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Hyperbaric Oxygen Therapy Module II

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Hyperbaric Oxygen Therapy Module II CRC 432 Subacute Cardiorespiratory Care Problem-Based Learning Hyperbaric Oxygen Therapy Physiologic Effects Hyperoxygenation ... – PowerPoint PPT presentation

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Title: Hyperbaric Oxygen Therapy Module II


1
Hyperbaric Oxygen Therapy Module II
  • CRC 432
  • Subacute Cardiorespiratory Care
  • Problem-Based Learning

2
HBO OUTLINE
  • Definitions
  • History
  • Altitude/descent
  • Gas laws
  • Physiological effects of HBO

3
Hyperbaric Oxygen Therapy
  • Therapeutic oxygen at pressures greater than 1
    atm
  • Unit expressing HBO pressure ata
  • Ata atmospheric pressure absolute
  • 1 ata 1 atmosphere (atm), or 760 torr
  • HBO general pressure range 2 to 3 ata

4
Hyperbaric Oxygen Therapy
  • Pressure
  • pressure force/area
  • Force
  • force mass x acceleration

5
Hyperbaric Oxygen Therapy
  • Ambient pressure surrounding pressure on land,
    or under water.
  • Atmospheric pressure surrounding pressure
    caused by the weight of air.
  • Water pressure surrounding pressure caused by
    weight of water.

6
Hyperbaric Oxygen Therapy
  • Barometric pressure measure of atmospheric
    pressure
  • Barometric pressure atmospheric pressure
  • When surrounded by air
  • atmospheric pressure
  • ambient pressure
  • barometric pressure

7
Hyperbaric Oxygen Therapy
  • When surrounded by water
  • atmospheric pressure
  • water pressure
  • ambient pressure
  • CAUTION!!! Dont confuse atmospheric pressure
    atmosphere as unit

8
Hyperbaric Oxygen Therapy
  • Atmospheric pressure can be ANY value
  • 1 atm (sea level)
  • ½ atm (8,000 feet elevation)
  • 3 atm (hyperbaric chamber)

9
Hyperbaric Oxygen Therapy
  • ABSOLUTE PRESSURE vs. GAUGE PRESSURE
  • 33 ft sea water 1 atm
  • Gauges set sea level pressure at 0
  • At 33 ft depth, gauge indicates 1 atm
  • Absolute pressure 2 atm

10
Hyperbaric Oxygen Therapy
  • Standard atmospheric pressure average sea level
    pressure
  • 14.7 psi
  • 1034 cm H2O
  • 101.3 kPa
  • 760 mm Hg (torr)
  • 33 ft H2O
  • 29.9 in Hg

11
Hyperbaric Oxygen Therapy
  • First sealed chamber called Domicilium built in
    1662
  • Chamber held compressed air (21 O2)
  • Treated various ailments scurvy, arthritis,
    inflammation, rickets
  • Likely too little compression to benefit patients

12
Hyperbaric Oxygen Therapy
  • Beddoes is known as the Father of Respiratory
    Therapy
  • Thomas Beddoes founded the Pneumatic Institute
    in Bristol, England 1780
  • Patients inhaled different gases to treat their
    diseases
  • Pneumatic laboratory enriched with O2 treated
    chronic conditions
  • Father of English poet Thomas Lovell Beddoes

13
Hyperbaric Oxygen Therapy
  • J. Priestly discovered O2 in England 1776
  • Antoinne Lavoisier of France shares O2 discovery

14
Hyperbaric Oxygen Therapy
  • GAS LAWS
  • Air under hyperbaric conditions obeys the same
    gas laws as air in the atmosphere.
  • Boyles law (1627 1691)
  • Daltons law (1766 1844)
  • Henrys law (1774 1790)

15
Hyperbaric Oxygen Therapy
  • Boyless law
  • When mass T are K, V P inverse.
  • K V x P
  • K 2V x ½P
  • K ½V x 2 P
  • If P increases, V decreases, vice versa.

16
Hyperbaric Oxygen Therapy
  • Boyles law
  • When mass T are K, D P direct.
  • K D/P
  • Consider container open at one end holding 1 L at
    1 atm.
  • At 2 atm, V by ½, D doubles.
  • At 3 atm, V by ?, D triples.

17
Hyperbaric Oxygen Therapy
  • Boyles law
  • During HBO, density in lungs increases.
  • Deep scuba diving density of air increases,
    breathing becomes more difficult.

