Hyperbaric Oxygen In Patients Research Articles

Key pathways and genes that are altered during treatment with hyperbaric oxygen in patients with sepsis due to necrotizing soft tissue infection (HBOmic study)

BackgroundFor decades, the basic treatment strategies of necrotizing soft tissue infections (NSTI) have remained unchanged, primarily relying on aggressive surgical removal of infected tissue, broad-spectrum antibiotics, and supportive intensive care. One treatment strategy that has been proposed as an adjunctive measure to improve patient outcomes is hyperbaric oxygen (HBO2) treatment. HBO2 treatment has been linked to several immune modulatory effects; however, investigating these effects is complicated due to the disease's acute life-threatening nature, metabolic and cell homeostasis dependent variability in treatment effects, and heterogeneity with respect to both patient characteristics and involved pathogens. To embrace this complexity, we aimed to explore the underlying biological mechanisms of HBO2 treatment in patients with NSTI on the gene expression level.MethodsWe conducted an observational cohort study on prospective collected data, including 85 patients admitted to the intensive care unit (ICU) for NSTI. All patients were treated with one or two HBO2 treatments and had one blood sample taken before and after the intervention. Total RNAs from blood samples were extracted and mRNA purified with rRNA depletion, followed by whole-transcriptome RNA sequencing with a targeted sequencing depth of 20 million reads. A model for differentially expressed genes (DEGs) was fitted, and the functional aspects of the obtained set of genes was predicted with GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of genes and Genomes) enrichment analyses. All analyses were corrected for multiple testing with FDR.ResultsAfter sequential steps of quality control, a final of 160 biological replicates were included in the present study. We found 394 protein coding genes that were significantly DEGs between the two conditions with FDR < 0.01, of which 205 were upregulated and 189 were downregulated. The enrichment analysis of these DEGs revealed 20 GO terms in biological processes and 12 KEGG pathways that were significantly overrepresented in the upregulated DEGs, of which the term; “adaptive immune response” (GO:0002250) (FDR = 9.88E-13) and “T cell receptor signaling pathway” (hsa04660) (FDR = 1.20E-07) were the most significant. Among the downregulated DEGs two biological processes were significantly enriched, of which the GO term “apoptotic process” (GO:0006915) was the most significant (FDR = 0.001), followed by “Positive regulation of T helper 1 cell cytokine production” (GO:2000556), and “NF-kappa B signaling pathway” (hsa04064) was the only KEGG pathway that was significantly overrepresented (FDR = 0.001).ConclusionsWhen one or two sessions of HBO2 treatment were administered to patients with a dysregulated immune response and systemic inflammation due to NSTI, the important genes that were regulated during the intervention were involved in activation of T helper cells and downregulation of the disease-induced highly inflammatory pathway NF-κB, which was associated with a decrease in the mRNA level of pro-inflammatory factors.Trial registration: Biological material was collected during the INFECT study, registered at ClinicalTrials.gov (NCT01790698).

Real-world evidence of hyperbaric oxygen therapy on cardiovascular outcomes in patients with chronic osteomyelitis

BackgroundThe effectiveness of hyperbaric oxygen (HBO) therapy for chronic osteomyelitis remains inconclusive. In particular, recent studies have shown that chronic osteomyelitis is a crucial risk factor for cardiovascular diseases. However, the preventive effect of HBO on cardiovascular events has not been reported in patients with chronic osteomyelitis. MethodsWe conducted a population-based cohort study to evaluate the impact of HBO on patients with chronic osteomyelitis. Overall, 5312 patients with chronic osteomyelitis were selected from the Taiwan National Health Insurance Database to evaluate the impact of HBO in patients with chronic osteomyelitis. Propensity-score (PS) matching and inverse probability weighting (IPTW) were employed to balance covariates between the HBO and non-HBO groups. The primary outcome was all-cause mortality. The secondary outcomes were myocardial infarction (MI) and stroke hospitalisation. Furthermore, we evaluated the appropriate timing for HBO intervention by the restricted cubic spline (RCS) functions. ResultsAfter 1:4 PS-matching, the HBO group (n = 265) was associated with lower 1-year mortality (hazard ratio [HR], 0.49; 95 % confidence interval [CI], 0.25–0.95) than the non-HBO group (n = 994); this was consistent with the IPTW weighting results (HR, 0.25; 95 % CI, 0.20–0.33). The risk of stroke was lower in the HBO group (HR, 0.46; 95 % CI, 0.34–0.63) than that in the non-HBO group. However, HBO therapy failed to reduce the risk of MI. Using the RCS model, patients with intervals within 90 days (HR, 1.38; 95 % CI, 1.04–1.84) presented a significant risk of 1-year mortality. After 90 days, as the length of interval increased, the risk gradually decreased and became insignificant. ConclusionThe present study revealed that adjunctive HBO could benefit the 1-year mortality and stroke hospitalisation in patients with chronic osteomyelitis. HBO was recommended to be initiated within 90 days of chronic osteomyelitis hospitalisation.

