Use Of Hyperbaric Oxygen Therapy Research Articles

Successful use of hyperbaric oxygen therapy for limb salvage of acute limb ischemia as a complication of acute carbon monoxide poisoning

Acute limb ischemia (ALI) as a complication of acute carbon monoxide (CO) poisoning is rare. Several reports have utilized hyperbaric oxygen therapy (HBO2) as an adjunctive therapy for peripheral arterial diseases. However, no study has yet described the use of HBO2 for ALI precipitated by CO poisoning. Herein we report successful limb salvage achieved with adjunctive HBO2 and conventional therapies in a patient with CO-induced ALI. A 69-year-old man was admitted with acute CO poisoning; ALI of both lower extremities occurred on hospitalization day 3. Pre-existing risk factors for ALI other than CO were not definite. After conventional treatments including catheter-directed thrombolysis and endovascular thrombectomy, the right-side lesion remained and a left-side lesion was newly developed. In addition to prior therapies, 47 sessions of serial HBO2 were administered as adjunctive therapy, resulting in limb salvage. Acute CO poisoning can cause ALI as a rare complication. HBO2 may be utilized as an adjunctive treatment in ALI.

Miller’s Anesthesia, 9th ed

Miller’s Anesthesia, 9th ed

Study of the Effect of Hyperbaric Oxygen Therapy on the Viability of Dorsal Cutaneous Flaps in Tobacco-Exposed Rats.

Smoking causes a threefold increase in the risk of surgical complications in flaps. Hyperbaric oxygen therapy (HBOT) increases the viability of chronic wounds. However, there are few studies concerning the effects of HBOT on surgical flaps in patients who smoke. This study aimed to analyze the effect of HBOT on the viability of cutaneous flaps in tobacco-exposed rats. Twenty Wistar rats were exposed to tobacco smoke for two months. Following this period, all animals underwent a dorsal cutaneous flap (3 × 10cm) surgery and were divided into two groups: control (n = 10) and HBOT (n = 10). HBOT was performed in seven daily sessions (2 ATA, 90min). After seven days, the animals were euthanized. The outcomes were total area, viable area, viable area/total area rate, analysis of dermal appendages and angiogenesis (hematoxylin-eosin), and gene expression analysis of iNOS and VEGF-a biomarkers. The HBOT group showed an increase in viable area compared with the control group (84% versus 47%, p = 0.009, respectively). The HBOT group also showed an increase in appendage units (1.69 ± 0.54 versus 1.87 ± 0.58, p = 0.04) and angiogenesis density (1.29 ± 0.45 versus 1.82 ± 0.64, p < 0.001) compared to the control group. There was a difference between the control and HBOT groups in iNOS levels (0.926 ± 1.4 versus 0.04 ± 0.1 p = 0.002, respectively). However, this study did not show a difference between the groups concerning the gene expression of VEGF-a. The use of hyperbaric oxygen therapy increased the viability of cutaneous flaps in tobacco-exposed rats and decreased iNOS mRNA levels; however, it did not change VEGF-a levels. 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.

Hyperbaric oxygen therapy in ophthalmic practice: an expert opinion

ABSTRACTIntroduction: There has been a growing interest in hyperbaric oxygen therapy (HBOT) in recent years across multiple disciplines. In the field of ophthalmology, the implications of increased HBOT use may include expanded applications in treating ocular vascular pathologies as well as a greater incidence of HBOT-induced visual complications.Areas covered: The authors review recent studies on HBOT usage in the treatment of ocular conditions. In addition to providing updates on the ophthalmic indications of HBOT, adverse visual effects of HBOT are also investigated.Expert opinion: Further evidence substantiating HBOT as an effective treatment modality for ocular vascular pathologies, such as central retinal artery occlusion and diabetic retinopathy, have been published in recent years. With the identification of more prognostic factors, increased success in HBOT has been reported. However, studies also show that adverse ocular effects associated with hyperbaric oxygen exposure include myopia and cataracts. It is important to recognize the risks of iatrogenic changes in visual acuity when considering patients for HBOT.

Guidelines on use of interventions to enhance healing of chronic foot ulcers in diabetes (IWGDF 2019 update).

