Hyperbaric Oxygen Therapy Protocol Research Articles

Efficacy and safety of hyperbaric oxygen therapy monitored by fluorescein angiography in patients with retinal artery occlusion

AimsTo assess the efficacy and safety of a standardised hyperbaric oxygen therapy protocol (HBOT) monitored by fluorescein angiography (FA) in patients with retinal artery occlusion (RAO).MethodsIt is a prospective, non-comparative,...

Hyperbaric Oxygen Therapy for Complications in Nipple-Sparing Mastectomy with Breast Reconstruction: A Systematic Review.

Background: Research advancing effective treatments for breast cancer is crucial for eradicating the disease, reducing recurrence, and improving survival rates. Nipple-sparing mastectomy (NSM), a common method for treating breast cancer, often leads to complications requiring re-operation. Despite advancements, the use of hyperbaric oxygen therapy (HBOT) for treating these complications remains underexplored. Therefore, we analyze the efficacy of HBOT in the post-operative care of patients undergoing NSM. Methods: A systematic search was conducted using PubMed, Scopus, and the Cochrane Library. Studies were assessed for eligibility using the PICO (Population, Intervention, Comparison, Outcome) framework and classified based on American Society of Plastic Surgeons (ASPS) levels of evidence. Seven studies, totaling a pool of 63 female patients, met the inclusion criteria. Among these studies, four were categorized as Level III (57.1%), one as Level IV (14.3%), and two as Level V (28.6%). These studies focused on HBOT's role in wound healing, the successful salvage of breast reconstruction, and the optimal timing for HBOT. Results: This review revealed that HBOT indeed has potential for improving tissue oxygenation, vascularization, and, consequently, wound healing. It is noted that HBOT is efficacious for mitigating post-NMS complications, including infections, re-operation, flap loss, seroma, and hematoma. Conclusions: Overall, HBOT could be beneficial in standard post-surgical care protocols for patients undergoing NSM due to its role in mitigating common adverse effects that occur after mastectomy. Despite promising outcomes, the recent literature lacks rigorous clinical trials and well-defined control groups, underscoring the need for further research to establish standardized HBOT protocols.

Functional MRI evaluation of hyperbaric oxygen therapy’s effect on hand motor recovery in a chronic post-stroke patient: a case report and physiological discussion

The objective of the case report was to evaluate a specific HBOT protocol as an effective treatment for stroke rehabilitation, specifically improving hand motor function in chronic post-stroke patients. Stroke is the second leading cause of long-term disability worldwide. About 80% of individuals with acute stroke present upper-limb motor impairment, and 50–60% will have persistent disability or weakness at the chronic phase. Impaired upper-limb motor function is highly associated with low self-care ability, limited mobility and poor quality of life. In recent years, there has been evidence of the neuroplasticity effects of HBOT, and HBOT was found to induce neuroplasticity in chronic stages, even years after brain injury. While the healthcare system is primarily focused on teaching patients to live with their impairments, this case report evaluates the effect of a specific hyperbaric oxygen therapy (HBOT) protocol on true stroke rehabilitation, specifically, improving upper-limb function. This case report studied motor task functional MRI (fMRI) activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb two years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and after the treatment using the Fugl–Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC). Following the HBOT protocol, the patient’s FMA score improved from 17 (severe impairment) to 31 (moderate impairment), and there was an increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally during trials involving the right hand. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity (P = 0.002) and a between-network connectivity increase (z-score: 0.35 ± 0.21 to 0.41 ± 0.21, P < 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex and the premotor cortex. This case report provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients, and shows HBOT’s potential as an effective, valuable treatment option for those suffering with lingering symptoms after a stroke. This work was conducted by a research team at the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center and Tel Aviv University, and published in Frontiers in Neurology. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effects of hyperbaric oxygen therapy on autistic behaviors and GRIN2B gene expression in valproic acid-exposed rats.

