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HIPERBARIK OKSIGEN TERAPI

HBOT
Erick Supondha
Hyperbaric medicine consultant
APLIKASI KLINIS
PENGOBATAN OKSIGEN HIPERBARIK
[OXYGEN HYPERBARIC THERAPY]
SEJARAH PERKEMBANGAN
PENGOBATAN OKSIGEN HIPERBARIK

FONTAINE, 1879
CUNNINGHAM, 1918

CHURCHILL- DAVIDSON, 1955


BOEREMA, 1961
BRUMMELKAMP, 1961
GEORGE SMITH AND SHARP,1962
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
CYLINDRICAL HYPERBARIC CHAMBER
OF ORVILLE J. CUNNINGHAM, KANSAS
CITY, USA

SECOND BIGGEST OPERATION THEATER


IN GRAZ AUSTRIA
OPEN HEART OPERATION 1964 IN
AMSTERDAME

PROFESSOR BOEREMA AND


HYPERBARIC CHANBER IN
“WILHELMINA GASTHUIS” 1972
OPERASI DILAKUKAN DI DALAM
HYPERBARIC CHAMBER

MULTIPLACE HYPERBARIC
CHAMBER DI “ACADEMIC
MEDICAL CENTER” THE
UNIVERSITY OF AMSTERDAME
THE HYPERBARIC CHAMBER CENTER
IN UNION CENTER FOR SURGICAL
RESEARCH, MOSCOW

THE HBO OPERATION THEATER IN


WILHELMINA GASTHUIS AT
AMSTERDAME
VERTICAL HYPERBARIC CHAMBER
FOR CARDIOPULMONARY EXPLORATION IN
L’HOPITAL CALMETTE, LILLE FRANCE
SPECTROMETER MASS OF HYPERBARIC CHAMBER
IN L’HOPITAL CALMETTE, LILLE FRANCE
HIPERBARIK OKSIGEN TERAPI (HBOT)

Terapi medis dengan cara pemberian


oksigen murni kepada pasien yang
berada didalam sebuah ruangan
bertekanan tinggi dengan tujuan
meningkatkan kadar oksigen dalam
darah, jaringan dan plasma
PRINSIP DASAR HBOT
1. TEKANAN TINGGI AKAN MEMPERKECIL VOL
GELEMBUNG GAS, DAN HBOT MEMPERCEPAT RESOLUSI
GELEMBUNG GAS.
2. MENGURANGI OEDEMA JARINGAN.
3. OKSIGENASI PADA JARINGAN ISKEMIA/HIPOKSIA LEBIH
BANYAK.
4. NEOVASKULARISASI (2-3 MINGGU TERAPI)
5. HBOT BERSIFAT BAKTERISID DAN BAKTERIOSTATIK.
6. MENDORONG PEMBENTUKAN FIBROBLAST DAN
MENINGKATKAN EFEK FAGOSITOSIS LEUKOSIT.
• Normally, 97% of the
Principles of HBO2 oxygen delivered to body
tissues is bound to hb,
while only 3% is
dissolved in the plasma.
• At rest, the tissues of the
body consume about 5
mL of O2 per 100 mL of
blood.
• Under hyperbaric
conditions, oxygen
content in the plasma is
increased from 0.3 to 6.6
mL per 100 mL of blood
with no change in
oxygen transport via
hemoglobin.
EFEK TERAPITIK HBOT

EFEK MEKANIK,
TEKANAN AMBIENT

EFEK, TEKANAN
PARSIAL OKSIGEN
EFEK TERAPITIK HBOT

EFEK MEKANIK, TEKANAN AMBIENT

EFEK, TEKANAN PARSIAL OKSIGEN


Indikasi : UHMS & FDA
Luka komplikasi DM
Skin graft
Iskemia trauma akut
Radiotherapi ( kanker)
Luka bakar
Osteomielitis/ kasus orthopedi
Ganggren
Abses intra cranial
Keracunan CO
Emboli udara
DCS
Anemia
Indikasi :
• Pre & post plastic surgery
• Penyembuhan post op tulang
• Infeksi kulit
• RA
• Chronic fatique syndrome
• Brain injury
• Stroke
• Autism
• Cerebral palsy
• Tinitus/sudden deafness
• Kecantikan/ kebugaran/atlet
Apakah Bahaya melakukan HBOT
• Bahaya tentunya ada sama seperti jika
minum obat, rontgent, operasi dll tindakan
medis. Antara lain;
– Barotrauma
– DCS
– Keracunan oksigen
PATHOBIOLOGI

KLASIFIKASI I [PENYEBAB]

