Handi Suyono, dr, M.

Ked

APA ITU TERAPI OKSIGEN HIPERBARIK (TOHB)? Terapi Oksigen Hiperbarik adalah pengobatan dengan pemberian oksigen murni yang dilaksanakan di sarana pelayanan kesehatan dengan menggunakan Ruang Udara Bertekanan Tinggi (RUBT) pada tekanan lebih dari satu atmosfer absolut (1 ATA) dalam jangka waktu tertentu.

Mechanism Hyperoxygenation*

Clinical Application DCS/AGE CO poisoning Central retinal artery occlusion Crush injury/compartment syndrome Compromised grafts and flaps Severe blood loss anemia Air or gas embolism Crush injury/compartment syndrome Thermal burns Problem wounds Compromised grafts and flaps Delayed radiation injury

Decrease gas bubble size Vasoconstriction Angiogenesis

Fibroblast proliferation/collagen synthesis Leukocyte oxidative killing

Problem wounds Delayed radiation injury Necrotizing soft tissue infections Refractory osteomyelitis Problem wounds

Reduces intravascular leukocyte adherence Reduces lipid peroxidation Toxin inhibition Antibiotic synergy

Crush injury/compartment syndrome CO poisoning Crush injury/compartment syndrome Clostridial myonecrosis Necrotizing soft tissue infections Refractory osteomyelitis

Biomolecular mechanisms of HBOT

Pro & Anti Apoptosis Endogenous antioxidant (SOD, GPx)

NO, NOS

Mitochondria biogenesis (ATP availability)

HBOT

Pro & Anti Inflammator y cytokines

Hypoxia Inducible Factor (HIF)

Gene transcription

Heat Shock Protein (HSP)

Growth factors

SEJARAH TOHB
PAUL BERT DURING A TEST IN HIS HYPO AND HYPERBARIC CHAMBER

THE VERY FIRST MOBILE HYPERBARIC CHAMBER

BIGGEST HYPERBARIC CHAMBER IN CUNNINGHAM, 3.880 M3

FIRST MEDICAL TREATMENT CHAMBER IN GERMANY,DR. JOSEF REUSH AT NITTEL ON THE MOSEL

OPEN HEART OPERATION 1964 IN AMSTERDAME

PROFESSOR BOEREMA AND HYPERBARIC CHANBER IN WILHELMINA GASTHUIS 1972

MOBILE

Suatu kegiatan yang dilakukan dibawah permukaan air dengan/ tanpa alat selam untuk tujuan tertentu

Hukum BOYLE Hukum HENRY Hukum DALTON Hukum CHARLES

Hukum Boyle
tekanan dan volume berbanding terbalik pada suhu konstan.

banyaknya gas yang terlarut di dalam cairan adalahsebanding dengan tekanan gas di atas cairan tersebut.

Hukum Charles

EVOLUSI O2 DALAM DARAH [HbO2], PLASMA [TERLARUT] THD FRAKSI O2 & TEK.LINGK.
[%] 6.0 ml O2/100ml plasma

3,8 ml O2/100ml plasma

PLASMA

20,1

19,7

HbO2

21% O2

100% O2

100% O2

[ATA] 1.0 2.0

3.0

Tabel Kindwall Modifikasi Guritno

Istirahat 5 menit
Descent Rate = As Fast As Posible

50

40

Total Elapsed

Time : 128 Min

r
Ascent Rate = 1Ft/Min

30

20

10

0 14

30

30

30

14

Indikasi Absolut TOHB

Decompression Sicknes Keracunan CO Emboli gas

Peranan TOHB

Pengendalian radikal bebas akibat polusi asap kendaraan bermotor, sisa pembakaran gas tidak sempurna akibat industri, asap rokok, penyelaman tradisional, dll.

UHMS INDICATIONS
Decompression Sickness Air or Gas Embolism. Carbon Monoxide Poisoning/Cyanide Poisoning. Clostridial Myositis and Myonecrosis (Gas Gangrene). Crush Injury, Compartment Syndrome and other Acute Traumatic Ischemias. 6. Arterial Insufficiencies Enhancement of Healing in Selected Problem Wounds and Central Retinal Artery Occlusion. 7. Severe Anemia. 8. Intracranial Abscess. 9. Necrotizing Soft Tissue Infections. 10. Osteomyelitis (Refractory). 11. Delayed Radiation Injury (Soft Tissue and Bony Necrosis). 12. Compromised Grafts and Flaps. 13. Acute Thermal Burn Injury. 14. Idiopathic Sudden Sensorineural Hearing Loss.
1. 2. 3. 4. 5.

