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Hyperbaric Oxygen Therapy

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Title: Hyperbaric Oxygen Therapy Author: William Wojciechowski Last modified by: William Wojciechowski Created Date: 5/28/2007 9:02:48 AM Document presentation format – PowerPoint PPT presentation

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Title: Hyperbaric Oxygen Therapy


1
Hyperbaric Oxygen Therapy Oxygen
Toxicity Module III
  • CRC 431
  • Special Procedures

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 mm Hg
  • HBO general pressure range 2 to 3 ata

4
Hyperbaric Oxygen Therapy
  • Pressure
  • Pressure Force/Area
  • Force
  • Force mass x acceleration
  • Remember MIP, not NIF!!!

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 one is surrounded by air
  • atmospheric pressure
  • ambient pressure
  • barometric pressure

7
Hyperbaric Oxygen Therapy
  • Absolute pressure referenced against a perfect
    vacuum
  • gauge pressure atmospheric pressure.
  • Gauge pressure referenced against ambient air
    pressure
  • absolute pressure - atmospheric pressure

8
Hyperbaric Oxygen Therapy
  • When surrounded by water
  • ambient pressure water pressure
  • CAUTION!!! Dont confuse atmospheric pressure
    atmosphere (atm) used as a unit.

9
Hyperbaric Oxygen Therapy
  • Atmospheric pressure can be ANY value
  • 1 atm (sea level) 760 mm Hg
  • ½ atm (8,000 ft elevation) 380 mm Hg
  • 3 atm (hyperbaric chamber) 2,280 mm Hg

10
Hyperbaric Oxygen Therapy
  • ABSOLUTE PRESSURE vs.
  • GAUGE PRESSURE
  • 33 ft sea water 1 atm
  • Gauges set sea level pressure at 0 mm Hg
  • At 33 ft depth, gauge indicates 1 atm
  • Absolute pressure 2 atm

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

13
Hyperbaric Oxygen Therapy
  • J. Priestly discovered O2 in England 1776 called
    dephlogisticated air.
  • Antoinne Lavoisier of France shares O2 discovery
    named oxygen
  • Father of English poet Thomas Lovell Beddoes

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

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

16
Hyperbaric Oxygen Therapy
  •  

17
Hyperbaric Oxygen Therapy
  • Boyles law
  • During HBO, D in lungs increases.
  • Deep scuba diving D 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)
  • EXAMPLES
  • 150 mm Hg 0.21(760 mm Hg 47 mm Hg)
  • 160 mm Hg 0.21(760 mm Hg 0 mm Hg)

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 plasma.

31
Hyperbaric Oxygen Therapy
  • Physiological 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
  • Physiological Effects
  • Hyperoxygenation
  • At sea level while breathing room air plasma O2
    concentration is 0.3 vol
  • 100 mm Hg x 0.003 vol/mm Hg 0.3 vol

33
Hyperbaric Oxygen Therapy
  • Physiological Effects
  • Hyperoxygenation
  • Alveolar Air Equation

PAO2 FIO2(PB PH2O) PaCO2 (FIO2 1.00
FIO2 R)
34
Hyperbaric Oxygen Therapy
  • Physiological Effects
  • Hyperoxygenation
  • HBO patient breathing FIO2 0.40 _at_ 2.5 atm


PAO2 0.40(1,900 mm Hg 47 mm Hg) 40
mm Hg(0.40 1.00 0.40/0.8)
35
Hyperbaric Oxygen Therapy
  • Hyperoxygenation
  • PAO2 0.40 (1,900 torr 47 torr) 40
    torr(1.15)
  • PAO2 1,807 torr (mm Hg)
  • 1,807 torr 0.003 vol/torr 5.4 vol
  • 5.4 ml O2/100 ml plasma

36
Hyperbaric Oxygen Therapy Normal a-v difference
5.0 vol
  • Arterial Blood
  • PaO2 100 mm Hg
  • SaO2 97.5
  • Hb 15 g
  •  

37
Hyperbaric Oxygen Therapy
  •  

38
Hyperbaric Oxygen Therapy
  • Physiological Effects
  • Hyperoxygenation
  • HBO increases dissolved oxygen in the plasma

39
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40
Hyperbaric Oxygen Therapy
  • Physiological 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
  • Physiological 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
  • Physiological Effects
  • Bactericidal/Bacteriostatic
  • Halts spread of toxins
  • Enhances killing of bacteria
  • Stimulates production of neutrophils

43
Hyperbaric Oxygen Therapy
  • Physiological 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 mm Hg

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
56
Oxygen Toxicity
57
Oxygen Toxicity
  • Joseph Priestley said in 1775,
  • . . . it oxygen might be peculiarly salutary
    to the lungs in certain morbid cases . . . and
    . . . oxygen might burn the candle of life too
    quickly, and too soon exhaust the animal powers
    within. . . .

58
Oxygen Toxicity
  • Present overview of biochemical processes
    involved in normal cellular utilization of
    oxygen.
  • Discuss implications of the processes in the
    context of hyperoxia.
  • Explain biochemical role of antioxidants.
  • Describe the pathophysiological aspects of
    pulmonary oxygen toxicity.

59
Oxygen Toxicity
  • Oxidation loss of electrons
  • Reduction gain of electrons
  • Dismutation same molecular species is oxidized
    and reduced, and two different products (species)
    are formed.