Autism is a complex neurodevelopmental condition characterized by deficits in social interaction, communication, and restricted repetitive behaviors. Hyperbaric oxygen therapy (HBOT) has emerged as a potential treatment for autism, although its effects on behavior and gene expression are not well understood. The GRIN2B gene, known for its involvement in encoding a glutamate receptor subunit crucial for neuron communication and associated with autism, was a focus of this study. Using a rat model induced by prenatal exposure to valproic acid, we examined the impact of HBOT on autism-like behaviors and GRIN2B gene expression. Male Wistar rats were categorized into four groups: control, VPA (valproic acid-exposed), VPA+HBOT [2 atmosphere absolute (ATA)], and VPA+HBOT (2.5 ATA). The rats underwent several behavioral tests to assess social behavior, anxiety, stereotype and exploratory behaviors, and learning. Following the behavioral tests, the HBOT groups received 15 sessions of HBOT at pressures of 2 and 2.5 (ATA), and their behaviors were re-evaluated. Subsequently, real-time PCR was employed to measure GRIN2B gene expression in the frontal lobe. Our results indicated that HBOT significantly increased social interaction and exploratory behaviors in VPA-exposed rats, alongside elevated GRIN2B gene expression in their frontal lobe. Our findings imply that HBOT might have a potential role in ameliorating autism-related behaviors in the VPA rat model of autism through potential modulation of GRIN2B gene expression. However, additional research is essential to fully comprehend the underlying mechanisms and refine the HBOT protocol for optimizing its effectiveness in improving autism-related symptoms.

Role of Hyperbaric Oxygen in Filler-Induced Vascular Occlusion.

The rising incidence of filler-induced vascular complications in the context of aesthetic procedures necessitates a thorough assessment of therapeutic options. Hyperbaric oxygen therapy (HBOT) has emerged as a potential intervention for filler-induced vascular occlusion (FIVO), although optimal dosing and timing remain undefined. This review explores the pathophysiology of FIVO and elucidates HBOT's multifaceted role in salvaging ischemic tissue. The physical and biochemical mechanisms of HBOT, including its vasodilatory, anti-spasmodic, and anti-inflammatory effects, are examined. HBOT serves as an adjunctive therapy in FIVO management, emphasizing timely intervention, adherence to specific pressures (two atmosphere absolute), and session durations (60 minutes) to optimize efficacy and minimize complications. While existing HBOT protocols for compromised grafts provide insights, standardized guidelines for FIVO are lacking. HBOT enhances tissue oxygenation, modulates reactive oxygen species, and influences angiogenesis and hypoxia response. However, it does not replace key treatment protocols for filler vascular complications. Further research and standardized protocols are warranted to define HBOT's definitive role in mitigating filler-induced vascular complications. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Adjunctive hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries: a systematic review.

Traumatic crush injuries of the lower limb often accompany severe complications. The incorporation of hyperbaric oxygen therapy to standard trauma care may have the potential to diminish injury-related complications and improve outcome in such cases. This systematic review aims to evaluate the effectiveness of hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries. The electronic databases Medline, Embase and Cochrane Library were searched to identify studies involving patients with crush-associated sever lower limb soft tissue injuries who received hyperbaric oxygen therapy in conjunction with standard trauma care. Relevant data on type of injury, hyperbaric oxygen therapy protocol and outcome related to wound healing were extracted. In total seven studies met the inclusion criteria, involving 229 patients. The studies included two randomized clinical trials, one retrospective cohort study, three case series and one case report. The randomized placebo-controlled clinical trial showed a significant increase in wound healing and decrease in the need for additional surgical interventions in the patient group receiving hyperbaric oxygen therapy when compared to those undergoing sham therapy. The randomized non-placebo-controlled clinical trial revealed that early hyperbaric oxygen therapy reduces tissue necrosis and the likelihood of long-term complications. The retrospective cohort study indicated that hyperbaric oxygen therapy effectively reduces infection rates and the need for additional surgical interventions. The case series and case report presented beneficial results with regard to wound healing when hyperbaric oxygen therapy was added to the treatment regimen. Hyperbaric oxygen therapy is generally considered a safe therapeutic intervention and seems to have a beneficial effect on wound healing in severe lower limb soft tissue injuries when implemented as an addition to standard trauma care.

Outcome of Chronic Foot Osteomyelitis Treated With Hyperbaric Oxygen: An Observational Study.

