INTRODUCTION.

The time is moving on and the approaches to the solution of various problems are also developing. Just recently the investigators hardly attempted to publish their discoveries, but today many businessmen are already interested in these researches.

The Embedding scientific organization "Alkor-P" known as a producer of treating oxygental hyperbaric chambers (HC; chamber BLKS-301M) asked me to assess its Recommendations on the application of HC in clinics. That request has two reasons: firstly the producer is interested in most complete service of its customers; secondly many of the Recommendations which are applied today, have been worked out long before 1980, and now they seem to be too archaic.

I agreed with pleasure, because I work in The Institute of Improvement of Doctor's Qualification and know very well about the vital importance of the application of that equipment in practical medicine.

Thus the success of the announced Recommendations, if any, will be also the success of the advantageous method of hyperbaric oxygenation (HBO), the success of the medicine in general.

First of all I'd like to say that the represented recommendations, all of which are based on practice, cannot scope all the feasibilities of HBO; but the schedule of cardiology, gastroenterology, purulent diseases, toxicology, endocrinology, neurology and reanimatology represent itself the best advertisement to the method.

The prominent treating centers lead by the merited, well known scientists are represented in this collection: The All Union Center of Hyperbaric Oxygenation; The First Moscow Medical Institute; The Sclyfosovsky Center; Clinic No. 6 of The Ministry of Health; The MONIKI after Vladimirsky; The Petersburg Institute after Polenov; The Samara Medical Institute; The Yaroslavl Medical Institute; The Voronezh Medical Institute; The Saratov Medical Institute; The Odessa Medical Institute; The Rostov Midwifery Institute; The Lvov Medical Institute; The Kazakh Institute of the Marginal pathology; The Bashkir Republic Clinic No. 1.

The works of professor V.Lukitch on the organization of the curing divisions, on preparation for treating, on probable complications of the application of the HBO should be marked. His methods are desirable, but hardly can be fulfilled in ordinary everyday practice.

The First Moscow Medical Institute is treating the ulcer of stomach. By the way their treating course could be prolonged if the collateral effects are absent. The work of Saratov's scientists on treating gastrointestinal hemorrhages can be ranged as the development of the previous one. Their activities could be completely adopted, but we have two remarks:

1. the value of tension and the exposition should vary individually in every case;

2. the HBO can be applied on the top of hemorrhage - that position is rejected by the authors.

The pregnants with diabetes are treated in Rostov Midwifery Institute. On my opinion the lowering of the level of sensitivity could be achieved by means of the reduction of concentration of oxygen, not by the application of the antioxidants.

Bashkir clinic No. 1 is successfully treating the thyrotoxical goiter.

The Sklifosovsky's scientists represent their work in treating of paroxysmal and extra systolic transgressions in cardiology. I'd like to point out that the values of the procedure of HBO are selected individually and the control of hemodynamics is applied.

The mitral defects supported by the violations of blood circulation are treated in All Union Center of Hyperbaric Oxygenation under the supervision of professor S. Efruni (1978). His activities represent the probability of preparation of the most of the patients to the operation and also present the exact recommendations for it.

Our recommendations on the complex therapy of cardiomyopathy (1984) can also be applied, especially in combination with ultrasonic diagnostics. That combination can be approximated on many branches of HBO with improvement of understanding of essence of HBO in curing process.

A plenty of publications touching upon the treating of obliteral vascular diseases are existing today. We represent here one of them; the publishment of our estimating of cardiac outlet and general resistance together with its compensation, can't be the postulation of our recommendations as the only right.

The recommendations of Professor Yu. Isakov and co-workers (Sklifosovsky Institute) on treating of acute violations of cerebral blood circulation dated 1987 are of principal importance.

The MONIKI's investigators are applying HBO in therapy of the discircular mielopathy; parkinsonism; polyradiculoneuritis, meningoencephalitis, post-hypocsic encephalopathy.

The application of HBO for therapy of wounds of skull causes the reduction of cerebral inflation by means of hyperbaric oxygen. This is the joint recommendation of the Petersburg Institute after Polenov and the Sklifosovsky Institute. This method of reduction of cerebral inflation was also adopted on The X International Congress on Hyperbaric Medicine in Amsterdam, 1990, in the reports from Italy, Japan, etc.

The application of HBO in lessening of pain shock after wounds is just in work now (Voronezh Medical Institute), but this represents the abilities of HBO in such kind of pathology.

The suppression of operational purulent sources takes place as described in recommendations of Sklifosovsky's Institute (1982). I'd like to remark once more here, that the operational values of HBO for different pathology would be variable, not constant as suggested by the authors. That suppression after operations on lung and pleura is investigated in the VKhNC together with the All Union Center of Hyperbaric Oxygenation. The recommendations of Yaroslavian scientists (as well as of Odessa Medical Institute and the Volgograd Clinic No.1) on complex therapy of purulent infection contain the concrete doses of oxygen influence.