Hyperbaric oxygen therapy for the treatment of rectovaginal fistulas in patients with Crohn's disease: results of the HOT-REVA pilot study.

BackgroundPositive effects of hyperbaric oxygen (HBO) on perianal fistulas in Crohn’s disease (CD) have been described, but the effect on rectovaginal fistulas (RVFs) has not yet been studied. The aim was to investigate the efficacy, safety and feasibility of HBO in patients with RVF in CD.MethodsIn this prospective study, consecutive CD patients between November 2018 and February 2020 presenting with RVF at the outpatient fistula clinic of the Amsterdam University Medical Centre were included and selected to receive treatment with 30 daily HBO sessions, if fistulas were actively draining and any concomitant treatment regimen was stable at least 6 weeks prior to start of HBO. Patients with a stoma were excluded. The primary endpoint was clinical closure at 3-month follow-up, defined as cessation of complaints and/or closure of the external orifice if visible at baseline. Secondary outcomes were improvement of concomitant perianal fistulas as measured by the perianal disease activity index (PDAI) and fistula drainage assessment (FDA), as well as improvement in patient-reported outcomes (visual analogue scale (VAS), inflammatory bowel disease questionnaire (IBDQ), faecal incontinence quality of life scale (FIQL) and female sexual functioning index (FSFI)) at 3-month follow-up.ResultsOut of 14 eligible patients, nine patients (median age 50 years) were treated, all of whom had previously had one or more unsuccessful medical and/or surgical treatments for their RVF. Clinical closure occurred in none of the patients at 3-month follow-up. There was no improvement in PDAI and patient-reported outcomes (VAS, IBDQ, FIQL and FSFI). Two patients had concomitant perianal fistulas; using FDA, one patient had a clinical response and one patient was in clinical remission 3 months after HBO. There were two treatment-related adverse events during HBO concerning claustrophobia and fatigue. Furthermore, two patients had a surgical intervention due to RVF and two patients were treated with antibiotics for a urinary tract infection during follow-up. One patient had a dose reduction of ustekinumab because of decreased luminal complaints.ConclusionTreatment with HBO was feasible, but in this therapy-refractory cohort without deviating ostomy no clinical closure of RVF or improvement in quality of life was seen 3 months after HBO. Treatment with HBO alone in this specific group of patients therefore appears to be ineffective.

517 Hyperbaric Oxygen and Mortality in Burns with Inhalation Injury: a Study of the National Burn Repository

Abstract Introduction Mortality in burn injury is primarily influenced by three factors: age, percent burn (%TBSA), and presence of inhalation injury. Numerous modalities have been tried in an attempt to treat those patients with burns and inhalation injury, including the use of hyperbaric oxygen (HBO). The aim of our study was to find the national prevalence of HBO for burns with inhalation injury, and whether HBO influenced mortality in these often severely injured patients. Methods This retrospective study used the National Burn Repository (NBR) to identify hospital admissions of patients with both cutaneous burns and inhalation injuries. After applying exclusion criteria, a total of 13,044 patients were identified. Variables included in the multivariate regression analysis included: age, sex, race, payer, mechanism of burn injury, TBSA group, total procedure number, mechanical ventilator days, and treatment with HBO. The main outcome variable was mortality. Results Of the 13,044 patients, 67 had HBO therapy. The HBO patients were older (mean age 51.7 years vs. 42.8 years, p&amp;lt; 0.001) but had smaller burns and thus a similar Baux score (66.6 vs. 65.2, p=0.661). The HBO patients had a higher mortality (29.9% vs. 17.5%, p= 0.01). On multivariate regression analysis, HBO was an independent predictor of mortality (OR= 2.484, p= 0.004). Other significant predictors of mortality included age, Black race, Medicaid or uninsured patients, and %TBSA. Conclusions The use of HBO for patients with burns and inhalation injury is uncommon in this database. It is unclear whether that reflects low prevalence or if individual centers do not all impute HBO into the NBR. For those patients in this database, HBO is an independent predictor of mortality. It can be difficult to determine the severity of inhalation injury in the NBR, so those patients receiving HBO could theoretically have more severe inhalation injury.

