Optimal Treatment Dosage
What should we consider as the optimal treatment dosage?
When we talk about the brain we must consider its own specific metabolic requirements. One of the best studies in this regard examined cerebral metabolism of patients given increased pressure oxygen from 1½-to 2.0-ata pressure. Drs. Holback, Caroli and Wassmann in Bonn, Germany concluded that "At an inspiratory oxygen pressure of 1½ ata we had nearly balanced cerebral glucose metabolism" which they referred to as a "Pasteur effect". The published article also analyzed 59 prior references involving brain and metabolism from as far back as 1879. Ref: Journal of Neurology 217,17-30 (1977). Anyone looking to promote the best brain chemistry ought to respect that research study and use 1½ ata pressure as the optimal pressure. Hyperbaric physicians usually come from the diving industry and have used much higher pressures to treat injuries. Asking them to consider this relative lower pressure requires a shift of thinking.
Duration of Treatment
As far as temporal duration. Practical application shows that sixty minutes duration provides optimal results when considering biochemical, social and scheduling factors. Once daily appears optimal for chronic brain injury whereas up to qid for acute traumatic brain injury may be indicated depending on other medical resources. As we learn more we may find measurement of patient body mass correlates to advise that less mass benefits better with less duration, perhaps as little as 45 minutes, while more mass may benefit better with more duration, such as 75 to 90 minutes each session. Also, the degree of brain swelling after an injury that impairs oxygen transport may factor into the duration and pressure. This presents opportunity for clinicians to adjust dosage. "HBO2 reduces pressure within the brain caused by swelling, helps restore the functional blood brain barrier and improves cell membrane function. HBO2 neutralizes toxic anoxic products in the brain, and over a period of time, the [alternating partial pressure of oxygen] enhances growth of new blood vessels. HBO2 acts as a scavenger of free radicals and promotes internal cleaning of debris through enhanced histocyte phagocytosis by reducing the stickiness of blood products (white blood cells and platelets). HBO2 makes oxygen available for use without energy transfer (when the hemoglobin carries oxygen, it requires energy), the free oxygen is available immediately for metabolic use." - Philip James
The most fundamental parameter in determining recovery from any brain injury - whether sustained at birth or at the other end of life is the level of oxygen available. All tissue injury (including surgery) not only causes damage to the tissue itself, it also damages the blood supply and therefore may compromise oxygen delivery. In this condition the universal prescription is to increase the oxygen supply to the tissues and the rate-limiting factor is the plasma tension. To suggest that to ensure adequate oxygenation should not be a universal prescription for hypoxia is the same as the suggestion that the administration of water should not be universal in the multifactorial causation of dehydration. - Philip James
Neurological conditions
Some factors facing research with HBO2 for neurological conditions: No person breathes the same. We do not force the oxygen into the plasma, only natural diffusion allows oxygen to dissolve into the plasma. Even if normal oxygen and blood flow returns to damaged brain tissue no two identical patients will show the same improvement in function. Too much patient variability exists to demand that only "Science" shall stand as the final arbiter to allow or disallow using HBO2 intervention. No HBO2 study can ever have a "true control group" as we cannot withhold oxygen or the subject dies. We deal with an inimitable element so ubiquitous that many physicians, despite knowing the importance of oxygen for metabolism, ignore its therapeutic importance for anything outside lung hypoxia. These factors make personal experience more important in shaping opinions about HBO2 than any published study. If in the end we cannot use HBO2 scientifically as an neurological agent in medicine it would join the 85% of medical interventions that carry along in that fashion. However, enough scientific proofs exist to validate the mechanisms by which HBO2 helps those who it helps to make this a good and safe intervention. In the final analysis we all do better when we can each feed ourselves. Think of the freedom a mother gets when her child can feed itself. Millions of self-paid hyperbaric sessions attest to its safe use at low pressure. Health sciences advance funeral by funeral; however, we the living can advance life using safe, non-invasive procedures that simply help people live. -
How Hyperbaric Oxygenation Therapy Works
Oxygen stands as the key substrate for metabolism. Every day an average adult consumes three pounds of food, three pounds of water and almost six pounds of oxygen. From that six pounds of oxygen about 2 pounds gets into the blood for transport to tissue cells. Humans need this oxygen in order to complete the energy cycle that sustains life. Oxygen given with increased pressure can correct many serious health problems. To provide this increased pressure one must be completely inside a pressurized room, a hyperbaric chamber. Oxygen breathed while inside a hyperbaric chamber is no different from natural oxygen. It is natural oxygen, only delivered in a pressurized chamber. The increased pressure does not change the molecular composition of oxygen. Increased pressure allows oxygen to get into tissues better.
