Hyperbaric oxygen (HBOT) is the administration of oxygen at high pressures. HBOT offers unique therapeutic advantages for patients such as stem cell production, improved mitochondrial ATP generation, improved wound and bone healing and improved immune activity during chronic infections.
Atomospheric vs. Hyperbaric oxygen therapy
Normally, when we consider the role of oxygen in medicine it is primarily for hypoxia due to cardioplulmonary indications, such as congestive heart failure, COPD, or pneumonia. Oxygen, carried by hemoglobin in red blood cells, is limited by how much it can increase tissue oxygenation due to rapid saturation of hemoglobin.
HBOT uses 100% oxygen in a pressurized tank at 1.5 atm or greater, leading to hundreds of times more oxygen delivery to cells. The key to the effects of hyperbaric oxygen is that it increases the amount of dissolved oxygen in plasma, which has several advantages for patients:
- Oxygen Delivery: Oxygen dissolved in plasma can be delivered to cells independently of oxygen dissociation factors required by hemoglobin such as 2,3- DPG, acidosis and elevated body temperature
-
Oxygen Perfusion:dissolved oxygen allows for oxygen to be delivered to the microvasculature where red blood cells could not due to
- Altered distensible, making it usefull for sickle cell anemia1, 2
- Blood rheology, improving oxygenation in the face of thrombembolic phenomenon
- Abnormal vasculature improving perfusion in paitents with diabetes3-6, cancer7-11, cardiovascular disorders12-14
- Compromised perfusion: traumatic brain injury15, stroke16, CHF12-14
- Circulation: HBOT increases peripheral vascular dilation through nitric oxide production4, 13, 14, 17
- Stem Cells: Increases stem cell production through nitric oxide production17
- Immunity: Improves oxidative burst capacity, improving native anti-microbial function, particularly in chronic infections (Lyme’s disease18), and acute, aggressive infections (Necrotizing infections19-21)
-
Cancer:
- Improves natural killer cell activity against cancer cells22
- Potentiates oxidative effects of chemotherapy and radiation therapy and improves quality of life in cancer patients7- 11
- Wound Healing3-5, 8, 20, 21, 23, 24:Improves fibroblast production23, angioneogenesis6, 12
- Sports Injuries: HBOT improves muscle recovery and reduces healing time25
- Neuro- Degenerative disorders:Improves ATP production in mitochondria which improves degenerative disorders: Autism26, 27, Alzheimer’s, Muscular dystrophies28
Safety of HBOT
Hyperbaric oxygen therapy is safe for all conditions except for untreated pneumothorax.29Certain chemotherapy drugs are contraindicated during HBOT treatment.
Efficacy of HBOT
HBOT has been studied in thousands of clinical, in vivo and in vitro studies and has been shown to be both safe and effective for dozens of disorders. The following section lists all the indications for HBOT, the insurance-reimbursed indications as well as citations of clinical studies for the most common indications.
Hyberbaric Oxygen Treatment: Conditions for treatment
Conditions in red may be reimbursed by Medicare and medical insurance. Most indications listed here are based on experimental considerations, case studies or anecdotal reports.
Emergency Indications
- Air or gas embolism* (in divers, but can also occur during bypass surgery)
- Bends in divers (decompression sickness)*
- Burns* (thermal burns)
- Carbon monoxide poisoning* (insurance usually stops paying before all brain injuryhas fully improved)
- Cyanide Poisoning*
- Exceptional Blood Loss Anemia*
- Gas gangrene*
- Blast injury
- Cerebral edema
- Closed head injuries (traumatic brain injury)
- Crisis of sickle cell anemia
- Hydrogen sulfide poisoning
- Ileus
- Near- drowning
- Near- electrocution
- Near- hanging
- Peyote poisoning
- Severed limbs
- Smoke inhalation
- Stroke (cerebral infarct, with benefit even long after the event)
Neurologic Indications
- Migraine
- Alzheimer’s disease
- Parkinson's Disease
- Multiple sclerosis
- Autism
- Cerebral edema
- Toxic encephalopathy
- Vascular compromise
- Traumatic