A BUBBLING HEART

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Air embolism is a rare but devastating event that occurs as a consequence of the entry of air into the vasculature. It mostly results from surgical procedures, barotrauma from mechanical ventilation or scuba diving. It can either be arterial or venous with varied implications. Venous air embolism from a routine blood draw is a rare entity not reported much in the literature. CASE PRESENTATION: 62 years old female with past medical history of congestive heart failure with preserved ejection fraction and Sjogren's syndrome presented with complains of sudden onset midsternal chest pain for 5 hours. She rated her pain 7/10 in intensity, radiating to back and pressure-like in sensation, aggravated by inspiration and coughing with no relieving factors. This was also associated with shortness of breath at rest for the same duration. Review of systems was also positive for one episode of lightheadedness and blurry vision on her way to the hospital. She denied any such symptoms in the past. She was a non-smoker. On presentation, she was found to be hypoxic and hypotensive. Her initial labs including workup for acute coronary syndrome was unremarkable, but her CT chest revealed moderate amount of air within the visualized portion of the right and left internal jugular veins, brachiocephalic veins and the right ventricle. She was subsequently admitted to the intensive care unit. The only triggering factor identified for her venous air embolism was a recent regular blood workup done at her rheumatologist’s office one day prior to the onset of her symptoms. She was placed on high-flow nasal oxygen and was also recommended to stay in a left lateral position. These conservative measures led to complete resolution of her symptoms as well as the air embolism on the repeat CT chest within 24 hours. DISCUSSION: Venous air embolism is a catastrophic entity which if not identified and managed on time can lead to life threatening complications. The spectrum of clinical findings ranges from minimal or no symptoms to dyspnea, chest pain, dizziness, sudden loss of consciousness, hemodynamic instability and cardiac arrest. One of the most dangerous complications is the acute right heart failure leading to obstructive shock due to dislodgement of air bubble from the right ventricle into the pulmonary vasculature. It is therefore, managed conservatively with keeping the patient in left lateral (Durant's maneuver) or trendelenburg position that helps in preventing the air lock. Other supportive measures include adequate hydration, high flow nasal oxygen or hyperbaric oxygen in patients with concerns for end organ damage for 12-24 hours. Use of inhalers or mechanical ventilation is contraindicated to prevent barotrauma. CONCLUSIONS: Venous air embolism if not recognized timely can prove to be fatal. Supportive treatment is the key to resolution in majority of the cases. Reference #1: Black, Michael, James Calvin, Kwan L. Chan, and Virginia M. Walley. "Paradoxic air embolism in the absence of an intracardiac defect." Chest 99, no. 3 (1991): 754-755. Reference #2: Cushman, Mary. "Epidemiology and risk factors for venous thrombosis." In Seminars in hematology, vol. 44, no. 2, pp. 62-69. WB Saunders, 2007. Reference #3: Bhatia, Sameer. "Systemic air embolism following CT-guided lung biopsy." Journal of Vascular and Interventional Radiology 6, no. 20 (2009): 709-711. DISCLOSURES: No relevant relationships by Fatima Ayub, source=Web Response No relevant relationships by Vishesh Paul, source=Web Response

AB009. Bioprosthetics in airway surgery

: Among many challenges in thoracic surgery, tracheal substitutes have been particularly elusive over nearly 75 years. Although nearly 4–5 cm of trachea can be resected and primarily reconstructed in properly selected patients, larger or more complicated resections have spawned innovation to overcome this limitation. The trachea functions as an airtight, mechanically stable passage from larynx to bronchi and facilitates clearance of secretions via a specialized epithelium. Ideal properties of a tracheal substitute include durable, non-immunogenic material that is resistant to infection and can easily incorporate surrounding tissue. Four methodologies have been implemented for airway reconstruction: autologous tissue, allotransplantation, bioprosthetics, and tissue engineering. Of note, complete circumferential prosthetic tracheal substitutes have historically failed. The most innovative solutions to tracheal replacement have been tissue engineering and bioprosthetics but both strategies have significant limitations. Tubularized aortic homograft supported by an endoluminal internal stent (Montgomery tube, silicone T-tube or nitinol stent) and external buttressing with muscle has been studied in patients with some limited success. A hypothesis has been put forward from some authors that aortic homografts contain undifferentiated stem cells that may play a role in migration, proliferation and cell signaling of host cells to form primitive tracheal elements including intima replacement with squamous or ciliated epithelium and chondrogenesis. In a few cases the internal stents were removed beyond 1–2 years with regeneration of cartilage elements within the graft. Despite this interesting biology, reported long-term complications include infection and tracheoesophageal fistula. Both aortic homograft and human acellular dermal matrix have experienced more success when implemented as a patch repair of large non-circumferential airway defects. The etiology of these defects can be derived from trauma with loss of tissue domain, infection and erosion (such as tracheoesophageal fistulae), or partial resection for neoplasm. In the case of human acellular dermal matrix the bioprosthetic is meticulously sutured so that the dermal side faces the airway lumen. Since this tissue matrix normally is broken down by the host, it primary serves as a scaffold for tissue ingrowth. Of note, the luminal side of aortic homograft is also oriented to face the airway lumen and the wall is perforated with a 16-gauge needle to promote tissue ingrowth and neovascularization. In the description of these reconstructions, repairs were routinely buttressed with vascularized tissue exteriorly and granulation tissue was observed at the site of reconstruction in many patients with mild tissue contracture and eventual native tissue ingrowth. It is understood that these patients require frequent surveillance bronchoscopy with debridement of granulation as necessary. Reported complications of this strategy were sputum retention, pneumonia and pneumomediastinum. One author reports selective use of hyperbaric oxygen in patients with complex repairs to enhance tissue ingrowth of the bioprosthetic. Tissue engineering generally involves the implantation of a biodegradable scaffold seeded with host cells that can repopulate the scaffold with new extracellular matrix. This has been reported in experimental settings with decellularized cadaveric trachea seeded with bone-marrow derived mesenchymal stroma cells as well as autologous respiratory epithelium. Initial attempts at tracheal tissue engineering showed promise in preclinical models but were associated with unacceptable outcomes in humans. Lastly, several studies have been published implementing three-dimensional (3D) printing technology to engineer tracheal substitutes that mimic mechanical behavior similar to native trachea. Biodegradable scaffolds of trachea have been 3D printed, some cultured with chondrocytes allowing formation of neocartilage, and tested in preclinical models. Although these investigations are very preliminary, 3D printing appears to provide infinite possibilities for tissue engineering.