Conditions Treated With Hyperbaric Oxygen Therapy

FDA Approved Conditions
Actinomycosis Air or Gas Embolism Carbon Monoxide Poisoning and Smoke Inhalation Gas Gangrene Cyanide poisoning
Crush Injury and other Acute Traumatic Ischemias Decompression Sickness Diabetic Wounds Necrotizing Soft Tissue Infections Osteomyelitis (Refractory) Radiation Tissue Damage Severe Anemia Skin Grafts and Flaps (Compromised) Thermal Burns

Off Label Conditions

ADD/ADHD ALS Alzheimers Anoxic Brain Injury Autism Bells Palsy Cancer Cerebral Palsy Chronic Fatigue Chronic Inflammatory Disease Crohn's disease Decreased Immune Function Diabetes Fibromyalgia
General Wellness/ Prevention Heart Disease Infections Immune Dysfunction Lyme Disease Macula Degeneration Menieres Disease Migraines Mitochondrial Disorders Multiple Sclerosis Near Drowning Peripheral Neuropathy Post Electrocution Raynaud's Phenomenon Reflex Sympathetic Dystrophy Retinitis Pigmentosa Rheumatoid Arthritis Severed Limbs Sickle Cell Crisis Spinal Cord Injury Sports Injuries Stroke Surgery Pre and Post Traumatic Brain Injury Trigeminal Neuralgia Vascular Disease Venomous Bites and other conditions

INDIKASI TAMBAHAN
Diabetes mellitus Stroke Allergy Autism Cerebral palsy Coronary heart disease Dementia Alzheimer disease Autoimmune diseases Antibiotic resistance Chemotherapy / radiotherapy resistance Fibromyalgia / Chronic fatique syndrome Rheumatic diseases Dermatologic diseases Infertility

Sebagai Pengobatan Pilihan, yaitu untuk : Pelayanan kesehatan kebugaran Pelayanan kesehatan olahraga Pasien lanjut usia (geriatri) Dermatologi dan kecantikan (Pelayanan kesehatan kecantikan) Sebagai seleksi penyelam (fit to dive)

KONTRAINDIKASI
Kontra Indikasi Mutlak yang terdiri dari : Pneumothoraks yang belum diobati Kontra Indikasi Relatif yang terdiri dari : Infeksi saluran nafas bagian Sinusitis kronik Kelainan kejang-kejang Emfisema Febris yang tidak terkontrol Riwayat Pneumotoraks spontan Riwayat bedah toraks Riwayat operasi telinga Lesi paru asimtomatik Keganasan yang belum mendapat terapi Claustrophobia

EFEK SAMPING
Barotrauma (telinga, sinus, paru-paru dan gigi)
Keracunan oksigen Temporer myopia

Peranan HBO Terapi Pada Kecantikan (Kulit)

Regenerasi sel epitel baru Merangsang pembentukan kolagen dan serat

elastin melalui aktivasi fibroblas Melembabkan kulit dg meningkatkan aktifitas kelenjar keringat dan sebacea Meningkatkan aktivitas folikel rambut (mencegah rambut rontok)

PRA HBO

Luka yang sulit sembuh tanpa DM

HBO 5x

HBO 15 x

Pada Autisme
(Willcox, 2002) Hipoperfusi relatif cerebral Evidensi neuroinflamasi Penambahan disregulasi imun Penambahan oxidative stress Penurunan
Penurunan fungsi mitokondria Peningkatan abnormalitas neurotransmiter Sirkulasi sel stem Hipoperfusi dari area prefrontal dan temporal kiri memburuk dan menjadi semakin dalam seiring dengan penambahan umur anak autis

3/23/2014

36

SPECT Scans- Single Photon Emission

Computed Tomography (SPECT) scan is a type of nuclear imaging test that shows how blood flows to tissues and organs.
boy, age 4

CASE: AUTISTIC SPECTRUM DISORDER

Before Hyperbaric
Blue and Purple Areas Reflect Low Blood Flow

After Hyperbaric
White, Pink and Red Reflect High Blood Flow

I want to live for 120 years Michael Jackson

Abstract Background: Several uncontrolled studies of hyperbaric treatment in children with autism have reported clinical improvements; however, this treatment has not been evaluated to date with a controlled study. We performed a multicenter, randomized, double-blind, controlled trial to assess the efficacy of hyperbaric treatment in children with autism. Methods: 62 children with autism recruited from 6 centers, ages 27 years (mean 4.92 1.21), were randomly assigned to 40 hourly treatments of either hyperbaric treatment at 1.3 atmosphere (atm) and 24% oxygen ("treatment group", n = 33) or slightly pressurized room air at 1.03 atm and 21% oxygen ("control group", n = 29). Outcome measures included Clinical Global Impression (CGI) scale, Aberrant Behavior Checklist (ABC), and Autism Treatment Evaluation Checklist (ATEC). Results: After 40 sessions, mean physician CGI scores significantly improved in the treatment group compared to controls in overall functioning (p = 0.0008), receptive language (p < 0.0001), social interaction (p = 0.0473), and eye contact (p = 0.0102); 9/30 children (30%) in the treatment group were rated as "very much improved" or "much improved" compared to 2/26 (8%) of controls (p = 0.0471); 24/30 (80%) in the treatment group improved compared to 10/26 (38%) of controls (p = 0.0024). Mean parental CGI scores significantly improved in the treatment group compared to controls in overall functioning (p = 0.0336), receptive language (p = 0.0168), and eye contact (p= 0.0322). On the ABC, significant improvements were observed in the treatment group in total score, irritability, stereotypy, hyperactivity, and speech (p < 0.03 for each), but not in the control group. In the treatment group compared to the control group, mean changes on the ABC total score and subscales were similar except a greater number of children improved in irritability (p = 0.0311). On the ATEC, sensory/cognitive awareness significantly improved (p = 0.0367) in the treatment group compared to the control group. Post-hoc analysis indicated that children over age 5 and children with lower initial autism severity had the most robust improvements. Hyperbaric treatment was safe and well-tolerated. Conclusion: Children with autism who received hyperbaric treatment at