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. In conjunction with advice from internal and external reviewers and expert consultants in the field, this update is based on a systematic review of the literature centred on the following: the Population (P), Intervention (I), Comparator (C) and Outcomes (O) framework; the use of the SIGN guideline/Cochrane review system; and the 21 point scoring system advocated by IWGDF/EWMA. This has resulted in 13 recommendations. The recommendation on sharp debridement and the selection of dressings remain unchanged from the last recommendations published in 2016. The recommendation to consider negative pressure wound therapy in post-surgical wounds and the judicious use of hyperbaric oxygen therapy in certain non-healing ischaemic ulcers also remains unchanged. Recommendations against the use of growth factors, autologous platelet gels, bioengineered skin products, ozone, topical carbon dioxide, nitric oxide or interventions reporting improvement of ulcer healing through an alteration of the physical environment or through other systemic medical or nutritional means also remain. New recommendations include consideration of the use of sucrose-octasulfate impregnated dressings in difficult to heal neuro-ischaemic ulcers and consideration of the use of autologous combined leucocyte, platelet and fibrin patch in ulcers that are difficult to heal, in both cases when used in addition to best standard of care. A further new recommendation is the consideration of topical placental derived products when used in addition to best standard of care.

Hyperbaric oxygen therapy in the prevention and management of tracheal and oesophageal anastomotic complications.

Failure of anastomotic healing is a morbid complication after airway or oesophageal surgery. Hyperbaric oxygen therapy (HBOT) has been used extensively in the management of complex wound-healing problems. We demonstrate the use of HBOT to rescue at-risk anastomoses or manage anastomotic failures in thoracic surgery. Retrospective review of 25 patients who received HBOT as part of the management of tracheal or oesophageal anastomotic problems during 2007-2018. HBOT was delivered at 2 atm with 100% oxygen in 90-min sessions. Twenty-three patients underwent airway resection and reconstruction while 2 patients underwent oesophagectomy. There were 16 (70%) laryngotracheal and 7 (30%) tracheal resections. Necrosis at the airway anastomosis was found in 13 (57%) patients, partial dehiscence in 2 (9%) patients and both in 6 (26%) patients. HBOT was prophylactic in 2 (9%) patients. Patients received a median of 9.5 HBOT sessions (interquartile range 5-19 sessions) over a median course of 8 days. The airway anastomosis healed in 20 of 23 (87%) patients. Overall, a satisfactory long-term airway outcome was achieved in 19 (83%) patients; 4 patients failed and required reoperation (2 tracheostomies and 1 T-tube). HBOT was used in 2 patients after oesophagectomy to manage focal necrosis or ischaemia at the anastomosis, with success in 1 patient. Complications from HBOT were infrequent and mild (e.g. ear discomfort). HBOT should be considered as an adjunct in the management of anastomotic problems after airway surgery. It may also play a role after oesophagectomy. Possible mechanisms of action are rapid granulation, early re-epithelialization and angiogenesis.

Hyperbaric oxygen therapy in diabetic foot ulceration: Useless or useful? A battle.

The use of hyperbaric oxygen therapy (HBO) in the treatment of certain types of diabetic foot ulcers (DFU) has been the topic of much debate and disagreement over the last several decades. In this review, the evidence for its use is presented and discussed by two experts in DFU management. Whereas some randomized controlled trials suggest that HBO may speed the healing of certain ischaemic or neuroischaemic ulcers after the failure of standard of care, most recent trials have been negative. No RCT is perfect, and the weaknesses of RCTs in this therapeutic area are discussed. It can be concluded that the indications for the use of HBO remain unclear, and that large, rigorously designed and executed RCTs are required to clarify the use of HBO in DFU treatment.

The use of hyperbaric oxygen therapy in head-and-neck conditions

Introduction: Hyperbaric oxygen therapy (HBOT) has been suggested to be beneficial in managing compromised acute and chronic wounds. To shed some light on its effectiveness in head-and-neck wounds, a retrospective review on the use of HBOT was done. Materials and Methods: The medical records of patients receiving HBOT for head-and-neck conditions were reviewed. The demographics and clinical data were collected. Results: Seventeen patients were identified. Four major indications for therapy were identified being osteoradionecrosis (ORN) treatment, ORN prophylaxis, treatment of compromised flaps/grafts, and treatment of medication-related osteonecrosis of the jaw. Favorable outcome following HBOT was seen in 77% of patients. In the treatment of ORN, 56% cases treated were successful. In the remaining groups, 100% success rates were obtained. The majority of patients had HBOT as an adjunctive treatment. HBOT as an adjunct was successful in 71% of patients, while prophylactic HBOT were successful in all patients. Complications including ear barotrauma and sinus squeeze were seen in 24% of patients. Conclusions: HBOT can be successfully used in various head-and-neck conditions, especially when used in cases with compromised flaps/graft or ORN prophylaxis. It is well tolerated and thus provides a valid adjunctive therapy in the management of tissue with compromised healing capability in the head-and-neck region.