Extra pressure improves oxygen flow in the blood.
Hemoglobin, the metalloprotein in red blood cells that holds oxygen, can carry only a limited amount of oxygen. We cannot rely on red blood cells to deliver oxygen to all our tissues in every crisis. One gram of hemoglobin can only carry 1.34 milliliters of oxygen. Red blood cells can only deliver a limited level of oxygen to tissue cells. Scientists measure this level, called oxygen tension (or oxygen partial pressure, "pO2") in units of pressure labeled "mmHg" (the amount of pressure able to raise the equivalent weight of a liquid mercury column, a pretty heavy liquid metal, also used to measure air pressure). Healthy blood circulation provides a tissue pO2 of 39 mmHg or less. 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. The body response to tissue damage mobilizes scavenger cells called histocytes that crawl with ameboid movement. This movement requires good oxygen availability. If oxygen levels drop, the histocyte movement stops and they become part of the problem instead of the solution. By using increased atmospheric pressure we can dissolve more oxygen into the circulation fluid. This extra oxygen helps revive numb histocytes and gets them back into action. Research has shown optimal tissue healing occurs when pO2 rises to between 50 and 80 mmHg. This level assures excellent delivery of oxygen to all the cells that need it. Oxygen given in a normal room cannot raise tissue oxygen levels to that level because red blood cells cannot carry the extra oxygen. We must raise the atmospheric pressure. This requires getting inside a pressurized chamber designed for human occupancy.
How does being inside a pressurized chamber give humans more oxygen?
When people are inside a chamber pressurized at twice the normal air pressure people breathe double the number of molecules. Breathing pure oxygen in such a chamber gives 10 times the regular amount of oxygen. In one hour humans can inhale 2.4 pounds of oxygen! Red blood cells instantly fill with oxygen and 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 breathing oxygen beginning at 1.5 atmospheres of increased pressure. Notice the phenomenal rise once atmospheric pressure increases twice above normal. This hyperoxia, increased tissue oxygen, is useful in healing.
How high is the pressure?
The pressure on a 30" hyperbaric chamber hatch with only 2 times atmospheric pressure has 5 tons of pressure exerted against it! This type pressure cannot be given in a plastic bag; it requires a solid chamber certified to safely hold the high pressure.
What is the difference between saturation and oxygen tension?
The problem in advocating proper usage of oxygen involves confusion between saturation and oxygen tension, 100% vrs. 100 mmHg. Only dissolved oxygen contributes to the tension (or partial pressure). The difference in amounts of oxygen transported by plasma (liquid) vrs. hemoglobin. One gram of hemoglobin can only combine with 1.34 ml oxygen to form oxyhemoglobin. In 100ml of healthy blood there is 19ml oxygen as oxyhemoglobin and 0.3ml oxygen in liquid solution. Thus normally the hemoglobin is near maximum saturation (98%) and the pressure or tension of oxygen in the liquid solution is initially 95mmHg and down line 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 down line tissue levels can rise upwards of 200mmHg.
What conditions are treated with hyperbaric oxygenation therapy?
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 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 other deadly soft tissue infections. Dr Capria
Reprinted with Permission
What should we consider as the optimal treatment dosage?
