You should never allow the battery’s terminals to touch together as they could cause the batteries to fail. Keep the battery away from water and never disassemble or deform the battery. Avoid from exposing a battery to excessive shock or vibration like dropping. Always charge the batteries in accordance with the manufacturer’s instructions, using specified chargers only. The batteries should be stored between -4 F and 140 F to help from degrading the batteries performance.

How to Clean your Respironics EverGo Air Inlet Filter

Its recommend that you clean the air inlet filter weekly. Wash the air inlet filter, located in the zippered compartment on the end of the device case. You may want to clean it more depending on your operating conditions.
Remove the filter and wash it in a solution of warm water and mild liquid dish detergent.

Rinse the filter thoroughly in warm water; remove any excess moisture by placing the filter in a paper towel and starting squeezing gently to dry. Allow the filter to air dry thoroughly. Ensure that the filter is completely dry before putting the filter back in the EverGo.

Place the dry filter in the zippered compartment and zip the compartment shut.

Cleaning the Carrying Case

If cleaning is necessary, use only warm water and liquid dish detergent.

Make sure the carrying case is closed.

Dampen a cloth in the detergent and water solution and wipe the outside surface of the case clean.
Warning: Do not use alcohol, solvents, polishes or any oily substances on the device, as they are flammable.
Caution: Do not allow liquids into any of the controls, the interior of the case, or the oxygen tubing connector.

Device Storage

Store the Respironics EverGo in a place where it will remain clean and dry. It should always be stored in the carrying case. The only time the carrying case should be removed is if airport security personnel asks you to during flight travel.

What is oxygen?
Air is a mixture of gases. Oxygen and nitrogen are the two main gases in the air we breathe. Oxygen accounts for about 21% of gas in air. The abbreviation for oxygen is O2. Every cell in our body needs oxygen to live. In order for oxygen to get to these cells, it must be transported through the airways of the lungs.
If there is a blockage in the airways from mucus or narrowing of the airways from swelling or constriction, air may not reach enough alveoli to deliver oxygen. In some COPD patients, adequate air is brought into the alveoli, but the oxygen contained in the air is not able to pass into the capillaries surrounding the alveoli. This results in low oxygen levels and is called hypoxemia. By breathing even small amounts of additional oxygen, the oxygen level in the air rises above 21% to 23 or 24%. This small amount is enough to help "push" the oxygen into the capillaries. Since the body cannot store oxygen, oxygen needs to be given whenever the body is low on oxygen. In some instances, this means that the COPD patient must use oxygen 24 hours a day. The need for continuous oxygen is called long term oxygen therapy (LTOT). Oxygen therapy is important to understand because oxygen is not useful for everyone with COPD. In fact, oxygen is probably one of the least understood and misused therapies for people with COPD.

How do I know I need oxygen?
The need for oxygen is found by measuring the amount of oxygen in your blood stream. If your oxygen level is below a critical level at rest, then you need oxygen close to 24 hours a day. Some people with COPD do not need oxygen when they are inactive, such as when sitting, but need oxygen when exercising, such as walking, or with eating and/or sleeping. Breathlessness is not a reliable way of determining if you need oxygen. Sometimes, you can be very short of breath and not need oxygen; other times your breathing may feel okay, but you are not getting enough oxygen. Oxygen is not given to treat breathlessness. Although some patients feel some relief in their breathlessness from the flow of oxygen on their face, less expensive ways of getting this same relief can be obtained with a fan.

Your healthcare provider will find out if you need oxygen therapy by taking a blood sample from your artery. This test is called an arterial blood gas (ABG) and it measures carbon dioxide and pH in addition to oxygen. This can be done in the office, clinic or hospital, wherever the arterial blood equipment is available. When making an important decision, such as who needs oxygen, the best evaluation is with an ABG. Measuring oxygen levels can also be done with a pulse oximeter. Oximetry is performed by attaching a clip to your finger that shines a light through it. A tiny computer in the oximeter then determines your oxygen level by the color of the light that shines through from the other side. Oximetry only measures one characteristic of the oxygen in your body and, since it is not as precise as an ABG, should only be used as a guide to oxygen therapy.

How much oxygen should I take?
Oxygen is a medication prescribed by your healthcare provider. Optimally, the amount is carefully decided based on an ABG and then guided by oximetry. Once the amount of oxygen you need is decided, your provider will advise you of the rate at which the oxygen should be set. It is very important that you only use the amount that your doctor or nurse has prescribed, no more or no less. The treatment goal is to keep your oxygen at a level that meets your body’s need for oxygen, usually above 89%. Taking too much oxygen sends a message to your brain to slow your breathing. Whereas too little may deprive the tissue in your brain and heart of oxygen and result in memory loss or changes in your heart.

How many hours a day will I need oxygen?
In some cases, you may only need to use oxygen when you are exercising or sleeping. However, in most cases, oxygen should be used as close to 24 hours a day as possible. If your oxygen level is found to be low, using less than 15 hours a day has not been shown to provide a benefit, and does not protect your heart, brain and other organs of the body. If you are instructed to use continuous oxygen and choose to go off oxygen temporarily, it is best to do so only while resting quietly, not while sleeping, walking or exerting yourself.

During exercise you use more energy and therefore need more oxygen. To find out how much oxygen is needed during exercise, an exercise stress test or a timed walk test is usually done. It is important that the test be performed while using the type of delivery device that is going to be used at home.

The immediate benefits of using oxygen during exercise may be relief of breathlessness (also called dyspnea) and an improvement in your ability to walk or do activities.

Will I need oxygen when I sleep?
During sleep, you slow down your breathing. People have low oxygen levels while awake are usually also lacking oxygen during sleep. In some cases, people that may not require oxygen while awake may require extra oxygen while sleeping. Your healthcare provider will determine if and how much oxygen you should take at night. Your needs may be determined by using an oximeter that will record your oxygen level while you sleep in your home or you may be asked to sleep at a sleep laboratory.

