hiperbarična komora Baromed Bolnica Trebinje

In addition to being inevitable for life, the oxygen can be used as medicine.

Basically, a large number of pathological conditions are caused by hypoxia - a state of reduced volume or a reduction in partial pressure of oxygen. Reduction of the oxygen concentration in cells and tissues causes disorder in the function of cells, organs and organ systems, e.g. only 3-4 minutes without oxygen is enough to cause permanent damage to the brain tissue. Oxygen medical treatment of various diseases is a routine practice in health care facilities. Oxygen is a MEDICINE and as such has:

  • Indications
  • Contraindications (absolute and relative)
  • Dosage and method of administration
  • Mechanism
  • Possible side effects
  • Interactions with other drugs

What is hyperbaric oxygenation (HBO)?

Hyperbaric oxygenation (HBO) is a research-based method which is based on usage of 100% molecular oxygen at the pressure higher than the atmosphere.

It is administered in special devices-hyperbaric chambers, for the purpose of treating various diseases and conditions. There are about 30 known physiological effects of HBO which indicate this type of therapy and almost no area of medicine in which hyperbaric oxygenation is not applicable.

On which principle is based hbo therapy (HBOT)?

The oxygen is transported through the blood in two ways:

  • linked to hemoglobin
  • physically dissolved in plasma

Hemoglobin is saturated 97% so there is possibility of additional increase of only 3%. However, the therapeutic effect of HBOT is based on physical laws that allow the dissolution of oxygen in plasma. By increasing environmental pressure, oxygen dissolute in plasma leading to increase in partial oxygen pressure. In this way, level of dissolved oxygen in the blood raises up to 20 times, which enables its transport and reduction of hypoxia independent of the red blood cells. Tissues and cells get the splendor of oxygen that is available to them and which is necessary for their normal function and to correct hypoxia as the basis of many diseases and pathological states.

HBOT has many benefits and some of them are:

  • Angiogenesis - stimulates the growth of blood vessels in the hypoxic tissue and accelerates the healing of wounds
  • Hyperoxygenation - A high level of oxygen helps to recover cell functions
  • Osteogenesis - stimulates the production of new bone tissue in fractured or compromised bone tissue
  • Vasoconstriction - leads to a decrease of tumefactions
  • Repair and regeneration of tissue by increase in production of stem cells
  • Reduction of inflammation
  • Stimulation of the immune response
  • Bactericidal and bacteriostatic effect (especially in anaerobic bacteria)
  • Synergistic effect with antibiotics

What conditions could be treated with HBO therapy?

Hyperbaric oxygen has been implemented in many branches of medicine:

  • ER: gas gangrene and air embolism, carbon monoxide poisoning, decompression sickness, acute traumatic ischemia (crush injuries and compartment syndrome)
  • Surgery: soft tissue infections, necrotizing fasciitis, chronic wounds, arterial, venous and combined ulcers, diabetic foot ulcers, diabetic foot rot and gangrene, decubitus
  • Vascular Surgery: atherosclerosis, acute and chronic arterial insufficiency, and ischemic wounds on the lower extremities, Mb Buerger, Mb Raynaud, vasculitis
  • Neurology: multiple sclerosis, migraine, cluster headache, polyneuropathy of different etiology (diabetic, alcoholic, medicamentous), after CVI (stroke), trigeminal neuralgia, Parkinson's disease, dementia
  • Dermatovenerology: pyoderma gangrenosum, psoriasis
  • Rheumatology: systemic sclerosis, osteoporosis, rheumatoid arthritis, lupus, fibromyalgia
  • Orthopedics and Traumatology: disbaric osteonecrosis, aseptic necrosis of the head of the femur and humerus, osteomyelitis, crush injuries, slow fracture repair
  • Plastic and Reconstructive Surgery: compromised skin transplants, burns, frostbite
  • Urology: gangrene Fournier, post radiation cystitis, vascular impotence
  • Gynecology: vascular sterility
  • ORL: acute deafness, malignant otitis externa, tinnitus, Bell's paresthesia
  • Ophthalmology: occlusion of the central retinal artery
  • Hematology: heavy anemia
  • Gastroenterology: ulcerous colitis, Crohn's disease
  • Sports Medicine: treatment of sport injuries of muscle, bone, tendon, an accel recovery after exhausting and training and competition
  • Pediatrics: cerebral paralysis, autism
  • Oncology: post radiation necrosis of the skin and soft tissues, increase in radiosensitivity of tumor tissue
  • Neurosurgery: cerebral abscesses, traumatic brain injuries
  • Stomatology: osteomyelitis of the mandibular, infections following surgical interventions and tooth extractions, prior and after implantation

What are the preconditions for treatment in HBO chamber?

Before the first treatment in HBO chamber, patient must be examined by physician in our institution, who will determine therapeutic protocol and medical plan in relation to overall health condition.

Additional examination from the different specialists (ORL, cardiologist, ECG, doppler of the blood vessels,…) and laboratory analysis of blood and urine might be requested for safe and adequate HBO treatment. After examining, and during the pre-treatment for HBO therapy in our institution, patient will receive clear written and oral instructions that are necessary to be followed for the adequate therapeutic effect of hyperbaric oxygenation and patient’s safety during the treatment.

