Putting together all the Answers to your Questions on HBOT is probably like trying to piece a quilt together and getting the look or in the case of HBOT, the understanding you want before adding Hyperbaric Oxygen Therapy to your plan.

If you have Questions which are not answered here, please email them to me and I will try to add them. After all, that is what this page is about, answering questions on HBOT. 
Questions and Answers about Hyperbaric Oxygen Therapy
HBOT
Q & A
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NOTE: Some of the answers given here are based on info for the USA and may vary in other countries.  Also, some may not agree with all answers or may have a different answer.  If you have better or more accurate information, or a different viewpoint, please email it to me by CLICKING HERE.   I want to provide the most up to date and accurate information possible.   We do not guarantee the accuracy of all answers and we make every effort to be as accurate as possible.  This info is provided as a public service by Miracle Mountain.

JUST CLICK ON THE QUESTION FOR THE ANSWER:

For more specific questions on HBOT for CP or more specific neurological problems in children with Autism, PVL, CVI, etc. , CLICK HERE  to return to the HBOT Manual.

For SPECIFIC QUESTIONS on HBOT Protocol, CLICK HERE
Q: Why is oxygen so important?
Q: What do you feel inside a hyperbaric chamber?
Q: What difference does extra pressure create?
Q: How does being inside a pressurized chamber give us more oxygen?
Q: What is the difference between saturation and oxygen tension?
Q: How does hyperbaric oxygenation help in pain management?
Q. Where can I find a Hyperbaric Provider?
Q. What is a monoplace chamber?
Q. What is a multiplace chamber?
Q. What is a soft side or inflatable chamber?
Q. Which chamber is best to use?
Q. Do I need a prescription for HBOT? 
Q. Which is better, a Hood or a Mask?
Q. What improvements can I expect to see for CP?
Q. What improvements can I expect with Autism?
Q. When will I know how many sessions of hbot are enough?


Q: Why is oxygen so important?
A: Every day an average adult consumes 4 pounds of food, 2 pounds of water and almost 6 pounds of oxygen. People need about the same amount of oxygen by weight compared to food and water combined! From that 6 pounds of oxygen about 2 pounds gets into the blood for transport to tissue cells.  We need this oxygen for the energy cycle that sustains life. When we do not have enough oxygen in our body tissues a series of events occur that if not corrected lead to disease conditions, either infection, tissue destruction or both.  If there is low oxygen in tissues (hypoxia) there is a short window of opportunity to correct it.  An excellent method to correct tissue hypoxia is by using a hyperbaric chamber.  This web site is dedicated to making complex physiology easier to understand so we can make informed choices about health care.

Q: What do you feel inside a hyperbaric chamber?
A: Chamber atmosphere pressurization occurs slowly allowing you to adjust ear pressure changes. Yawning, swallowing or "blow the nose" clears ear pressure changes. Other than this ear pressure there are no unusual or different sensations.

Q: What difference does extra pressure create?
A: Hemoglobin (in red blood cells) holds 97% of its maximum amount of oxygen from normal air or holds 100% when breathing pure oxygen. One gram of hemoglobin can only combine with 1.34 ml of oxygen.  Therefore, red blood cells can only deliver a limited level of oxygen to tissue cells, a pO2 of 39 mmHg or less.  This is  called oxygen tension (or oxygen partial pressure, "pO2") and is measured in units labeled "mmHg" (the amount of pressure able to raise the equivalent weight of a liquid mercury column. Injuries, infections and diseases can drop this vital tissue oxygen level down to almost zero! As we age we can loose vital lung capacity and the ability to effectively obtain adequate oxygen.  Some disease conditions impair oxygen utilization. Also, injuries or conditions with swelling can cause pressure that cuts off
circulation flow. This loss of blood flow, called ischemia, cuts off oxygen circulation to the affected areas of the body. This problem drops the pO2 gravely low, destroys tissue, and slows healing. Research has shown optimal tissue healing occurs if pO2 rises to between 50 and 80 mmHg. Oxygen given in a normal room is not sufficient to raise tissue oxygen levels to that level because red blood cells cannot carry the extra oxygen. The answer is to deliver the oxygen in a pressurized chamber to raise oxygen tension beyond red blood cell saturation.

Q: How does being inside a pressurized chamber give us more oxygen?
A: When we are inside a chamber pressurized at twice the normal air pressure it may not feel different, but we breathe double the number of molecules. Breathing pure oxygen in such a chamber gives us 10 times the regular amount of oxygen. In one hour we can inhale about 2.4 pounds of oxygen. The extra
oxygen dissolves directly into the blood fluid. In a few minutes this extra oxygen builds up tissue oxygen levels far above  normal. This action has been scientifically proven to stimulate healing.  In order to raise tissue oxygen tension above 50mmHg for optimal healing one must have oxygen delivered under increased atmospheric conditions. Look at the hyperbaric chart and observe the venous oxygen tension, which closely represents the final tissue oxygen tension, rise as we breathe oxygen beginning at 1.5 atmospheres of increased pressure.  This marks the start of true hyperbaric pressure.  Notice the phenomenal rise once atmospheric pressure increases twice above normal.  This hyperoxia, increased tissue oxygen, is useful in healing.

