Hyperbaric Oxygen Therapy (HBOT)
Hyperbaric Oxygen Therapy (HBOT) is powered by natural healing mechanisms of oxygen set into motion by the increased atmospheric pressure inside sealed hyperbaric chambers. Hyperbaric Oxygen Therapy is considered to be a medicine because oxygen under elevated pressure acts like a drug doing things that under normobaric conditions (e.i. under normal atmospheric pressure) it wouldn’t do. Most conditions associated with hypoxia or ischemia can benefit from HBOT.218
Healing of several acute or critical conditions like crush injury, closed head injury (traumatic brain injury), air embolism, decompression sickness, chest injury, blast injury, abdominal injury, carbon monoxide poisoning, strokes, sports injuries and other can be effectively supported by Hyperbaric Oxygen Therapy.
At a cellular level, by revitalizing the mitochondrial DNA and enzymes, Hyperbaric Oxygen can return damaged cells back to the life, like for example damaged brain neurons deprived of oxygen as a result of several possible reasons. Regardless of the specific cause of the brain damage, e.g. strokes, carbon monoxide poisoning, brain hypoxia or autism – the mitochondrial biogenesis triggered by Hyperbaric Oxygen Therapy will start returning cellular metabolism back to life, also healing ischemia by restoring blood flow around hypoxic tissues of the brain.
Certain chronic conditions like diabetic ulcer wounds, radiation burns, necrotizing soft tissue infections, other non-healing wounds, as well as multiple sclerosis, cerebral palsy, sleep apnea, autism, Alzheimer’s and many other diseases are also in the list of conditions treated by Hyperbaric Oxygen Therapy. Some of them are officially approved by authorized health authorities like FDA, others are still categorized as investigational in spite of considerable positive clinical evidence worldwide.
Today approved and investigational indications for Hyperbaric Oxygen Treatment belongs to several categories of medicine such as Traumatology, Neurological Disorders, Peripheral Vascular Disorders, Hematology, Endocrine Disorders, Cardiac Disorders, Orthopedic Disorders, Ophthalmology, Otorhinolaryngology, Plastic and Cosmetic Surgery, Gastrointestinal, Autoimmunity Related Disorders.
Dr. Thomas M. Bozzuto, in the introduction to his article The Role of Hyperbaric Oxygen Therapy in Emergency Medicine gives the following historical perspective of the modern age developments of HBOT…
During the last century treatment in hyperbaric/decompression chambers proved to be an effective method to heal cerebral arterial gas embolism and decompression sickness – both conditions are very well known among Scuba Divers, Navies, and Pilots.
The growth of new blood vessels in damaged tissues (angiogenesis) is another permanent effect of Hyperbaric Oxygen Treatment boosting oxygen delivery to the hypoxic tissues. It is the most significant clinical benefit in the healing improvement of certain hypoxic wounds. Exposure to hyperbaric oxygen improves collagen synthesis by fibroblasts and stimulates angiogenesis.
By opening up the blood circulation into damaged tissues Hyperbaric Oxygen helps with the tissue detoxification. By normalizing various enzyme systems it helps with the detoxification process because metabolically healthy cells are able to accelerate required chemical processes thus promoting and expanding detoxification.
Healing effects of Hyperbaric Treatment of life-threatening gas poisoning such as by carbon monoxide (CO), which binds to hemoglobin 200 times more intensively then oxygen forming so-called carboxyhemoglobin is well known. Hyperoxygenation achieved in Hyperbaric Chamber significantly reduces the half-life of carboxyhemoglobin, based on the fact the oxygen molecules displace CO molecules from hemoglobin.
Other beneficial effects of HBOT on brain cells damaged by carbon monoxide are the reduction in lipid peroxidation, endothelial leukocyte migration, and other post-hypoxic events. The quick admission of the CO2 poisoned patients to the Hyperbaric Chamber is crucial for patient’s survival and rehabilitation.
Intermittent increases in arterial PO2 to levels promoted by hyperbaric oxygen have a variety of delayed (prolonged) effects which may be beneficial in certain clinical conditions.
Vasoconstriction which reduces the caliber of blood vessels is caused by the arterial hyperoxia which occurs during Hyperbaric Oxygen Treatment but increased perfusion maintained by hyperbaric oxygen produces most sufficient tissue PO2 level resulting in a reduction of tissue edema in acute medical conditions such as crush injury, reperfusion after ischemic injury, compartment syndrome, etc…
Hyperbaric Oxygen Therapy is an effective and safe therapy for vasculitis patients suffering from non-healing skin ulcers.