"Xingnao Kaiqiao" Acupuncture(Acupuncture Technique for Restoring Consciousness) Combined with Hyperbaric Oxygen in Patients with Hypoxic Ischemic Encephalopathy: Clinical Observation and Its Influence on Blood Rheology

To observe the effect of "Xingnao Kaiqiao" acupuncture(acupuncture technique for restoring consciousness) combined with hyperbaric oxygen in patients with hypoxic ischemic encephalopathy and assess its influence on blood rheology. Forty patients with hypoxic ischemic encephalopathy were randomly divided into treatment group and control group with 20 cases in each group. The treatment group received "Xingnao Kaiqiao" acupuncture combined with hyperbaric oxygen, and the control group received hyperbaric oxygen only. The two groups of patients were treated once per day for 6 consecutive days, which consisted of one course of treatment, and the total treatment lasted for four courses. Before and after treatment, the patients underwent the mini mental state examination (MMSE) to evaluate cognitive function and the barthel index score for activities of daily living. The changes of whole blood viscosity, plasma viscosity, and erythrocyte aggregation index were determined. After treatment, both the treatment and control groups showed improvements in cognitive function，activities of daily living, and blood rheology compared with those before treatment (P<0.05). However, these improvements in the treatment group were significantly greater than those in the control group (P<0.05). Application of "Xingnao Kaiqiao" acupuncture combined with hyperbaric oxygen in patients with hypoxic ischemic encephalopathy can result in an integrated curative effect, a significant improvement in the blood rheology indexes, and promote the recovery of brain cells.

Effect of hyperbaric oxygen combined with progressively controlled decompression on the prognosis of patients with emergency craniocerebral trauma

Objective To explore the effect of hyperbaric oxygen combined with progressively controlled decompression on the prognosis of patients with emergency craniocerebral trauma. Methods Ninety-six patients with emergency craniocerebral trauma were selected as study subjects, and they were divided into observation group(n=50) and control group(n=46) according to the random number table.The observation group was treated by progressively controlled decompression combined with hyperbaric oxygen, while the control group was treated by standard large trauma craniotomy combined with hyperbaric oxygen.The incidence of perioperative complications, prognosis (evaluated by GOS) and activities of daily living(evaluated by ADL) were compared between the two groups. Results In the observation group, the incidence rates of perioperative acute encephalocele, delayed hematoma and postoperative cerebral infarction were 6.0%, 10.0%, 6.0%, respectively, which were lower than 19.6%, 26.1%, 21.7% of the control group(χ2=4.031, 4.255, 5.069, all P 0.05). After treatment, the ADL scores of the two groups were increased(t=5.673, 8.223, all P<0.05). Meanwhile, the ADL score of the observation group was higher than that of the control group(t=2.920, P<0.05). Conclusion The application of progressively controlled decompression combined with hyperbaric oxygen in patients with emergency craniocerebral trauma is conductive to reduce acute encephalocele, bone window brain tissue incarceration, delayed hematoma, postoperative cerebral infarction and other complications.Besides, it can repair the damaged nerve cells, and eventually improve activities of daily living of patients and reduce morbidity and mortality, and the prognosis is better. Key words: Craniocerebral trauma; Progressively controlled decompression; Hyperbaric oxygenation; Prognosis