Chronic refractory osteomyelitis of the foot stands as a formidable challenge in medical care, associated with significant morbidity and escalating healthcare costs. Traditional therapeutic approaches, including surgical debridement and systemic antibiotics, often fall short, leaving patients and clinicians in search of more efficacious interventions. Hyperbaric oxygen therapy (HBOT), an innovative therapeutic modality, has recently emerged as a promising adjunct therapy, offering a beacon of hope in this therapeutic conundrum. In this groundbreaking observational study, we meticulously analyzed the experiences of 80 patients suffering from chronic refractory osteomyelitis of the foot. Following surgical debridement and tailored antibiotic therapy, each patient was treated with HBOT at 2.5 atmospheres absolute for 120 min, 5 days a week, spanning an average of 50 days. Our primary endpoints focused on complete eradication of infection, recurrence metrics, and any adverse effects linked to HBOT. Astonishingly, 68 of the 80 patients (85%) achieved a total infection clearance, maintaining this status through a mean follow-up period of 36 months, all without a single report of HBOT-induced complications. Our compelling findings advocate that HBOT, synergized with standard surgical and antibiotic regimens, can revolutionize the treatment landscape for chronic refractory osteomyelitis of the foot. Given these promising preliminary results, there's an imperative need for extensive research to delineate the long-term advantages and to fine-tune HBOT protocols, potentially paving the way for a new therapeutic gold standard.

Effects on Pulmonary Functions in Patients Undergoing Hyperbaric Oxygen Therapy: A Prospective Observational Study

Abstract Introduction: Hyperbaric Oxygen Therapy (HBOT) consists of administering oxygen at pressures higher than atmospheric pressure. Though HBOT remains one of the safest therapies used today, it is not completely devoid of side effects. Pulmonary oxygen toxicity can result as a result of continuous exposure of elevated levels of oxygen for increased duration and at increased pressures. The main pathological manifestations occur as acute exudative phase followed by subacute proliferative phase. Effects of HBOT on pulmonary functions has not been studied in detail. This study was conducted to ascertain the effects of HBOT on pulmonary functions and determine if these changes are reversible in nature. Material and Method: A prospective observational study was conducted at a tertiary care hospital over a period of 02 years. A total of 72 patients who were undergoing HBOT for any indication normal chest radiograph and normal spirometry/DLCO were included in the study. Spirometry and DLCO was done initially at the time of inclusion and repeated after half of the total planned HBOT sessions and finally at the end of all sessions of HBOT. Spirometry and DLCO was also repeated 6 months post completion of HBOT. The HBOT protocol consisted of breathing 100% oxygen at 2.4 atmospheric absolute (ATA) for 90 minutes which was referred as one session. Total sessions varied from 20-30 based on indication and response of their primary disease to HBO. Results: The mean age score in study population was 47.12 ± 12.88. Among the study population, 12(24%) participants were male and 38(76%) participants were female. The mean BMI was 24.49 ± 5.45. The mean DLCO was 6.67 ± 1.45 ml/min/mm Hg pre intervention, it was 6.38 ± 1.43 ml/min/mm Hg at mid cycle and 6.21 ± 1.41 ml/min/mm Hg post intervention and at 6 months follow up it was 6.43 ± 1.46 ml/min/mm Hg. The difference in the DLCO at mid cycle, post intervention and 6 months follow up period with baseline value were statistically significant (P value <0.05). The mean FVC was 2.59 ± 0.59 L pre intervention, 2.41 ± 0.6 L at mid cycle, 2.22 ± 0.53 L immediately post intervention and 2.44 ± 0.59 L at 6 months follow up. The difference in the FVC score at mid cycle, post intervention and 6 months follow up with baseline value were statistically significant (P value <0.001). The mean FEV1 was 2.15 ± 0.52L pre- intervention, 2.14 ± 1.97L at mid cycle, 2.03 ± 0.53 L post intervention and 2.52 ± 2.02 L at 6 months follow up. The difference in the FEV1 score at post intervention with baseline value (pre-intervention) was statistically significant (P value <0.001). However, the difference in the FEV1 score at 6 months follow up period with baseline value (pre-intervention) was not statistically significant (P value >0.005). Conclusion: HBOT although a safe intervention, it is not totally devoid of complications. Although our study did reveal statistically significant changes in pulmonary function in most of the instances, it did not show any clinically significant changes in pulmonary function with use of HBOT protocol at 2.4 ATA. Studies with larger sample size will be required to ensure evidence based safety of HBOT use.