What kind of devices provide oxygen?
There are several types of oxygen devices. The type of device you are given will depend on where you live and on the purpose of your oxygen. Oxygen can be delivered by three types of devices: oxygen concentrator, liquid system or oxygen in a metal cylinder.

What are oxygen concentrators?
A concentrator draws in air from the room/environment (which contains 21% oxygen) and passes the air through a special filter collecting only the oxygen into a reservoir. When the machine is turned on, this process of collection takes place. The reservoir and the concentrator have limited storage, so virtually all the oxygen saved is released into the oxygen tubing for delivery to the patient. The concentration of oxygen delivered by a concentrator is 90-95%. The concentrator is run by electricity. The concentrator weighs about 50 pounds (23 kg) and is usually on wheels so that it can be easily moved in the home from room to room. The machine should be located where there is good circulation and away from furniture and walls. There is a compressor inside the machine that makes a regular noise that can be distracting to some. The device is not intended to be portable, however, recently, a new type of concentrator has been developed that makes it possible to fill portable cylinders from a concentrator. Also in development is a concentrator that weighs less than 10 pounds (5 kg) and runs off of a battery.

What maintenance do oxygen concentrators require?
Concentrators have an air inlet and a filter in front of the air inlet. Make sure that the air inlet is not covered and that it allows fresh air into the concentrator. This filter should be washed once a week in dishwasher detergent. After washing it should be thoroughly rinsed and completely dried before re-inserting. The instruction manual will outline how many filters your concentrator has and how often each of these should be changed. Your concentrator should be serviced after approximately 10,000 hours of use or annually. At that time it should be checked to assure that it is producing the right amount of oxygen. Improper maintenance may result in low concentrations of oxygen being delivered.

What is liquid oxygen?
Liquid oxygen is oxygen that is cooled to -183° C (-297°F), at which point it becomes a liquid. When in liquid form, the oxygen takes up much less room and can be stored in specially designed containers. The concentration of oxygen delivered from liquid oxygen is 100%. Most hospitals use oxygen in liquid form. The gas molecules in the container are in constant movement, allowing for the liquid to slowly turn into a gaseous form. This results in a build up of pressure in the container, which is either delivered to the patient or released by a ventilation valve. Liquid oxygen is stored in the home in large storage reservoirs. The patient uses a smaller tank to fill for portability. You will need to be instructed on how to fill the smaller tank from the larger storage tank. Your oxygen delivery service will routinely fill the larger tank, every 1-2 weeks, depending on the flow rate you use.

What maintenance do liquid oxygen devices require?
The stationary tank should be placed on a level surface so there is minimal chance of the tank tipping. Little maintenance is required. If a bottle is attached to the tank for collecting condensed water, it must be emptied and cleaned regularly. The outside of the tank can be cleaned with a damp cloth when necessary. In addition to instructions for transferring the oxygen from the large tank to the smaller tank, instruction should be received in what should be done if any part of the system should freeze.

What are oxygen cylinders?
This is the oldest method for delivering oxygen. Oxygen is compressed into a steel cylinder under high pressure, often a pressure of about 200 atmospheres. Like liquid oxygen, the concentration of oxygen delivered from cylinders is 100%. Oxygen is stored in large or small cylinders. Large cylinders are very heavy and have to be changed often as the contents are quickly used. Smaller cylinders are therefore emptied more quickly than larger cylinders, but are portable. Smaller aluminum cylinders are also available for portability. When using oxygen-sparing tubes or oxygen-conserving devices, these small cylinders can last for up to 8 hours. The small cylinders are usually used for portability when an oxygen concentrator is the main source of oxygen in the home.

What maintenance do oxygen cylinders require?
The pressure valves must be checked frequently. When the cylinders are empty, the regulator must be removed and placed on a full cylinder.

What about hoses or tubes attached to the oxygen device?
The main tubing attached to the different systems can be up to 15 meters/50 feet long to allow for mobility. The length of the tubing should only be as long as necessary in order to be mobile, for example long enough to get from one end of the house to the other. Having excess tubing may become a hazard to yourself and others. Long tubing also increases chances of knotting and cutting off the flow of oxygen. The tubes should be changed every 6-12 months. The tubing must be the right dimension. The inner diameter should be at least 5 mm to ensure the resistance is minimal.

What is a nasal cannula?
A nasal cannula is a dual-pronged tube attached to the oxygen device for delivering oxygen through the nose. These tubes come in different sizes and lengths. Make sure that the one you have fits you well. The typical length of the tubing is about 2 meters (6 feet). The nasal cannula should be changed approximately once a month due to the plastic nasal cannula becoming hard and stiff. The part of the cannula that is situated in the nose may be washed and the rest of the cannula may be wiped with a damp cloth.

What are oxygen sparing/conserving devices?
Oxygen-sparing/conserving devices are devices used to reduce the amount of oxygen needed from the oxygen source (liquid, concentrator or cylinder). These devices improve the efficiency of the delivery of oxygen, reducing the amount of oxygen that is used. This is accomplished by increasing the flow of oxygen on inhalation and limiting the flow of oxygen on exhalation. By increasing the delivery of oxygen when you breathe in, and reducing or stopping the delivery when you are breathing out, less of the oxygen is wasted. This makes it possible to use smaller and lighter ambulatory systems or standard systems. In addition, the delivery systems (liquid or cylinders) last longer. There are three types of oxygen-sparing/conserving devices: the on-demand device, reservoir cannula and transtracheal oxygen.