Therapeutic effect of hyperbaric oxygen therapy on patients with severe craniocerebral injury and its influence on serum interleukin-1 beta and interleukin-6 levels

Objective To explore the clinical curative effect of hyperbaric oxygen therapy for severe craniocerebral injury, and its influence on the level of serum interleukin-1 beta(IL-1 ) and interleukin-6(IL-6). Methods 150 patients with severe craniocerebral injury were selected and divided into two groups by random and single blind method.75 patients of the control group were treated with conventional therapy, 75 patients of the observation group were given hyperbaric oxygen on the basis of the conventional treatment, and the clinical efficacy was compared between the two groups. Results The total effective rate of the observation group was 94.67%, which was significantly higher than 77.33% of the control group, the difference was statistically significant(χ2=7.83, P 0.05). After treatment, the GCS and ADL scores of the observation group were (12.18±2.13)points, (67.46±12.55)points, which were significantly higher than those before treatment(t=8.01, 7.76, all P 0.05). After treatment, the serum levels of IL-1 and IL-6 in the observation group were (127.48±16.35)pg/mL, (89.66±13.47)pg/mL, which were significantly lower than before treatment(t=8.34, 7.89, all P<0.05), there were significant differences between the two groups(t=7.65, 7.22, all P<0.05). Conclusion Implementation of hyperbaric oxygen in patients with severe traumatic brain injury on the basis of conventional symptomatic treatment can effectively improve the clinical symptoms and signs, reduce the serum IL-1 and IL-6 levels, promote the recovery of brain function and ability of daily life, and which is worth to be promoted in clinical. Key words: Craniocerebral trauma; Hyperbaric oxygenation; Interleukin-1 beta; Interleukin-6

Hyperbaric oxygen therapy for radiation-induced injury: evidence is needed

Hyperbaric oxygen therapy for radiation-induced injury: evidence is needed

Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomised, double-blind, sham-controlled phase 3 trial

SummaryBackgroundHyperbaric oxygen has been used as a therapy for patients experiencing chronic intestinal syndromes after pelvic radiotherapy for decades, yet the evidence to support the use of this therapy is based almost exclusively on non-randomised studies. We aimed to provide conclusive results for the clinical benefits of hyperbaric oxygen in patients with chronic bowel dysfunction after radiotherapy for pelvic malignancies.MethodsHOT2 was a double-blind, sham-controlled, phase 3 randomised study of patients (≥18 years) with chronic gastrointestinal symptoms for 12 months or more after radiotherapy and which persisted despite at least 3 months of optimal medical therapy and no evidence of cancer recurrence. Participants were stratified by participating hyperbaric centre and randomly assigned (2:1) by a computer-generated list (block size nine or 12) to receive treatment with hyperbaric oxygen therapy or sham. Participants in the active treatment group breathed 100% oxygen at 2·4 atmospheres of absolute pressure (ATA) and the control group breathed 21% oxygen at 1·3 ATA; both treatment groups received 90-min air pressure exposures once daily for 5 days per week for a total of 8 weeks (total of 40 exposures). Staff at the participating hyperbaric medicine facilities knew the allocated treatment, but patients, clinicians, nurse practitioners, and other health-care professionals associated with patients' care were masked to treatment allocation. Primary endpoints were changes in the bowel component of the modified Inflammatory Bowel Disease Questionnaire (IBDQ) score and the IBDQ rectal bleeding score 12 months after start of treatment relative to baseline. The primary outcome was analysed in a modified intention-to-treat population, excluding patients who did not provide IBDQ scores within a predetermined time-frame. All patients have completed 12 months of follow-up and the final analysis is complete. The trial is registered with the ISRCTN registry, number ISRCTN86894066.FindingsBetween Aug 14, 2009, and Oct 23, 2012, 84 participants were randomly assigned: 55 to hyperbaric oxygen and 29 to sham control. 75 (89%) participants received 40 pressure exposures, all participants returned the IBDQ at baseline, 75 (89%) participants returned the IBDQ at 2 weeks post-treatment, and 79 (94%) participants returned the IBDQ at 12 months post-start of treatment. Patients were excluded from analyses of co-primary endpoints if they had missing IBDQ scores for intestinal function or rectal bleeding at baseline or at 12 months. In an analysis of 46 participants in the active treatment group and 23 participants in the control group, we found no significant differences in the change of IBDQ bowel component score (median change from baseline to 12 months of 4 (IQR −3 to 11) in the treatment group vs 4 (−6 to 9) in the sham group; Mann-Whitney U score 0·67, p=0·50). In an analysis of 29 participants in the active treatment group and 11 participants in the sham group with rectal bleeding at baseline, we also found no significant differences in the change of IBDQ rectal bleeding score (median change from baseline to 12 months of 3 [1 to 3] in the treatment group vs 1 [1 to 2] in the sham group; U score 1·69, p=0·092). Common adverse events in both groups were eye refractive changes (three [11%] of 28 patients in the control group vs 16 [30%] of 53 patients in the treatment group), increased fatigue (three [11%] vs two [4%]), and ear pain (six [21%] vs 15 [28%]). Eight serious adverse events were reported in eight patients: two were reported in two patients in the control group (tonsillitis requiring surgery [grade 3]; recurrent cancer of the vulva [grade 4]) and six serious adverse events were reported in six patients in the treatment group (malignant spinal cord compression requiring surgery [grade 3]; malignant paraortic lymph node involvement requiring surgery [grade 3]; recurrence of vomiting and dehydration [grade 3]; diarrhoea and fever associated with Campylobacter infection [grade 3]; recurrence of abdominal pain, bloating, diarrhoea, and urinary tract infection [grade 3]; aneurysm [grade 4]), none of which were deemed treatment-related.InterpretationWe found no evidence that patients with radiation-induced chronic gastrointestinal symptoms, including those patients with rectal bleeding, benefit from hyperbaric oxygen therapy. These findings contrast with evidence used to justify current practices, and more level 1 evidence is urgently needed.FundingCancer Research UK and National Health Service (NHS) funding to the National Institute of Health Research Biomedical Research Centre at The Royal Marsden and the Institute of Cancer Research.