- Cerebral Palsy (CP)
- Spinal cord contusion
- Physiological transaction
- Partial motor or sensory loss
- Fetal alcohol syndrome
- Stroke (acute and chronic residuals)
- Cranial nerve syndromes
- Trigeminal neuralgia
- Optic neuritis
- Vestibular disorders (vertigo, tinnitus, Meniere's syndrome)
- Sudden deafness
- Brain stem syndromes (ischemia, infarct)
- Retinal artery occlusion
- Acoustic trauma
- Peripheral neuropathy
- Charcot Marie's tooth disease
- Radiation myelitis
- Traumatic Brain Injury
- Near Drowning
- Sympathetic Reflex Dystrophy
Orthopedic Indications
- Sports injuries
- Fracture healing and nonunion*
- Crush injuries* (vascular compromise)
- Soft tissue swelling
- Traumatic
- Cellulitis* (infection/mixed flora)
- Compartment syndrome*
- Acute necrotizing fasciitis (so-called "flesh-eating bacteria")*
- Necrotizing soft tissue infections*
- Clostridial myonecrosis* (gas gangrene)
- Severed limbs and digits*
- Acute and chronic osteomyelitis* (bone infection)
- Bone grafting
- Aseptic necrosis
- Tendon and ligament injuries, post-surgical repair
- Delayed wound healing
- Stump infections (following amputation)
- Edema under cast
Hematology/Oncology
- Cancer
- Erythroproliferative disorders due to hypoxia
- Polycythemia vera
- Myelofibrosis (when secondary to hypoxia-induced polycythemia)
- Thrombocytosis (when secondary to hypoxia-induced polycythemia)
Vascular/Surgical Indications/h3>
-
Plastic surgery (speeds healing, reduces scar formation and infection)
- Peripheral vascular ulcer*
- Arterial (atherosclerosis)
- Decubitus (bed sores)
- Neuropathy related (diabetes)
- Venous (deep vein thrombosis complication)
- Diabetic
- Compromised Skin Flaps and Grafts*
- Osteoradionecrosis* (post radiation damage)
- Suturing of Severed Limbs*
- Retinal artery occlusion
- Retinal vein thrombosis
- Frostbite
- Biliary atresia (after surgical correction)
- Diabetic retinopathy
Infection
- Abscesses* (intra- abdominal and intracranial)
- Refractory mycoses* (fungal infections)
- Gangrene (wet and dry, atherosclerosis, more common in diabetes)
- Lepromatous leprosy
- Lyme disease
- Meningitis
- Pneumatosis cystoides intestinalis
- Pseudomembranous colitis
- Crohn's disease
- Ulcerative colitis
- ALS
- Carbon tetrachloride poisoning
- Fibromyalgia
- Glaucoma with visual field loss
- Gulf War Syndrome
- Rheumatoid arthritis (acute)
- Brown Recluse Spider Bite
- Scleroderma
- Sickle cell crisis and hematuria
- Peptic ulcer
- Chronic Fatigue Syndrome
- Post-polio syndrome
- Cirrhosis
References
1. Reynolds JD. Painful sickle cell crisis. Successful treatment with hyperbaric oxygen therapy.JAMA. Jun 21 1971;216(12):1977-1978.
2. Wallyn CR, Jampol LM, Goldberg MF, Zanetti CL. The use of hyperbaric oxygen therapy in the treatment of sickle cell hyphema. Invest Ophthalmol Vis Sci. Aug 1985;26(8):1155-1158.
3. Al-Waili NS, Butler GJ, Beale J, et al. Influences of hyperbaric oxygen on blood pressure, heart rate and blood glucose levels in patients with diabetes mellitus and hypertension. Arch Med Res.Nov 2006;37(8):991-997.
4. Chen SJ, Yu CT, Cheng YL, Yu SY, Lo HC. Effects of hyperbaric oxygen therapy on circulating interleukin-8, nitric oxide, and insulin-like growth factors in patients with type 2 diabetes mellitus.Clin Biochem. Jan 2007;40(1-2):30- 36.
5. Hinchliffe RJ, Valk GD, Apelqvist J, et al. A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. May-Jun 2008;24 Suppl 1:S119-144.
6. Unfirer S, Kibel A, Drenjancevic-Peric I. The effect of hyperbaric oxygen therapy on blood vessel function in diabetes mellitus. Med Hypotheses. Nov 2008;71(5):776- 780.
7. Chen YC, Chen SY, Ho PS, et al. Apoptosis of T-leukemia and B-myeloma cancer cells induced by hyperbaric oxygen increased phosphorylation of p38 MAPK. Leuk Res. Jun 2007;31(6):805-815.
8. Dall'Era MA, Hampson NB, Hsi RA, Madsen B, Corman JM. Hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer. J Urol. Jul 2006;176(1):87-90./font>
9. Krahn MJ, Hagen NA. Analgesic effect of hyperbaric oxygen for pain caused by cancer treatment. J Palliat Care. Summer 1999;15(2):53-55.
