Hyperbaric oxygen ppt

oncology

1. HYPERBARIC OXYGEN THERAPY DR.SHUCHITA PATHAK DNB RESIDENT

2. Hyperbaric oxygen therapy is defined as adminstration of 100% oxygen to patient placed inside a chamber pressurized to greater than 1 atmosphere i.e where oxygen dissolve in arterial blood plasma in increased amount thus this dissolved plasma oxygen is carried to different tissues.

3. MECHANISM OF ACTION Oxygenation of ischemic, hypoxic tissue :-HBO increases plasma and tissue oxygen tensions 10 times which helps tissue to maintain tissue viability without RBC’s Neutrophil oxidative killing :- Neutrophils regain ability to kill bacteria by generation of oxygen dependent superoxides and peroxides Suppression of multiplication in bacteria :-High oxygen tension suppress growth of bacterias like streptococcus

4. Augmentation of antibiotic effectiveness :- Increased oxygen tension allow oxygen dependent active transport to bring i n antibiotic across bacterial cell wall. Angiogenesis: - Increased oxygen tension increases vascular endothelial growth factor function as well as secretion of matrix by fibroblasts

5. TYPES OF HYPERBARIC OXYGEN CHAMBER

6. MONOPLACE

7. MULTIPLACE

8. Advantages of Monoplace Chamber Patients are cared individually thereby maintaining privacy Isolation of patients insures that there is no amplification or spread of disease from other patients

9. PROCESS OF TREATMENT Initial compression for 30minutes Treatment for 90 minutes with air breaks(10 minutes every 30 minutes is standard) Decompression for 30 minutes All regimen uses 100% O2 Pressure :- Most use 2.4atm Maximum tolerated is 3 atm 4 atm induces seizures

10. INDICATION Decompression sickness Thermal Burns Diabetic wound care Air embolism Mandibular osteoradionecrosis Necrotising soft tissue infection Enhancement of Skin graft and flap viability Radiation sensitization Sudden SNHL Malignant otitis externa

11. Chronic ulcer Oxygen is required for angiogenesis , collagen deposition, re epithelisation, cellular respiration and oxidative killing of bacteria Decreased edema noted following hyperbaric treatment allow better diffusion of oxygen and nutrients through tissue while also relieving pressure on surrounding vessels and structures HBO has been used for treating foot ulcer in diabetic patient, burn wound, flap and skin graft

12. OSTEORADIONECROSIS Damage to osteocytes from radiotherapy HBOT does not affect necrotic bone Target is viable bone and soft tissue Goal is to revascularise radiated tissue and to improve fibroblastic density Healing process requires oxygen for:- Differentiation of fibroblast Synthesis of collagen 2.5-2.8 atm FOR 90-120 minutes

13. SKIN GRAFTS AND FREE FLAPS Grafted and transplanted tissue may be healthy,but implantation site may be hypoxic Due to tissue bed disease, vasospam , edema , infection Oxygen and nutrient supply compromised Their should be vascular connection for survival by giving HBOT HBO2 Mechanism:- Improves tissue po2 Promotes angiogenesis Augments immune response and limit inflammation

14. Radiation Sensitization Hypoxia increases the resistance of cancer to radiotherapy Increasing oxygen pressure in tumor can aid tumoricidal therapies .

15. Absolute Contraindications Untreated Pneumothorax - Converted to tension pneumothorax Cisplatin - Delayed wound healing Disulfiram -Blocks superoxide dismutase which decreases body’s ability to neutralise oxygen free radicals; inhibit hyperoxic induction of cytochrome P450.Potential for pulmonary toxicity

16. Relative contraindications History of spontaneous pneumothorax History of thoracic surgery Concurrent URTI Emphysema and COPD Seizures disorders Pregnancy

17. Complications Mild:- Claustrophobia (In monoplace chamber) Headache More serious complications:- Sinus damage Ruptured middle ear Lung damage

18. 3. Major complication Convulsion Respiratory failure

19. P itfalls of HBOT Doctors are rarely taught about HBOT HBOT Facilites are very expensive to estabilish

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