What is an on-demand device?
On-demand oxygen delivery devices deliver a small amount of oxygen, usually when you begin to take a breath in through your nose. The delivery device is connected to the oxygen source by the nasal cannula. The device senses the start of inhalation (through the nasal cannula) and immediately gives a short pulse of oxygen.

Nose congestion and mouth breathing may make it hard for the delivery device to sense inhalation. If the level of inspiration through the nose is very low, no oxygen may be delivered. Some types of devices have an alarm that goes off if no breathing activity is detected. Most of the on-demand devices are battery driven and the batteries need to be replaced every couple of weeks.

What are reservoir cannulas?
A reservoir cannula operates by storing oxygen in a small chamber. Storage of oxygen takes place while you are breathing out. This stored oxygen is available when you breathe in. This may allow you to require lower oxygen flow rates while still receiving the same amount of oxygen. There are two types of reservoir devices, the Oxymizer and the Pendant Oxymizer. The differences in the two devices are the location where the storage chamber is located.

What is transtracheal oxygen?
Transtracheal oxygen is oxygen delivered through a catheter placed directly through the neck into the trachea (windpipe). Delivery of oxygen directly into the trachea provides higher amounts of oxygen to be delivered because little is wasted. Flow rates of oxygen can often be reduced by close to 50% at rest and 30% during exercise, as compared with oxygen delivered via a standard nasal cannula. A cosmetic advantage of transtracheal oxygen therapy is that the tubing is not as visible as with standard devices.

Not everyone is a candidate for transtracheal oxygen delivery (TTOD). Candidates must be evaluated, educated and monitored by a trained team of healthcare providers. Complications from TTOD are not frequent, but can be serious.

Do I need a humidifier on my oxygen system?
If you use transtracheal oxygen, humidification of the oxygen is important. With other delivery systems at less than 4 liters per minute, humidification is not usually necessary or beneficial. If you have dryness in your nose, you can use a saline (salt water) spray. If this does not help, a humidifier can be attached to the oxygen system. The humidifier is a bottle filled with sterile or distilled water. The oxygen passes through the water to gather moisture. Water from the humidifier should be changed every 1-2 days.

What should I watch for while I am on oxygen?
In some cases too much oxygen may lead to an increase of carbon dioxide in your blood. This can give symptoms like drowsiness and difficulty keeping awake. Receiving too much oxygen while sleeping can also result in a morning headache. A sign of receiving too little oxygen is a general feeling of fatigue. If any of these problems occur, contact your healthcare provider.

What safety precautions should I use when on oxygen?
Oxygen used properly is safe. DO NOT SMOKE NEAR OXYGEN! Also, stay away from open flames. It is important that no oil or grease is used on any of the oxygen equipment. Oxygen cylinders should be secured and placed in an area where they will not fall. Cylinders are under high pressure and a crack in the cylinder can be lethal. Remember to turn off all equipment when not in use. Oxygen containers should not be stored near water heaters, furnaces, or other sources of heat or flame. Oxygen containers and the storage room should be properly marked/labeled. There should be good ventilation around oxygen equipment. Your oxygen supplier should provide you with a complete list of instructions and safety precautions.

Do I have to worry about oxygen exploding or burning?

* Oxygen alone will not explode and does not burn but oxygen will feed a flame.
* Keep oxygen at least 2 meters or 6 feet away from an open flame.
* Do not smoke while using oxygen, as clothing and hair can easily be ignited.
* Stabilize all cylinders by placing carts in a safe area or by securing them to a wall.

In case of an accident what should I do?
In case of fire, evacuate immediately. Contact the fire department. Understand your oxygen system and what you need to do if there is a problem. Also, you should always have emergency telephone numbers in a central location, such as on the refrigerator. Emergency numbers should include 911 (or country code), your healthcare provider and your oxygen supplier.

Can I travel with oxygen?
It is safe to travel with oxygen, however, various transports have different regulations about their use with oxygen. Contact the appropriate business (airport, boat, train, bus) about their regulations well in advance of travel. Make sure that you have plenty of oxygen with you in case of delays or emergencies. Carry the contact numbers of your healthcare provider and oxygen supplier; you never know when you might need them. General information is listed below. More specific information on traveling with oxygen is available at .

When traveling by car, oxygen equipment must be fastened securely in an upright position so that the equipment is stable during the trip.

When traveling by boat, ferry, train or bus take the same considerations as traveling by car. Contact the boat, ferry, train or bus company a few weeks before traveling to find out which rules apply.

When traveling by plane you should plan your trip weeks in advance and inform the airline and check their regulations. Obtain an oxygen prescription from your doctor that provides your diagnosis, your present condition, a statement that it is safe for you to travel and your oxygen prescription. Your oxygen company can help to arrange for oxygen at the airport and travel destinations. You should book a direct flight for several reasons: some airlines charge for oxygen by each leg of the trip, you will be off oxygen during part of your layover and travel is much less tiring when you do not have to make a connection. Make sure you keep a copy of your oxygen prescription, medication prescriptions, know the health facilities and healthcare providers at each travel destination, and take extra medicines on the plane with you, Your oxygen company can be a great source of help for travel.

While increasing tissue-oxygen levels is a primary therapeutic effect of HBOT, other benefits include reducing edema, modifying growth factors and cytokine effects, stimulating more rapid development of capillary budding and granulation tissue formation within the wound bed, promoting cellular proliferation, accelerating collagen deposition, and increasing microbial oxidative killing.

Damaged tissue can have decreased oxygen levels that reduce the activity of several antibiotics, including aminoglycosides, sulfonamides, and fluoroquinolones. By raising the oxygen in ischemic tissue to normal levels, HBOT may normalize the activity of these antimicrobials. Additionally, HBOT may potentiate the activity of certain antimicrobials by inhibiting biosynthetic reactions in bacteria. HBOT can modulate the immune system response and also enhance oxygen-radical scavengers, thereby decreasing ischemia-reperfusion injury.