10. Teas J, Cunningham JE, Cone L, et al. Can hyperbaric oxygen therapy reduce breast cancer treatment- related lymphedema? A pilot study. J Womens Health (Larchmt). Nov 2004;13(9):1008-1018.
11. Teguh DN, Levendag PC, Noever I, et al. Early hyperbaric oxygen therapy for reducing radiotherapy side effects: early results of a randomized trial in oropharyngeal and nasopharyngeal cancer. Int J Radiat Oncol Biol Phys. Nov 1 2009;75 (3):711-716.
12. Bartorelli AL. Hyperoxemic perfusion for treatment of reperfusion microvascular ischemia in patients with myocardial infarction. Am J Cardiovasc Drugs. 2003;3 (4):253-263.
13. Cabigas BP, Su J, Hutchins W, et al. Hyperoxic and hyperbaric-induced cardioprotection: role of nitric oxide synthase 3. Cardiovasc Res. Oct 1 2006;72(1):143- 151.
14. Yogaratnam JZ, Laden G, Guvendik L, Cowen M, Cale A, Griffin S. Pharmacological preconditioning with hyperbaric oxygen: can this therapy attenuate myocardial ischemic reperfusion injury and induce myocardial protection via nitric oxide? J Surg Res. Sep 2008;149(1):155-164.
15. Shi XY, Tang ZQ, Xiong B, et al. Cerebral perfusion SPECT imaging for assessment of the effect of hyperbaric oxygen therapy on patients with postbrain injury neural status. Chin J Traumatol. Dec 2003;6(6):346-349.
16. Kidd PM. Integrated brain restoration after ischemic stroke--medical management, risk factors, nutrients, and other interventions for managing inflammation and enhancing brain plasticity. Altern Med Rev. Mar 2009;14(1):14-35.
17. Thom SR, Bhopale VM, Velazquez OC, Goldstein LJ, Thom LH, Buerk DG. Stem cell mobilization by hyperbaric oxygen. Am J Physiol Heart Circ Physiol. Apr 2006;290 (4):H1378-1386.
18. Taylor RS, Simpson IN. Review of treatment options for lyme borreliosis. J Chemother. Sep 2005;17 Suppl 2:3-16.
19. Korhonen K. Hyperbaric oxygen therapy in acute necrotizing infections. With a special reference to the effects on tissue gas tensions. Ann Chir Gynaecol. 2000;89 Suppl 214:7-36.
20. Hirn M. Hyperbaric oxygen in the treatment of gas gangrene and perineal necrotizing fasciitis. A clinical and experimental study. Eur J Surg Suppl. 1993(570):1- 36.
21. Holland JA, Hill GB, Wolfe WG, Osterhout S, Saltzman HA, Brown IW, Jr. Experimental and clinical experience with hyperbaric oxygen in the treatment of clostridial myonecrosis. Surgery.Jan 1975;77(1):75-85.
22. De Ridder M, Van Esch G, Engels B, Verovski V, Storme G. Hypoxic tumor cell radiosensitization: role of the iNOS/NO pathway. Bull Cancer. Mar 2008;95(3):282- 291.
23. Niinikoski JH. Clinical hyperbaric oxygen therapy, wound perfusion, and transcutaneous oximetry. World J Surg. Mar 2004;28(3):307-311.
24. Thom SR. Oxidative stress is fundamental to hyperbaric oxygen therapy. J Appl Physiol. Mar 2009;106(3):988-995.
25. Staples J, Clement D. Hyperbaric oxygen chambers and the treatment of sports injuries.Sports Med. Oct 1996;22(4):219-227.
26. Rossignol DA, Rossignol LW, James SJ, Melnyk S, Mumper E. The effects of hyperbaric oxygen therapy on oxidative stress, inflammation, and symptoms in children with autism: an open-label pilot study. BMC Pediatr. 2007;7:36.
27. Rossignol DA, Rossignol LW, Smith S, et al. Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial. BMC Pediatr. 2009;9:21.
28. Peach G. Hyperbaric oxygen and the reflex sympathetic dystrophy syndrome: a case report.Undersea Hyperb Med. Dec 1995;22(4):407-408.
29. Toklu AS, Korpinar S, Erelel M, Uzun G, Yildiz S. Are pulmonary bleb and bullae a contraindication for hyperbaric oxygen treatment? Respir Med. Aug 2008;102(8):1145- 1147.
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