HBOT

HBOT

An Overview of Benefits of Hyperbaric
Oxygen Therapy in Food and Drug
Administration-Approved Treatments

by Rashmi Gulati, MD
Rashmi Gulati Head Shot

Anemia/Blood Loss: In cases where a patient cannot accept a blood transfusion or sufficient oxygen delivery might be compromised, hyperbaric treatment increases the oxygen content of existing red blood cells as well as the blood plasma. Tissues compromised by insufficient blood flow benefit from the increased oxygen levels.

Air or Gas Embolism: This condition is commonly known as "the bends." When ascending too quickly from a high-pressure environment, such as deep-sea divers experience, air or gas bubbles form in arteries or veins, reducing blood flow and affecting oxygen circulation. The elevated pressures within a hyperbaric chamber dissolve gas embolisms back into the blood and tissues. Through slow decompression back to normal atmospheric pressure, the gas remains safely dissolved in the blood, body fluids, and tissues.

Carbon Monoxide Poisoning: Carbon monoxide (CO), a colorless, odorless gas, is a byproduct of combustion. It binds to red blood cells, blocking delivery of oxygen to the body. Hyperbaric oxygen accelerates the clearance of CO from the body, restoring oxygen delivery and preventing toxic effects on the central nervous system and blood vessels from CO.

Gas Gangrene: This bacterial infection eats away soft tissues, releases toxins into the blood stream, and inhibits the body's defense mechanisms. These bacteria prefer low-oxygen environments. High doses of oxygen delivered via hyperbaric therapy inhibit bacteria and toxin production. As an adjunct to antibiotic treatment, HBOT helps overcome infection and promote healing.

Crush Injuries: Complications of crush injuries, such as from motor vehicle accidents, falls and gun shots, are very frequent. By increasing oxygen delivery to injured tissues, hyperbaric treatments reduce swelling, improve healing, and help fight infection.

Problem Wounds: Wounds may fail to respond to standard care because of low oxygen levels and impaired circulation. Foot ulcers in diabetics are one such problem. By increasing oxygen levels within the wound tissues, hyperbaric therapy promotes healing. Amputations, such as those resulting from advanced diabetic ulcers, have been avoided through hyperbaric oxygen therapy.

Intracranial Abscess: A sinus or bone infection may form an abscess within the skull or brain cavity. Antibiotics may have limited access to the infection and be ineffective. Furthermore, white blood cells require a minimum oxygen level to kill bacteria. Hyperbaric treatment provides oxygen for white blood cells and inhibits bacteria that prefer low oxygen levels for growth.

Soft Tissue Infections: Necrotic infections—in which tissue is dying—may be complications resulting from conditions such as diabetes, radiation therapies, or vascular disease. While the primary treatments may indicate removal of the infected tissue and administering antibiotics, hyperbaric oxygen enhances the ability of white blood cells to kill bacteria, and promotes healing of damaged tissue and growth of new tissue.

Bone Infections: When osteomyelitis, a bacterial infection of bone tissue, does not respond to standard antibiotic treatment, the patient may benefit from hyperbaric oxygen. Hyperbaric oxygen inhibits bacterial growth, increases the killing power of white blood cells, and enhances the effects of some antibiotics.

Radiation Necrosis: Radiation therapy used to treat cancer may result in scarring and narrowing of blood vessels, decreasing blood flow to radiation-damaged tissues. Hyperbaric treatment allows oxygen to reach these damaged areas, promoting healing and growth of new tissues. It is often used for conditions that affect the head and neck areas, but also treats conditions resulting from irradiation to the pelvic region. Hyperbaric therapy has provided an alternative to quality-of-life changing colostomy.

Skin Grafts: The success of transferred skin grafts or flaps (which might include skin, deeper tissue, muscle, and bone) is largely dependent upon sufficient oxygen supply to the affected area. Hyperbaric treatment can be used to saturate the area with oxygen before and after grafting, promoting healing and revascularization.

Burns: Hyperbaric therapy is sometimes used to treat burns to the hands, face, or groin area, or for deep second-degree and third-degree burns that cover more than 20% of the patient's body. Hyperbaric oxygen reduces swelling, limits progression of the burn injury (which continues for three to four days following the initial injury), decreases inflammation, and may also diminish lung damage from inhalation of smoke and hot gases.

HBOT Side Effects and Contraindications

The most common side effect of hyperbaric oxygen therapy (HBOT) is barotrauma to the ears and sinuses, caused by the change in pressure. To minimize this side effect, patients learn techniques to promote adequate clearing of the ears during compression, or alternatively, tubes may be inserted in the ears. A rare side effect is oxygen toxicity, which is caused by administering too much oxygen for too long a duration.

There are a few contraindications to hyperbaric oxygen therapy. The absolute contraindications include history of untreated pneumothorax, and a history of treatment with bleomycin (tradename Blenoxane), cisplatin, disulfiram (tradename Antabuse), doxorubicin (trade name Adriamycin), and mafenide (tradename Sulfamylon). Bleomycin is a mixture of glycoprotein antibiotics derived from Streptomyces and used to inhibit the spread of malignant cells. Cisplatin is a chemotherapy agent. HBOT treatment should not be undertaken for an extended period of time after treatment with either drug. Treatment may be considered after discontinuation of the other drugs listed.

Relative contraindications for HBOT include asthma, claustrophobia, congenital spherocytosis, chronic obstructive pulmonary disease (COPD), Eustachian tube dysfunction, high fever, pacemaker, epidural pain pump, pregnancy, upper respiratory infection (URI), or history of seizures. Some of the potential side effects include seizures, pulmonary toxicity including hemorrhage and edema, barotraumas to sinuses or ear, progression of cataracts , and myopia, which is usually reversible.

Other potential side effects include headaches, vomiting, and fatigue. Most complications are avoided, however, when pressures are less than 3 atmospheres and the treatment duration is less than 120 minutes.


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