The role of hyperbaric oxygen in osteoradionecrosis-a prophylactic insight.

Osteoradionecrosis (ORN) is an uncommon and debilitating consequence of head and neck radiotherapy and hyperbaric oxygen therapy (HBOT) has been advocated for prophylaxis prior to performing dentoalveolar procedures. The aim of this study was to evaluate a prophylactic HBOT protocol and describe the outcomes of susceptible individuals. A retrospective audit of adults who attended the Oral and Maxillofacial Surgery department at the Royal Adelaide Hospital (South Australia) who received dental extractions with a history of radiotherapy to the jaws from 2008 to 2020. Data including demographic information and outcomes of osteoradionecrosis and delayed healing was recorded. A total of 121 individuals were eligible for case note review; 68.6% of individuals were male and 55.4% were aged over 67 years. Osteoradionecrosis occurred in 9.1% of individuals and delayed healing for 3.3%; fifteen individuals (12.4%) were unable to complete the HBOT protocol. The individuals who were diagnosed with ORN had a significant association with age (P = 0.006) and binary analysis showed alcohol consumption to be a significant predictor. Prophylactic HBOT protocol had a lower proportion of individuals diagnosed with ORN and those who were diagnosed were more likely to be younger males and have current alcohol consumption.

Hyperbaric Oxygen Therapy versus placebo for post-concussion syndrome (HOT-POCS): A randomized, double-blinded controlled pilot study

Post-Concussion Syndrome (PCS) refers to the persistence of physical, cognitive, and emotional symptoms following mild traumatic brain injury (mTBI)/concussion, occurring in roughly 15–30% of individuals. Hyperbaric oxygen therapy (HBOT) has been suggested as a potential treatment for PCS; however, the evidence to date is mixed due to inconsistencies in the treatment protocol and focus on veterans with combat-related injuries, which may not be generalizable to the general population. The goal of Hyperbaric Oxygen Therapy for Post-Concussion Syndrome (HOT-POCS) is to assess the efficacy and safety of HBOT for the treatment of PCS in the civilian population. This randomized, controlled pilot study will be using a standardized HBOT protocol (20 sessions of 100% O2 at 2.0 atm absolute [ATA]) compared with a true placebo gas system that mimics the oxygen composition at room air (20 sessions of 10.5% O2 and 89.5% nitrogen at 2.0 ATA) in a cohort of 100 adults with persistent post-concussive symptoms 3–12 months following injury. Change in symptoms on the Rivermead Post-concussion Questionnaire (RPQ) will be the primary outcome of interest. Secondary outcomes include the rate of adverse events, change in the quality of life, and change in cognitive function. Exploratory outcome measures will include changes in physical function and changes in cerebral brain perfusion and oxygen metabolism on MRI brain imaging. Overall, the HOT-POCS study will compare the efficacy of a standardized HBOT treatment protocol against a true placebo gas for the treatment of PCS within 12 months after injury.

Clinical Considerations for Implanted Neurological Devices in Patients Undergoing Hyperbaric Oxygen Therapy: A Case Report and Review of Manufacturer Guidelines

Patients with implanted medical devices are increasingly referred for hyperbaric oxygen therapy (HBOT), and the safety of exposing some of these devices to hyperbaric environments has not previously been explored. There is a paucity of evidence surrounding the management of implanted neurological devices such as neurostimulators and intrathecal drug delivery (IDD) pumps in the context of HBOT. However, these devices can be expected to harbor unique risks; for example, vacant space in the reservoir of an implanted IDD pump may change in pressure and volume during the compression and decompression phases of HBOT, resulting in a damaged or dysfunctional device. We present the case of a 27-year-old woman with cerebral palsy referred for HBOT to manage a necrotizing soft tissue infection cultured from a dehiscent abdominal wound at the previous implantation site of an intrathecal baclofen pump. An HBOT protocol was ultimately chosen in partnership with the patient and her family, but treatment was not performed due to a paucity of evidence that the implanted IDD pump could safely withstand hyperbaric exposure. In this review, we have synthesized manufacturer recommendations regarding the management of implanted neurological devices before, during, and after HBOT to inform future decision-making in this setting. Among these recommendations, we highlight that neurostimulators should be switched off for the duration of HBOT and implanted pumps should be refilled prior to each treatment session to minimize empty reservoir space.