When we talk about the brain we must consider its own specific metabolic requirements. One of the best studies in this regard examined cerebral metabolism of patients given increased pressure oxygen from 1½-to 2.0-ata pressure. Drs. Holback, Caroli and Wassmann in Bonn, Germany concluded that "At an inspiratory oxygen pressure of 1½ ata we had nearly balanced cerebral glucose metabolism" which they referred to as a "Pasteur effect". The published article also analyzed 59 prior references involving brain and metabolism from as far back as 1879. Ref: Journal of Neurology 217,17-30 (1977). Anyone looking to promote the best brain chemistry ought to respect that research study and use 1½ ata pressure as the optimal pressure. Hyperbaric physicians usually come from the diving industry and have used much higher pressures to treat injuries. Asking them to consider this relative lower pressure requires a shift of thinking.
Duration of Treatment
As far as temporal duration. Practical application shows that sixty minutes duration provides optimal results when considering biochemical, social and scheduling factors. Once daily appears optimal for chronic brain injury whereas up to qid for acute traumatic brain injury may be indicated depending on other medical resources. As we learn more we may find measurement of patient body mass correlates to advise that less mass benefits better with less duration, perhaps as little as 45 minutes, while more mass may benefit better with more duration, such as 75 to 90 minutes each session. Also, the degree of brain swelling after an injury that impairs oxygen transport may factor into the duration and pressure. This presents opportunity for clinicians to adjust dosage. "HBO2 reduces pressure within the brain caused by swelling, helps restore the functional blood brain barrier and improves cell membrane function. HBO2 neutralizes toxic anoxic products in the brain, and over a period of time, the [alternating partial pressure of oxygen] enhances growth of new blood vessels. HBO2 acts as a scavenger of free radicals and promotes internal cleaning of debris through enhanced histocyte phagocytosis by reducing the stickiness of blood products (white blood cells and platelets). HBO2 makes oxygen available for use without energy transfer (when the hemoglobin carries oxygen, it requires energy), the free oxygen is available immediately for metabolic use." - Philip James
The most fundamental parameter in determining recovery from any brain injury - whether sustained at birth or at the other end of life is the level of oxygen available. All tissue injury (including surgery) not only causes damage to the tissue itself, it also damages the blood supply and therefore may compromise oxygen delivery. In this condition the universal prescription is to increase the oxygen supply to the tissues and the rate-limiting factor is the plasma tension. To suggest that to ensure adequate oxygenation should not be a universal prescription for hypoxia is the same as the suggestion that the administration of water should not be universal in the multifactorial causation of dehydration. - Philip James
Neurological conditions
Some factors facing research with HBO2 for neurological conditions: No person breathes the same. We do not force the oxygen into the plasma, only natural diffusion allows oxygen to dissolve into the plasma. Even if normal oxygen and blood flow returns to damaged brain tissue no two identical patients will show the same improvement in function. Too much patient variability exists to demand that only "Science" shall stand as the final arbiter to allow or disallow using HBO2 intervention. No HBO2 study can ever have a "true control group" as we cannot withhold oxygen or the subject dies. We deal with an inimitable element so ubiquitous that many physicians, despite knowing the importance of oxygen for metabolism, ignore its therapeutic importance for anything outside lung hypoxia. These factors make personal experience more important in shaping opinions about HBO2 than any published study. If in the end we cannot use HBO2 scientifically as an neurological agent in medicine it would join the 85% of medical interventions that carry along in that fashion. However, enough scientific proofs exist to validate the mechanisms by which HBO2 helps those who it helps to make this a good and safe intervention. In the final analysis we all do better when we can each feed ourselves. Think of the freedom a mother gets when her child can feed itself. Millions of self-paid hyperbaric sessions attest to its safe use at low pressure. Health sciences advance funeral by funeral; however, we the living can advance life using safe, non-invasive procedures that simply help people live. -
How Hyperbaric Oxygenation Therapy Works
Oxygen stands as the key substrate for metabolism. Every day an average adult consumes three pounds of food, three pounds of water and almost six pounds of oxygen. From that six pounds of oxygen about 2 pounds gets into the blood for transport to tissue cells. Humans need this oxygen in order to complete the energy cycle that sustains life. Oxygen given with increased pressure can correct many serious health problems. To provide this increased pressure one must be completely inside a pressurized room, a hyperbaric chamber. Oxygen breathed while inside a hyperbaric chamber is no different from natural oxygen. It is natural oxygen, only delivered in a pressurized chamber. The increased pressure does not change the molecular composition of oxygen. Increased pressure allows oxygen to get into tissues better.