1. BIOMEKANIK, BAROTRAUMA

2. BIOKIMIA, KERACUNAN GAS (O2.CO2,CO, INERT)

3. BIOFISIK, DECOMPRESSION SICKNESS


ABSOLUTE
CONTRAINDICATIONS

• UNTREATED PNEUMOTHORAX
• PACEMAKER IMPLANTED
• SELECTED MEDICATION:
RELATIVE
CONTRAINDICATION
• UPPER RESPIRATORY INFECTION
• CHRONIC SINUSITIS
• SEIZURE DISORDERS
• EMPHYSEMA WITH CO2 RETENTION
• HIGH FEVER
• HISTORY OF SPONTANEOUS
PNEUMOTHORAX
• HISTORY OF THORAX SURGERY
• HISTORY OF SURGERY FOR
OTOSCLEROSIS
Siapa saja yg Boleh mengikuti
HBOT
Siapa saja yg Boleh mengikuti HBOT
• Semua pasien dengan indikasi HBOT boleh
mengikuti terapi ini. Mulai usia dini sampai
usia lanjut dengan catatan tidak ada
kontraindikasi dengan HBOT.
Keuntungan Terapi hiperbarik

• Meningkatkan kualitas hidup


• Mengurangi biaya pengobatan
• Mempercepat kesembuhan
• Mengurangi angka hari perawatan
• Mengurangi angka kegagalan pengobatan
terhadap infeksi
• Meningkatkan kebugaran dan kecantikan.
Example of a non-healing diabetic wound treated for 7 weeks

BEFORE AFTER
 HBOT 10X
 HBOT 22X
 HBOT 22X
22 Apr 2005, 62yo lady, R lateral ulcer 2+yrs, PtcO2 = 13mmHg
30 Aug 2005, 25 HBO2
23 April 2004, 55yo lady, Right toes
4 June 2004, 26 HBO2
13 July 2005, continued healing
EVOLUSI TRANSPORTASI
O2 DLM TUBUH

ETAPE ALVEOLER

ETAPE DARAH

ETAPE JARINGAN
ETAPE ALVEOLAR

PAO =(Pb -PH O).FIO -PACO [FICO .(1-FICO )/R)]


2 2 2 2 2 2

PAO2 = (Pb-47).FIO2 - PACO2 /R

PAO2 = TEK.PARSIAL O2 ALVEOLER

Pb = TEK.AMBIENT

PH2O = TEK.UAP AIR

FIO2 = FRAKSI O2 INSPIRASI

PACO2 = TEK.PARSIAL CO2 ALVEOLER

FICO2 = FRAKSI CO2 INSPIRASI


R = RESPIRATORI QUOTIENT
ETAPE DARAH

CaO2 =(Hb x SaO2 x 1,34) + (0,003 x PaO2)

TaO2 =IC x CaO2 x 10

CaO2 = KONSENTRASI O2 ARTERI


Hb = HAEMOGLOBINE
SaO2 = SATURASI O2
PaO2 = TEK.PARSIAL O2 ARTERI

TaO2 = TRANSPORT O2 KE JARINGAN


IC = INDEKS KARDIAK
EVOLUSI O2 ALVEOLAR & DARAH
THD TEK.PARSIAL & FRAKSI O2

FiO2 (%) 0,21 1.0 1.0 1.0

Pb (ATA) 1.0 1.0 2.0 3.0

PAO2 (mmHg) 104 673 1433 2193

PaO2 (mmHg) 100 627 1267 2000

HbO2 (%) 19,7 20,1 20,1 20,1

CaO2 (ml/100ml) 0,3 1,88 3,8 6,0


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
EFEK TERAPITIK OHB

EFEK MEKANIK,
TEKANAN AMBIENT

EFEK, TEKANAN
PARSIAL OKSIGEN
EFEK TERAPITIK
TEK.BAROMETRIK

BOYLE-MARIOTT LAW

DECOMPRESSION SICKNESS

EMBOLI GAS
•REVERSE HYPOXIA
•ALTER ISCHEMIC EFFECT
•INFLUENCE VASCULAR REACTIVITY
•REDUCE EDEMA
•MODULAR NITRIC OXIDE PRODUCTION
•MODIFY GROWTH FACTORS AND CYTOKINE
•EFFECT BY REGULATING THEIR LEVEL AND/OR RECEPTORS
INDUCE CHANGES IN MEMBRANE PROTEIN
•AFFECTING ION EXCHANGE AND GATING MECHANISMS
•PROMOTE CELLULAR PROLIFERATION
•ACCELERATE COLLAGEN DEPOSITION
•STIMULATE CAPILLARY BUDDING AND ARBORIZATION ENHANGE
•ACCELERATE MICROBIAL OXIDATIVE KILLING
•IMPROVE SELECT ANTIBIOTIC EXCHANGE ACROSSE MEMBRANES
INTERFERE WITH BACTERIAL DISEASE
•PROPAGATION BY DENATURING TOXINS
•MODULATE THE IMMUNE SYSTEM RESPONSE
•ENHANGE OXYGEN RADICAL SCAVENGER
•THEREBY DECREASING ISCHEMIA-REPERFUSION INJURY
Tissue Oxygen Requirements