HYPERBARIC OXYGENT HERAPY AND CANCER - A REVIEW.

Hypoxia is a critical hallmark of solid tumors and involves enhanced cell survival, angiogenesis, glycolytic metabolism, andmetastasis. Hyperbaric oxygen (HBO) treatment has for centuries been used to improve or cure disorders involving hypoxia and ischemia, by enhancing the amount of dissolved oxygen in the plasma and thereby increasing О 2 delivery to the tissue. Studies on HBO and cancer have up to recently focused on whether enhanced oxygen acts as a cancer promoter or not. As oxygen is believed to be required for all the major processes of wound healing, one feared that the effects of HBO would be applicable to cancer tissue as well and promote cancer growth. Furthermore, one also feared that exposing patients who had been treated for cancer, to HBO, would lead to recurrence. Nevertheless, two systematic reviews on HBO and cancer have concluded that the use of HBO in patients with malignancies is considered safe. To supplement the previous reviews, we have summarized the work performed on HBO and cancer in the period 2004–2012. Based on the present as well as previous reviews, there is no evidence indicating that HBO neither acts as a stimulator of tumor growth nor as an enhancer of recurrence. On the other hand, there is evidence that implies that HBO might have tumor-inhibitory effects in certain cancer subtypes, and we thus strongly believe that we need to expand our knowledge on the effect and the mechanisms behind tumor oxygenation.

Clinical effect of hyperbaric oxygen for patients with hypertension hemorrhage

Objective To study the clinical effect of hyperbaric oxygen for patients with hypertension hemorrhage.Methods 70 cases of hypertensive cerebral hemorrhage patients admitted in our hospital from June 2012 to June 2013 were randomly divided into experimental group and control group,35 cases in each group.The control group was given routine treatment,while the experimental group was given hyperbaric oxygen and routine treatment.After treatment,the clinical efficacy of the two groups,patients with Glasgow Coma Scale(GCS),the NIH Stroke Scale (NIHSS),Barthel Index (Barthel) and the edema area of two groups were observed and analyzed.Results After treatment,the total effective rate of the experimental and the control group was 88.6％,71.4％,showing a statistical significant difference (P ＜ 0.05); the GCS,NIHSS,Barthel score and the edema area of experimental group were significantly better than those of the control group (P ＜ 0.05).Conclusion Hyperbaric oxygen has significant clinical efficacy in postoperative recovery for patients with hypertensive cerebral hemorrhage after operation,it is worthy of clinical promotion. Key words: Hyperbaric oxygen; Hypertension hemorrhage; Clinical effect

