Home English Version
English version PDF Stampa E-mail
Scritto da Roberto Pruiti   
Giovedì 29 Ottobre 2009 23:03

Hyperbaric oxygen therapy (HBOT) is a medical treatment that uses pure oxygen to speed and enhance the body’s natural ability to heal.  During hyperbaric oxygen therapy, the patient breathes 100% oxygen under increased atmospheric pressure.  The air we normally breathe contains only 21% of this essential element. The concentration of oxygen normally dissolved in the bloodstream is thus raised many times above normal (up to 2000%).  With HBOT therapy, in addition to the blood, all body fluids including the lymph and cerebrospinal fluids are infused with the healing benefits of this molecular oxygen.  It can reach bone and tissues which are inaccessible to red blood cells, enhance white blood cell function, and promote the formation of new capillary and peripheral blood vessels. Hyperbaric treatment results in increased infection control and faster healing of a wide range of conditions.  

INDICATIONS AND RATIONALE FOR HBO THERAPY 

Indications

Rationale

Acute carbon monoxide poisoning

Relieve hypoxia; hasten elimination of CO; antagonize brain lipid peroxidation.

Acute Exceptional blood loss anemia

Increase physically dissolved oxygen; treat hypoxia; support marginally perfused tissues.

Acute thermal burns

Relieve hypoxia; decrease fluid losses; limit burn wound extension and conversion; beat edema; promote wound closure.

Cerebral arterial gas embolism

Overcome free gas volume; relieve hypoxia; antagonize leukocyte mediated ischemia – reperfusion injury.

Chronic osteomyelitis

Agument host antimicrobial defenses; induce angiogenesis; potentiate leukocyte superoxide and peroxide production; relieve hypoxia; augment antibiotic therapy; extend postantibiotic effect; augment osteoclast activity.

Clostridial gas gangrene

Reduce size of gaseous bullae; inactivate clostridial alpha toxin; inhibit alpha toxin production; induce bacteriostasis; potentiate leukocyte superoxide and peroxide production.

Compromised skin flaps

Support marginally perfused/oxygenated tissues; antagonize ischemic-reperfusion injury; accelerate angio-genesis.

Crush injury; acute ischemic

Provide interim tissue oxygenation in relative states of ischemia; reduce edema; reduce compartment pressures; antagonize ischemic-reperfusion injury; augment limb salvage.

Decompression sickness

Overcome free gas volume-induced ischemia; relieve hypoxia; hasten elimination of offending inert gas; treat edema.

Late radiation tissue injury

Re-establish wound oxygen gradients; relieve hypoxia; induce angiogenesis; prepare for definitive coverage.

Late radiation tissue injury prophylaxis

Re-establish wound oxygen gradients; induce angiogenesis prior to surgical wounding.

Necrotizing soft tissue infections (fasciffis and cellulitis)

Induce bacteriostasis of anaerobes; potentiate leukocytic superoxide and peroxide production; relieve hypoxia; more closely demarcate potentially viable tissue.

Non-healing hypoxic wounds

Re-establish wound oxygen gradients; relieve hypoxia; reduce edema; induce angiogenesis; correct diabetic-induced leukocyte changes; prepare for definitive coverage.

WHAT CAN BE TREATED BY HBO?


Indications included in Italian Health Service:

·        Air Embolis

·        Decompression Illness

·        Burns

·        Carbon monoxide poisoning

·        Blast injury

·        Gas Gangrene

·        Severed limbs

·        Smoke inhalation

·        Crush injuries

·        Diabetic Gangrene

·        Vestibular disorders

·    Peripheral vascular ulcer
       a) Arterial
       b) Decubitus
       c) Venous

·       Compartment Syndrome

·       Acute Necrotizing Fasciitis

·       Clostradial myonecrosis

·        Chronic osteomyelitis

·       Bone grafting

·       Fractures/Non-union

·   Aseptic Necrosis

·       Delayed Wound Healing

·       Meniere Maladie

·       Sudden deafness

  ·   Soft Tissue Swelling
      a) Traumatic
      b) Cellulitis
      c) Infection/Mixed Flora


