The Cerebral Palsy Network

Hyperbaric oxygenation is the use of I00% oxygen at greater than atmospheric pressure. It is the same oxygen that we breathe normally (which is 19-21% of air). However under pressure, oxygen, a gas, adheres to all of the laws of physics. When pressure is increased, oxygen will be dissolved into any body fluid in direct proportion to the pressure (Henry's Law). More oxygen, therefore, may be dissolved in the bone, the urine, the lymph, especially the blood plasma and the cerebrospinal fluid (the fluid- that bathes the entire central nervous system). Hyperbaric oxygenation is a method of delivering extra oxygen into the body. It is not just the increased oxygen that is important, but that free molecular oxygen is made immediately available for metabolic use by the mitochondria at the tissue spaces in the body, where all life takes place.

Normally, in the body, oxygen is delivered to the, tissue spaces by way of the hemoglobin in the blood. This requires energy to break off the oxygen molecule from the hemoglobin and to pick up the carbon dioxide that is returned to the lungs to be exhaled. This is the basic cycle of life. With Hyperbaric oxygenation, it is possible to greatly increase the availability of oxygen. Hyperbaric oxygen has a positive effect on the nervous system in that it reduces swelling, repairs the blood brain barrier and stabilizes the cell membrane. It increases the ability of the phagocytes (white blood cells) to clean up damaged areas and over a long term, it creates a whole new supply of blood vessels called neo-angiogenesis. Also, it provides a mechanism whereby if there is hypoxic ischeinic (severe lack of oxygen) damaged tissue in the brain that is not adequately supplied by way of blood, Hyperbaric oxygen may be used immediately to deliver necessary oxygen to the area for viability, damage control and healing.

Hyperbaric oxygen is a drug and is administered in a closed chamber and has a specific dose which relates to the depth of pressure. This is referred to as the atmospheric pressure absolute (ATA). Sea level is 1.00 ATA, with the partial pressure of 19-21 -percent of O'. The length of time of treatment, the pressure, the number of treatments per 24 hours and the total number of treatments all represent the "dose".

There are two types of chambers. One is a monoplace chamber which is an acrylic tube and compressed with 100% oxygen. There is no question as to the exact dosage (ATA) of oxygen. The other type of chamber is a multi-station chamber that holds more than one patient. In China, there are chambers that hold up to 36 patients and they actually perform open heart surgery within the chamber. This type of chamber, however, is compressed with air and the delivery of oxygen is either by way of mask or a hood. In the multi-station chamber employing the mask delivery, the appropriate dose may not be accurate since the mask that fits one person may not securely fit another and there can be leakage of the oxygen, thus the exact pressure may not be achieved. Also, in some patients with severe head and facial injuries, masks are impossible. The hood, however, is more accurate for Hyperbaric oxygenation and fits over the head with a Velcro strap to seal it around the neck. The monoplace chamber may be wheeled into an emergency room setting and be immediately available for use. The multi-station, however, requires an attendant inside the chamber with the patients and a technical engineer outside to regulate the pressures.

We are concerned that before this data is totally scientifically validated, a number of centers may open up purely for financial purposes. Thus, it is imperative that before you choose a center, you know:

1) That they have a "Medical Director" with an appropriate background in and knowledge of Hyperbaric medicine, as well as a consultant knowledgeable in developmental pediatrics

2) the protocol for treating the neuroloizically injured child,

3) Whether the chamber will accommodate a parent to go in with the child,

4) The charge per treatment. The charges may vary from $150-$1,000. per hour.

5) Membership in an association such as The American College of Hyperbaric Medicine, the Undersea and Hyperbaric Medical Society or the newly founded Association of Free-standing Hyperbaric Centers.

Certain centers may insist upon controlled studies. For the scientific evaluation of this procedure in the older child, cross-over double blind studies may be needed. This means that a group of children will be randomly assigned, one to a chamber breathing only air (sham or placebo treatment) and another to a chamber with oxygen. Double blind means that neither the doctors nor the patients will know which patients are actually receiving the oxygen treatment until the study and all evaluations are complete. After a completion of approximately 40 treatments, the code will be broken. If there is a difference between the two groups, (i.e., the results are more positive with the oxygen), those who were given the sham treatment will be crossed over and given the oxygen treatment.

This may be satisfactory for a child several years old, but the ideal situation would be to take the brain injured newborn from the delivery room to the Hyperbaric chamber to prevent/repair the damage immediately. With newer diagnostic techniques such as transcranial doppler, functional MRI and SPECT scanning, brain injuries can sometimes be detected at birth. It is at this time that the patient should be considered for treatment as is done in Mexico City and has been for many years in Russia and a British trial published in 1964 in The Lancet.

Under such circumstances that the questions of the ethics of the double-blind study exist: Should only half the babies be given the actual treatment if it may safely benefit all of them? This will be one of the topics for discussion in this program.

The safety record for Hyperbaric oxygen treatment is excellent. In the United Kingdom, there have been 1.3 million hours of outpatient Hyperbaric oxygen administered without incident. Certain outpatient centers insist upon myringotomy, i.e., tubes put into the ears of the children to equalize the pressure. We do not feel that this is necessary if the compression and decompression are appropriately done. In our experience, 1 out of several hundred children may require this. Ear inspection prior to and during the course of treatment is mandatory.

Side effects are primarily (> 5% of patients) sinus squeeze or ear pain - like taking off and landing in an airplane. Long term treatments in the elderly may have an acceleration effect on cataract formation. In children, a transient change may rarely occur in the lens to make them more nearsighted. This is rapidly fleeting and there is no permanent sequelae known.

N.B.: Seizure disorder is not a contraindication to Hyperbaric oxygenation. In China, seizure disorders are treated with Hyperbaric oxygen. We have treated many cases, and in certain patients, reduction or discontinuance of ant-seizure medication was accomplished. Pressures, however, must be begun at a low pressure 1.25 ATA for thirty minutes and gradually worked up to 1.5 ATA for one hour twice a day.

It is hoped that as a result of this conference that:

1) the proper subset of patients and the timing in which this treatment is most advantageous will be ascertained,

2) an appropriate protocol will be determined,

3) a database will be established,

4) patients will have an information source and be able to access the website hopefully for approved centers, i.e., that is those being members of an association or being guided by a responsible M.D., 5) the role of various other modalities in conjunction with Hyperbaric oxygen in the future will be further evaluated, such as biofeedback, amino acids, craniosacral therapy, herbal medications, physical, speech and occupational therapies.

Although the positive evidence is compelling and highly suggestive, until this is scientifically validated and appropriately documented, please do not rush into this type of therapy.

It is hoped that someday, should all of this data be appropriately evaluated scientifically, that no brain injured child will ever be denied Hyperbaric oxygenation because of financial or social reasons.

A special thankyou to the countless Drs and children whom have made this research possible. All information contained within these pages are the sole property of the Dr.s and experts that have spent the countless hours researching for OUR CHILDREN. Please read each page of content and please contact your local congressmen and appropriate government officials today. Thankyou.

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Last updated 03/24/03

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