Hyperbaric Oxygen Treatment (HBOT), often called Hyperbaric Oxygenation Therapy, refers to the delivery of oxygen at greater than normal atmospheric pressure at sea level for a prescribed duration which is usually 60 to 90 minutes.
The air we normally breathe contains 21% oxygen, 78% nitrogen, with the remaining 1% being contributed by the noble gases and carbon dioxide. The concentration of these gases is determined by the atmospheric pressure which is determined by the weather and is reduced at altitude. Unfortunately the variations in this pressure are ignored in general medical practice. Atmospheric pressure is accorded the unit 1 to represent atmospheric pressure absolute (1 ata) and this unit is divided according to the percentages of the gases in air to give their ‘partial pressures’ that is the part of the total pressure each gas is responsible for – oxygen therefore being 0.21 ata (21% of 1) and nitrogen 0.78 ata (78% of 1).
A hyperbaric chamber is needed to allow the pressure around the body to be increased. The technology is very well established, in fact all commercial aircraft are hyperbaric chambers equipped with oxygen breathing systems.
The air that we breathe usually provides enough oxygen for both normal body metabolism and repair to tissue damage after injury or illness. However increasing the pressure surrounding a patient in a hyperbaric chamber and using 100% oxygen can allow a very significant increase in the amount of oxygen dissolved in the bloodstream. This is in addition to the oxygen carried by haemoglobin. Normally the amount carried dissolved in plasma is about 0.3 ml per 100 ml of blood. At twice atmospheric pressure (2 ata) breathing 100% oxygen this increases to 3 ml oxygen in 100ml of blood. The increased concentration means that the gradient for the transport of free oxygen from blood into the tissues is increased 10 fold.
When tissues are damaged the capillaries within the tissues are also damaged which increases the distances for oxygen to diffuse. This can lead to a severe oxygen deficit in the tissues even when the amount of oxygen carried in the blood is normal. The object of using the increase in pressure and oxygen concentration is to raise tissue oxygen values towards normal to initiate normal cellular repair mechanisms. In fact oxygen, like glucose and water is an essential substrate.
Oxygen is dissolved in the blood and transported, in combination with haemoglobin in the red blood cells throughout the body. This dissolved oxygen passes into the tissues. Breathing high levels of oxygen under hyperbaric conditions causes greater uptake of oxygen by the bodily fluids and so more can reach areas where the circulation is diminished or blocked and therefore improve recovery. The extra oxygen has additional benefits as it greatly enhances the ability of white blood cells to kill bacteria. It also reduces swelling and allows new blood vessels to grow more rapidly into the affected areas.
Severe tissue hypoxia (oxygen deprivation) has many adverse effects from abolishing normal cell activity as, for example, with loss of consciousness to disabling white blood cell activity in infection. Only the administration of oxygen can ‘treat’ hypoxia and the objective of the administration of oxygen is to establish tissue oxygen values compatible with the initiation of normal healing.
Alcohol and drug detoxification Hyperbaric oxygen therapy has a documented role in alcohol and drug detoxification with claims that it reduces the time of withdrawal by up to half. It can also help reduce the symptoms and cravings experienced during nicotine withdrawal. 3
Asphyxiation High dosages of oxygen can be life saving in asphyxiation, such as near-hanging and carbon monoxide poisoning. 4
Brain cell damage HBOT can repair damaged brain cells, such as in alcohol and drug related cognitive impairment and there have been reports that it has had positive effects on Korsakoff’s syndrome.
Cancer Administration of oxygen under hyperbaric conditions may enhance the delivery of oxygen to hypoxic tumour cells, thereby increasing their sensitivity to radiation and chemotherapy.
Cerebral stroke, brain trauma, and neurologic disease
Chronic Multiple Sclerosis
Cognitive disorders Cognitive functioning in the aged
Decompression sickness and arterial gas embolism
Diabetes HBOT has been used to treat diabetic food wounds and can prevent sufferers from losing limbs.
Liver Disease Alcoholic liver disease and cases of Hepatitis have been helped by HBOT. A phase I trial launched by the University of Edinburgh and Castle Craig Hospital in Scotland is currently examining alcoholic liver function following HBOT.
Stem Cells HBOT increases the natural production of stem cells in the body by eightfold.
Radiation Injuries There is a risk of serious complications developing after radiation treatment for cancer (late radiation tissue injury (LRTI). Radiation treatment kills good cells along with bad cells. With HBOT the destructive effect of radiation can be mitigated as HBOT improves oxygen supply to damaged tissue and stimulates healing.
Transplant surgery The viability of an amputated limb or organ can be extended up to 12 hours for re-implantation surgery.
Virus treatment Breathing oxygen under pressure is virucidal i.e. it kills viruses.
Wound and burn healing HBOT helps to heal wounds and helps treat chronic ulceration.
Other HBOT can aid sleep, thereby helping reduce insomnia, it also stimulates the appetite
HBOT is a simple, non-invasive and painless treatment which most patients find comfortable and relaxing. You will be treated in a secure and comfortable purpose built chamber with a trained operator present to operate the barochamber. In certain circumstances the attendant will accompany clients into the chamber. There has been no recorded case of a patient suffering either a heart attack or a stroke undergoing hyperbaric oxygen treatment, and oxygen under hyperbaric conditions can be used as a treatment of both conditions.
On entering the chamber clients can use a chair or, alternatively, they may sit on the floor. It is recommended that you wear comfortable clothing and leave any jewellery or watches outside. No smoking materials, matches or lighters are allowed in the chamber.
The treatment session is conducted in three phases:
Once the door is closed, there will be some noise as the pressure increases. It will get warmer and you will feel fullness in your ears similar to when descending in an aeroplane. You will have been taught how to avoid discomfort by clearing or ‘equalising’ your ears. As soon as the chamber pressure increases, you will need to start making your ears ‘pop’. There are several ways to do this and the chamber attendant will find the best way that suits you. Some people find that swallowing is sufficient. If you develop any discomfort inform the attendant and the rate of compression will be reduced. There may be a few unusual noises but this is normal as the chamber ‘descends’.
On reaching the desired pressure (usually 1.5 to 2.0 ata) the client places a mask over the head and breathes oxygen for the duration of the session. The treatment begins when the pressure reaches the prescribed level. You may then rest, sleep, read or watch television if your chamber is equipped with one. The mask can be removed occasionally and the chamber can be decompressed at any time if necessary.
After the prescribed amount of time has elapsed the attendant will let you know when the treatment is complete and the pressure will be lowered slowly, at a rate that is comfortable. A session usually lasts just over an hour and can be repeated daily. If a patient is receiving two treatments a day the second treatment follows the first after a three to four hour break outside the chamber. A patient receiving one treatment per day will spend about two hours at the treatment centre.
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There has never been an accident due to fire in type 3 hyperbaric chambers and due to this safety record this is the type of chamber used at Castle Craig. The Department of Health in the UK believes that type 3 hyperbaric oxygen chambers do not need to continue to be regulated by the Healthcare Commission in order to ensure the provision of safe and effective services. Even so, at Castle Craig all precautions are taken.