90 % oxidative phosphorylation

9% oxidative amino acids & amines

1% Oxygenation biogenic amines &


hormones
PRODUKSI NITRIT OKSID

eNOS
nNOS
iNOS

FAD + FMD
L-ARGININE + n NADPH + O2 L- CITRULINE + NO + NADP+
BH4

O2 NO VASOKONSTRIKSI
CO2 NO VASODILATASI
Oxygen Hyperbaric Therapy
and
Problems of Aviation, Altitude
Problems of Altitude

Adaptation Normale à la Haute Altitude (ANHA)

Mal-Adaptation à la Haute Altitude (MAHA)


Mal Aigu des Montagnes (MAM)
œdèmes Localisées à la Haute Altitude (OLHA)

Complications :
Hémorragies Rétiniennes de Haute Altitude (HRHA)
Gelures de Haute Altitude (GEHA)
Thrombo Emboliques de Haute Altitude (TEHA)
Œdèmes Pulmonaire de Haute Altitude (OPHA)
Œdèmes Cérébral de Haute Altitude (OCHA)
Hypoxie

Réponse Importante Réponse Faible


Des Chémorécepteurs Des Chémorécepteurs

Hyperventilation ++ Hyperventilation +

PaCO2 PaCO2

Débit Sanguin Cérébral Débit Sanguin Cérébral

œdeme

Adaptation Normale Mal-Adaptation


OPHA HYPOXIA OCHA

VENTILATION COMA
Problems of Aviation

On Ascent Reduction in Total Pressure Decompression Sickness

Effect on gas Containing


Cavities

Reduction in PO2 Hypoxia

Reduction in Temperature Cold Injury

On Descent Increase in Total Pressure


PSYCHONEUROIMMUNOLOGY

ACTION
NEUROENDOCRINE
PRODUCTION SYSTEM

ACTION

PEPTIDE HORMONES
NEUROTRANSMITERS
CYTOKINES PEPTIDE HORMONES
ACTION NEUROTRANSMITERS
CYTOKINES

ACTION
IMMUNE
SYSTEM PRODUCTION
MODEL DIFERENSIASI SEL T
CD4+
SELECTION

CD8+
THYMIC

TCR CD4+
CD4+
CD8+
CD4+
CD8+
TCR
CD8+
TCR
TCR CD4+ CD8+
TCR TCR

MEMORY T CELL
PRIMARY IMMUN
RESPONSE

CD8+ CD4+ CD8+ CD4+


TCR TCR TCR TCR
APC APC
MHC
MHC II
I

CYTOTOXICITY
CTLs Th1 IFN Ƴ
CD8+ CD4+
TCR IL2
FUNCTIONS

TCR
EFFECTOR

LYPHOKINE SECRETION
CTLs Th2 IL4
CD8+ CD4+ IL5
TCR TCR IL10
STRESSOR
OHB OHB & IMMUNOHUMORAL

CD4+ +
TCR APC
MHC
II

Th1 Th2
CD4+ CD4+
TCR TCR
-
IFN Ƴ IL 10
+ +

CD8+
+
-
B
TCR +
APC
MHC SP
I

IgG
STRESSOR
OHB OHB & IMMUNOSUPRESI

CD4+
TCR APC
MHC
II

-
IgG IgE

B
IFN Ƴ IL 4

Th1 Th2
CD4+ CD4+
TCR TCR
OHB AND VASCULAR GROWTH
CONSTITUTIVE NOS
RECOMPRESSION CHAMBER

SINONIM
HYPERBARIC VESSEL
CAISSON
DECOMPRESSION CHAMBER

KLASIFIKASI
FUNGSI
TIPE “A”, FOR HUMAN
TIPE “B”, FOR ANIMAL
TIPE “C”. FOR HUMAN AND ANIMAL
KLASIFIKASI
RUANG
1. MULTIPLACE
2. MONOPLACE