Q: What is the difference between saturation and oxygen tension?
A: The problem we face in advocating proper usage of oxygen involves confusion between saturation and oxygen tension, 100% vs.. 100 mmHg. Only dissolved oxygen contributes to the tension (or partial pressure). Study the figures for oxygen transported by plasma (liquid) vs.. hemoglobin (one gram hemoglobin  can only combine with 1.34 ml oxygen) - in 100ml of healthy blood there is 19ml oxygen as oxyhemoglobin and 0.3ml oxygen in liquid solution, here the hemoglobin is near maximum saturation (98%) and the pressure or tension of oxygen in the liquid solution is initially 95mmHg and downline tissue levels drop to 39mmHg or less. Breathing pure oxygen at 2.5 times atmospheric pressure increases the amount of oxygen in (plasma) liquid solution to about 6 ml per 100ml blood.  This increased oxygen volume measurably increases the oxygen tension and downline tissue levels can rise upwards of 200mmHg.

Oxygen given with increased pressure can correct many serious health problems. Hyperbaric oxygenation helps the body heal from conditions that have low oxygen  in the tissues causing or complicating the outcome. Repetitive hyperbaric sessions can help many different conditions; let's mention the first few ABC's such as anemia, burns and crush injuries. Compromised skin grafts often improve with hyperbaric oxygenation. Difficult to heal infections treated with hyperbaric oxygenation has attracted interest lately as antibiotic therapy can fail to clear today's resistant strains of pathogens. Treatable infections include such
diverse situations as actinomycosis, osteomyelitis, diabetic wounds, gangrene and related deadly tissue infections. In the last four decades hyperbaric oxygenation research has raised the value of this unique therapy. Doctors used to ask, "Can it work?" now they ask, "How much is needed to completely work?"

Q: How does hyperbaric oxygenation help in pain management?
A: Related to crush injuries, pain results from swelling around sensory nerves.  Hyperbaric oxygenation acts internally to reduce swelling. Swelling causes ischemia, lack of oxygen circulation.  When ischemia is severe and persistent it may lead to an anaerobic form of tissue metabolism that perpetuates the entire
ischemic process. Reference: W. Boyd A Textbook of Pathology 8th edition pg. 69.   Irritation of nerve roots with muscle spasms along the segmental distribution of nerve roots can create ischemic changes that can lead to serious impairment.  Reference: R. Jackson The Cervical Syndrome 4th edition pg 148.   A major cause of musculoskeletal pain originates from ischemia, that compares with the pain experienced in angina. Reference: T. Lewis "Pain in muscular ischemia" Archives Internal Medicine 1932;49(5):713-27.  Many conditions of the central nervous system stem from vascular ischemia. Reference: N.A. Hood "Diseases of the central nervous system" British Medical Journal 1975;3:398-400.   It has been well known for several decades that ischemia has a depressant effect on nerve conduction, especially in the more sensitive afferent fibers. Reference: J.W. Magladery,et al "Electrophysiological studies of nerve and reflex activity in normal man" Bulletin John Hopkins Hospital 1950;86:291-312.  Ischemic changes in nerve root microcirculation often leads to intraneural edema that worsens the trouble. Reference: B.Rydevik, M.D.Brown, "Pathoanatomy and pathophysiology of nerve root compression" Spine 1984;9(1):7-15.
Recovery of nerve (and other tissue) depends on eliminating ischemia in the affected tissue. Reference: F.H.Bentley, W.Schlapp "Experiments on the blood supply of nerves" Journal Physiology (London) 1943;102:62-71.   Hyperbaric oxygenation has proven benefits in reversing the effects of ischemia. References: J.D.Yeo "A study of the effects of hyperbaric oxygen on the experimental spinal cord injury" July 30, 1977 The Medical Journal of Australia pg.145-147.  I.Eltorai "Hyperbaric oxygen in the management of pressure sores in patients with injuries to the spinal cord" Journal Dermatological Surgical Oncology 7:9  Sept 1981; 737-739.  A.Sirsjö et al "Hyperbaric oxygen treatment enhances the recovery of blood flow and functional capillary density in post-ischemic striated muscle" 1993 Circulatory Shock 40:9-13.

Q. Where can I find a Hyperbaric Provider?
A. The easiest way it to go to the HBOT Providers Page.

Q. What is a monoplace chamber?
A. A monoplace chamber is designed for one person to go inside.  Most monoplace chambers are compressed using 100% oxygen although some are compressed using air and a hood or mask for oxygen.  Some monoplace chambers have large acrylic windows while others may have portholes to see out.

Q. What is a multiplace chamber?
A.  A multiplace chamber is designed for more than one person to go inside.  The oxygen is usually administered using a hood or mask.  There is also a duoplace chamber which is designed for 2 people.