18
Hyperbaric Oxygen Therapy
  • Daltons law
  • PT pressure exerted by gas equals the sum of
    all the Pgas of the constituent gases.
  • PT P1 P2 P3 . . . Pn

19
Hyperbaric Oxygen Therapy
  • Daltons law
  • To calculate the partial pressure of a gas in a
    mixture of gases
  • Pgas Fgas (PT PH2O)

20
Hyperbaric Oxygen Therapy
  • Daltons law
  • TRUE or FALSE
  • The sum of the partial pressures of all the
    gases in a gas mixture can never exceed the total
    pressure of the gas mixture.
  • ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?

21
Hyperbaric Oxygen Therapy
  • Daltons law
  • TRUE!!!

22
Hyperbaric Oxygen Therapy
  • Daltons law
  • TRUE or FALSE
  • As air pressure increases (hyperbarism) or
    decreases (altitude), the partial pressures
    exerted by the constituent gases increases or
    decreases, as well.
  • ???????????????????????????????????????

23
Hyperbaric Oxygen Therapy
  • Daltons law
  • TRUE!!!

24
Hyperbaric Oxygen Therapy
  • Daltons law
  • TRUE or FALSE
  • When room air is compressed in a hyperbaric
    chamber, the percentage of the individual gases
    in the mixture is the same.
  • ???????????????????????????????????????

25
Hyperbaric Oxygen Therapy
  • Daltons law
  • TRUE!!!

26
Hyperbaric Oxygen Therapy
  • Daltons law
  • Lower partial pressures at altitude reflect
    presence of less O2 N2 molecules per volume
    compared to sea level.
  • Summit at Mt. Everest (29,000 ft)
  • 21 O2, 78 N2, 1 other
  • of O2 N2 molecules per volume of air only 1/3
    that at sea level.
  • PO2 PN2 only 1/3 that at sea level

27
Hyperbaric Oxygen Therapy
  • Henrys law
  • Amount of gas that dissolves in a liquid at a
    given temperature is a function of the partial
    pressure of the gas in contact with the liquid,
    and the solubility of the gas in that particular
    liquid.

28
Hyperbaric Oxygen Therapy
  • Henrys law
  • SIMPLIFIED As the partial pressure of a gas
    above the surface of a liquid increases, more of
    that gas will dissolve into that liquid.

29
Hyperbaric Oxygen Therapy
  • Henrys Daltons laws
  • When ambient pressure decreases (altitude), the
    partial pressures of O2 N2 in the body fall,
    and fewer O2 N2 molecules dissolve into the
    blood.

30
Hyperbaric Oxygen Therapy
  • Henrys Daltons laws
  • When ambient pressure increases (hyperbarism),
    the partial pressures of O2 N2 in the body
    increase, and more O2 N2 molecules dissolve
    into the blood.

31
Hyperbaric Oxygen Therapy
  • Physiologic Effects
  • Hyperoxygenation
  • Increases volume of O2 in plasma
  • 10 to 13 x greater than normal
  • Elevated O2 levels purge toxins CO from the body

32
Hyperbaric Oxygen Therapy
  • Physiologic Effects
  • Hyperoxygenation
  • At sea level while breathing room air plasma O2
    concentration is 0.3 vol
  • 100 torr x 0.003 vol/torr 0.3 vol

33
Hyperbaric Oxygen Therapy
  • Physiologic Effects
  • Hyperoxygenation
  • At sea level while breathing room air plasma O2
    concentration is 0.3 vol
  • 100 torr x 0.003 vol/torr 0.3 vol

34
Hyperbaric Oxygen Therapy
  • Physiologic Effects
  • Hyperoxygenation
  • Alveolar Air Equation

35
Hyperbaric Oxygen Therapy
  • Physiologic Effects
  • Hyperoxygenation
  • HBO patient breathing FIO2 0.4_at_ 2.5 atm

36
Hyperbaric Oxygen Therapy
  • Hyperoxygenation
  • PAO2 1,807 torr
  • 1,807 torr x 0.003 vol/torr 5.4 vol

PAO2 0.4 (1,900 torr 47 torr) 40 torr(1.15)
37
Hyperbaric Oxygen Therapy Normal a-v difference
5.0 vol
  • Arterial Blood
  • PaO2 100 torr
  • SaO2 97.5
  • Hb 15 g
  • Mixed Venous Blood
  • PvO2 46 torr
  • SvO2 73
  • Hb 15 g