 Miscellaneous Indications

·     Burger’s Disease

·     Radiation cystitis and enteritis

·     Chronic fatigue

·     Cerebral Palsy

·     Crohn’s Disease

·     Radiation myelitis

·     And Other Maladies

Introduction

Hyperbaric Oxygen Therapy (HBOT) is the intermittent use of 100% oxygen under increased pressure to treat a wide range of medical conditions. The increased pressure is achieved by use a multi-place hyperbaric oxygen chamber for ten patients, which is compressed with air. In this HBOT chamber, the patient breathes the 100% oxygen through a mask or hood. The HBOT chamber has the advantage that the oxygen pushed into the fluids of the body. It is the saturation of body fluids with oxygen during HBOT that delivers the majority of oxygen to ischemic areas.

History of the Use of Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric Oxygen Therapy (HBOT) was first used in the 1890’s to control infection.  The basis for modern hyperbaric oxygen therapy was developed in the 1930’s.  There are now more than 20,000 articles on HBOT in the medical literature.  During the past decade, there has been rapid expansion of the availability of Hyperbaric Oxygen Therapy facilities which are now located in most public and private areas.  The use of HBOT is also increasing in USA, Canada and Europe.  Clinical indications for HBOT are also increasing rapidly.  There are usual and customary indications for use of Hyperbaric Oxygen Therapy in treating patients with problems of healing or control of infection.  Recognition of the benefit of hyperbaric oxygen therapy for these difficult cases has moved the use of HBOT as a treatment of last resort to an important part of primary treatment.  Diabetics have problems controlling infections and have a higher incidence of vascular disease in their brain, legs and feet.  Diabetes is the cause for nearly 50% of the non-traumatic amputations in the United States.

How Hyperbaric Oxygen Therapy Works

At atmospheric pressure of 1ATA (sea level), 98 percent of oxygen is carried in the hemoglobin and red blood cells.  About 2 percent is dissolved in the plasma.  Oxygen levels of 30mm of Hg are required to maintain normal cell functions.  Many of the body’s cells can survive at 5mm Hg, but they cannot perform any healing functions.  The 100% oxygen under increased ATA during hyperbaric medicine procedures pushes oxygen into the fluids of the body and can achieve PO2 values of 1,100 to 1,900 mm Hg.  At 3 ATA with 100% oxygen, experimental animals have been shown to function normally without blood cells.  In addition, the increased ATA within our hyperbaric oxygen chamber causes oxygen to diffuse to a greater distance from capillaries.  These are the reasons HBOT can reduce ischemia.  The fluid draining from a non-healed ulcer or incision during HBOT carries oxygen to these tissues.  Also, hyperbaric oxygen treatment is the only way to reduce edema while increasing oxygenation.

Beneficial Mechanisms of HBOT

Several beneficial mechanisms are associated with hyperbaric medicine. 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:  Hyperbaric oxygen treatment provides immediate support to poorly perfused tissue in areas of compromised blood flow. The elevated pressure within the hyperbaric oxygen chamber produces a 10-15-fold increase in plasma oxygen concentration. What this means is that arterial oxygen values increase from 30 mm Hg to 1,500 or even 2,000 mm Hg. Oxygen diffuses four times as far from the capillaries. Any hyperbaric doctor would agree, however, that this form of hyperbaric oxygen treatment is only a temporary measure, it will often serve to buy time and maintain tissue viability until corrective measures can be implemented or a new blood supply established.

2.                 NEOVASCULARIZATION:  The development of a new blood supply system is an indirect and delayed response to hyperbaric medicine procedures. Major injuries, surgery, radiation, refractory osteomyelitis, ulcerations, and diseases can damage or destroy portions of the circulatory system and the tissue supported by that blood supply. To rebuild healthy new capillaries requires the building blocks—new fibroblast cells and collagen—once a blood supply is re-established, the body can regenerate damaged tissue. Hyperbaric oxygen treatment accelerates the processes, both of growing new capillaries (angiogenesis) and repairing tissues.

