SPECIAL CONSIDERATIONS

Providing oxygen therapy to the neonatal population is complex and based on each individual clinical situation. For the immediate newborn period, it is generally accepted that oxygen is provided based on the American Academy of Pediatrics’ Textbook of Neonatal Resuscitation using the Canadian Adaptations from Canadian Pediatric Society.

Resources:
Canadian Pediatric Society (2020). 7^th Edition NRP Guidelines.
Retrieved from: https://cps.ca/en/nrp-prn/faqs#Oxygen%20Administration

The Basic Principles of Operation of Hyperbaric Chambers

The increased pressure inside the chamber, combined with the delivery of 100% oxygen (FiO₂ = 1.0), drives the diffusion of oxygen into the blood plasma at up to 10 times normal concentration. Patients are monitored at all times during HBOT, often by RTs.

Indications

As of 2019, the following indications are approved uses of hyperbaric oxygen therapy as defined by the Undersea & Hyperbaric Medical Society (UHMS):

The Safety of Hyperbaric Chambers (Health Canada)

Hyperbaric chambers are class 3 medical devices which must be licensed by Health Canada before they can be imported and sold in Canada. The Medical Devices Regulations require that the medical devices imported and sold in Canada are safe, effective, and of quality manufacture. This is achieved by a combination of a premarket review prior to licensing, and post-market surveillance of adverse events.

Health Canada has reviewed the scientific evidence related to hyperbaric chambers. The evidence shows that chambers are effective in treating at this time the 14 conditions recognized by the Undersea and Hyperbaric Medical Society. Therefore, Health Canada has issued medical device licences for hyperbaric chambers to treat only these 14 conditions. No device licences have been issued for the use of hyperbaric chambers to treat other conditions.

Undersea and Hyperbaric Medical Society
http://membership.uhms.org/?page=Indications

Undersea and Hyperbaric Medical Society Canadian Chapter
https://cuhma.ca/

University of Toronto Hyperbaric Medicine
(educational resource for healthcare professionals)
https://www.uhn.ca/Surgery/Treatments_Procedures/Hyperbaric_Medicine_Unit

As altitude increases, barometric pressure decreases. Barometric pressure is the pressure that is exerted by the gases at a given point in the atmosphere, and is the sum of the partial pressures of the component gases. The composition of the atmosphere does not change with altitude, however, the barometric pressure does. As altitude increases, there is a decrease in the partial pressure exerted by each component gas. Thus, as altitude increases, the partial pressure of oxygen in the alveoli decreases. A reduced partial pressure of oxygen results in a relative hypoxia.

The following document is helpful for those planning travel by commercial airline:

Transport Canada – “Passengers with Medical Oxygen”
https://tc.canada.ca/en/aviation/reference-centre/advisory-circulars/advisory-circular-ac-no-700-002#s4-1

It is also helpful to consult the website of the specific airline that the patient intends to travel with for assistance in planning/arranging air travel when oxygen is required.

For some time now, RTs have administered therapeutic oxygen in a hyperbaric practice setting under the 4^th authorized act (“administering a substance by injection of inhalation”). As previously mentioned, the Public Hospitals Act still requires RTs to obtain an order from a valid authorizer to administer oxygen in this environment.  As such, there is no change to the existing practices in hyperbaric settings within hospitals in Ontario.

The 5^th authorized act, in combination with the Prescribed Substances regulation, now permits RTs to independently administer therapeutic oxygen.  This means that in a hyperbaric setting outside of a hospital, RT s can administer oxygen without the additional requirement of an order for the oxygen from a physician or other authorizer.  Administration of Hyperbaric Oxygen Therapy (HBOT), however, must occur in accordance with a diagnosis, pre-treatment screening and prescribed treatment profile (e.g., dive depth/pressure, time, etc.) that have been established by the most responsible physician (MRP). Therefore, RTs cannot independently initiate HBOT, but can implement this treatment in collaboration with the MRP.

HBOT is considered to be within the scope of practice of respiratory therapy; however, it requires competencies that are beyond those that an RT would possess at an entry-to-practice (i.e., graduate) level.  In both the hospital and community setting, obtaining credentials as a Certified Hyperbaric Technologist (CHT) from the Undersea and Hyperbaric Medical Society (UHMS) is considered the industry standard, and is the benchmark that any RT administering hyperbaric oxygen would be expected to perform to. 

As noted above, the CRTO has endorsed the list of 14 indications for hyperbaric oxygen therapy that are established by the UHMS.  Health Canada supports the application of HBOT that is based on the UHMS guidelines and warns against “off label” uses that have not been scientifically proven to be effective. The CRTO does not endorse “off label” use of hyperbaric therapy and the engagement of an RT in such activity may be considered professional misconduct.