Although any therapeutic application of hyperbaric oxygenation is intrinsically associated with the potential for producing mild-to-severe side effects, the appropriate use of hyperoxia is one of the safest therapeutics available to the practitioner.

It is unknown if hyperbaric oxygen therapy will cause congenital defects in horses. In human studies it has not been shown to have adverse effects. In our hyperbaric center, we do not hesitate to treat a mare with HBOT, especially when the benefits outweigh the risks. It is not unusual in our clinic, if treating a foal, to allow the mare in the chamber during treatments to aid in the relaxation of the foal.

Migraine headaches are severely painful and usually occur with other symptoms such as nausea, vomiting and painful sensitivity to light. Cluster headaches cause sharp, burning pain on one side of the head.

Physicians commonly rely on a number of drug therapies to both treat and prevent migraine and cluster headaches, but some also prescribe oxygen therapy. The aim of the systematic review — comprising nine small studies involving 201 participants — was to determine whether inhaling oxygen actually helps.

“We wanted to locate and assess any evidence from randomized trials that oxygen administration was a safe and effective treatment for migraine or cluster headaches,” said lead reviewer Michael Bennett, of Diving and Hyperbaric Medicine at Prince of Wales Hospital in Sydney. “We hoped this would assist physicians to make effective treatment decisions in this area.”

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

The Cochrane reviewers examined studies that evaluated normobaric oxygen therapy and hyperbaric oxygen therapy. Normobaric therapy consists of patients inhaling pure oxygen at normal room pressure, and hyperbaric therapy involves patients breathing oxygen at higher pressure in a specially designed chamber.

Five studies compared hyperbaric versus sham (placebo) therapy for migraine; two compared hyperbaric versus sham therapy for cluster headache; and two investigated the use of normobaric therapy for cluster headache. Length of treatment varied with each study.

Three studies reported the number of patients who had significant relief from their migraines within 40 to 45 minutes of hyperbaric therapy. Although the studies did not specify each patients’ response to treatment, they reported a significant increase in the proportion of patients who had relief with hyperbaric oxygen compared to sham therapy.

For cluster headaches, two studies (69 patients) found a significantly greater proportion of patients had relief of their headaches after 15 minutes of normobaric compared to sham therapy.

The reviewers concluded that hyperbaric treatment might give some relief for migraine headache and that normobaric therapy might provide similar relief for cluster headache, but there is no evidence that these therapies will prevent future attacks.

“We believe that hyperbaric oxygen is also a reasonable measure for migraineurs who have not responded to other measures to treat an acute attack,” Bennett said. “However, the poor availability of hyperbaric chambers makes this an option only in a minority of health facilities. Most physicians treating headaches will continue to rely on established and emerging pharmacological options for treating and preventing acute attacks.”

Estimates indicate that 6 percent to 7 percent of men and 15 percent to 18 percent of women suffer from severe migraine headaches, and cluster headaches effect about 0.2 percent of the population.

John Kirchner, M.D., of the Kirchner Headache Clinic in Omaha, Neb., has treated thousands of patients suffering from a variety of headaches, including migraine and cluster, and said he does not include oxygen therapy in his patients’ treatment plans.

“This [oxygen therapy] would not be practical as the headache comes on fast and does not last long,” he said. “So there would not be time to get the patient to the chamber.”

Kirchner’s treatment for migraine includes avoiding triggers, taking preventive and symptomatic medications and undergoing behavior modification.

The French surgeon Fontaine built a mobile compressorized operating suite in 1879. Patients reportedly had better outcomes because of improved oxygenation and decreased postoperative vomiting and cyanosis. Easier reduction of hernias was noted. Corning introduced the therapeutic compression chamber to the US in 1891 to treat nervous and mental afflictions. This chamber was the first operated by electric power.

Orville Cunningham noted 25 years later that patients with certain cardiovascular disorders improved when moved from high altitudes to sea-level altitudes. He discovered this during the Spanish flu epidemic in 1918, which resulted in more than 500,000 deaths. Many of these victims died in a cyanotic state. Under the care of Dr Cunningham, a rather sick resident physician was treated in the compression chamber and recovered completely. Cunningham subsequently built an 88-ft long and 10-ft wide chamber to treat numerous patients, with remarkable success. The credibility of the compression chamber was reinforced during treatment of flu patients. One night when the chamber’s power accidentally was shut off, all patients died. At the time, the interpretation credited hyperbaric therapy with keeping the patients alive. When the compression stopped, these patients died. However, the deaths were likely the result of rapid ascent from the compression rather than the secondary effects of the Spanish flu.

In 1928, Mr Timkin, an appreciative patient whose uremic state was resolved after receiving hyperbaric therapies, constructed for Cunningham an enormous 60-ft tall, 6-story hyperbaric hospital that looked like a steel sphere. Conditions such as hypertension, diabetes, syphilis, and cancer were treated here until 1930, when the local medical society closed the hyperbaric hospital for lack of scientific evidence or merit. After 1930, much of the medical or scientific community did not look favorably upon the use of hyperbaric medicine.

Supplemental use of oxygen increased with availability after this time. The military soon had an increased interest in underwater activities, and this promoted the use of oxygen and hyperbaric medicine for diving and decompression sickness. Hyperbaric medicine treatments had sound physiologic principles based on known physics of mixed gas when treating decompression sickness.

A flurry of interest in therapeutic hyperbaric medicine was fostered by Dr I. Boerema, who, while in Amsterdam in 1956, reported hyperbaric oxygen (HBO) as an aid in cardiopulmonary surgery, particularly for congenital conditions such as tetralogy of Fallot, transposition of great vessels, and pulmonic stenosis. A colleague of Boerema’s, W. H. Brummelkamp, also interested in hyperbaric medicine, discovered in 1959 (and subsequently published in 1961) that anaerobic infections were inhibited by hyperbaric therapy. Meanwhile, Boerema had published an article, “Life without blood,” a report of fatally anemic pigs treated successfully with volume expansion and pressurized hyperoxygenation. Boerema often is credited as the father of modern-day hyperbaric medicine.