Extra pressure improves oxygen flow in the blood.
Hemoglobin, the metalloprotein in red blood cells that holds oxygen, can carry only a limited amount of oxygen. We cannot rely on red blood cells to deliver oxygen to all our tissues in every crisis. One gram of hemoglobin can only carry 1.34 milliliters of oxygen. Red blood cells can only deliver a limited level of oxygen to tissue cells. Scientists measure this level, called oxygen tension (or oxygen partial pressure, "pO2") in units of pressure labeled "mmHg" (the amount of pressure able to raise the equivalent weight of a liquid mercury column, a pretty heavy liquid metal, also used to measure air pressure). Healthy blood circulation provides a tissue pO2 of 39 mmHg or less. 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. The body response to tissue damage mobilizes scavenger cells called histocytes that crawl with ameboid movement. This movement requires good oxygen availability. If oxygen levels drop, the histocyte movement stops and they become part of the problem instead of the solution. By using increased atmospheric pressure we can dissolve more oxygen into the circulation fluid. This extra oxygen helps revive numb histocytes and gets them back into action. Research has shown optimal tissue healing occurs when pO2 rises to between 50 and 80 mmHg. This level assures excellent delivery of oxygen to all the cells that need it. Oxygen given in a normal room cannot raise tissue oxygen levels to that level because red blood cells cannot carry the extra oxygen. We must raise the atmospheric pressure. This requires getting inside a pressurized chamber designed for human occupancy.
How does being inside a pressurized chamber give humans more oxygen?
When people are inside a chamber pressurized at twice the normal air pressure people breathe double the number of molecules. Breathing pure oxygen in such a chamber gives 10 times the regular amount of oxygen. In one hour humans can inhale 2.4 pounds of oxygen! Red blood cells instantly fill with oxygen and 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 breathing oxygen beginning at 1.5 atmospheres of increased pressure. Notice the phenomenal rise once atmospheric pressure increases twice above normal. This hyperoxia, increased tissue oxygen, is useful in healing.
How high is the pressure?
The pressure on a 30" hyperbaric chamber hatch with only 2 times atmospheric pressure has 5 tons of pressure exerted against it! This type pressure cannot be given in a plastic bag; it requires a solid chamber certified to safely hold the high pressure.
What is the difference between saturation and oxygen tension?
The problem in advocating proper usage of oxygen involves confusion between saturation and oxygen tension, 100% vrs. 100 mmHg. Only dissolved oxygen contributes to the tension (or partial pressure). The difference in amounts of oxygen transported by plasma (liquid) vrs. hemoglobin. One gram of hemoglobin can only combine with 1.34 ml oxygen to form oxyhemoglobin. In 100ml of healthy blood there is 19ml oxygen as oxyhemoglobin and 0.3ml oxygen in liquid solution. Thus normally the hemoglobin is near maximum saturation (98%) and the pressure or tension of oxygen in the liquid solution is initially 95mmHg and down line 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 down line tissue levels can rise upwards of 200mmHg.
What conditions are treated with hyperbaric oxygenation therapy?
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 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 other deadly soft tissue infections. Dr Capria
Reprinted with Permission