Hyperbaric oxygen therapy in the healing process of foot ulcers in diabetic type 2 patients marked by interleukin 6, vascular endothelial growth factor, and PEDIS score: A randomized controlled trial study

IntroductionDiabetic foot ulcers (DFU) is a major social issue in terms of treatment cost. DFU has a high risk of infection with morbidity and an increased risk of lower-extremity amputations. Currently, there are no satisfactory treatments for DFU. This motivates a search for methods that can stimulate the acceleration of wound healing; one of these methods is the use of hyperbaric oxygen therapy (HBOT). This study attempts to prove the ability of HBOT to accelerate the healing process of DFU by increasing levels of both serum Interleukin 6 (IL-6) and Vascular Endothelial Growth Factor (VEFG), assessed by the perfusion, extent, depth, infection and sensation (PEDIS) score. MethodsTwenty DFU patients were divided into two groups. The control group underwent a holistic DFU treatment without HBOT and was tested twice for serum IL-6 and VEGF levels, 1 day apart. The HBOT group underwent a holistic DFU treatment with HBOT and was also tested twice for serum IL-6 and VEGF levels: one day before HBOT and 2 h after the first day of HBOT. ResultsThe changes in serum IL-6 and VEGF levels were greater in patients with HBOT than in control patients (p = 0.025 and p = 0.004). As for PEDIS score assessment, the HBOT group had significantly lower PEDIS scores than the control group (p < 0.001). ConclusionHBOT can help accelerate the wound healing process, which was proven by increased serum IL-6 and VEGF levels and a lower PEDIS score.

S-100β in predicting the need of hyperbaric oxygen in CO-induced delayed neurological sequels.

Delayed neurological sequels (DNS) have been described after carbon monoxide (CO) poisoning. There is a need to find a new prognostic marker to guide the use of hyperbaric oxygen (HBO) therapy. To evaluate serum S-100β level in patients presenting with acute CO poisoning as an indicator of poisoning severity and predictor of DNS occurrence and HBO need in those patients. This prospective cohort study included patients with acute CO poisoning. On admission, carboxyhemoglobin (COHb) and S-100β levels were measured. Patients were followed up for 6 months for signs of DNS. Out of 50 patients, 6 only developed DNS. The mean of S-100β levels was significantly higher in patients with severe poisoning and those with DNS. Receiver operating characteristic curve analysis revealed that S-100β had an area under the curve 0. 871; at a cutoff value ≥ 0.67 µg/L, its sensitivity and specificity were 100% and 77.3%, respectively. The sensitivity of S-100β was significantly higher than that of COHb, while its specificity and overall accuracy were significantly higher than those of HBO criteria. Serum S-100β level on admission could be a marker of poisoning severity and a predictor of CO-induced DNS development that guides the use of HBO therapy.

Parameters of the oxidative-reduction system of the homeostasis in female transplant patients with tumors of the reproductive system treated with hyperbaric oxygen therapy

Introduction. Studies on the effects of hyperbaric oxygenation have often been represented as animal model experiments. Currently, the number of studies on the use of hyperbaric oxygen therapy in the post-transplant period in humans is growing. The need in investigating the efficacy of hyperbaric oxygen therapy in the postoperative period in female transplant patient with tumors of the reproductive system is dictated by time.The aim of the study was to evaluate the efficacy of hyperbaric oxygen therapy in the complex treatment of transplant patients at an early stage of the postoperative period.Material and methods. We have studied the course of an early postoperative period in 8 female transplant patients with reproductive system tumors treated in N.V. Sklifosovsky Research Institute for Emergency Medicine, using hyperbaric oxygenation. The hyperbaric oxygen therapy sessions were provided in a single-patient hyperbaric chamber at 1.2–1.6 ATA for 40 minutes. The status of the redox homeostasis system was assessed based on the data of the platinum electrode open circuit potential measured in blood plasma by using the potentiometric method; and the blood plasma antioxidant activity was assessed by cyclic voltammetry.Results. The analysis of the results showed that there was a direct relationship indicating the positive effect of hyperbaric oxygen therapy on the balance status of the pro- and antioxidant systems of the body, and on the improvement of blood counts.Conclusion. The early inclusion of hyperbaric oxygen therapy in the complex treatment of transplant patients with tumors of the reproductive system contributes to a more rapid recovery of pro- and antioxidant systems of the body, blood counts.