In 1962, Smith and Sharp reported the enormous benefits of HBO in carbon monoxide poisoning. International interest thus was rekindled, and HBO therapy was thrust into the modern era. Hyperbaric units subsequently were built at Duke University, New York Mount Sinai Hospital, Presbyterian Hospital and Edgeworth Hospital in Chicago, Good Samaritan in Los Angeles, St. Barnaby Hospital in New Jersey, Harvard Children’s Hospital, and St. Luke’s Hospital in Milwaukee. Further chambers were installed in numerous international sites.

The benefits of hyperbaric medicine subsequently were observed for split-thickness skin graft acceptance, flap survival and salvage, wound re-epithelization, and acute thermal burns. These studies lent credibility to the therapeutic employment of HBO therapy. This fostered the establishment of organized scientific congresses and societies such as the International Congress on Hyperbaric Oxygen and the Undersea Medical Society. Unfortunately, as the availability of hyperbaric medicine chambers increased, the indiscriminate and inappropriate use of the chamber for a variety of medical conditions by practitioners searching for a “cure-all” therapy resulted in a backlash from the scientific society, once again tarnishing the credibility of hyperbaric medicine. As a result, by the late 1970s, the Undersea Medical Society had formulated guidelines for the use of hyperbaric therapy.

Researchers conducting wound-healing studies continued to try to take advantage of the angiogenic properties of increasing oxygen gradients resulting from hyperbaric therapy. Foot wounds from diabetes, radiation ulcers, and other ischemic wounds have been manipulated and successfully treated with HBO. Prospective blinded randomized trials and well-executed laboratory studies continue to further define the role of hyperbaric therapy in medical therapeutics.

Once the critical level of oxygen is determined, oximetry may be used to adjust oxygen flow settings over time (see Symptoms and Diagnosis of Lung Disorders: Arterial Blood Gas (ABG) Analysis). Oximetry is painless and uses a simple device that is attached to a finger or ear to measure the concentration of oxygen in the blood.

Oxygen for long-term home use is available from three different delivery systems: electrically driven oxygen concentrators, liquid systems, and compressed gas. Inside the home, liquid and compressed gas systems use large tanks to store oxygen. Small, portable tanks of compressed oxygen also may be needed for brief periods—a few hours—outside the home. Each system has advantages and disadvantages.

Oxygen is typically administered with continuous flow through a two-pronged nasal tube (cannula), even though this system is highly wasteful of oxygen. To improve efficiency and increase the person’s mobility, several devices, including reservoir cannulas, demand-type systems, and transtracheal catheters, can be used. Usually, a respiratory therapist or physician instructs the person about proper oxygen use.

While using oxygen therapy at home, it is important to stabilize the tank (possibly using a stand) and store it in an area that is out of the way so it will not fall. Tanks should be closed tightly when not in use. Because oxygen can cause an explosion, it is also important to keep tanks away from any flammable source, such as matches, heaters, or hair dryers. No one in the house should smoke when oxygen is in use.

Hyper” means increased and “baric” relates to pressure. Hyperbaric oxygen therapy (HBOT) thus refers to intermittent treatment of the entire body with 100-percent oxygen at greater than normal atmospheric pressures. The earth’s atmosphere normally exerts approximately 15 pounds per square inch of pressure at sea level. That pressure is defined as one atmosphere absolute (abbreviated as 1 ATA). In the ambient atmosphere we normally breathe approximately 20 percent oxygen and 80 percent nitrogen. While undergoing HBOT, pressure is increased up to two times (2 ATA) in 100% oxygen. In the Sechrist monoplace chambers utilized at our facilities, the entire body is totally immersed in 100-percent oxygen. There is no need to wear a mask or hood. This increased pressure, combined with an increase in oxygen to 100 percent, dissolves oxygen in the blood plasma and in all body cells, tissues and fluids at up to 10 times normal concentration—high enough to sustain life with no blood at all (from 20% to 100% oxygen is a 5-fold increase, from 1 ATA to 2 ATA can double this again to a 10-fold or 1,000% increase).

While some of the mechanisms of action of HBOT, as they apply to healing and reversal of symptoms, are yet to be discovered, it is known that HBOT:

1) greatly increases oxygen concentration in all body tissues, even with reduced or blocked blood flow;

2) stimulates the growth of new blood vessels to locations with reduced circulation, improving blood flow to areas with arterial blockage;

3) causes a rebound arterial dilation after HBOT, resulting in an increased blood vessel diameter greater than when therapy began, improving blood flow to compromised organs;

4) stimulates an adaptive increase in superoxide dismutase (SOD), one of the body’s principal, internally produced antioxidants and free radical scavengers; and,

5) aids the treatment of infection by enhancing white blood cell action and potentiating germ-killing antibiotics.

While not new, HBOT has only lately begun to gain recognition for treatment of chronic degenerative health problems related to atherosclerosis, stroke, peripheral vascular disease, diabetic ulcers, wound healing, cerebral palsy, brain injury, multiple sclerosis, macular degeneration, and many other disorders (conditions treated). Wherever blood flow and oxygen delivery to vital organs is reduced, function and healing can potentially be aided with HBOT. When the brain is injured by stroke, CP, or trauma, HBO may wake up stunned parts of the brain to restore function.

Many conditions are being treated with HBO worldwide.

For help finding a Hyperbaric Oxygen Therapy Provider near you.

