Use of hyperbaric chamber in bladder tumours...

  1. As a urology nurse I came across the use of hyperberic treatment for a patient with bladder tumours who had a problem with bleeding... can someone please explain the basis for this please?
    I ain't no hyperbaric specialist but I do find it fascinating!

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    Joined: Nov '02; Posts: 68; Likes: 1


  3. by   Stargazer
    Poked around online for a while and found a lot of studies but this was one of the best explanations for the treatment rationale I found:

    The National Cancer Institute issued a consensus statement in 1990 stating that osteoradionecrosis can be prevented but when present is best managed by hyperbaric oxygen (HBO) alone, or with surgery. 1) Late radiation tissue injury is a progressive, obliterative endarteritis which results in a hypoxic, hypovascular, hypocellular tissue bed. 2) These changes make healing after surgical procedures difficult or impossible. This has led to the development of the "Marx Protocol", which induces neovascularization and healing in these damaged tissues and has been proven clincally effective and cost-effective.
    Marx previously reported the 5 year recurrence rate of squamous cell carcinoma in 405 patients followed from 1985-1991.2 Of these patients, 245 received HBO under a protocol for reconstructive surgery, or for mandibular osteoradionecrosis. All were staged using the Joint Commission of Cancer Staging TNM classification system.

    The results reveal a reduced incidence of recurrence in every stage of squamous cell carcinoma in those who have been exposed to HBO. These differences, though statistically significant, were small, and Marx was quick to point out that while HBO may have a chemoprotective effect, it is also possible that the greater radiation dose was applied to those who required HBO and thus one would anticipate better tumor control.
    A recent prospective study followed 46 cancer patients for 3 years who were exposed to a minimum of 30 hours of HBO. 3) This study population was compared to a study-group matched for tumor type, age, sex, stage and year of treatment.

    Review of this data (Table 2) shows a reduced incidence of cancer recurrence in the HBO group when compared to a matched control group.
    Of note is the fact that the matched control group was not statistically different from a larger control group consisting of all 1175 cancer patients treated by the ENT Division of the author's institution, between 1988 and 1992.
    Additional review of data indicated that within the HBO-treated group of patients, there were fewer than expected recurrences of maxillary carcinomas, gingival carcinoma, floor of the mouth carcinomas and tongue carcinomas. Only in the recurrence rate of adenoidcystic carcinomas of the salivary glands was there a comparable number between the HBO and non-HBO treated groups.
    The preponderance of available literature now suggests that HBO is not cancer causing or cancer promoting.4 Work by both Marx and Granstrom has provided another provocative conflict that requires further clinical research - namely: can HBO be considered chemoprotective against cancer recurrence. Time (and research) will tell.
    1.National Cancer Institute: Monograph 1990: No. 9 Consensus Development Conference on Oral Complications of Cancer Therapies: Diagnosis, Prevention and Treatment. US Dept. HHS. National Institute of Health, Washington, D.C.
    2.Marx RE:. Radiation Injury to Tissue. In: Hyperbaric Medicine Practice. Kindwall EP, Ed.. Best Publishing Co., Flagstaff (AZ) 1994;23:500-503.
    3.Granstrom G: Tumor recurrence and development of new head and neck cancers after HBO treatment, a prospective clinical study. Proceedings: Int. Joint Meeting of Hyperbaric and Underwater Medicine. 1996, Milan:47-60
    4.Feldmeier JJ, et al.: Does hyperbaric oxygen have a cancer causing or promoting effect? A review of the pertinent literature. Undersea and Hyperbaric Medicine 1994;21(4):467-475
    The basic principle behind hyperbaric oxygen (HBO) treatment is that normally oxygenated blood is only delivered to cells and tissue as quickly as hemoglobin can transport it. In HBO therapy, a pt is placed in a chamber which is then pressurized to be equivalent to X number of feet below sea level (usually 1 to 2 atmospheres). Once at "depth", the pt is put on 100% O2. This causes oxygen to be "pressured" into tissues at a very high level, independent of hemoglobin. The increased oxygenation promotes wound healing and treatment of anerobic infections.

    Here's a great info page on hyperbaric treatment in general:

    Hope that helped!
    Last edit by Stargazer on Jan 16, '03
  4. by   mackrn
    Hyperbaric Oxygen is useful in the treatment of radiation cystitis. This is the bleeding that sometimes can develop following radiation therapy. Basically what HBO (hyperbaric oxygen) does is try to heal the tissue of the bladder. Have one gentleman that we are treating at the moment with this problem.
  5. by   Kallie
    I am an RN that has spent the past two years working in Hyperbaric Medicine. The appearance of the chambers (monoplace) are frightening to most patients. Hyperbaric medicine is still considered investigational for a lot of treatments. Does it work? I have seen good results, with some patients with wounds, only to have them reappear later. There are numerous safety concerns with Hyperbaric chambers. The least spark from a sheet or piece of clothing caused by static electricity, while in the chamber could be fatal to everyone involved. Oxygen toxicity seizures are another great danger of hyperbaric medicine. Too much oxygen is just like any other drug, it can be fatal. I would have to consider the odds if I were the patient going to be locked inside an enclosed chamber for 2 hours. Is the wound that I have going to heal with any other treatment, is losing a limb worth losing your life to fire?
    Last edit by Kallie on Aug 9, '03
  6. by   mackrn
    I have worked in hyperbarics for over 20 years and have found it to be a very safe and effective modality. If you will check, there has never been a fire in a monoplace chamber in the United States and the ones that have happened oversea's are caused by not following fairly simple safety precautions. If the patient is properly grounded and the linens 100% cotton, there is no chance for static electricity to build up. Before worrying about a fire in a monoplace you have to come up with the last fatality in a monoplace chamber due to fire in the U.S. and that has never happened.
    As for oxygen toxicity, not only is it a self limiting problem, but easily prevented by an appropriate physical work up and air breaks. The #1 problem with oxygen toxicity is the CNS effects or oxygen toxicity seizures. This is due to too much oxygen on board and since the patient does not breath during the seizure, the excess oxygen is used up and the patient then becomes non-oxygen toxic adn stops seizing. The you have to find out what caused the patient to become oxygen toxic.
    As for wounds that return, sure they will if you just heal the wound and don't deal with what caused it to be non-healing in the first place.
    The hyperbaric unit is a highly effective treatment modality if the staff working with the patients are well trained and understand what they are doing. Recently as a part of the Baromedical Nursing Association, was one of the authors of the book Hyperbaric Nursing (the first text o n the nursing aspect of HBO) and suggest y ou get a copy.

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