Emerging indications for hyperbaric oxygen

To identify and discuss emerging trends in the therapeutic use of hyperbaric oxygen. There has been a maturing of the clinical evidence to support the treatment of sudden hearing loss, a wide range of problematic chronic wound states and the prevention and treatment of end-organ damage associated with diabetes mellitus. On the other hand, the controversy continues concerning the use of hyperbaric oxygen therapy (HBOT) to treat sequelae of mild traumatic brain injury. HBOT remains poorly understood by many medical practitioners despite more than 50 years of clinical practice. Pharmacological actions arise from increased pressures of oxygen in the blood and tissues. Most therapeutic mechanisms identified are not the simple result of the reoxygenation of hypoxic tissue, but specific effects on immunological and metabolic pathways by this highly reactive element. HBOT remains controversial despite biological plausibility and a solid clinical evidence base in several disease states. Multiple proposals for new indications for HBOT continue to emerge. Although many of these will likely prove of limited clinical importance, some show significant promise. Responsible practitioners remain acutely aware of the need for high-quality clinical evidence before introducing emerging indications into routine practice.

Hyperbaric Oxygen Treatment – Helpful or placebo?

Hyperbaric oxygen therapy use has become common practice amongst certain athlete groups. Theoretically, the additional oxygen available from a hyperbaric oxygen treatment aids the body in healing and recovery, creating an optimal environment for the body to heal faster than it normally would. Debate remains as to whether a treatment in a mild hyperbaric oxygen unit (cheaper and portable) can have the same beneficial results of a treatment in a standard hyperbaric oxygen unit. The data needed to authenticate the benefits of mild hyperbaric oxygen use as compared to standard hyperbaric oxygen exists in the various settings that use this modality. The data needs to be collected, analyzed, and disseminated.

Update on hyperbaric oxygen therapy in burn treatment.

Hyperbaric oxygen therapy (HBOT) has been shown to improve tissue hypoxia, neovascularization and ischemia reperfusion injury and reduce pathologic inflammation in various clinical settings and was proposed to be agame changer in treatment of burns. Improved and faster wound healing as well as areduction of morbidity and mortality after thermal and concomitant carbon monoxide poisoning are expected. In defiance of the observed benefits for burn wounds and carbon monoxide poisoning in animal models and few randomized controlled trials there is an ongoing controversy regarding its use, indications and cost effectiveness. Furthermore, the use of HBOT, its indications and the evidence behind its efficiency are still widely unknown to most physicians involved in the treatment of burn patients. Therefore, areview of the up to date evidence-based literature was performed with afocus on available data of HBOT in burn care, to elaborate its use in acute thermal injury and carbon monoxide intoxication. Although beneficial effects of HBOT seem very likely insufficient evidence to support or disprove the routine use of HBOT in the treatment of burn care was found. Although difficult to carry out because of the high interindividual variability of burns and chronic wounds, the need for larger high-quality prospective randomized double-blinded controlled multicenter trials are necessary to be able to evaluate useful applications, expense and cost-efficiency of HBOT for burn care.

Clinical and morphological effects of hyperbaric oxygen therapy in patients with interstitial cystitis associated with fibromyalgia

BackgroundInterstitial Cystitis (IC) is a debilitating disorder of the bladder, with a multifactorial and poorly understood origin dealing with microcirculation repeated damages. Also Fibromyalgia (FM) is a persistent disorder whose etiology is not completely explained, and its theorized alteration of pain processing can compromise the quality of life. Both these conditions have a high incidence of conventional therapeutic failure, but recent literature suggests a significant beneficial response to Hyperbaric Oxygen Therapy (HBOT). With this study, this study we evaluated the effects of HBOT on quality of life, symptoms, urodynamic parameters, and cystoscopic examination of patients suffering from both IC and FM.MethodsWe structured an observational clinical trial design with repeated measures (questionnaires, urodynamic test, and cystoscopy) conducted before and 6 months after a therapeutic protocol with hyperbaric oxygen for the treatment of patients suffering from both IC and FM. Patients were exposed to breathing 100% oxygen at 2 atm absolute (ATA) in a multiplace pressure chamber for 90 min using an oro-nasal mask. Patients undertook a cycle of 20 sessions for 5 days per week, and a second cycle of 20 sessions after 1 week of suspension.ResultsTwelve patients completed the protocol. Changes after HBOT were not significant, except for hydrodistension tolerance (mean pre-treatment: 409.2 ml; mean post-treatment: 489.2 ml; p < 0.05). A regression of petechiae and Hunner’s ulcers was also noted 6 months after the completion of HBOT.ConclusionsOur study showed no improvement of symptoms, quality of life, and urodynamic parameters, except for hydrodistension, and a slight improvement in cystoscopic pattern. However, to date, we could not demonstrate the significance of overall results to justify the use of HBOT alone in patients with IC and FM. This observation suggests that additional studies are needed to better understand if HBOT could treat this subset of patients.Trial registrationNCT03693001; October 2, 2018. Retrospectively registered.