One of the world’s most experienced authorities on hyperbaric medicine was Dr. Edgar End, clinical professor of environmental medicine at the Medical College of Wisconsin, who voiced his opinion on HBOT’s value for the treatment of stroke in this way: “I’ve seen partially paralyzed people half carried into the (HBOT) chamber, and they walk out after the first treatment. If we got to these people quickly, we could prevent a great deal of damage.”

Using the Sechrist monoplace chamber, HBOT is administered in a transparent, cylindrical chamber, approximately 8 feet long and 3 feet in diameter. The patient is made comfortable on a cot-like stretcher and rolled into the chamber. While in the chamber, the patient has full 360-degree vision through the transparent enclosure. The chamber is equipped with two-way microphones and speakers. The patient can watch TV, listen to music, read, nap, or talk with the chamber operator, family, or whoever is outside. During treatment, usually lasting an hour, the patient is surrounded by and inhales pure oxygen while pressure within the chamber is increased from 1-1/2 to 2 times the outside pressure. At the end of treatment, the patient is gradually decompressed to normal pressure and leaves the chamber.

Several therapeutic principles are made use of in HBOT:

* The increased overall pressure is of therapeutic value when HBOT is used in the treatment of decompression sickness and air embolism.
* For many other conditions, the therapeutic principle of HBOT lies in a drastically increased partial pressure of oxygen in the tissues of the body. The oxygen partial pressures achievable under HBOT are much higher than those under breathing pure oxygen at normobaric conditions (i.e. at normal atmospheric pressure).
* A related effect is the increased oxygen transport capacity of the blood. Under atmospheric pressure, oxygen transport is limited by the oxygen binding capacity of hemoglobin in red blood cells and very little oxygen is transported by blood plasma. Because the hemoglobin of the red blood cells is almost saturated with oxygen under atmospheric pressure, this route of transport cannot be exploited any further. Oxygen transport by plasma, however is significantly increased under HBOT.

Uses

The United States, the Undersea and Hyperbaric Medical Society, known as UHMS, approved for reimbursement diagnoses for application of HBOT in hospitals. The following indications are approved uses of hyperbaric oxygen therapy as defined by the UHMS Hyperbaric Oxygen Therapy Committee.

* Air or gas embolism
* Carbon monoxide poisoning
o Carbon Monoxide Poisoning Complicated by Cyanide Poisoning
* Clostridal Myositis and Myonecrosis (Gas gangrene)
* Crush Injury, Compartment syndrome, and other Acute Traumatic Ischemias
* Decompression sickness
* Enhancement of Healing in Selected Problem Wounds
* Exceptional Blood Loss (Anemia)
* Intracranial Abscess
* Necrotizing Soft Tissue Infections (Necrotizing fasciitis)
* Osteomyelitis (Refractory)
* Delayed Radiation Injury (Soft Tissue and Bony Necrosis)
* Skin Grafts & Flaps (Compromised)
* Thermal Burns

In the United States, HBOT is recognized by Medicare as a reimbursable treatment for 14 UHMS “approved” conditions. An HBOT session costs anywhere from $100 to $200 in private clinics, to over $1,000 in hospitals. U.S. physicians may lawfully prescribing HBOT for “off-label” conditions such as Lyme Disease, stroke and migraines. Such patients are treated in outpatient clinics. In the United Kingdom most chambers are financed by the National Health Service, although some, such as those run by Multiple Sclerosis Therapy Centres, are non-profit.

Other reported applications include:

* Diabeticaly derived illness, such as diabetic foot, diabetic retinopathy, diabetic nephropathy
* Epidural abscesses
* Certain kind of hearing loss
* Radiation-induced hemorrhagic cystitis
* Inflammatory bowel disease

HBOT is controversial and health policy regarding its uses is politically charged. Both sides of the controversy on the effectiveness of HBOT is available in the form of Cochrane Library reviews.

Structure

Traditional

The traditional type of hyperbaric chamber used for HBOT is a hard shelled pressure vessel. Such chambers can be run at absolute pressures up to 600 kilopascals or 85 PSI (lbf/in²), nearly six atmospheres.

Navies, diving organizations and hospitals typically operate these. They range in size from those which are portable and capable of treating just one patient to those which are fixed, very heavy and capable of treating eight or more patients.

The chamber may consist of:

* a pressure vessel that is generally made of steel and aluminium with the view ports (windows) or hull made of acrylic.
* one or more human entry hatches—these could be small and circular or wheel-in type hatches for patients on trolleys
* an airlock allowing human entry—a separate chamber with two hatches, one to the outside world and one to the main chamber, which can be independently pressurized to allow patients to enter or exit the main chamber while it is still pressurized
* an airlock allowing medicines, instruments and food to enter the main chamber
* glass ports or closed-circuit television allowing the technicians and medical staff outside the chamber to monitor the inside of the chamber
* an intercom allowing two-way communications inside and outside the chamber
* a carbon dioxide scrubber—consisting of a fan that passes the gas inside the chamber through a soda lime canister
* a control panel outside the chamber is used to open and close valves allowing air to enter or leave the chamber and oxygen to be supplied to oxygen helmets or masks

Oxygen breathing

Breathing 100% oxygen from an aviators’ oxygen mask.
A recompression chamber for a single diving casualty

In today’s larger “multiplace” chambers, both patients and medical staff inside the chamber breathe from “oxygen helmets”, flexible, transparent soft plastic helmets with a seal around the neck similar to a space suit helmet, or tightly fitting aviators oxygen masks, which supply pure oxygen and remove the exhaled gas from the chamber. During treatment patients breathe 100% oxygen most of the time but have periodic air breaks to minimize the risk of oxygen toxicity. The exhaled gas must be removed from the chamber to prevent the build up of oxygen, which could provoke a fire. Medical staff may also breathe oxygen to reduce the risk of decompression sickness. Administration of 100% breathing oxygen maximizes the patient’s treatment. The pressure inside the chamber is increased by opening valves allowing high-pressure air to enter from storage cylinders, similar to diving cylinders. A gas compressor is used to fill these cylinders.