60
Leo the lion goes gerrr!
e, e, e
e, e, e
e, e, e, e, e, e
Oxidation
Reduction
Loss of electrons
Gain of electrons
Dismutation
e, e, e
e, e, e
e, e, e, e, e, e
Oxidation
Reduction
61
Oxygen Toxicity
  • Atmosphere
  • Lungs
  • A-C membrane
  • Dissolved in plasma as PaO2 (Henrys law of
    Solubility)
  • Chemically reversibly bound to Hb
  • Mitochondria electron transport chain

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Oxygen Toxicity
  • Oxygen atom
  • 8 electrons (e-)
  • 2 e- in 1s orbital
  • 2 e- in 2s orbital
  • 4 e- in 2p orbitals (px, py, pz)
  • 2 e- are paired
  • 2 e- are unpaired spin in same direction causing
    paramagnetism

65
e
66
Mitochondrion
67
Mitochondrion
Electron micrograph
68
  • Electron Transport Chain
  • http//www.youtube.com/watch?vxbJ0nbzt5Kwfeature
    related
  • http//www.youtube.com/watch?vajZajFrCjtAfeature
    related
  • http//www.youtube.com/watch?vRvqR4pExHX8feature
    related
  • http//www.youtube.com/watch?veizHVQfeMwofeature
    related
  • http//www.youtube.com/watch?vXI8m6o0gXDY

69

Mitochondrion Electron Transport
Chain
  • Single electron transfers occurs 4 times/O2
    molecule)
  • O2 undergoes 4 separate univalent reductions
  • 1 e- at a time added to O2
  • O2 gains 1 e- at a time
  • Reduction of O2 molecule 2 H2O

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72
dehydrogenase
bc1
c oxidase
Q ubiquinone, or co-enzyme Q
73
Mitochondrion Electron Transport Chain
  • e- brought to ETC from Krebs Cycle
  • by electron carriers
  • NADH
  • FADH2
  • http//bcs.whfreeman.com/thelifewire/content/chp07
    /0702001.html
  • Overall reaction
  • O2 4H 4e- 2 H2O

74
Cytotoxic Metabolites of Oxygen
  • O-2 (superoxide anion)
  • H2O2 (hydrogen peroxide)
  • OH (hydroxyl radical)

75
Cytotoxic Metabolites of Oxygen
  • 1st Electron Transfer O2 e- ? O-2
  • 2nd Electron Transfer O-2 e- 2H ? H2O2
  • 3rd Electron Transfer H2O2 e- H ? H2O OH
  • 4th Electron Transfer OH e- H ? H2O
  • Overall Reaction
  • O2 4H 4e- ? 2 H2O

76
O2 Metabolism
  • Summary Univalent Reduction of O2
  • O2 O-2 H2O2 OH
    H2O

e
e 2H
e H
e H
H2O
77
Free Radicals
  • form during chemical RXN between atoms when one
    product contains unpaired electron in outermost
    shell
  • extremely unstable state
  • highly reactive with other molecules to achieve
    stable state
  • ROS includes free radicals

78
Free Radicals
  • During oxygen metabolism, natural by-products
    often possess unpaired valence shell electrons
  • O12 (singlet O2) and OH contain unpaired
    electrons in their outermost shells
  • highly unstable, reactive, can be cytotoxic

79
Endogenous Antioxidant Defense Mechanisms
  • ROS free radicals can compromise the integrity
    of cell membranes
  • cytotoxic effects of ROS free radicals can
    occur
  • Normally, they do not
  • Aging?

80
Endogenous Antioxidant Defense Mechanisms
  • Counteract potentially harmful effects of the
    oxygen metabolites generated during aerobic
    respiration
  • ROS free radicals cytotoxic
  • Large quantities
  • Defense mechanisms lacking/compromised

81
Endogenous Antioxidant Defense Mechanisms
  • Oxidative stress
  • Double-edged sword
  • Essential for life PMNs
  • Potentially lethal damaging amount
  • PMNs release O-2 proteolytic enzymes to wage
    war with invading microbes
  • Destroy cell wall of microbes
  • Antioxidant defense mechanisms protective

82
Oxidative Damage
  • Destruction of Normal Tissue
  • Immunocompromised (e.g., AIDS)
  • Frequent pulmonary infections (e.g., CF, COPD)
  • Granulomatous disease (e.g., CGD)

83
Enyzymatic Antioxidant Defense Mechanisms
  • Superoxide dismutase (SOD) breaks down 2 O-2
    species to H2O2 O2
  • Catalase breaks down H2O2 to H2O O2
  • Glutathione peroxidase breaks down H2O2 to H2O
    R-OHs

84
Non-Enyzymatic Antioxidant Defense Mechanisms
  • Vitamin E (alpha tocopherol) membrane-bound
    stops free radical reactions
  • Vitamin C (ascorbic acid) membrane-bound stops
    free radical reactions

85
Pulmonary O2 Toxicity
  • Disruption of A/C membrane unsaturated fatty
    acids along phospholipid bilayer are targets
  • Exudation of fluid
  • Alveolar fibrosis

86
Animations Information
  • http//plantandsoil.unl.edu/croptechnology2005/pag
    es/animationOut.cgi?anim_namelipid_peroxidation.s
    wf
  • http//www.medmotion.com/html/hydroxyl.html
  • http//www.cyberlipid.org/perox/oxid0002.htm3
  • http//www.youtube.com/watch?vGItnvCzV618

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