Q. What is a soft side or inflatable chamber?
A.  An inflatable chamber is designed and approved primarily for high altitude sickness although they are becoming popular and are now being designed for multiple use.   They normally use ambient air and go to 1.3 ATA although some newer designs are being introduce which will go to 1.5 ATA and can be used with oxygen with proper credentials and training.

Q. Which chamber is best to use?
A.  This is a matter of personal preference.  No matter what type chamber you are in, if you are recieving oxygen at a specific pressure, the result will be the same.   You normally will use what is available at the specific facility you go to for HBOT.  

Q. Do I need a prescription for HBOT? 
A.  In the USA a prescription is required to recieve oxygen in a hyperbaric chamber.  Oxygen is considered a drug by the FDA and therefore requires a prescription.

Q. Which is better, a Hood or a Mask? 
A.  This is a matter of preference as both are just as effective.   Hoods are more popular, especially with children because they are totally clear with easy visibility and children get used to them very fast.  Some adults may prefer masks over hoods.  Some masks are more difficult to adjust to the face to avoid the escape of oxygen.

Q. What improvements can I expect to see for CP?
A. This is one of those questions which has so many different variables and answers we will have to generalize.  We will answer this question from general experience and with the understanding that no 2 children get the same results.  It is very rare that we do not see improvements.  They range from very mild to amazing.  One of the first improvements you will see is the relaxing of muscles, hands, legs, etc.   You will see the opening of clenched hands normally as one of the first improvements.   CVI, Cortical Vision Impairment improvements is one of the amazing results we see normally during the first 40 sessions.  Most children who do not sleep well and wake up often during the night will improve which can be a major relief for everyone.  Do not expect miracles or overnight cures.  It simply does not happen that way with brain injury.  It can take 30 or 40 sessions to begin to see improvements because of the time required for new capillary growth to take place to provide a continuous supply of oxygen to those areas which show damage.    The more sessions, the more growth, the more permanent improvements.  Motor skills will improve at all levels and in varying degrees.  They will continue to improve as the quantity of treatments increase.    Appetites normally increase, sometimes significantly which will often cause a growth spurt.  Eating skills also will improve and many times the ability to chew and swallow will improve.  If a child is on a feeding tube, don't expect them to go off the tube, although it can happen.   What we are looking for is an improvement in the quality of life for the child.   What may seem very small to us now could be major as the child becomes an adult. 

Q. What improvements can I expect to see for Autism?
A.  Autism being treated by hbot is fast  becoming a very popular therapy  because of the success we are experiencing.  Some of the fastest results being seen are in the childs ability to comprehend commands, be more manageable, etc.   Direct eye contact seems to be a positive result in most cases.   Also, sensitivities to sound, feel, etc. seem to improve very fast.  Children begin to respond to parents faster and better.  These improvements seem to be permanent and continue to improve with additional treatments.   They work well with children who have been doing chelation as well as those who have had no chelation.   And it can be done before, during or after hbot.

Q. When will I know how many sessions of hbot are enough?  
A. You will not.  What you will be able to notice as a parent or caregiver is whether you are continuing to get improvements.   If you saw results during the first 40 sessions, do another 40.  If improvements continue, do another 40.  Etc. Etc.   You are a better judge of the number of sessions needed than any Doctor.  No one knows your child better than you do.   




SPECIFIC PROTOCOL QUESTIONS:
Q.  What protocol is best for HBOT?  A. Protocols are set up according to the specific diagnosis.  Most brain injury protocols are 1.5 ATA, however, the specific requirements of individual patients may need to be adjusted.  Most facilities are familiar with different protocol requirements for different diagnosis.  

Q.  How long should each session be?    A. This depends on specific protocols for the condition being treated.  Most treatments under 2 ATA are one hour in duration with no oxygen breaks required.  Over 2 ATA may require oxygen breaks depending on length of treatment.

Q. Which is best, 1 or 2 sessions per day?   A. For most conditions involving brain injury, either is acceptable.  Many believe that 1 per day may be less stressful if you are within easy driving distance of the facility.  However, 2 per day is probably better if you must stay away from home.  The main issue is not to create stressful conditions for the patient. 

Q. How much time should there be between treatments?  A. Normally, 3 to 4 hours should lapse between sessions of HBOT.

Q.  What about Oxygen Toxicity?   A.  Oxygen Toxicity is not a problem at pressures below 2 ATA.  Many times stress is mistaken for oxygen toxicity.   Occasionally, there may be a patient who is more sensitive to Oxygen than others and pressures may need to be adjusted to meet the needs of the patient.

Q.  How many sessions are needed at each Series of treatments?   A.  Normally, the protocol will be to do at least 40 sessions the first time.  After that they may be grouped in smaller numbers.  

Q.  Should we do therapy during sessions or between sessions? 
Q.  How long should we wait from one series of treatments to do another series?
Q.  How many sessions will it take for my child?


Chapter 1 of the HBOT Manual
UNDER CONSTRUCTION
Questions answered by Dr. Harch on the MUMS site, click here

Questions answered by Dr. Kenneth Stoller