Smaller “monoplace” chambers can only accommodate the patient. No medical staff can enter. The chamber is flooded with pure oxygen or compressed air. The cost of using pure oxygen in a monoplace chamber is much higher than using compressed air. If pure oxygen is used no oxygen breathing mask or helmet is needed. If compressed air is used then an oxygen mask or helmet is needed as in a multiplace chamber. In monoplace chambers that are compressed with pure oxygen a mask is available to provide the patient with “air breaks,” periods of breathing normal air, in order to reduce the risk of hyperoxic seizures.

Effects of Pressure

Patients inside the chamber will notice discomfort inside their ears as a pressure difference develops between their middle ear and the chamber atmosphere. This can be relieved by the Valsalva maneuver or by “jaw wiggling”. As the pressure increases further, mist may form in the air inside the chamber and the air may become warm. When the patient speaks, the pitch of the voice may increase to the level that they sound like cartoon characters.

To reduce the pressure, a valve is opened to allow gas out of the chamber. As the pressure falls, the patient’s ears may “squeak” as the pressure inside the ear equalizes with the chamber. The temperature in the chamber will fall.

Home treatment

There are portable HBOT chambers, which are used for home treatment. These are usually referred to as “mild chambers”, which is a reference to the lower pressure of soft-sided chambers. Those commercially available in the USA go up to 4 PSI (1.27 ATA 8.92 FSW). International portable chambers can go to 7.35 psi (1.5 ATA 16.38 FSW) or higher. These chambers are operated with oxygen concentrators (typically 95% oxygen) or with 100% oxygen as the breathing gas. Total concentration of oxygen should not exceed 25% as this can increase the risk of fire.

These chambers are often used in a clinical settings, but are also used in homes. Mild hyperbaric chambers use standard 120 volt outlets and can also be configured for 220 volt use. Ranging in size from 21″ up to 40″ in diameter these chambers measure between 84″ to 120″ in length. The soft chambers are FDA approved only for the treatment of altitude sickness but are commonly used off label primarily for the treatment of autism and other neural conditions though there is no proof that it is effective and hospitals refuse to allow their chambers to be used for this purpose. The FDA has a specific warning that supplemental oxygen is not to be used.

Treatments

Initially, HBOT was developed as a treatment for diving disorders involving bubbles of gas in the tissues, such as decompression sickness and gas embolism. The chamber cures decompression sickness and gas embolism by increasing pressure, reducing the size of the gas bubbles and improving the transport of blood to downstream tissues. The high concentrations of oxygen in the tissues are beneficial in keeping oxygen-starved tissues alive, and have the effect of removing the nitrogen from the bubble, making it smaller until it consists only of oxygen which is then re-absorbed into the body. After elimination of bubbles, the pressure is gradually reduced back to atmospheric levels.

Protocol

The slang term for a cycle of pressurization inside the HBOT chamber is “a dive”. An HBOT treatment for longer-term conditions is often a series of 20 to 40 dives.

Emergency HBOT for diving disorders typically follows one of two forms. For most cases, a shallow “dive” to a pressure the equivalent of 18 meters / 60 feet of water for 3 to 4.5 hours with the casualty breathing pure oxygen with air breaks every 20 minutes to reduce oxygen toxicity. For extremely serious cases, a deeper “dive” to a pressure the equivalent of 37 meters / 122 feet of water for 4.5 hours with the casualty breathing air.

In Canada and the United States, the U.S. Navy Dive Charts are used to determine the duration, pressure and breathing gas of the therapy. The most frequently used tables are Table 5 and Table 6. In the UK the Royal Navy 62 and 67 tables are used.

The Undersea and Hyperbaric Medical Society[57] (UHMS) publishes a report which compiles the latest research findings and contains information regarding the recommended duration and pressure of the longer-term conditions.

Possible complications

There are risks associated with HBOT, similar to some diving disorders. Pressure changes can cause a “squeeze” or barotrauma in the tissues surrounding trapped air inside the body, such as the lungs[58], behind the eardrum[59][60], inside paranasal sinuses[59], or trapped underneath dental fillings[61]. Breathing high-pressure oxygen for long periods can cause oxygen toxicity. Temporarily blurred vision can be caused by swelling of the lens, which usually resolves in two to four weeks.[62][63]

There are reports that cataract may progress following HBOT.[64] Also a rare side effect has been blindness secondary to optic neuritis (inflammation of the optic nerve).[citation needed]

Contraindications

The only absolute contraindication to hyperbaric oxygen therapy is untreated pneumothorax.[65] Also, the treatment may raise the issue of Occupational safety and health (OHS), which has been encountered by the therapist.[66][clarification needed]

Patients should not undergo HBO therapy if they are taking or have recently taken the following drugs:

* Doxorubicin (Adriamycin) – A chemotherapeutic drug.
* Disulfiram (Antabuse) – Used in the treatment of alcoholism.
* Cis-platinum – A cancer drug.
* Mafenide acetate (Sulfamylon) – Suppresses bacterial infections in burn wounds

The following are relative contraindications:

* Upper respiratory infections – These conditions can make it difficult for the patient to clear their ears, which can result in what is termed sinus squeeze.
* High fevers – In most cases the fever should be lowered before HBO treatment begins.
* Emphysema with CO2 retention – This condition can lead to pneumothorax during HBO treatment.
* History of thoracic (chest) surgery – This is rarely a problem and usually not considered a contraindication. However, there is concern that air may be trapped in lesions that were created by surgical scarring. These conditions need to be evaluated prior to considering HBO therapy.
* Malignant disease: Since cancers both thrive in blood rich environments and may be suppressed in high oxygen environments, cancer and HBO poses a dilemma since HBO both increases blood flow via angiogenesis and also raises oxygen levels. Taking an anti-angiogenic supplement may provide a solution to this problem.
* Middle ear barotrauma (MEBT) is always a consideration in treating both children and adults in a hyperbaric environment, but most children currently being treated with HBOT are being pressurized to 1.3 ATA which reduces the risks of potential side effects.

