In accordance with current legislation:
- Persons who undergo a hyperbaric environment must first carry out a specialized medical examination.
- This examination or subsequent recognitions must be performed by physicians who possess a degree, specialty, diploma or certificate, related to underwater activities, issued by an official body.
It is the specialist doctor in charge of carrying out the patient’s evolution, where the patient’s suitability for hyperbaric treatment will be determined, that is to say, possible contraindications will be ruled out. Occasionally, tests such as chest plates, spirometry, stress tests
It will also be the medical specialist who marks the protocol to follow with each patient. This protocol should include the following information:
- No. of sessions
- Continuity of sessions (daily).
- Pressure reached (>1.5ATA).
- Iso-pressure time (60/90 min).
- Air rupture.
- Repeating cycles.
During the initial check-up, the doctor will inform the patient about all his doubts related to the effectiveness of the treatment as well as to the practice itself. It shall also provide information on the security measures to be followed for the conduct of the sessions. However, the patient will receive a document summarizing the safety information.
Both the patient and the doctor must sign an INFORMED CONSENT, understanding that both agree with the treatment applied, its consequences and risks.
The operator in charge of the sessions must again confirm that the patient has respected the safety rules before entering the camera:
- They are not allowed to carry any type of lotion, oil, perfume, lacquers, nail polish (nail polish remover either).
- No entry with any object, be it metallic, plastic or paper, books or magazines.
- No electronic devices.
The operator must know and analyse every possible object that enters the chamber, for example external prostheses. Making sure gears do not contain oil from any other material that may interact with oxygen.
The patient will be provided with comfortable clothing, obligatory 100% cotton, preferably without pockets to avoid accidentally leaving any object inside.
Clothes must not contain zippers, velcro, buttons, hooks..
Likewise, sheets must be 100% cotton. Usually disposable clothing is made of cellulose so it would not be allowed. It is also not allowed to enter with diapers or soaps, otherwise 100% cotton towels will be used.
Once the patient lies on the stretcher, an anti-static bracelet will be placed upon them, that we have been previously checked to its proper functioning.
Process of a session
International protocols estimate the duration of a standard session to be between 60 or 90 minutes of Iso-pressure.
In the USA the standard session is always 90 minutes, whereas in Europe and specifically in Spain it is more difficult to find MH centres that work in those times, and the usual is usually 60 minutes.
Sequence of a session:
- PRESSURIZATION – duration approx. 10 min. (depending on the pressure to be reached).
- ISOPRESSURE – 60 / 90 min.
- DESPRESSURIZATION – same time as pressurization.
Techniques to compensate for pressure changes.
- Swallow saliva.
- Move jaw.
- Drinking water (control the access of the bottle inside the chamber).
Patients with problems compensating for pressure.
The pressurization is the most delicate moment of the session, where it is necessary to be very vigilant before any suspicion of discomfort. From 1 to 1.5 ATA we will find most of the time the problems.
- In the event of discomfort, to pressurize and remind the patient to perform the indicated manoeuvres to compensate for pressure.
- If the manoeuvres do not improve, decompress slightly and check if the discomfort has subsided.
- If it has ceased, it is possible to continue pressurizing more slowly and without ceasing to monitor.
- If it does not improve, continue to decompress slightly until it stops completely. Wait a few minutes and try again.
- If the discomfort is repeated, it must be assessed whether or not to continue with the session.
- If the patient has reached a pressure equal to or greater than 1.5 ATA the session can be continued for the set time without further increasing the pressure.
- If the patient is below 1.5 ATA, the session is suspended.
The patients with the most problems in compensating for the pressures are undoubtedly the elderly. In the case of children, apparently everything is simpler but not for that reason we should stop watching and look at each gesture made by the little one to give us the pattern of their condition, just like people with disabilities.
In extreme cases and due to the need for treatment, MYRINGOTOMY is practiced.
Some models of single-seater chambers are prepared for critical patient treatment, and may incorporate ventilators, infusion pumps or transcutaneous meters.
Excess Iso-pressure time (over 90 minutes) can lead to pro-oxygen intoxication. In patients who need to overcome these times (decompression accident) is practiced the technique of Air Break in a pressurized single-seater chamber with oxygen consists of wearing a medical air mask for at least 5 minutes (according to protocol).
The chamber must be able to be completely depressurized from 3 ATA to 1 ATA in a maximum time of 120 seconds, and 90 seconds when the pressurization is 2 ATA.
With a patient in treatment, this mechanism should only be used as an emergency!
Normally the discomfort from pressure changes is less during depressurization. But there is a small percentage of patients who experience greater discomfort during this sequence, so it is always necessary to be especially vigilant with patients who perform their first session.