Professor G. Ratner with his Surgeon Clinic from Samara is among the leaders in developing of theory and practice of hyperbaric oxygenation. He has a success in suppressing the anaerobic infections since 1973.

The application of HBO for therapy of appendicular peritonitis of youngsters is especially interesting, as it shows the probability of the application of high concentrations of oxygen among youngsters.

Professor E.Luzhin cures the phosphorous intoxications. This branch of application of HBO is of significant importance because of steady worthening of ecological situation in different regions.

The collection is complete. We wish that will be applicable in primary education of specialists in HBO as well as for a broad range of medical stuff.

Doctor of Medicine.

On tthe preparation of sicks for treatment by means of hbo. indications, contra - indications.

Probable complications when use.

Recommendations.

Under the supervision of Doctor of Medicine V.Lukitch.

 

The HBO is an effective Treating method, the essence of which is in the improvement of partial tension of oxygen in tissue as the result of the respiration under under the improved pressure.

The HBO method is based on physical laws of solubility of gases in liquids (Boil-Mariott, 1662; Pascal,1663; Henry,1803; Dalton,1803; Pauzeil,1840-1841; Pfick,1855), according to which the amount of gas (oxygen),been dissolved in blood, directly rates to the pressure and temperature.

Partial pressure of any gas in composition directly rates to the concentration of that gas and pressure.

The extra pressure - that is the pressure additional to the normal atmosphere. Sum of extra pressure and the atmosphere's one gives us an absolute pressure. Extra and absolute ones are measured in technical atmospheres and are marked ATI and ATA correspondingly.

Technical atmosphere,AT - that is 1 kilogram per square santimeter ­equals the pressure of mercury cord of 735,6 sm. height. Physical atmosphere equals 1,033 kg/(sm.*sm.), or 10,33 meters high water cord or 760 mm high mercury cord.

The normoxy and the hyperoxy would be discriminated (pO2 equals 0,21 ATA, or exceed that, respectively).

For today one can see the treating chambers MLB of 3000 liters volume, for many patients simultaneously, with pressure up to 10AT, being contained with pressed air. The oxygen is passed to a sick person in a special way. The stuff can exist inside jointly with the sick. There are also existing single place treating chambers OLB for one patient; their volume is 2500 liters; tension is no more than 3 AT. These chambers are fulled only with oxygen.

Working pressure - that is the one during the procedure of HBO.

The HBO in the First Moscow Medical Institute is concentrated in a special division (Tel. No.2481439, 2481507) with OLB "Oka". The system includes conditioner and a special closed bed. The air stream is released in conditioner from the carbon dioxide and vapor. It can also regulate the temperature. The sick can be placed lying or sitting in the bed.

Hypoxia appears when the tissue suffers from the shortage of oxygen or when its utilization is damaged in the process of biooxydation. Hypoxia can be acute or chronic.

Acute hypoxia appears when the external respiration can't supply body with oxygen; the support of an ordinary balance of gases needs extra energy. There are temporary hypoxia and the "tissue" one.

Chronic hypoxia contains a couple of phenomena, appearing as a result of prolonged deficiency of oxygen.

There are four kinds of hypoxia:

Hypohemia is the result of the deficiency of oxygen in arterial vascular blood. The hemoglobin isn't satisfied with oxygen.

Hemic hypoxia deals with the deficiency of hemoglobin or its competition with carbon dioxide or cyanides. The pO2 is high.

Circulatory hypoxia appears when a plenty of oxygen on blood can't embed the tissue. Tissue hypoxia - when the tissue cells can't utilise the molecules of oxygen.

The HBO is applied in treating of all the four cases ( both: ordinary and acute).

If the hypoxia is acute, the treating contains regular (3-4 times a day) prolonged (up to 2 hours) procedures of HBO. The whole course contains about 20 hours.

If the hypoxia is chronic, the procedures takes place once a day or two days. The whole course contains 12-15 procedures with the exposition of 30-50 minutes per procedure.

HBO has a wide application in treating of acute and chronic defects of the regional blood circulation, anaerobic infections and sepsis.

The HBO,when accompanied with medicinal therapy and operations, is applied in:

1. Acute or chronic cardiac diseases - circulator hypoxia, cardiosclerosis and some other cases.

2. Acute or chronic transgressions of the regional blood circulation - infarct of myocardium, acute diseases of vegetative vascularity, circulatorial violations of the network.

3. Pulse violations - trachicardia, fibrillating arrhythmia.

4. Acute and chronic respiratoric deficiency.

5. Acute and chronic liver deficiency.

6. Acute and chronic kidney deficiency.

7. Burns.

8. Anaerobe infection.

9. Surgeon sepsis (peritonitis, wounds, etc.).

10.Prolonged wounds and ulcers.

