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The time or length of the air break can vary from five (5) to ten (10) minutes (up to 15 minutes for treatment protocols used for decompression illness), typically after 100 O 2 breathing periods of 20-30 minutes.

We still struggle to answer the question of whether patients with a remote history can have HBO 2.

The issue of concurrent chemo HBO 2 has next to no published information and really has become a fairly recent issue because patients are now living longer with active malignancy.

There are more and more options for systemic treatment and quality of life issues are pertinent for patients even when they have active disease.

Some are antibiotics: some are spindle cell blockers etc., etc.

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Those that mediate cytotoxicity through free radicals are likely to have their effect enhanced in the tumor and normal tissues.

Since the therapeutic goal is to enhance QOL, this would not be perceived as an appropriate effect.

On the other hand Dick Clarke has done a preliminary study with colleagues at U of Chicago using HBO2 along with Cisplatin and radiation without signs of increased toxicity.

Avastin and some of the other so called biologics (Erbitux) target growth factors including VEGF to exert their effect.

Since we enhance VEGF with HBO 2 are we diminishing the anti-cancer effects of Avastin Will HBO2 be effective if VEGF is being suppressed by the Avastin We dont know.

Avastin is 60 days 3) I would avoid Avastin and some of the other biologics as well as Bleomycin as concurrent therapies.

There are no issues with respect to hyperbaric oxygen therapy regarding a prosthetic valve.

The UHMS HBO 2 safety committee can provide information to assist you in answering your question, but the ultimate responsibility for these types of questions rests with the medical director and safety director of your facility.

The hyperbaric treatment protocol is the responsibility of the medical director and the safety director.

The first to reduce oxygen toxicity involving the central nervous system.

The second is to reduce oxygen toxicity to the pulmonary system.

Due to the complexity of our patients and the underlying disease processes, the patient may present with conditions that could possibly lead to a lower threshold limit for oxygen toxicity (i.e.

In 2011 Banham examined the incidence of oxygen toxicity seizures over 41,273 treatments for 3,737 patients and found the overall rate was 0.06 or 610,000 exposures with a higher incident rate in patients treated at increased pressures (0.56 at Navy Treatment Table 6 for dysbarism) (Banham, 2011).

Another article reported zero per 10,000 at 2.0 ATA, 15 per 10,000 at 2.42.5 ATA and 51 per 10,000 at 2.8 ATA (Heyboer et al.

Patients treated for CO poisoning or decompression illness have an incidence as high as 0.5-2, presumably due to a combination of CNS injury and higher PO 2 (2.8-3 ATA) used for treatment of those conditions (Hampson et.

Banham, 2011).

A 2016 retrospective chart review of 2334 patients treated at a hyperbaric center in Israel found a seizure incident rate of 0.3 (7 patients); however, they determined only one patient (0.04) had a true oxygen toxicity event (Hadanny et al.

J Appl Physiol. 1977;42(4):593-9).

Use of 5-minute air breaks after every 20 minutes of 100 O 2 delayed the onset of a measurable reduction in vital capacity (-5) from 6 hours (without air breaks) to 17 hours.

We are not aware of any specific studies that look at the influence of air breaks on CNS O 2 toxicity.

Such a study would be difficult to perform since O 2 toxicity is rare.

Routine use of air breaks for other hyperbaric treatment algorithms is at the discretion of the treating physician and is often implemented when treatment pressure exceeds 2 ATA.

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