Hyperbaric Oxygen Therapy in Orthopaedics: An Adjunct Therapy with an Emerging Role.

Hyperbaric oxygen therapy (HBOT) has emerged as an adjunct treatment modality in various orthopedic and rheumatological conditions. Undersea and Hyperbaric Medical Society (UHMS) defined the minimum number of HBOT cycles, dose, and frequency for various diseases. UHMS laid the 14 absolute indications for HBOT. This article deals with the mechanism of actions of HBOT and evidence of various musculoskeletal disorders where HBOT was utilized to accelerate the healing process of the diseases. The review literature search was conducted by using PubMed, SCOPUS, and other database of medical journals for identifying, reviewing, and evaluating the published clinical trial data, research study, and review articles for the use of HBOT in musculoskeletal disorders. Various clinical researchers documented cellular and biochemical advantages of HBOT which possess allodynic effects, anti-inflammatory, and prooxygenatory effects in patients with musculoskeletal conditions. Studies on the usage of HBOT in avascular necrosis and wound healing provide a platform for exploring the plausible uses of HBOT in other musculoskeletal conditions. Literature evidence states the complications associated with HBOT therapy. The existing HBOT protocols have to be optimized for various musculoskeletal disorders. Large scale blinded RCTs have to be performed for demonstrating the level of evidence in the usage of HBOT in various musculoskeletal clinical scenarios.

The effects of combined hyperbaric oxygenation and erythropoietin therapy in treatment of heart failure

Abstract It well known that hyperbaric oxygenation (HBO) and erythropoietin (EP) are growth factors. Because of that, it is logical to apply them together as a therapeutic procedure in the regeneration and recovery of the heart muscle. Hyperbaric oxygen therapy has increased the amount of oxygen which “presents” to cardiac muscle, while the use of EP is reduced the intensity of apoptosis of heart muscle. The aim of this study was to analyze if combined therapy of HBO and EP can be usefulness in patients (pts) with heart failure (HF), especially in chronic type of HF. Material and methods The study was designed as a cross-sectional study in the field of new procedures of HF treatment. From January 2017 to January 2019, there were analyzed 92 patients (pts) with chronic HF. There were more men (69.6%). All pts were divided in two groups: Group I – 72 pts (78.3%) with ischemic HF and Group II – 20 pts (21.7%) with non-ischemic HF. Hyperbaric oxygen therapy protocol was defined as protocol for pts with sever cardiac diseases (total of 15 treatment, once daily, on pO2 1.3–1.7 ATA). Recombined EP was administered deeply subcutaneous, every second day 2000 IU, until dose of 18000 IU. In all pts, on admission and one month after therapy, next procedures were arranged: hemoglobin level, distribution of NYHA class, 6-minutes walking test and EF (by radionuclide ventriculography). Results There were no differences between two groups in gender (p=0.0170) and hemoglobin level before and after therapy (p=0.4400). There were significant changes in distribution of NYHA class in both group of pts, from NYHA class III to NYHA class I and II (p=0.0179) one month after therapy, as well as in 6-minutes walking test one month after therapy (p=0.0148), too. Ejection fraction was significantly better in both groups of pts, one month after therapy (p=0.0040). Conclusion The results of this study open up completely new aspects of the combined use of comparative therapeutic procedures with significant final positive effect in the treatment of chronic HF, ischemic, as well as in non-ischemic type of HF. Funding Acknowledgement Type of funding sources: None.

Necrotic Wound Caused by Jararaca (Bothrops jararaca) in a Dog - Hyperbaric Oxygen Therapy (HBTO)