Cutaneous nonhealing ulceration is a threatening manifestation of vasculitis. Hyperbaric oxygen (HBO), frequently used as adjuvant therapy for patients with ischemic ulcers, exerts additional beneficial effects on the vascular inflammatory response.
Vasculitides are defined by the presence of leucocytes in the vascular vessel wall, with reactive damage to mural structures leading to tissue ischemia and necrosis. Cutaneous presentation of vasculitis includes purpura, erythema, urticaria, moduli, bullae and skin infarction leading to ulceration. Cutaneous ulceration is usually caused by vasculitis in medium to small-sized vessels.
Most of the benefits of Hyperbaric Oxygen Therapy are explained by the simple physical relationships determining gas concentration, volume, and pressure. By altering conditions of local hypoxia, HBO2 facilitates the wound-healing energy-consumption processes.
HBOT has been used as an adjunct to antibiotics, debridement, and revascularization in the therapy of chronic nonhealing wounds associated with diabetes 167, 168, 169, 170 or nondiabetic vascular insufficiency. Hyperoxia has an anti-inflammatory effect on the vascular bed.
Hyperbaric Oxygen Therapy can be used as adjuvant therapy for patients with ischemic ulcers. Using HBO, the circulating hemoglobin is fully oxygenated and the oxygen dissolves in the plasma, correlating with the partial pressure of oxygen. Under HBO of 2–2.5 ATA, the amount of dissolved oxygen in the plasma increases more than 10-fold, exceeding the tissue oxygen requirements. This primary effect of Hyperbaric Oxygen Therapy generates a favorable gradient for oxygen diffusion from functioning capillaries to ischaemic tissue sites.
Dr. S. Efrati, Institute of Hyperbaric Medicine and Wound Care Clinic from Assaf Harofeh Medical Center, Zerifin, Israel
Doctor S. Efrati, the Head of the Institute of Hyperbaric Medicine and Wound Care Clinic from Assaf Harofeh Medical Center, Zerifin, Israel studied effects of Hyperbaric Oxygen Therapy on nonhealing vasculitic ulcers.
The following graph presents a baseline ulcer tissue oxygenation at room air concentration, after 20 min exposure to 100% oxygen at 1 atmosphere absolute (1 ATA) and after 20 min exposure to 100% oxygen at 2 ATA. The ulcer tissue oxygenation was evaluated by transcutaneous O2 pressure (TCpO2) measurements using a pulse oximeter.
By altering conditions of local hypoxia, HBO facilitates the wound-healing processes such as fibroblast proliferation or angiogenesis. The increase in tissue oxygenation, as measured by TCpO2, is the most important predictive parameter used to identify patients who are likely to benefit from HBO therapy.
At the end of the study, 80% of Dr. Efrati’s patients demonstrated complete healing and 11.4% showed partial healing. 8.6% did not respond to the basal 20 HBO treatments. The results of their clinical outcome are summarized in the following chart.
The examples of vasculitis ulcers before and after HBOT are presented below. Mean duration of the HBO therapy was 7.08 ± 2.68 weeks (five sessions per week). At the end of the HBO therapy, there was a significant decrease in the daily prednisone dose (from 0.57 ± 0.33 to 0.22 ± 0.18 mg/kg, P ¼ 0.002).
Four patients demonstrated only partial resolution of the ulcer. However, by observation, despite the incomplete healing, the redness and edema around the ulcer were completely resolved. Moreover, there was a significant improvement in the ulcer-related pain, so that the number of painkillers used could be reduced.
In addition to the physical relationships determining the local gas concentration, volume, and pressure, HBO has a beneficial effect on ischaemic ulcers. The effect of hyperoxia on vascular inflammatory responses has already been studied in a considerable number of experimental models. HBO reduces rolling and adhesion of polymorphonuclear cells in the microcirculation of skeletal muscle, small bowel, brain, skin flaps, and liver.
HBO2 has been reported to exert beneficial effects in other inflammatory conditions, including experimental colitis, Crohn’s disease, carrageenan-induced paw edema in a rat model of systemic inflammatory response, and in a model of circulatory shock induced by intraperitoneal injection of zymosan.
HBO2 therapy is generally safe and well tolerated. Most side-effects are mild and reversible, although adverse events can occur in rare cases (e.g. reversible myopia, symptomatic otic barotraumas, pulmonary barotraumas or pulmonary oxygen toxicity, as well as seizures due to central nervous system oxygen toxicity).
Applying Hyperbaric Oxygen Therapy properly and in time would often mean a return from death to life, from a coma to consciousness, from suffering to enjoying a normal life.