HBOT presentation

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AN ADJUVANT IN TREATMENT OF DIABETIC FOOT HYPERBARIC OXYGEN THERAPY 1 Presenter: Arpit Patwari HBOT (arpitpatwari27@gmail.com)

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What is Hyperbaric Oxygen Therapy? Hyperbaric Oxygen Therapy (HBOT) - prescribed treatment approved by the FDA and AMA. A person breathes 100% medical grade oxygen under increased pressure which is almost 15 times of normal oxygen inhaled. Treatment is given within a multi-place (multiple occupancy) or mono-place (single occupancy) hyperbaric oxygen chamber. During treatment, one can relax by watching a movie, reading, or just rest. 2 HBOT

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Description of HBOT and its Benefits Oxygen Saturation Fights Infection Increased Oxygen Levels Mass Action of Gases Vasoconstriction Neovascularization Neurological Function 3 HBOT

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The Equipment Mono-Place Chamber Multi-Place Chamber 4 HBOT

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Mono-place chamber allows us to also offer private treatments. Relax and watch your favorite movie or select one from library. Chamber meets or exceeds the latest guidelines governing hyperbaric chamber manufacturing. 5 Mono-Place Chamber HBOT

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Mono-Place Chamber 6 HBOT

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Large multi-place chamber has an interior diameter of five (5) feet and is thirteen and a half (13 ½ ) feet in interior length. The chamber can comfortably seat six (6) people on two bench seats and allows them to easily view the entertainment system, read, or relax. 7 Face Hood Face Mask Multi-Place Chamber HBOT

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How does HBOT work Normal Blood Flow Restricted Blood Flow Hyperbaric Oxygenation Blood Vessel Regeneration 8 HBOT

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Normal Blood Flow 9 HBOT

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Restricted Blood Flow 10 HBOT

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Hyperbaric Oxygenation 11 HBOT

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Blood Vessel Regeneration 12 HBOT

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Currently there are 16 Medicare approved conditions for which HBOT is indicated, these include: Diabetic Wounds Acute Cyanide Poisoning Acute Peripheral Arterial Insufficiency Intravascular Gas Embolism Carbon Monoxide Poisoning Clostridial Myonecrosis Compromised Skin Decompression Illness Osteoradionecrosis Progressive Necrotizing Infection (Meleney's ulcer) Burns Chronic Refractory Osteomyelitis Soft Tissue Radiation Necrosis Actinomycosis Exceptional Blood Loss Anemia Intracranial Abscess 13 What Conditions Are Treated By HBOT? HBOT

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Reversible myopia Symptomatic otic barotrauma Pulmonary barotrauma Pulmonary oxygen toxicity Seizures Decompression sickness Tinnitus Side effects 14 HBOT

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Diabetes mellitus is the most common of the serious metabolic disorders . Disorder due to deficiency of insulin secretion from B-cells of islet of langherhans or due to reduced sensitivity of body to insulin. Characterized by- Diabetic mellitus High plasma sugar level Neuropathy Nephropathy Retinopathy Cardiac disease Diabetic foot Diabetic angiopathy leads to chronic foot lesions and has a higher risk of amputation than non-diabetics due to poor control of infection. 15 HBOT

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Causes of Diabetic Foot Problems 16 HBOT

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17 HBOT

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Progression of decubitis ulcer 18 HBOT

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Grade O - foot has no open lesions, but is the ‘at risk’ foot. Grade 1 - lesions consist of a superficial ulcer, but with full thickness skin loss. Grade 2 - lesion is deep and often penetrates subcutaneous fat down to tendon or ligaments, but without abscess formation or bony infection. 19 Wagner`s Classification of the Lesion HBOT

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Grade 3 - have deep infection with cellulites or abscess formation, often with underlying 2 foot is that in grade 3 foot, surgery is usually needed. Grade 4 -Gangrene, which may be localized to a toe, a small area of the heel or involve more of the distal foot. Grade 5 - lesions are characterized by extensive gangrene of the foot and need urgent hospital admission, control of diabetes and infection and usually a major amputation. 20 HBOT

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Grade 0 Grade 2 Grade 1 21 HBOT

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Grade 4 Grade 5 Grade 3 22 HBOT

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Locally, with Eusof (1.25% w/v boric acid and 1.25% w/v of bleaching powder) In those patients in whom the gangrene/infection ascended above the ankle, amputation was performed to limit the spread of infection. Antibiotics were administered along with metronidazole for 3 days. Antibiotics commonly used were cephalosporins and amino glycosides and were changed according to sensitivity patterns. Diabetic control was achieved by crystalline insulin given subcutaneously daily in 3 doses. 23 Normal treatment of Diabetic foot HBOT

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Patients were given treatment at 3 atmospheric pressure everyday for about 45 minutes. Therapy continued for about 2 weeks. To study the effects of HBOT the following parameters were evaluated: Wound cultures-before and after each sitting . 2) Assessment of local wound daily. 3) In case of amputations, skin flaps were assessed. 24 Treatment with HBOT HBOT

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25 HBOT

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26 INITIAL AFTER 27 HBOT SESSIONS INITIAL AFTER 32 HBOT SESSIONS HBOT

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From about 30 patients under study, 28 recovered quickly from diabetic foot as compared to control group. They were given 10-15 sessions of HBOT. Radical healing and decrease in the lesions were seen. Grades 1,2,3 feet far better with 92.3% of the study group having benefitted. The overall outcome was better in the study group with 86.6% of patients showing complete healing or marked improvement as compared to 46.7% in controls (P < 0.01). 27 Results HBOT

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Conclusion HBOT works for all grade of diabetic foot. Such promising results obtained for treatment of diabetic foot by HBOT, shows how effectively such serious diseases can be treated with shorter duration of action. Moreover doses of drug can be decreased for the treatment and thereby a possible way to decrease drug side effects and toxicities. 28 HBOT

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29 List of references www.hbot.com wikipedia.org www.omnimd.com www.hhi-kc.com www.drcranton.com www.hbot4u.com www.hyperbaricmedicalassociation.org www.podiatrytoday.com www.springerlink.com HBOT

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Thanking You 30