Background: Snakebites are the main responsible for envenoming in dogs and the bothropic venom remains the most common in Brazil, which can induce a necrotic skin wound. Hyperbaric oxygen therapy (HBOT) use 100% oxygen under high pressure and used to treat different wounds in human patients. To the authors’ knowledge, no reports regarding to use the HBOT in skin wound caused by snakebite (Bothrops jararaca) are present in the literature. The present clinical case aimed to describe the use of HBOT for the treatment of an extensive necrotic wound caused by jararaca snakebite in a dog.Case: A neutered 8-year-old mixed-breed dog, weighing 12 kg, was admitted with a 7-day history of extensive necrotic wound was identified in the face and neck causing by a snakebite, and no sign of pain. The procedure of HBOT (single sessions of 1.5 ATM, 45 min, repeated every 48 h, up to 12 sessions) was decided, and the complete blood cells, alanine aminotransferase, creatinine, creatine kinase, prothrombin time, activated partial thromboplastin time, wound clinical evaluation were measured at the following time-points: 2nd, 5th, 10th, and 12th sessions. At the 5th session was identified leukopenia, neutropenia and lymphopenia. Wound re-epithelialization was initiated after the 5th session, and the complete epithelialization was identified at the 12th session of HBOT. During the HBOT no side effects were identified. Three months after the HBOT finished, the animal returned to the clinic and the clinical status evolved positively, and the wound was completed healed.Discussion: This report described the treatment of an extensive necrotic skin wound caused by snakebite (Bothrops jararaca) in an 8-year-old, neutered, mixed-breed dog using the HBOT. The wound healing was achieved after 12 sessions, similar to the literature, which reported a ranging from 1 to 12 sessions. The HBOT protocol used in this case was similar as reported for human patients with chronic wounds due to the lack of HBOT protocols for animals. No reports regarding the use of HBOT for treat necrotic wound caused by snakebite was described in the literature, and to the authors’ knowledge, this is the first report in Brazil describing the use of HBOT in dogs. On the other hand, dogs with surgically induced skin wounds and treated with daily session of HBOT using the treatment protocol of 1.7 ATM (30 min) and 2.0 ATM (40 min) up to 7th day of treatment did not show significant results on healing [9]. This fact was associated with the HBOT achievement in the proliferative and remodeling phases of the healing process. The high intensity of HBOT was between the 5th and 10th session since the wound showed a higher area decrease rate and consequently increase of wound contraction. This period was corresponding to the 10th and 20th day of the healing process, which can be identified angiogenic activity, re-epithelialization, and collagen maturation. The decrease in PVC has been associated with the anticoagulant and/or hemorrhagic activity caused by the venom, and leukopenia, neutropenia and lymphopenia was related with possible bone marrow exhaustion. Single sessions of HBOT (1.5 ATM, 45 min, and repeat each 48 h, up to 12 session) induces healing of necrotic wound caused by snakebite (Bothrops jararaca) in an 8-year-old, neutered, mixed-breed dog without any side effects.Keywords: dog, healing, hyperbaric chamber, skin wound, snake.

Application of a new hyperbaric oxygen therapy protocol in patients with arterial and venous gas embolism due to hydrogen peroxide poisoning

Hydrogen peroxide (H2O2) ingestion can cause vascular gas embolism (GE). Hyperbaric oxygen therapy (HBO2) is known to improve neurological abnormalities in patients with arterial gas embolism (AGE). Previously, HBO2 based on the U.S. Navy Table 6 diving protocol has been adopted for treating AGE and preventing the progression of portal venous GE, caused by H2O2 ingestion, to AGE. However, the indication and protocol for HBO2 have not been established for GE related to H2O2 ingestion. Herein, we describe a case in which GE caused by H2O2 ingestion was treated using HBO2 with a short protocol. A 69-year-old female patient presented with abdominal pain, vomiting, and transient loss of consciousness after ingesting 35% H2O2. Computed tomography revealed gastric wall and portal venous gas. She was administered an HBO2 protocol with 2.8-atmosphere absolute (ATA) compression for 45 minutes. This was followed by a 2.0-ATA treatment for 60 minutes with a five-minute air break, after which all gas bubbles disappeared. After HBO2 treatment, brain magnetic resonance imaging revealed focal cytotoxic edema lesions; however, the patient was discharged without additional symptoms.

Effects of Ovariohysterectomy and Hyperbaric Oxygen Therapy on Systemic Inflammation and Oxidation in Dogs.

