Audiology

Conditions Benefits:

  • Idiopathic sudden deafness
  • Tinnitus
  • Acoustic trauma or noise induced hearing loss
  • Barotrauma
  • Bone involvement in ENT Area (Osteomyelitus)
  • Retrocochlear hearing loss
  • Meniere’s Disease
  • Otitis externa maligna
  • Vertigo

How can your patients benefit?

  • Greatly increases the partial of oxygen in the inner ear
  • Angiogenesis created after oxygen saturation
  • Improves hemorheology and contributes to improved microcirculation
  • Lowers hemocrit and whole blood viscosity, and improves erythrocyte elasticity

Literature Survey:

Some controlled trials concerning 1100 patients in 8 publications were performed, a mojority of which were in Germany. After ineffective conservative treatement including plasmaexpander such as Hydroxyaethylstarch or others, normovolaemic haemodilution, cortisone and oral haemo-rheological substances, HBOT is effective in 50% of the cases to reduce hearing loss by 20 dB or more. Approximatley 11% have a complete recovery. All authors confirm better results with earlier onset of HBOT.

A randomized prospective trial of primary HBOT versus primary conservative treatment in Germany shows a better outcome in the HBOT group with substantial recovery in 80% of the patients. Another controlled prospective trial including patients after ineffective conservative treatment including cortisone shows substantial improvement in more than 30% of the cases even if the delay was more than 3 months.

Evaluations of 7766 patients in 13 publications show reduction of molestation and intensity of Tinnitus by 50% in around 70% of the cases if treated within 3 months of the onset. Around 30% lose their Tinnitus completely. Chronic tinnitus with duration of more than 3 months or bilateral manifestation shows improvement rates of 50% and around 30% of the cases after ineffective conservative treatment.

Based on 1200 cases of acoustic trauma – partially evaluated in prospective studies Pilgramm states that the best results by HBOT in combination with Haes. Because of 50%spontaneos remission within the first 48 hours HBOT should start immediately the third day after trauma. If hyperbaric oxygenation is begun later, the effectiveness decreases rapidly.

A prospective controlled study was performed in 1996 : Out of 625 patients treated for tinnitus for a 2 month period 211 were included in the study for acute tinnitus.

69 patients were treated with haemodilution and cortisone alone and had no HBOT. 142 patients had HBOT, 72 of these after unsuccessful haemodilution.

Results of Haemodilution for Tinnitus
69 Cases 36.2% healed completely 63.8% unchanged (25% decompensation)

Results of HBOT for Tinnitus
142 Cases 64.1% completely healed 35.9% unchanged (18% decompensation)

Results of secondary HBOT for Tinnitus
72 cases 51.4% completely healed 37.5% improved 11.1 unchanged 0% worsened

Contraindications
To see a PDF file detailing reasons why you might not prescribe HBOT, click here.

Cardiology

Conditions Benefits:

  • Heart Attack, Myocardial Ischemia
  • Aid to cardiac surgery and rehabilitation

How can your patients benefit?

Mitochondiral respiratory rate is an essential component of myocardial function because it influences production of adenosine triphosphate during oxidative phosphorylation. This process requires oxygen tension, as provided by HBOT. Bondarenko et al (1981) studied the influence of HBO on certain indices of tissue metabolism in patients with acute cardiac insufficiencies. They found that the metabolic effects of HBO in patients with acute cardiac insufficiency are not secondary to changes of systemic circulation, but precede them due to direct action of hyperoxia on metabolic processes in the peripheral tissues. Moreover, improvement of regional blood flow and metabolism of peripheral tissues by HBO also exerts a beneficial effect on the systemic circulation thus breaking the vicious circle. Many patients, when following closely the prescribed protocol for Hyperbaric Oxygen Therapy notice the following cumulative benefits from the oxygen:

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Circulatory hypoxia | Myocardial hypoxia

The above findings are confirmed by a decrease of both lactate level and metabolic acidosis, with an unchanged cardiac output. Further improvement in the hemodynamics of these patients is conditioned by a mechanism of compensation, including myocardial hypofunction, with removal of peripheral oxygen debt.

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“Figure 1A, Figure 1B, Figure 1C, Figure 1D” Hyperbaric medicine practice, pg 1044HBOT in acute myocardial infarction.

Oral & Maxillofacial

Conditions Benefits:

  • Osteomyelitis
  • Osteoradionecrosis
  • Non healing wounds
  • Non healing infection
  • Post oral surgery healing

How can your patients benefit?