Is the HBO therapy safe?

Patient is under medical supervision during the whole treatment. The therapy is completely painless.

The patient is lying calmly in the chamber and inhales the oxygen that fills the chamber. There is audio and visual contact between patient and doctor. At any time during the treatment, communication with the medical staff operating the chamber is enabled. To prevent potential risk situations, before the treatment patients receive clear instructions on how to prepare for treatment, and a list of materials and devices which are prohibited in HBO chamber. When following all instructions and cooperating with the medical staff who manage the chamber, therapy is completely safe.

How many HBO treatments are needed?

The number of treatments in the HBO chamber depends on the disease and patient’s condition that indicated HBO therapy and is determined by the physician that monitors the status of the patient and in relation to the recommended treatment protocols, the patient's condition, the reaction to the treatment, all in accordance with the principles of Good clinical practice.

10-15 treatments are recommended for the improvement of general psycho-physical condition in healthy people. In chronic wounds, the complications of diabetes and inflammation of the soft tissue, 20-30 treatments are recommended, and 40 - 60 treatments for osteomyelitis. Therapy is generally performed once a day. Depending on the condition, the therapy can be performed twice per day, and for anaerobic infections of soft tissues every 8 hours. Plan and protocol of treatment is made for each individual patient according to the health status and needs of the patient in order to achieve a better therapeutic effect.

One treatment in HBO chamber - how long does it take and how does it look like?

The treatment in the HBO chamber depends on the protocol that is designed for each patient. Usually treatments last 60-90 minutes. Each treatment consists of three stages:

  • Compression phase - phase when pressure raises up in the chamber. During this phase, you need to equalize the pressure in your ears in one of the ways that you will be explained verbally and in writing in the Instruction for patients.
  • Phase of isopression - Phase when you are at therapeutic pressure. You just need to be relaxed and concentrated on breathing that needs to be completely normal, without forcing.
  • Decompression phase - return to normal pressure. During this phase, it is not necessary to equalize the pressure in the ears, as this happens spontaneously. It is forbidden to hold breath during this phase of treatment.

How does a patient in HBO chamber react to high preassure and is there a chance of getting sick?

Patient during treatment in the chamber has the same feeling as when diving.

  • In the beginning of treatment, during the compression phase, the pressure increases in the chamber to the patient feels pressure or fullness in the ear. It is necessary that the patient, using some of the procedures learnt before treatment, equalize the pressure in his ears. While lying in the chamber, the patient is in verbal and visual contact with the medical staff that will help him in this process.
  • If there is any discomfort to the patient during treatment, the physician will terminate the therapy and react in accordance with the situation.
  • Prior entering the chamber, the patients mustn’t be hungry. It is necessary to intake a sufficient amount of liquids. It is necessary to take your regular therapy.
  • Due to a possible drop in blood sugar during HBO treatment in diabetics, it is forbidden to get insulin 1 hour prior to therapy.

Are there complications of treatment in the HBO chamber?

Complications in the chamber may be caused by elevated pressure or oxygen.

Due to exposure to high pressure, barotrauma of various organs can occur (ears, sinuses, teeth, lungs). Exposure to elevated oxygen concentrations under pressure can lead to toxic effects of oxygen on the CNS or lungs. It can also come to a transient myopia.

When is HBO treatment of choice, when is used as supplementary treatment, and can it be used for prevention or cosmetics purposes?

HBO therapy is method of choice in gas gangrene, carbon monoxide poisoning and decompression sickness. In these cases, hyperbaric oxygenation saves life.

  • For many other diseases HBO therapy is used as supplemental, along with other medicines and medical procedures. In medicine multidisciplinary approach for treatment of patients is required as well as the use of multiple therapeutic procedures and medicaments to achieve a satisfactory result. HBO therapy has great effect in the treatment of complications of diabetes, chronic wounds, circulatory problems, bone infections, gangrene, where combined with other medical and surgical therapy significantly reduces healing time, reduces amputation, improves quality of life. The process of rehabilitation after stroke is accelerated, as well as after other surgical procedures.
  • It is certain that HBO treatments can be used in prevention in healthy people and in athletes. It improves the general psycho-physical state and is more often used in treating management stress disease. HBO treatments in the athletic help to reduce swelling and pain in the acute phase, accelerate healing of bone fractures and soft tissue injuries and particularly accelerate recovery after exhaustion leading to more rapid return to the active training.
  • As far as application in cosmetics, HBO treatment is used because of the impact on cellular metabolism, accelerated synthesis of collagen and improvement of skin elasticity. Hyperbaric oxygenation is an inseparable part of anti-aging medicine.

Can everyone benefit from HBO treatment?

- NO!

Even HBO treatment is very safe there are absolute and relative contraindications for hyperbaric oxygenation.

Absolute contraindications:

  • Untreated pneumothorax
  • Certain types of medications: cytostatic (bleomycin, cisplatin, doxorubicin), disulfiram, sulfamylon

Relative contraindications:

  • Asthma, COPD, bullous lung alterations
  • Infections of the upper respiratory tract
  • Claustrophobia
  • Epilepsy
  • Pregnancy
  • Febrility
  • Congenital spherocytosis
  • Eustachian tube dysfunction
  • The presence of a pacemaker