1.3 atm and 24% oxygen for 40 hourly sessions had significant improvements in overall functioning, receptive language, social interaction, eye contact, and sensory/cognitive awareness compared to children who received slightly pressurized room air.
Trial Registration: clinicaltrials.gov NCT00335790

Abstract Hyperbaric oxygen therapy (HBOT) is used for a number of applications, including the treatment of diabetic foot ulcers and CO poisoning. However, we and others have shown that HBOT can mobilize cellular antioxidant defenses, suggesting that it may also be useful under circumstances in which tissue protection from oxidative damage is desired. To test the protective properties of hyperbaric oxygen (HBO) on a tissue level, we evaluated the ability of a preconditioning treatment regimen to protect cutaneous tissue from UV-A-induced oxidative damage. Three groups of hairless SKH1-E mice were exposed to UV-A 3 days per week for 22 weeks, with two of these groups receiving an HBO pretreatment either two or four times per week. UV-A exposure increased apoptosis and proliferation of the skin tissue, indicating elevated levels of epithelial damage and repair. Pretreatment with HBO significantly reduced UV-A induced apoptosis and proliferation. A morphometric analysis of microscopic tissue folds also showed a significant increase in skin creasing following UV-A exposure, which was prevented by HBO pretreatment. Likewise, skin elasticity was

found to be greatest in the group treated with HBO four times per week. The effects of HBO were also apparent systemically as reductions in caspase-3 activity and expression were observed in the liver. Our findings support a protective function of HBO pretreatment from a direct oxidative challenge of UV-A to skin tissue. Similar protection of other tissues may likewise be
achievable. Keywords Hyperbaric oxygen . Preconditioning . UV-A . Skin . Apoptosis . Liver . SKH1-E mice

Mayo Clin Proc. 2013 Feb;88(2):166-75. doi: 10.1016/j.mayocp.2012.10.021.

Systematic review of the effectiveness of hyperbaric oxygenation therapy in the management of chronic diabetic foot ulcers.
Liu R, Li L, Yang M, Boden G, Yang G. Author information Abstract OBJECTIVE: To assess the efficacy and safety of hyperbaric oxygenation (HBO) therapy as adjunctive treatment for diabetic foot ulcers with a systematic review and meta-analysis of the literature. METHODS: MEDLINE, EMBASE, and the Cochrane Library were searched to find relevant articles published up to April 20, 2012, without restriction as to language or publication status. All controlled trials that evaluated adjunctive treatment with HBO therapy compared with treatment without HBO for chronic diabetic foot ulcers were selected. A meta-analysis was performed to assess the efficacy and safety of hyperbaric oxygen in managing foot ulcers. RESULTS: Thirteen trials (a total of 624 patients), including 7 prospective randomized trials, performed between January 1, 1966, and April 20, 2012, were identified as eligible for inclusion in the study. Pooling analysis revealed that, compared with treatment without HBO, adjunctive treatment with HBO resulted in a significantly higher proportion of healed diabetic ulcers (relative risk, 2.33; 95% CI, 1.51-3.60). The analysis also revealed that treatment with HBO was associated with a significant reduction in the risk of major amputations (relative risk, 0.29; 95% CI, 0.19-0.44); however, the rate of minor amputations was not affected (P=.30). Adverse events associated with HBO treatment were rare and reversible and not more frequent than those occurring without HBO treatment (P=.37). CONCLUSIONS:

This meta-analysis reveals that treatment with HBO improved the rate of healing and reduced the risk of major amputations in patients with diabetic foot ulcers. On the basis of these effects, we believe that quality of life could be improved in selected patients treated with HBO.
Copyright 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Hyperbaric Oxygen Therapy

Bahaya:
Kebakaran Pakaian / kain : 100% cotton No alcohol/petroleum products

No sprays, makeup, deodorant, balm, parfums

MULTIPLACE CHAMBER (4 10 patients)

MONOPLACE CHAMBER

Valsava Maneuver

Valsava Maneuver is used to equalize pressure in middle ear

Autism

CURRICULUM VITAE
Dosen Fakultas Kedokteran Universitas

Katolik Widya Mandala Surabaya, bidang ilmu: Fisiologi Kedokteran Hiperbarik dan Penyelaman Ahli Kedokteran Hiperbarik dan Penyelaman

Man can survive without food for weeks, and without water for days, but only minutes without oxygen.

Oxygen is the basis of life.