Wednesday, August 20, 2008

Hyperbaric Oxygen Therapy (HBOT)

Written by Andy

As Lisa mentioned in a previous journal entry, we are considering hyperbaric oxygen therapy for Elijah. I have contacted many subject matter experts in the field of hyperbaric medicine over the past few weeks and have received an overall positive response regarding using HBOT to treat brain injury. I found this explanation of HBOT posted to an online support group by a medical doctor, some of which I’ve edited and added to for clarity.

There are two components to hyperbaric oxygen: increased ambient pressure and increased inspired oxygen concentration. The physics of hyperbaric oxygen in a nutshell is that under increased atmospheric pressure, more gas goes into substances.

This increased oxygenation, or hyperoxia, has several beneficial effects. First, the high level of oxygen in the blood allows improved oxygen delivery to tissues that are not getting enough oxygen at baseline (i.e. hypoxic tissues). Second, having times of alternating hyperoxia and hypoxia (as occurs during a series of HBO treatments) promotes the growth of new blood vessels into the hypoxic tissues, a process known as neovascularization.

In the case of a brain injury, whether from a traumatic brain injury, a stroke, a near-drowning, cerebral palsy, or any incident which causes lack of oxygen to part of the brain, there are some cells that have died.

It is thought that around the area of the dead cells or the "umbra" there is a surrounding area of damaged and dormant nerve cells--the "penumbra"--which can heal over time.

The theory--and there does seem to be considerable evidence to support it--is that when a patient is in a hyperbaric oxygen chamber and given 100% oxygen under increased atmospheric pressure, the oxygen dissolves not only into the red blood cells (as happens normally when we breathe) but also in much higher concentration into the blood plasma, the cerebral spinal fluid, the lymphatic system and all of the body's fluids, bathing all of the body's cells with increased oxygen levels.

The result is high levels of oxygen carried to the brain, bypassing the normal way the brain gets oxygen; by the circulation of the blood stream bringing oxygen rich red blood cells.

At least one study was conducted comparing the use of air, which has about 21 percent oxygen, to the use of 100 percent oxygen. The patients given room air were intended to be the "control" group, and they did as well as those with 100 percent oxygen. The conclusion, erroneously, I think, was that because there was no difference in outcome between the two groups, that hyperbaric oxygen was ineffective.

However, importantly BOTH groups improved. So the conclusion I believe is that the use of hyperbaric pressure does significantly help in healing injured tissue--in this case, the brain.

The KEY is the use of increased atmospheric pressure, so that increased oxygen dissolves into the cerebral spinal fluid to be delivered to the damaged brain tissue to speed up healing.I know that
Dr. Harch and some of the other hyperbaric medicine physicians have found 1.5 ATA with 100 percent oxygen given either once or twice a day to be safe.

It appears--although it would be nice to have better studies--that any amount of oxygen from room air to 100 percent oxygen has a beneficial effect. We know that for prolonged periods, using 100 percent oxygen can be toxic, but those are under conditions of using 100 percent oxygen over days or weeks. The short periods of time used for hyperbaric oxygen chamber treatment don't seem to carry that risk--the exposure is much shorter.

I hope my comments help in understanding how this process works. I'm not an expert in hyperbaric medicine, but I am a physician, and I have been certified as a PADI scuba diver, and I've tried to put together my medical knowledge and what I know about the physics of this to help make some sense out of it.

It is way past time for the US government to sponsor controlled studies using a variety of protocols, with careful assessments using
SPECT scanning. It is clear to many of us that there is a very great benefit from hyperbaric oxygen in treating a variety of brain injuries and many studies as well as individual case reports which prove this is true.

As you recall, Elijah suffered a lack of oxygen at birth, otherwise know as hypoxic ischemic encephalopathy (HIE), along with seizures shortly after birth. He has developmental delay and cortical vision impairment (CVI) as well as secondary microcephly (small head size) due to the lack of oxygen at birth.

I spoke with one certified neuroscience registered nurse (CNRN) who has been closely involved with clinical trials for many years using HBOT to treat acute traumatic brain injury. She told me in so many words that as a professional she could not recommend HBOT for brain injury as the studies to date have been inconclusive. She continued by telling me that as a mother, she would be doing what we’re doing.

I also spoke with a clinical research nurse involved in an ongoing clinical trial in Ohio sponsored by the Department of Defense involving 80 some children with cerebral palsy. She informed me of many positive initial results from the study
An Evaluation of Hyperbaric Treatments for Children With Cerebral Palsy. Many children see a decrease in spasticity (tight tone) and increased attention span.

Bottom line – there are minimal serious side-effects and maximum potential for positive results.

Please pray that we make the right decision regarding the use of HBOT for Elijah.


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