Hyperbaric oxygen and cancer: more complex than we expected

Hyperbaric oxygen (HBO) therapy refers to the breathing ofpure oxygen while in a sealed chamber that has been pres-surized at 1.5 to 3 times normal atmospheric pressure. Todate, HBO therapy has been applied in a series of diseaseswith potential hypoxia including decompression sickness,carbonmonoxidepoisoning,gasgangrene,osteomyelitis,andso on (http://en.wikipedia.org/wiki/Hyperbaric_medicine).However, cancer is not an indication for hyperbaric oxygenin both USA and China.Recently, Moen and Stuhr reviewed the evidence on theinfluence of HBO on cancers in past 9 years [1]. Their con-clusionwasconsistentwithtwoprevioussystemicreviewsonHBO and cancer that the use of HBO in patients with malig-nanciesisconsideredsafe.Inthisreview,theysummarizedtherelationship between hypoxia and cancer and the influence ofHBO on cell survival, angiogenesis, metastasis, chemothera-py,andradiotherapy.Finally,theyreviewedtheeffectofHBOon cancer cells of different types. Although they proposedsome explanations on the effects of HBO on cancers, themechanisms are more complex than we expected.HBO, hypoxia, and angiogenesisIt has been accepted that HBO can increase the dissolvedoxygen significantly, which may rectify the hypoxia incancers. However, HBO is often used once or twice dailyfor patients, and a hypoxic environment may form betweentwo exposures. As shown in this review, hypoxia is essentialfor the progression of cancers and related to the angiogen-esis. In addition, some studies have also shown that HBOtherapy can improve the angiogenesis after ischemic injury.Our previous study also revealed that HBO pretreatment canincrease the expression of hypoxia-inducible factor and itsdownstream factor vascular endothelial growth factor [2]which is a potent pro-angiogenic factor. Thus, HBO seemsto exert promotive effect on cancer growth.HBO and metastasisMetastasis is a complex process involving local cancer cellinvasion, entry into the blood or lymph vessels, and re-penetration and colonization at a distant site [3]. Theintegrity of vascular basement membrane (VBM) iscrucial for the cancer cell invasion. Suzuki et al. foundthat HBO enhanced transendothelial permeability in ratbrains [4]. In addition, HBO preconditioning was foundto increase the expression of matrix metalloproteinase(MMP) [5] which is may break the VBM. This maypotentiate the cancer cell invasion. Of interest, HBOtherapy may reduce the insult-induced expression ofMMP [6]. Thus, whether the effect of HBO on VBMintegrity depends on the microenvironment is not clear.If so, this may partially explain the absence of influenceof HBO on the metastasis of cancers.HBO and cancer stem cellsCancer stem cells (CSCs) are cancer cells that possesscharacteristics associated with normal stem cells, specifically

Hyperbaric oxygen therapy and cancer—a review

Hypoxia is a critical hallmark of solid tumors and involves enhanced cell survival, angiogenesis, glycolytic metabolism, and metastasis. Hyperbaric oxygen (HBO) treatment has for centuries been used to improve or cure disorders involving hypoxia and ischemia, by enhancing the amount of dissolved oxygen in the plasma and thereby increasing O2 delivery to the tissue. Studies on HBO and cancer have up to recently focused on whether enhanced oxygen acts as a cancer promoter or not. As oxygen is believed to be required for all the major processes of wound healing, one feared that the effects of HBO would be applicable to cancer tissue as well and promote cancer growth. Furthermore, one also feared that exposing patients who had been treated for cancer, to HBO, would lead to recurrence. Nevertheless, two systematic reviews on HBO and cancer have concluded that the use of HBO in patients with malignancies is considered safe. To supplement the previous reviews, we have summarized the work performed on HBO and cancer in the period 2004–2012. Based on the present as well as previous reviews, there is no evidence indicating that HBO neither acts as a stimulator of tumor growth nor as an enhancer of recurrence. On the other hand, there is evidence that implies that HBO might have tumor-inhibitory effects in certain cancer subtypes, and we thus strongly believe that we need to expand our knowledge on the effect and the mechanisms behind tumor oxygenation.

Adjunctive effect of hyperbaric oxygen treatment after thrombolysis on left ventricular function in patients with acute myocardial infarction

Background The role of hyperbaric oxygen in patients with acute myocardial infarction is controversial, ranging from not beneficial to having a favorable effect. This randomized study was conducted to further assess the benefit of hyperbaric oxygen treatment after thrombolysis on left ventricular function and remodeling in patients with acute myocardial infarction. Methods Seventy-four consecutive patients with first acute myocardial infarction were randomly assigned to treatment with hyperbaric oxygen treatment combined with streptokinase (HBO+) or streptokinase alone (HBO−). Results There was a significant decrease of end-systolic volume index from the first day to the third week in HBO+ patients compared with HBO− patients (from 30.40 to 28.18 vs from 30.89 to 36.68 mL/m 2, P < .05) accompanied with no changes of end-diastolic volume index in HBO+ compared with increased values in HBO− (from 55.68 to 55.10 vs from 55.87 to 63.82 mL/m 2, P < .05). Ejection fraction significantly improved in the HBO+ group and decreased in the HBO− group of patients after 3 weeks of acute myocardial infarction (from 46.27% to 50.81% vs from 45.54% to 44.05 %, P < .05). Conclusions Adjunctive hyperbaric oxygen therapy after thrombolysis in acute myocardial infarction has a favorable effect on left ventricular systolic function and the remodeling process.

