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Hyperbaric oxygen therapy

Hyperbaric oxygen for acute carbon monoxide poisoning

Traumatic brain injury (TBI) is a major public health issue. The complexity of TBI has precluded the use of effective therapies. Hyperbaric oxygen therapy (HBOT) has been shown to be neuroprotective in multiple neurological disorders, but its efficacy in the management of TBI remains controversial. This review focuses on HBOT applications within the context of experimental and clinical TBI. We also discuss its potential neuroprotective mechanisms. Early or delayed multiple sessions of low atmospheric pressure HBOT can reduce intracranial pressure, improve mortality, as well as promote neurobehavioral recovery. The complimentary, synergistic actions of HBOT include improved tissue oxygenation and cellular metabolism, anti-apoptotic, and anti-inflammatory mechanisms. Thus HBOT may serve as a promising neuroprotective strategy that when combined with other therapeutic targets for TBI patients which could improve long-term outcomes.

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Hyperbaric oxygen therapy for traumatic brain injury.

Improving preservation techniques to minimize injury is of particular importance in organs from marginal donors. Since the introduction of transplantation and routine use of hypothermic temperatures for kidney preservation, there has been much debate on whether it is necessary to add oxygen to support the low level of metabolism under these conditions. Supplementing the kidney with oxygen during hypothermic preservation is not common practice. However, there is evidence to support its application. Oxygen can be added by various techniques such as retrograde persufflation whereby filtered and humidified oxygen is bubbled through the vasculature; under hyperbaric conditions using specialized pressurized chambers; during hypothermic machine perfusion; with the addition of oxygen carriers; and under normothermic conditions. Evidence suggests that oxygenation is particularly beneficial in restoring cellular levels of adenosine triphosphate after kidneys have been subjected to warm or cold ischemic injury. However, under normal conditions, the benefits are less convincing, but the evidence is insufficient to draw any conclusions. This overview explores the ways in which oxygen can be administered during preservation in experimental and clinical models of kidney transplantation.

Oxygenated kidney preservation techniques.

Oxygen as an antibiotic. The effect of inspired oxygen on infection

Objective – Review the historical development and physiologic principles of hyperbaric oxygen therapy (HBOT) based on human and veterinary experimental literature and current equipment in use.

Data Sources – Review of basic physiologic concepts. Data from human and veterinary journals were reviewed through Pubmed and Veterinary Information Network database searches as well as reference searches on several articles covering hyperbaric therapy in clinically applicable situations.

Human Data Synthesis – HBOT has been gaining acceptance as an adjunctive treatment in human medicine. The understanding of the physiology and application of hyperbaric therapy is increasing through ongoing research and greater access to hyperbaric equipment.

Veterinary Data Synthesis – Several animal models have been utilized to examine the effects of HBOT. Most models utilize dogs and rats but pigs, cats, and other species have been studied.

Conclusions – Hyperbaric therapy utilizes several physiologic principles of how gases respond under pressure and more specifically of how oxygen responds under pressure. The increase in concentration of oxygen in solution, based on its solubility under pressure, increases the diffusion gradient for its delivery deeper into tissues, which is the premise of HBOT. Ultimately the increases in dissolved oxygen generated by hyperbaric therapy have several physiologic effects that can alter tissue responses to disease and injury. As this technology becomes more available to clinical practice, HBOT should be considered as a therapeutic option.

Hyperbaric oxygen therapy. Part 1: history and principles.

Objective – Review the mechanisms of action and clinical application of hyperbaric oxygen therapy (HBOT) based on human and veterinary clinical and experimental literature.

Data Sources – Pubmed and Veterinary Information Network databases were searched for human and veterinary journal articles on hyperbaric therapy in clinically applicable situations. Historical reference searches on several articles in addition to basic physiologic concepts were also reviewed.

Human Data Synthesis – HBOT has gained acceptance as an adjunctive treatment in clinical conditions other than diving-related injuries, such as select problem wounds and central nervous system diseases, in human medicine. Access to hyperbaric therapy has increased and ongoing research has furthered understanding of the mechanisms and potential therapeutic uses of HBOT.

Veterinary Data Synthesis – Several animal models have been utilized to examine the effects of HBOT; primarily rodents (mice, rats) and rabbits but also dogs, cats, and pigs. Data related to animal model research as it pertains to clinical application of HBOT is reviewed.

Conclusions – There is a substantial body of literature that has examined the adverse and beneficial effects of HBOT in animal models. As technology becomes more readily available to clinical practice and more clinical trials are performed to define its effectiveness, HBOT may be considered as an additional therapeutic option in many conditions including select problem wounds, spinal cord injury, and cerebral ischemic injury. Understanding the mechanisms by which HBOT exerts its effects will help guide research and use of the modality in clinical patients.

Melissa L. Edwards

Papers

Hyperbaric oxygen therapy. Part 1: history and principles.

Hyperbaric oxygen therapy. Part 2: application in disease.