Hyperbaric Oxygen Therapy

Hyperbaric oxygen (HBO) is a mode of therapy in which the patient breathes 100% oxygen at pressures greater than normal atmospheric (sea level) pressure. In contrast to attempts to force oxygen into tissues by topical applications at levels only slightly higher than atmospheric pressure, hyperbaric oxygen therapy involves the systemic delivery of oxygen at values 2-3 times greater than atmospheric pressure.

What are the Beneficial Mechanisms Associated with Hyperbaric Oxygen Therapy?

Several beneficial mechanisms aye associated with intermittent exposure to hyperbaric doses of oxygen. Either alone, or more commonly in combination with other medical and surgical procedures, these mechanisms serve to enhance the healing process of treatable conditions.

1. HYPEROXYGENATION provides immediate support to poorly perfused tissue in areas of compromised blood flow. The elevated pressure within the hyperbaric chamber results in a 10-15 fold increase in plasma oxygen concentration. This translates to arterial oxygen values of between 1,500 and 2,000 mmHg, producing a four-fold increase in the diffusing distance of oxygen from functioning capillaries. While this form of hyperoxygenation is only a temporary measure, it will serve to buy time and maintain tissue viability until corrective measures can be implemented or a new blood supply is established.

2. NEOVASCULARIZATION represents an indirect and delayed response to hyperbaric oxygen exposure. Therapeutic effects include enhanced fibroblast division, neoformation of collagen and capillary angiogenesis in areas of sluggish neovascularization such as late radiation damaged tissue, refractory osteomyelitis and chronic ulcers.

3. Hyperoxia enhanced ANTIMICROBIAL ACTIVITY has been demonstrated at a number of levels. Hyperbaric oxygen causes toxin inhibition and toxin inactivation in Clostridial perfringens infections (gas gangrene). Hyperoxia enhances phagocytosis and white cell oxidative killing, and has been shown to enhance aminoglycocide activity. Recent research has demonstrated a prolonged post-antibiotic effect when hyperbaric oxygen is combined with tobramycin against Pseudomonas aeroginosa.

4. DIRECT PRESSURE utilizes the concept of Boyle's Law to reduce the volume of intravascular or other free gas. For more than a century, this mechanism has formed the basis of hyperbaric oxygen therapy as the standard of care for decompression sickness and cerebral arterial gas embolism. Commonly associated with divers, CAGE is a frequent iatrogenic event in modern medical practice. It Results in significant morbidity and mortality and remains grossly underdiagnosed.

5. Hyperoxia-induced VASOCONSTRICTION is another important mechanism. It occurs without component hypoxia and is helpful in managing intermediate compartment syndrome and other acute ischemias in injured extremities, and reducing interstitial edema in grafted tissue. Studies in burn wound applications have indicated a significant decrease in fluid resuscitation requirements when HBO therapy is added to standard burn wound management protocols.

• Exceptional Blood Loss Anemia - patient refusal of blood; cross matching difficulties

Oxygen, when breathed under increased atmospheric pressure, is a potent drug. In addition to the beneficial effects that have been discussed, hyperbaric oxygen can produce noticeable toxic effects if administered indiscriminately. Safe time-dose limits have been established for hyperbaric oxygen exposure, and these limitations form the basis for today's treatment protocols.

Emergency cases, such as carbon monoxide poisoning or cerebral arterial gas embolism may only require one or two treatments. In those cases for which angiogenesis is the primary goal, as many as 30 to 40 treatments may be necessary. The precise number of treatments will often depend upon the clinical response of each patient.

With the exception of decompression sickness and cerebral arterial gas embolism, treatments last approximately two hours. These treatments may be given once, twice or occasionally three times daily, and can be provided in both inpatient or outpatient settings.

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