3.                 HYPEROXIA:  By utilizing HBOT, the increased oxygen levels help kill harmful bacteria and inhibit the development and activity of toxins (particularly in Clostridial infections—gas gangrene). The extra oxygen also makes the body’s immune system function more effectively, increasing efficiency in destroying foreign organisms. Recent research has demonstrated a prolonged post-antibiotic effect when hyperbaric oxygen therapy is combined with tobramycin against Pseudomonas aeroginosa—HBOT boosts and prolongs the effectiveness of the medication.

4.                 DIRECT PRESSURE:  Hyperbaric oxygen therapy utilizes the concept of Boyle’s Law, where pressure and volume are inversely proportional, is used to reduce the volume of intravascular or other free gas (within the body). This has been used for more than a century to reduce the blood and tissue gases released when a diver or patient undergoes a pressure reduction too quickly. Re-pressurization, with a more gradual return to normal pressures is an effective treatment for decompression sickness and cerebral arterial gas embolisms. Untreated decompression sickness results in significant illness and death and remains grossly under diagnosed.

5.                 Hyperoxia-induced VASOCONSTRICTION: With or without causing oxygen deprivation, a swollen circulatory system is probably less efficient in facilitating tissue healing. Hyperbaric oxygen therapy reduces blood vessel swelling, enabling blood to flow more freely through damaged tissues, bringing healing oxygen and nutrients and carrying away cellular debris. In intermediate compartment syndrome (caused by tissue swelling in a limited space), in injured extremities, and in the fluid accumulation associated with grafts, blood vessel swelling restricts blood flow. Studies have shown a significant decrease in fluid resuscitation requirements when hyperbaric oxygen treatment is added to standard burn wound management treatment—limiting the tremendous fluid loss associated with these injuries makes healing a lot faster.

6.                 ATTENUATION OF REPERFUSION INJURY:  A traumatic incident causes immediate, recognizable, and often irreversible damage. Often, when blood flow is restored (reperfusion) after the initial damage, the body responds by sending out protective leukocytes (white blood cells). Recent theory is that these leukocytes react inappropriately, causing further damage to marginal tissues. mechanism of HBOT to be discovered. Hyperbaric oxygen appears to reduce this secondary, indirect injury by preventing such activation. The net effect of hyperbaric oxygen treatment is the preservation of marginal tissues that may otherwise be lost to ischemia-reperfusion injury.

Contraindications of  Hyperbaric Oxygen Therapy

Contraindications to HBOT are not extensive and often temporary. Communication with your HBOT physician about concerns is essential. Contraindications include:

>  Claustrophobia (fear of enclosed spaces, which is usually controllable).

> Emphysema, which can usually be treated at lower atmospheric pressure.

>  Uncontrolled high fever.

>  History of ear complications.

Thoracic surgery or spontaneous pneumothorax.

  >  Pneumothorax unless treated with a Heimlich valve.

Seizures at pressure have been documented at one per 10,000 compressions in children with Cerbral Palsy (CP), a rate identical with the occurrence in the overall hyperbaric therapy population. Even though seizures are a frequent symptom CP, most CP children with seizure who have been treated with HBOT have shown reduced seizure activity.

Patients with seizure disorders may have recurrence of seizures while at pressure during Hyperbaric Oxygen Therapy.

In China, HBOT is being used to treat seizures in children.

Side Effects of HBOT

The predominant side effect hyperbaric medicine is barotraumas (pressure damage) to the eardrums. Ear tubes may be required by some patients. Although no ruptured eardrums have occurred in my hyperbaric facility, this complication has been reported.


Pure hyperbaric oxygen can produce toxicity, but the treatment parameters used in clinical HBOT are well within the safe limits. In about one in 10,000 compressions, a patient may have an epileptic type seizure due  to oxygen sensitivity or low blood  sugar these seizures

have produced no long-term effects.


During a prolonged course of treatment, some patients will note a change in vision caused by the molding of the cornea by the increased pressure this reverses when HBOT is completed.

 

For more information about what hyperbaric oxygen therapy may be able to do for you, contact:

 

MD Roberto Pruiti 
Via  Aurelia Ovest, 349
54100  Massa (MS)  -  Italy
Ph         +39 (0)585.834141

Fax        +39 (0)585.837203

Mobile    +39 337.711242

 

Ultimo aggiornamento ( Martedì 06 Luglio 2010 09:07 )