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HBOT protocols
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3/21/2013 at 4:50:19 PM GMT
Posts: 2
HBOT protocols

Hi, we are in the midst of implementing air breaks at our center which obvioulsy involves updating and revising our protocols. My question is it up to our medical director to subjectively choose protocols based on rather loose and somewhat vague suggestions based on available references? In other words their does not seem to be any reference material that is  universally accepted that states concretely what treatment protocols should be. 2.0 vs 2.4 ATA, air breaks for 2.0 vs 2.4? air breaks for co2 retainers...etc. 2.0 for osteoradio. vs 2.4.? Seems to me trial and error plays a significant part in treatment protocols- if we arent seeing any improvement at 2.0 then increase treatment to 2.4......Thank you to those that can reply..

5/30/2013 at 2:29:18 PM GMT
Hi.  I think it is prestty standard to do a 45/5 breathing schedule or a 30/5 schedule.  My experience has been at 2 ATA utilize a 45 O2/5 min air schedule and at greater pressure of 2.4ATA utilize a 30 min O2 /5 min air schedule.  I think this a good rule of thumb.  Obviously  this is not applicable to any emergent txs requiring a T5,T6 etc.

2/28/2014 at 1:19:27 AM GMT
Posts: 5
2.0 vs 2.4 ATA for treatments is the proverbial Holy Grail in the HBO world, and I'm not familiar with any studies comparing the two treatment pressures. With respect to air breaks, I routinely treated patients at 2.0 ATA for 90 minutes without an air break, and the patients all did well.

3/3/2014 at 6:33:05 PM GMT
Posts: 17
You will find you get better outcomes when treating at 2.4 ATA vs 2.0 ATA. Not all patients respond to 2.0 ATA. If you can do an in-chamber TCOM, you will see the difference in some patients. At our facility we treat at 2.4 ATA with two 5 minute Air Breaks. Air Breaks are given regardless of treatment pressure. Not all patients fit this criteria, ie: COPD pts, pts with a history of seizures, those on pain mangement programs etc etc. We have specific protocols drafted up for them. If you want a good idea on what is safe to treat patients, I highly recommend purchasing "Hyperbaric Medicine Practice" by Eric Kindwall, MD & Harry Whelan, MD, if you have not done so already. Every unit should have this.

3/6/2014 at 6:42:16 PM GMT
Posts: 5
Do you have a referrence to any studies comparing outcomes of 2.0 vs 2.4? It's true that some TCOMs values will go up at 2.4 vs 2.0, but the outcome we're measuring is wound healing (at least when TCOMs are involved).
Until I see real evidence that 2.4 is better, I'm sticking with 2.0 since it's both safer for inside attendants and the patients.

10/1/2014 at 1:00:57 AM GMT
Posts: 1
I agree that your in-chamber TCOM should guide you. If tissue TCOM does not exceed 200 mm Hg, tissue healing is unlikely. With other conditions, such as ORN, well researched protocols should be followed unless cotraindicated.
My understanding is that air breaks are not necessary at 2.0 ATA, but I do air breaks if at any risk, the most common being narcotic pain meds. Anything higher, I use air breaks.
What I don't understand is why we use 2.4 ATA as opposed to 2.5. 2.5 ATA = 45 fsw, nice round number. 2.4 ATA = 42.6 fsw. I can't imagine a difference of 2.4 fsw making a significant physiologic difference in either treatment response or risk profile. Why don't we just use 2.5?

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