Introduction: Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen in a specialized compression chamber leading to hyperoxia. This treatment modality is associated with anti-inflammatory, antioxidant, and healing properties in people and laboratory animals. However, there are relatively few reports that evaluate the effects of HBOT in companion animals. The goal of this study was to investigate the physiological effects of HBOT on surgically induced systemic inflammation and oxidation in dogs.Material and Methods: Twelve healthy female beagle dogs were spayed and randomized into control and HBOT groups (n = 6). Both groups received conventional post-ovariohysterectomy therapy, and the HBOT group received two hyperbaric treatments at 2.0 atmosphere of absolute pressure and 100% oxygen for 35 min, 6 and 18 h after surgery. Blood samples were collected 3 h prior to ovariohysterectomy, 6, 18, and 30 h after surgery, prior to HBOT when applicable. Inflammatory biomarkers, including C-reactive protein, circulating cytokines, and changes in iron homeostasis were evaluated at each time point to determine the effects of surgery and HBOT on inflammation. Similarly, serum total oxidant status and total antioxidant status were measured to assess the oxidative stress. Pain and incision scores were recorded and compared between groups.Results: Following ovariohysterectomy, all dogs had significantly increased serum concentrations of C-reactive protein, KC-like, IL-6, and increased unsaturated iron-binding capacity compared to their pre-surgical values (p < 0.02), while serum iron, total iron-binding capacity and transferrin saturation were significantly decreased after surgery (p < 0.02). There was no significant difference between the control group and the HBOT group for any of the variables. There were no overt adverse effects in the HBOT group.Conclusion: This is the first prospective randomized controlled study to investigate the effects of HBOT on surgically induced systemic inflammation in dogs. While elective ovariohysterectomy resulted in mild inflammation, the described HBOT protocol portrayed no outward adverse effect and did not induce any detectable pro-inflammatory, anti-inflammatory, or antioxidant effects. Additional investigation is required to identify objective markers to quantify the response to HBOT and determine its role as an adjunctive therapy in dogs with more severe, complicated or chronic diseases.

Hyperbaric oxygen therapy for pediatric “hypospadias cripple”—evaluating the advantages regarding graft take

Hypospadias cripple patients pose a major surgical challenge with high complication rates attributed mainly to graft contraction. Hyperbaric oxygen therapy (HBOT) is an established treatment for compromised grafts and used extensively as a salvage therapy for compromised grafts and ischemic non-healing wounds. We evaluated the graft-take rates in hypospadias cripple cases undergoing a staged tubularized autograft repair (STAG)and compared between patients treated with or without preemptive HBOT. All patients underwent a STAG. Patients receiving preemptive HBOT were compared with patients receiving the standard surgical procedure without HBOT. The HBOT protocol included a daily session, 5 days per week for four weeks before the surgery and 10 additional daily sessions immediately after first-stage surgery. Each HBOT session included 90min exposure to 100% O2 at 2 atmospheres absolute with 5min air breaks every 20min. The primary endpoint was graft take. Sequential tubularization without tension at second stage was defined as success. Seven boys received HBOT and 14 boys comprised the control group. All patients in the HBOT group had good graft take with no graft contraction. In the control group, 57% had good graft take and could proceed to the second-stage surgery and 43% had graft contraction (Table). Except for one patient who had claustrophobia while entering the chamber, no significant side-effects developed during the HBOT. The basic pathophysiology of compromised flaps includes both ischemia and reperfusion injury, which can be attenuated by HBOT. The beneficial effects of HBOT relates to several mechanisms, including hyperoxygenation, fibroblast proliferation, collagen deposition, angiogenesis, and vasculogenesis. Graft contraction is a well-known complication in hypospadias cripple population with reported failure rate of 39-63%. The HBOT procedure was found to be very effective and the entire HBOT group had a good graft take. Accordingly, all patients in the HBOT group proceeded to a successful second-stage tubularization. In addition, HBOT was found to be safe and generally well tolerated by this pediatric population. Study limitations were a relative small, non-homogenous sample size and lack of prospective randomization. Success was defined as sufficient graft elasticity sufficing for tubularization of the neourethra, and exact graft measurements are lacking in this study. Preemptive HBOT can be used safely in the hypospadias cripple pediatric population and can potentially reduce the expected high surgical failure secondary to graft contraction.