Neuro-rehabilitation
The Collet (Quebec) trial that was published in the Lancet in 2001 was the largest randomized trial of Hyperbaric Oxygen Therapy (HBOT) for children with cerebral palsy (CP); it followed the McGill pilot study on the same subject.

The evidence showed both groups of children treated with two very different hyperbaric treatment dosages improved significantly. The motor improvements that were seen and measured with the gross motor function measure were greater, more generalized, and were obtained in a shorter period of time than most of the changes found in any other studies of recognized conventional therapies in the treatment of children with cerebral palsy. The children in both groups improved an average of ten times more during the two months of HBOT (whilst all other therapies and medication were stopped) than during the three months follow-up (when medication and all the ancillary treatments were restarted). This impressive change in the rate of improvements clearly indicates the probable effectiveness of hyperbaric treatment. Both the Lancet commentary and the tech report by the Agency for Healthcare Research and Quality (AHRQ) concluded that the hypothesis of both treatments being equally effective should be retained.

Since the Quebec study of HBOT for children with CP, many reports have been made on the possible efficacy of a low pressure hyperbaric treatment and all the trials conducted with HBOT in CP have demonstrated positive results.

An editorial on CP published by the Undersea and Hyperbaric Medical Society in 2007 called for further research that will include “basic science research to determine a reasonable mechanism of action” for hyperbaric oxygenation as well as “clinical studies of the highest possible methodological rigor”.

Some medical practitioners recommend the use of HBOT for the treatment of acute tinnitus but this treatment has not been verified by independent evidence and the treatment was withdrawn from support by the German health insurance. There is evidence that the therapeutic effects could be greatly due to psychological mechanisms triggered by the patients attitude towards therapy prior to the treatment.

The earliest randomized, placebo-controlled, double-blind study on multiple sclerosis patients treated with HBOT suggested the therapy could improve balance and bladder function. However, by 2004 a Cochrane review assessing ten trials and 21 analyses “found no consistent evidence to confirm a beneficial effect of hyperbaric oxygen therapy for the treatment of multiple sclerosis and do not believe routine use is justified.

For more informaton on Hyperbaric Chambers

“I have an Eclipse at home where it is my primary oxygen source for continuous flow while sleeping,” said Mike Rosenthal, an oxygen patient in Phoenix. “But the reason the unit is so attractive to me is that I can use it for travel as well. I just recently took a 3-hour plus flight to Chicago on battery power. And I can now take road trips since the Eclipse works on a 12 volt automobile power source.”

Developed over 5 years at a cost of $12 million, the Eclipse weighs 17 pounds, has a retractable handle and wheels for mobility, and is about the size of a student’s backpack. It was designed to fit easily under standard airplane seats. For more information on the Sequal Eclipse Portable Oxygen Concentrator

“For me, the bottom line is now I can travel to Germany to visit my grandkids,” said Trixie Robinson, an oxygen patient in Carlsbad. “Before the Eclipse, I had to arrange for oxygen tanks wherever I was going. Now I just buy a plane ticket and go.”

Developed over five years at a cost of $12 million, the Eclipse weighs 17 pounds, has a retractable handle and wheels for mobility, and is about the size of a student’s backpack. It was designed to fit easily under standard airplane seats. Prior to the Eclipse, patients needing continuous flow oxygen were required to make arrangements for the delivery of multiple oxygen cylinders or to ship large stationary concentrators to their destination and pay extra fees for oxygen onboard the airplane.

In addition to oxygen patients, oxygen providers also stand to benefit from the FAA decision.

“Now, when we have a patient going on a long trip, we just give them an Eclipse,” said Jim Karls, President of Halprin, Inc., a provider in upstate New York. “The Eclipse gives us a simple solution to what used to be a very complicated logistical problem.”

The new Special Federal Aviation Regulation (SFAR 106) ruling that allows airline passengers to use their Eclipse onboard became effective on September 12, 2006.

“This is also good news for the airlines because of the light weight, portability and safety of the Eclipse when compared to cylinders,” said Jim Bixby, SeQual CEO. “The Eclipse runs on battery power and is the only portable concentrator with continuous-flow capability, the standard for long-term oxygen therapy patients. Also, it’s much quieter when compared to other concentrators – an important attribute for travelers.”

Vernon Pertelle, a member of the SeQual board who has more than 20 years experience in the field, most recently as corporate director of respiratory care and HME services at Apria Healthcare, said the approval marks a significant step in improving the quality of life for oxygen patients.

“They can be un-tethered from old technology and have their therapeutic needs met wherever they go — from home, to car, to RV, to train or airplane,” said Pertelle. “They now have a portable with both continuous and pulse flow – integral to meeting their needs.”

About SeQual Technologies Inc. Founded in 1991, SeQual offers a family of innovative products ranging from the 3 LPM (liter-per-minute) continuous flow portable Eclipseâ„¢ to its popular, compact, easy-to-use bedside 10 LPM unit. More than 80,000 oxygen systems in use today rely on SeQual’s proven technology. SeQual’s air separation systems are used for industrial applications such as water purification, oxygenation for aquaculture, producing feed gas for ozone generators, or for any other processes needing high-purity, dry oxygen or nitrogen on site. SeQual is a private company based in San Diego. For information on the Sequal Eclipse Portable Oxygen Concentrator