The Use of Hyperbaric Oxygen Therapy to Treat an Anaerobic Retroperitoneal Abscess with Extension into the Mediastinum

The Use of Hyperbaric Oxygen Therapy to Treat an Anaerobic Retroperitoneal Abscess with Extension into the Mediastinum

Is there a role for hyperbaric oxygen therapy in the treatment of refractory wounds of rare etiology?

Delayed wound healing indicates wounds that have failed to respond to more than 4-6 weeks of comprehensive wound care. Wounds with delayed healing are a major source of morbidity and a major cost to hospital and community healthcare providers. Hyperbaric oxygen therapy (HBOT) is a treatment designed to increase the supply of oxygen to wounds and has been applied to a variety of wound types. This article reviews the place of HBOT in the treatment of non-healing vasculitic, calcific uremic arteriolopathy (CUA), livedoid vasculopathy (LV), pyoderma gangrenosum (PG) ulcers. We searched electronic databases for research and review studies focused on HBOT for the treatment of delayed healing ulcers with rare etiologies. We excluded HBOT for ulcers reviewed elsewhere. We included a total of three case series and four case reports including 63 participants. Most were related to severe, non-healing ulcers in patients with vasculitis, CUA, LV, and PG. There was some evidence that HBOT may improve the healing rate of wounds by increasing nitric oxide (NO) levels and the number of endothelial progenitor cells in the wounds. HBOT may also improve pain in these ulcers. We recommend the establishment of comprehensive and detailed wound care registries to rapidly collect prospective data on the use of HBOT for these problem wounds. There is a strong case for appropriately powered, multi-centre randomized trials to establish the true efficacy and cost-effectiveness of HBOT especially for vasculitis ulcers that have not improved following immunosuppressive therapy.

Use of Hyperbaric Oxygen Therapy for the Treatment of Crush Injuries

Use of Hyperbaric Oxygen Therapy for the Treatment of Crush Injuries

Antimicrobial Tolerance and Metabolic Adaptations in Microbial Biofilms.

Active bacterial metabolism is a prerequisite for optimal activity of many classes of antibiotics. Hence, bacteria have developed strategies to reduce or modulate metabolic pathways to become tolerant. This review describes the tight relationship between metabolism and tolerance in bacterial biofilms, and how physicochemical properties of the microenvironment at the host-pathogen interface (such as oxygen and nutritional content) are key to this relationship. Understanding how metabolic adaptations lead to tolerance brings us to novel approaches to tackle antibiotic-tolerant biofilms. We describe the use of hyperbaric oxygen therapy, metabolism-stimulating metabolites, and alternative strategies to redirect bacterial metabolism towards an antibiotic-susceptible phenotype.

Use of hyperbaric oxygen therapy for tissue ischemia after breast reconstruction

Introduction: Mastectomy skin flap necrosis represents a significant complication of breast reconstructive procedures and is reported to occur in 30%-52% of patients undergoing breast reconstruction. Early identification of ischemia and early initiation of hyperbaric oxygen (HBO2) therapy can mitigate the effects of ischemia and rescue otherwise non-viable breast flap tissue. Methods: We retrospectively examined the outcomes of HBO2 therapy in eight breasts with compromised mastectomy skin flaps between September 2015 and January 2017. Indocyanine green angiography (ICGA) was used to assess perfusion intraoperatively and post-HBO2 administration. Results: Seven patients were referred for HBO2 within 24 hours of mastectomy. One patient failed to improve despite starting hyperbaric treatment within 24 hours. All other patients manifested successful healing of their mastectomy skin flaps with acceptable cosmesis after 10 HBO2 treatments. The mean relative perfusion of the at-risk area was 13.8% (Å}3.7%) pre-HBO2 and 101.6% (Å}37.3%) post-HBO2. The average area at-risk pre-HBO2 was 17.1 cm2 and reduced to zero post-HBO2. Relative perfusion values after HBO2 were found to be 6.8 (Å}3.4) times greater than those measured prior to HBO2. Conclusions: A short course of HBO2 may be sufficient to successfully rescue at risk post-mastectomy breast flaps. ICGA is a useful adjunct for evaluating post-mastectomy breast flap perfusion before and after HBO2 therapy.