The effects of hyperbaric oxygen therapy on diabetic retinopathy: A preliminary study

The objective of this study was to prospectively assess the effect of hyperbaric oxygen therapy (HBOT) on diabetic retinopathy lesions and macular edema in patients undergoing the treatment for diabetic foot ulcers. We compared two groups: a first group including 25 patients with non-proliferative diabetic retinopathy treated by HBOT for foot ulcers, and a second group (control group) composed of 25 patients with diabetic retinopathy who did not receive HBOT. The HBOT protocol performed for the patients in the first group was: 30 sessions of 90 minutes each at 2.5 ATA with a mean frequency of five sessions per week. All patients had an ophthalmological exam at baseline (visual acuity, intraocular pressure, fundus exam), fundus photography and an OCT exam. A follow-up exam was performed at the conclusion of the HBOT. Compared to the control group, patients treated with HBOT showed a regression or stabilization of diabetic retinopathy lesions and a decrease in central macular thickness (CMT). Hyperbaric oxygen therapy may improve diabetic retinopathy and diabetic macular edema. This therapy may serve as an adjunctive treatment in the management of retinal ischemia and capillary hyperpermeability in diabetic retinopathy.

Hyperbaric oxygen therapy effects on pulmonary functions: a prospective cohort study

BackgroundOxygen toxicity is one potential side effect of hyperbaric oxygen therapy (HBOT). Previous small studies showed mild reductions in pulmonary functions reflecting reductions in small airway conductance after repetitive hyperbaric oxygen sessions. However, there are no updated data with well performed pulmonary tests that address the pulmonary effect of the currently used HBOT protocols.The aim of this study was to evaluate the effect of HBOT on pulmonary functions of patients receiving the currently used HBOT protocol.MethodsProspective analysis included patients, 18 years or older, scheduled for 60 daily HBOT sessions between 2016 and 2018. Each session was 90 min of 100% oxygen at 2 ATA with 5 min air breaks every 20 min, 5 days per week. Pulmonary functions, measured at baseline and after HBOT, included forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1) and peak expiratory flow rate (PEF).ResultsThe mean age was 60.36 ± 15.43 and 62.5% (55/88) were males. Most of the patients (83/88, 94.3%) did not have any pulmonary disease prior to inclusion and 30.7% (27/88) had a history of smoking.Compared to baseline values, at the completion of 60 HBOT sessions, there were no significant changes in FEV1 (0.163), FEV1/FVC ratio (0.953) and FEF25–75% (0.423). There was a statistically significant increase though not clinically relevant increase in FVC (0.1 ± 0.38 l) and PEF (0.5 ± 1.4 l) with a 0.014 and 0.001 respectively.ConclusionRegarding pulmonary functions, repeated hyperbaric oxygen exposure based on the currently used HBOT protocol is safe. Surprisingly, there was a modest non clinically significant though statistically significant improvement in PEF and FVC in the current cohort of patients who were without chronic lung diseases.Trial registrationClinicaltrials.gov, trial ID: NCT03754985, (Nov 2018) Retrospectively registered.

Effects of hyperbaric oxygen therapy on uncomplicated incisional and open wound healing in dogs.

To determine the safety of a hyperbaric oxygen therapy (HBOT) protocol and its influence on the healing of uncomplicated open and incisional wounds in dogs. Prospective, controlled experimental study. Adult dogs (n = 10). Two 2 × 2-cm open wounds and two 3-cm-long full-thickness dermal incisions were created on the dorsum of each dog. Dogs in the hyperbaric oxygen treatment group (HBO) received HBOT once daily (1.7 atmospheres absolute [ATA], 30 minutes on day 1; 2.0 ATA, 40 minutes on days 2-7) for 7 consecutive days, and dogs in the control group (CON) received standardized wound care. Dogs were monitored during HBOT for adverse side effects. Total wound area, percentage epithelialization, and percentage contraction were compared for the open wounds. Subjective wound scores were compared for the open and incisional wounds. Biopsies of both wound types were taken and used to determine histopathology scores. Bacterial cultures were completed on open wounds. No difference was detected between HBO and CON uncomplicated open and incisional wounds at any time for contraction, epithelialization, subjective wound scores, histopathology scores, or bacterial loads. All HBO dogs tolerated hyperbaric oxygen treatments with no adverse effects. The HBOT protocol tested here was safe but did not enhance the healing of uncomplicated acute wounds and incisions of dogs. These results do not provide evidence to support the use of HBOT to manage uncomplicated wounds in dogs.