A Phase I safety study of hyperbaric oxygen therapy for amyotrophic lateral sclerosis

Vascular endothelial growth factor and mitochondrial abnormalities have been described in ALS and its animal models. We have reported that hyperbaric oxygen (HBO) treatment delayed the onset of weakness in the wobbler mouse. To perform a Phase I safety study of HBO in patients with ALS. Five patients with ALS were treated for 60min with 100% oxygen at 2 atmospheres pressure daily for five days a week for four weeks. The patients reported any deterioration in their condition after each treatment, and their neurological condition was measured serially during the four weeks of the treatment, and for four further weeks. Four patients reported decreased fatigue, while one patient dropped out at three weeks because of increased fatigue. Maximum isometric voluntary contraction (MVIC) of all muscle groups except right hand grip improved significantly by up to 97%. Most improvement occurred during the four weeks after treatment. It is possible that the improvement in muscle strength was a placebo or a learning effect, though no such effects have been detected in prior therapeutic trials in ALS using MVIC. No change was detected in other measures of neuromuscular function. A longer duration, placebo controlled trial in a larger number of patients is needed to determine the safety and efficacy of HBO. Until that is completed, it is not recommended that ALS patients should be treated with HBO.

Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy

Background: Radiation-induced brachial plexopathy (RIBP) is an untreatable complication of curative radiotherapy for early breast cancer, characterized by chronic neuropathic pain and limb paralysis. Hyperbaric oxygen (HBO 2) therapy is known to promote healing of tissue rendered ischaemic by radiotherapy, but is untested in RIBP. Methods: Thirty four eligible research volunteers suffering from RIBP were randomized to HBO 2 or control group. The HBO 2 group breathed 100% oxygen for 100 min in a multiplace hyperbaric chamber on 30 occasions over a period of 6 weeks. The control group accompanied the HBO 2 group and breathed a gas mixture equivalent to breathing 100% oxygen at surface pressure. All volunteers and investigators, except the operators of the hyperbaric chamber and the trial statistician, were blind to treatment assignments. The warm sensory threshold, which measures the function of small sensory fibres, was selected as the primary endpoint. Findings: Pre-treatment neurophysiological tests were grossly abnormal in the affected hand compared to the unaffected hand in both HBO 2 and control groups, as expected, but no statistically significant differences were noted in either group at any time up to 12 months post-treatment. However, normalization of the warm sensory threshold in two of the HBO 2 group was reliably recorded. Two cases with marked chronic arm lymphoedema reported major and persistent improvements in arm volume for at least 12 months after treatment with HBO 2. Interpretation: There is no reliable evidence to support the hypothesis that HBO 2 therapy slows or reverses RIBP in a substantial proportion of affected individuals, although improvements in warm sensory threshold offer some suggestion of therapeutic effect. Improvement in long-standing arm lymphoedema was not anticipated, and justifies further investigation.

The treatment of chronic radiation proctitis with hyperbaric oxygen in patients with prostate cancer.

The treatment of chronic radiation proctitis with hyperbaric oxygen in patients with prostate cancer.

TRIAL OF NORMOBARIC AND HYPERBARIC OXYGEN FOR ACUTE CARBON MONOXIDE INTOXICATION

The value of hyperbaric oxygen in the treatment of acute carbon monoxide intoxication was assessed in 629 adults who had been poisoned at home in the 12 h before admission to hospital. In patients without initial impairment of consciousness (group A) the effect of 6 h of normobaric oxygen (NBO) (group A0, n = 170) was compared with that of 2 h of hyperbaric oxygen (HBO) at 2 atmospheres absolute (ATA) plus 4 h NBO (group A1, n = 173). At the 1 month follow-up 66% of A0 and 68% of A1 patients had recovered. In patients with initial impairment of consciousness the effect of one session of HBO (group B1, n = 145) was compared with that of two sessions (group B2, n = 141); all group B patients also received 4 h of NBO. At 1 month of follow-up 54% group B1 and 52% group B2 patients had recovered. The 7 patients left with neuropsychiatric sequelae (3 B1, 4 B2) and the 4 who died (2 B1, 2 B2) had all presented with coma. HBO was not useful in patients who did not lose consciousness during carbon monoxide intoxication, irrespective of their carboxyhaemoglobin level, nor were two sessions of HBO in patients who sustained only a brief loss of consciousness. The prognosis is poorest for those presenting with coma; the trial needs to be pursued in this group of patients until the power of the study is sufficient to demonstrate the value or otherwise of HBO.