38
Hyperbaric Oxygen Therapy
  • CaO2 (1.34)(15) (0.975) 100(0.003)
  • 19.6 vol
  • CvO2 (1.34)(15)(0.73) 46(0.003 vol.torr)
  • 14.6 vol
  • CaO2 CvO2 a-v diff 5.0 vol

39
Hyperbaric Oxygen Therapy
  • PHYSIOLOGIC EFFECTS
  • Hyperoxygenation
  • HBO increases dissolved oxygen in the plasma

40
Hyperbaric Oxygen Therapy
  • Physiologic Effects
  • Direct Pressure
  • Shrinks gas bubbles (Boyles law) to expedite
    reabsorption of gases
  • Good for decompression sickness (DCS aka the
    bends)
  • Good for air/gas embolism

41
Hyperbaric Oxygen Therapy
  • Physiologic Effects
  • Vasoconstriction
  • Reduces blood flow
  • No significant reduction in tissue O2nation
  • Benefits crushing type injuries
  • Benefits thermal burns
  • O2 directly enters interstitial fluid promoting
    healing

42
Hyperbaric Oxygen Therapy
  • Physiologic Effects
  • Bactericidal/Bacteriostatic
  • Halts spread of toxins
  • Enhances killing of bacteria
  • Stimulates production of neutrophils

43
Hyperbaric Oxygen Therapy
  • Physiologic Effects
  • Angiogenesis/Neovascularization
  • Promote growth of new blood vessels
  • Promote collagen formation to support new blood
    vessels

44
Hyperbaric Oxygen Therapy
  • Atmospheric pressure caused by weight of gas
    molecules in contact with earths surface
  • Atmospheric pressure exerted on a surface of
    water
  • Pressure decreases with altitude
  • Denver, CO at 5,280 ft elevation 1 atm 630 torr

45
Hyperbaric Oxygen Therapy
  • Water more dense than air
  • 33 ft sea water 1 atm (760 torr)
  • Pressure at any depth hydrostatic pressures
    atm pressure
  • Depth of 33 ft of H2O 2 atm, or 2 ata
  • At 33 ft H2O, 2,112 lbs over each ft2 of body (33
    ft x 64 lbs/ft3 2,112 lbs/ft2)
  • 66 ft H2O 3 ata

46
Hyperbaric Oxygen Therapy
  • Indications CHRONIC
  • Nonhealing wounds
  • Refractory osteomyelitis
  • Radiation necrosis
  • www.uhms.org/indications/indications.htm

47
Hyperbaric Oxygen Therapy
  • Hazards
  • Fire 50 deaths worldwide in 20 years (1997)
  • Most common FATAL complication
  • Only 100 cotton fabrics in chambers
  • No alcohol/petroleum products
  • No sprays, makeup, deodorant
  • Barotrauma
  • Ear/sinus trauma
  • Tympanic membrane rupture
  • pneumothorax

48
Hyperbaric Oxygen Therapy
  • Hazards
  • O2 Toxicity
  • CNS toxicity (twitching, seizures, convulsions)
  • Pulmonary toxicity (leaky A/C membrane)
  • Other
  • Sudden decompression
  • Reversible visual changes
  • Claustrophobia

49
Hyperbaric Oxygen Therapy
  • Hyperbaric Chambers
  • Monoplace transparent Plexiglas cylinder
  • One patient
  • No mask
  • No electric equipment inside
  • 100 oxygen
  • Less expensive than multi-place

50
Hyperbaric Oxygen Therapy
51
Hyperbaric Oxygen Therapy
52
Hyperbaric Oxygen Therapy
  • Multi-place chambers
  • large tanks able to accommodate 2 14 people
  • achieve pressures up to 6 atm
  • have a chamber lock entry system that allows
    medical personnel to pass through without
    altering the pressure of the inner chamber
  • allows patients to be directly cared for by staff
  • filled with compressed air patients breathe 100
    oxygen through facemask, head hood, or
    endotracheal tube.

53
Hyperbaric Oxygen Therapy
54
Hyperbaric Oxygen Therapy
55
COHb SYMPTOMS
10 Usually none
10-20 Mild headache, dyspnea
20-30 Throbbing headache, impaired concentration
30-40 Severe headache, impaired thinking
40-50 Confusion, lethargy , syncope
50-60 Respiratory failure, seizures
60-70 Coma, convulsions, depressed cardiac respiratory function
70 Coma, rapidly fatal
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