AMBIENT

1. DRY
2. WET
3. DRY AND WET

SETTING
1. HOSPITAL
2. SHIP OR OFF SHORE
3. SIMULATOR
HYPERLITE ®

FUNGSI

1. EARLY RECOMPRESSION

2. UNDERPRESSURE TRANSPORTATION
HYPERLITE ®

ADVANTAGES

1. RINGAN (40 Kg, 80 Kg)

2. VOLUME RELATIVE KECIL[66X66X56CM,62X62X28CM]

3. MOBILE [HELLY,AMBULANCE CAR]

4. MUDAH DIOPERASIKAN
HYPERLITE ®

TECHNICAL DETAILS

DIMENSION:

1. PANJANG 2.16 M [7 FT]

2. DIAMETER 58.5 CM [23 INC]

3. WORKING PRESSURE 21 MSM [69 FSW]


HYPERLITE ®

TECHNICAL DETAILS
COMPONENTS:

1. FLEXIBLE MONOPLACE CHAMBER

2. CONTROL BOX

3. BIBS

4. 2 SCUBA TANKS

5. CONNECTION HOSES
1ST INTERNATIONAL CONGRESS ON
HYPERBARIC OXYGENATION, 1963

AMERIKA
EROPA
AUSTRALIA
CHINA
INDONESIA
FASILITAS HIPERBARIK
DI INDONESIA

GRAVINGDOCK, SBY 1960

RSAL Dr MINTOHARDJO, JKT


RSAL HALONG, AMB
RSAL MIDIATO,TPI
LAKESLA, SBY
RSP BALIKPAPAN
RSP CILACAP
RSU MAKASAR
RSU MANADO
RSU SANGLA,DPS
DISKES KOARMABAR
DEPKES
PERTAMINA
TNI AL
MASALAH SDM PENYELAM

•TINGKAT PENDIDIKAN DASAR


KURANG MEMADAI

•PENGETAHUAN & KETRAMPILAN


KERJA PENYELAMAN KURANG MEMADAI
MASALAH SDM
KESEHATAN PENYELAMAN & HIPERBARIK

BELUM BANYAK TENAGA MEDIS & PARAMEDIS


YANG MEMILIKI PENGETAHUAN TENTANG
KESEHATAN PENYELAMAN & HIPERBARIK
MASALAH PERANGKAT LUNAK
KESEHATAN PENYELAMAN & HIPERBARIK

•BELUM ADANYA PETUNJUK TEKNIS


KESEHATAN PENYELAMAN & HIPERBARIK

•BELUM ADANYA PERANGKAT HUKUM


YANG MELINDUNGI TENAGA KERJA
PENYELAM & HIPERBARIK
MASALAH INFRASTRUKTUR
KESEHATAN PENYELAMAN & HIPERBARIK

•MASIH KURANGNYA FASILITAS RUJUKAN


KESEHATAN PENYELAMAN & HIPERBARIK

•BELUM DIMILIKINYA PERALATAN MONOPLACE


CHAMBER SBG ALAT PENGOBATAN DITEMPAT
DAN TRANSPORTASI
UNDANG-UNDANG NO.23
TAHUN 1992

DEPARTEMEN KESEHATAN
SBG PEMBINA KES.MATRA NAS.
UPAYA YANG TELAH DILAKUKAN

•KESEPAKATAN BERSAMA DEPKES DAN TNI AL

•DILENGKAPINYA FASILITAS KESEHATAN HIPERBARIK


DI BEBERAPA RSU MANADO, MAKASAR DAN DENPASAR

•PELATIHAN BAGI MEDIS,PARAMEDIS DAN KEPALA


PUSKESMAS DI SURABAYA, TANJUNG PINANG, JAKARTA
DEPANSAR
•PENYELESAIAN PERANGKAT LUNAK, PERMEN KESEHATAN
MATRA, KONSEP JEJARING KESEHATAN PENYELAMAN &
HIPERBARIK
•PENDIDIKAN S2 KEDOKTERAN PENYELAMAN & HIPERBARIK
& MANAJEMEN KELAUTAN, HIPERKES DI UNAIR,UI DAN
MASUKNYA MATERI KES.HIPERBARIK DI KURIKULUM S1 FK
FASILITAS HIPERBARIK
DI INDONESIA
GRAVINGDOCK, SBY 1960

RSAL Dr MINTOHARDJO, JKT


RSAL HALONG, AMB
RSAL MIDIATO,TPI
LAKESLA, SBY
RSP BALIKPAPAN
RSP CILACAP
RSU MAKASAR
RSU MANADO
RSU SANGLA,DPS
DISKES KOARMABAR