Abstract
IntroductionAlthough hyperbaric oxygen therapy (HBOT) has beneficial effects, some patients experience fatigue and pulmonary complaints after several sessions. The current limits of hyperbaric oxygen exposure to prevent pulmonary oxygen toxicity (POT) are based on pulmonary function tests (PFT), but the limitations of PFT are recognized worldwide. However, no newer modalities to detect POT have been established. Exhaled breath analysis in divers have shown volatile organic compounds (VOCs) of inflammation and methyl alkanes. This study hypothesized that similar VOCs might be detected after HBOT.MethodsTen healthy volunteers of the Royal Netherlands Navy underwent six HBOT sessions (95 min at 253 kPa, including three 5-min “air breaks”), i.e., on five consecutive days followed by another session after 2 days of rest. At 30 min before the dive, and at 30 min, 2 and 4 h post-dive, exhaled breath was collected and followed by PFT. Exhaled breath samples were analyzed using gas chromatography-mass spectrometry (GC-MS). After univariate tests and correlation of retention times, ion fragments could be identified using a reference database. Using these fragments VOCs could be reconstructed, which were clustered using principal component analysis. These clusters were tested longitudinally with ANOVA.ResultsAfter GC-MS analysis, eleven relevant VOCs were identified which could be clustered into two principal components (PC). PC1 consisted of VOCs associated with inflammation and showed no significant change over time. The intensities of PC2, consisting of methyl alkanes, showed a significant decrease (p = 0.001) after the first HBOT session to 50.8%, remained decreased during the subsequent days (mean 82%), and decreased even further after 2 days of rest to 58% (compared to baseline). PFT remained virtually unchanged.DiscussionAlthough similar VOCs were found when compared to diving, the decrease of methyl alkanes (PC2) is in contrast to the increase seen in divers. It is unknown why emission of methyl alkanes (which could originate from the phosphatidylcholine membrane in the alveoli) are reduced after HBOT. This suggests that HBOT might not be as damaging to the pulmonary tract as previously assumed. Future research on POT should focus on the identified VOCs (inflammation and methyl alkanes).
Highlights
Hyperbaric oxygen therapy (HBOT) has beneficial effects, some patients experience fatigue and pulmonary complaints after several sessions
The protocol was approved by the Medical Ethical Committee of the University of Amsterdam (Reference: 2017.183) and the Surgeon General of the Ministry of Defence
All pulmonary function tests (PFT) parameters, including vital capacity (VC) and diffusion capacity, remained almost unchanged. This confirms earlier studies suggesting that volatile organic compounds (VOCs) are a more sensitive marker than PFT to detect the onset of pulmonary oxygen toxicity (POT)
Summary
Hyperbaric oxygen therapy (HBOT) has beneficial effects, some patients experience fatigue and pulmonary complaints after several sessions. HBOT administers oxygen at a partial pressure of 253 kPa (2.5 ATA) for a duration of 80–90 min for 30–60 daily sessions (Fosen and Thom, 2014; Stoekenbroek et al, 2015). Since patients receiving HBOT frequently report fatigue and pulmonary complaints after several sessions, HBOT is often paused in the weekends to allow patients to recover before the week. ROS are known to cause alveolar damage and inflammation to the respiratory system (van Ooij et al, 2016). Other than generic symptoms like coughing or dyspnea, there are no objective or discriminating signs of clinical pulmonary oxygen toxicity (POT) (van Ooij et al, 2016; Wingelaar et al, 2017)
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