11. Some kinds of shock.

12. Posthypoxical encephalopathy, cerebral inflation.

13. Some forms of acute poisonings (carbon oxide, phosphor-containing compounds, narcotics, etc.).

14. Botulism.

15. Ulcer of stomach or intestine.

16. Some diseases of skin.

17. Ishemic neuritis of hearing nerves.

18. Diabetes.

Contraindications for HBO are:

1. Epilepsy and similar diseases.

2. Diseasive holes in lung.

3. Hard hypertension.

4. Some otorhinolaryngologic diseases.

5. Claustrophobia.

6. Acute sensitivity to the oxygen.

Special attention should be paid to the first procedure, when some diseases (claustophobia) and individual sensitivity to compression or decompression can be discovered.

Clinic divisions should have a special duty officer, responcible for the termination with HBO division. The problem of the application of HBO should be solved jointly by that officer and the representatives of the HBO division.

The curing doctor is required to visit the first procedure. Primary conclusions should be given in the process of HBO therapy; final conclusions - three weeks later. Repeating course can permit only the head of HBO division.

In the process of HBO therapy some kinds of accompaning pain can appear: in head, in nose, in ears. The procedure should be interrupted; its continuation should depend on otorhinolaringologist. The defects of lung can take place rare enough.

The preceding diagnosis should take place before the HBO. These are:

1. Electrocardiography.

2. Policardiography.

3. Tetra polar reography of lung.

4. Spyrography.

5. Capnography.

6. Electrothermography.

7. Oxygen tension (pO2 in vasa).

All of this should take place before, after 5, 10 procedures and after course. Besides every nosologic group should have its own plan of inspections.

For cardiological sicks men the following investigations should take place on beforehand:

1. Electrocardiography.

2. Policardiography.

3. Echocardiography.

4. Reovasography.

5. Reoencephalography.

6. Spirography.

7. Oxygen tension (pO2 in vasa).

8. Coagulogram.

9. Lactatdehydrogenaza.

10. Perohidase activity.

11. Lactate and piruvate. 12. Blood catecholamines. 13. Cynines.

14. Cholesterin.

15. Triglicerides.

16. The value of the acid-alcaline balance.

For diabetic sicks:

1. Electrocardiography.

2. Echocardiography of heart and pancreas gland. 3. Reovasgraphy.

4. Reoencephalography.

5. Spirography.

6. Oxygen tension (pO2 in vasa).

7. Coagulogram.

8. Cholesterin.

9. Triglycerides.

10 Fresh oily acids.

11. Sugar in blood and urine.

12. Immunoreactive insulin.

13. Lactatdehydrogenaza.

14. Perohidase activity.

15. Lactate and piruvate.

16. Catecholamines.

17. Cynines.

18. Value of acid-alcaline balance

For ulcer sicks:

1. Electrocardiography.

2. Spirography.

3. Rentgenoscopy of stomach.

4. Gastroscopy.

5. Probing of stomach.

6. Blood gastrin.

7. Cholesterin.

8. Triglycerides.

9. Lactate and piruvate.

10. Lactatdehydrogenaza.

11. Cynines.

12. Blood catekholamines.

13. Coagulogram.

14. Perohidase activity.

15. Oxygen tension (pO2 in vasa).

16. Value of acid-alcaline balance.

For sicks with vascular diseases:

1. Electrocardiography.

2. Reovasgraphy.

3. Reoencephalography.

4. Thermography.

5. Capillaroscopy.

6. Coagulogram.

7. Lactate and piruvate.

8. Lactatdehydrogenaza.

9. Cynines.

10. Oxygen tension (pO2 in vasa).

11. Value of acid-alcaline balance.

The corresponding investigations should examine the efficiency of HBO, its optimal values. The otolaryngology's consultation is desirable in advance as well as slight sedative medicines.

The probable interruption of course should be discussed in advance between HBO stuff and curing doctor from clinic.

We should stress that the main field of HBO is the hypoxia which cannot be treated by means of the other kinds of therapy. The improvement can be observed from the very beginning, but for steady changes all the course could be persued.

We believe, our recommendations could be applicable for the HBO stuff, for sicks with the indications for HBO, and our contraindications could avoid some mistakes in the curing.

NOTE FOR A SICK.

Before the treating in baro-chamber an investigation should be done according to the plan nominated by your curing doctor and the HBO stuff. A probe procedure should also take place to examine your response. Your feelings will be something like flight in a plane. If pain will appear, you should swallow or breath out the air without opening nose and mouth. If pain isn't not diminishing, you should inform doctor by phone.

If you have a head-cold, the procedure should be delayed.

Your dress shouldn't contain synthetics, wool or silk. For absence of static electricity you should contact to a special metal plate.

You should inform the stuff about all the inconveniences, which can appear in the process of the procedure.

Smoking is forbidden for 3 hours after the procedure!

Before the end of course a repeating general investigation should take place. The medicines, gymnastics, sanatory or repeat course of HBO can be recommended as the result of it.

The breakfast before the procedure should be slight; the skin should be clean; the use of creams and cosmetics before the procedure is forbidden; clocks and jewelry should be taken off in advance.