space, these chambers require careful cleaning procedures and patient screening to minimize risk of cross-contamination of infectious diseases.

10 Delivery of oxygen in Multiplace chamber The entire chamber is pressurized with compressed air and oxygen is inhaled by the patients through a mask or hood with a neck seal. Mask T Piece Hood

11 Other Oxygen Chambers : Do not Deliver HBO Numobag topical Oxygen delivery The Numobag Kit generates Topical Oxygen that is proclaimed to increase blood levels of oxygen. This does not deliver hyperbaric Oxygen Therapy

12 Topical Oxygen delivery Topical oxygen delivery ( TOPOX ) is a technique of delivering 100% oxygen directly to an open, moist wound at a pressure slightly higher than ambient pressure. It is theorized that the high concentrations of oxygen diffuse directly into the wound to increase the local cellular oxygen tension, which in turn promotes healing. This does not deliver Hyperbaric Oxygen Topical Hyperbaric Medicine Device 12

13 Portable hyperbaric chambers These are usually referred to as "mild hyperbaric chambers", which is a reference to the lower pressure of soft-sided chambers. They are only approved by the FDA for the treatment of altitude sickness This does not deliver Hyperbaric Oxygen 13

14 Brief History of HBOT Three phases in the history can be distinguished: Phase I A time for discoveries: from the Renaissance to the Age of Enlightenment; Phase II A time for hyperbaric therapy Phase III The practice of Hyperbaric Medicine on a scientific basis: 14

15 Phase I - A time for discoveries The Renaissance (14 th to 17 th Century) was a cultural movement beginning in Italy in the Late Middle Ages and later spreading to the rest of Europe. Science and technical knowledge flourished from the very beginning of the Renaissance. The Age of Enlightenment or Age of reason (late 17 th century onwards) was a cultural movement of intellectuals emphasizing reason and individualism rather than tradition. Its purpose was to reform society using reason, to challenge ideas grounded in tradition and faith, and to advance knowledge through the scientific method.

16 Henshaw built first Hyperbaric Chamber A landmark in the Phase I was In the year 1662 when the first hyperbaric chamber was created by British physician Henshaw; he named it a Domicilium. He used a system of organ bellows and valves to adjust the pressure within a sealed chamber. The simplistic principle behind its use was that acute conditions would respond to elevated atmospheric pressures, whereas chronic conditions would benefit from reduced pressure. Henshaw s Domicilium

17 Phase II - A time for hyperbaric therapy This was a period when the therapeutic use of hyperbaric oxygen (HBO) grew in France and rest of the world Mid 19th century to beginning of the 20th century. 17

18 Cunningham s Chamber Steel Ball Hospital A landmark in the Phase II is the Chamber that received the most publicity and was the most actively used, was that of a Dr Cunningham in Kansas City during the 1920's. In 1928 Cunningham constructed the largest chamber ever built - five stories high and 64 feet in diameter. Each floor had 12 bedrooms with all the amenities of a good hotel. At that time it was the only functioning hyperbaric chamber in the world. Cunningham chamber was later dismantled for scrap in 1937, which brought to a temporary end the era of Hyperbaric Oxygen Therapy for medical disorders.

19 Phase III - Practicing Hyperbaric Medicine on scientific basis This is the period from the second half of the 20th century. Hyperbaric became an integral part of modern medicine and is now routinely administered across the world in many centers 19

20 During 1970s and 80s During the 1970s and eighties, the practice of hyperbaric oxygen therapy experienced hard times because the usefulness of HBO underwent doubt and suspicion. More effective therapies such as cardiac surgery became available, Efforts to use it for various medical conditions proved unsuccessful, and Rogue physicians who were high-profile HBOT advocates damaged its reputation by using it for profit alone From the nineties has been a phase of rigorous scientific validation. Through subsequent decades, scores of therapeutic recompression/decompression protocols were devised. These developments were spearheaded by the military, who eagerly exploited the advantages of the hyperbaric submarine environment.

21 Era of Professional Societies The growth of hyperbaric Oxygen has now become a global phenomenon and may professional societies have been established for this purpose in different parts of the world. Some of them are:- Baromedical Nurses Association National Board of Diving & Hyperbaric Technicians American Board of Medical Specialists UHMS (Undersea & Hyperbaric Medical Society) EUBS (European undersea and Baro medical society) SPUMS (South Pacific Undersea Medical society) APUHMS (Asian and Pacific Undersea and Hyperbaric Medical Society) AHDMA (Asian Hyperbaric & Diving Medical Association), HSI (Hyperbaric Society of India) are other well established societies promoting the growth of hyperbaric medicine in their regions. 21

22 Present-day Scenario HBOT now has an application in mainstream clinical medical practice and is currently, an integral part of evidence-based medicine. The field of HBOT is expanding rapidly and now touches upon almost all segments of modern medicine. The diagram shows the key indications of evidence based indications for hyperbaric oxygen therapy Neurorehabilitation ( CP, head injury, stroke etc.)

23 Future of Hyperbaric Medicine Recent and significant documented advances with Hyperbaric Medicine, have emerged with the utilization of isotopic tracers with Magnetic Resonance Imaging (MRI) and Single Photon Emission Computed Tomography (SPECT). MRI and SPECT performed as a pre and post hyperbaric evaluation have provided valuable insights into the mechanisms and actions of Hyperbaric Medicine through oxygenation. The addition of Central retinal Artery Obstruction (CRAO) and Acute Sensorineural hearing Loss (ASNHL) to the approved list demonstrates the growing role of hyperbaric oxygen in many diseases. The field of Hyperbaric medicine has had a long and lonely journey and the time has come when it is gaining acceptance and momentum. Today, the hyperbaric community is moving ahead as an integrative part of medicine creating many opportunities for young professionals to follow and move ahead in this emerging science of hyperbaric medicine. 23

24 Best wishes We hope you enjoy the course hyperbaric community and best wishes to you on joining the The LearnNheal team is with you at every step to help you succeed 24