  • Significantly shortens the inflammation process
  • Growth of new blood vessels (Angiogenesis)
  • Increases oxygen perfusion area around wounds
  • Increases new capillary growth
  • Increases production and improves the action of osteo- blasts and osteoclasts
  • Helps prevent infection
  • Enhances the ability of Leukocytes to remove bacteria and debris
  • Potentiates the use of antibiotics and helps kill bacteria

Many patients, when following closely the prescribed protocol for Hyperbaric Oxygen Therapy notice the following cumulative benefits from the oxygen:

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HBOT is used commonly before and/or after surgery

HBOT can help to heal bone disorders by stimulating both the osteoclasts and the osteoblasts. This helps and leads to the re-absorption of dead bone and the creation of new bone. In addition, HBOT stimulates the production of new blood vessels, so that the growing bone receives a steady supply of nutrients, including oxygen. This blood vessel network does two other things: it helps support the function of the osteoclasts, and brings infection fighting white blood cells to the area. Nerve repairing and quicker healing are also positive side effects many notice when undergoing HBOT.A good three-part treatment for bone infections includes the use of antibiotics, surgery to remove the dead bone, and HBOT as a supporting or adjunct treatment. Many dental surgeons are using HBOT before and after surgery.

Do you have a patient with Osteomyelitis?

Although Antibiotics will help kill microorganisms in the nonossified tissues around the focus of infection and surgery will remove the macroscopic portions of dead, infected bone, HBO improves host responsiveness by making the environments more favorable to WBC oxidative killing, neovascularization, and resorption, of dead, infected bone (reproduced from Strauss 1987, by permission) K.K. Jain, The Textbook of Hyperbaric Medicine, 5th ed, pg 146.

case_study

Refractory Osteomyelitis

refactory

General Practice

Conditions Benefits:

  • Chronic Fatigue
  • Anemia
  • Fibromyalgia
  • Lyme disease
  • Rheumatoid arthritis
  • Lupus
  • Diabetes
  • Chrones disease

Hyperbaric Oxygenation Effects on Blood Flow

Normal blood flow

There is 21% oxygen in the air that we breathe, and our lungs transfer this oxygen to our red blood cells (via hemoglobin). These oxygen-filled red blood cells are carried around the body by the plasma (fluid), which travels through the blood vessels. The oxygen diffuses into the surrounding tissue ensuring that it is delivered to where it is needed most.

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Restricted blood flow (ischemia) causes Hypoxia

When there is a restriction (occlusion) in blood flow due to surgery, illness, or injury, the red blood cells block the blood vessel and are unable to transfer oxygen to the cells on the other side of the occlusion. This causes swelling and starves the area of oxygen, causing hypoxia (a lack of oxygen); when this occurs the tissue begins to break down. Hypoxia triggers ‘apoptosis’ (programmed cellular degeneration – clumping and clustering of damaged nerve cells surrounded by healthy neuronal tracts).

Apoptosis modifies the expression of plasticity (the ability of the body to repair). Apoptotic bodies and altered DNA fragmentations are observed in the avascular ischemic region with increased inhibitory biochemical factors (proteins) released into the damaged parts of the brain and spinal cord causing further deterioration. Apoptosis has been identified in all neurodegenerative disorders including brain and spinal cord injury. Apoptosis fosters the cycle of continued dysfunction, degeneration and ultimate neuronal death.

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Hyperbaric Oxygenation

Breathing 100% oxygen under pressure causes the oxygen to diffuse into the blood plasma. This oxygen-rich plasma is able to travel past the restriction, diffusing up to 3 times further into the tissue. The pressurized environment helps to reduce swelling and discomfort, while providing the body with at least 10-15 times its normal supply of oxygen to help repair tissue damaged by the original occlusion or subsequent hypoxic condition. Hyperbaric Oxygenation (HBOT) directly increases the saturation of tissue oxygenation, slowing and reversing hypoxic induced apoptosis – restoring blood supply to the compromised region by the development of new capillary networks (neo-vascularization) enabling the body to alter the course and impact of the disease process.

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Neurovascular Regeneration

HBOT mobilizes the body’s circulating stem cells. American Journal Physiology – Heart and Circulatory Physiology (Nov 05)] reports a single 2-hour exposure to HBOT at 2 ATA doubles circulating CD34+ progenitor stem cells (primordial cells targeted to salvage and restore damaged structures); and at approx. 40-hours of HBOT; circulating CD34+ cells increases eight fold (800%).

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Images by Malcolm R Hooper – HyperMED Australia

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Hyperbaric Oxygen Therapy Process Indications

Many patients, when following closely the prescribed protocol for Hyperbaric Oxygen Therapy notice the following cumulative benefits from the oxygen:

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Neurology

Conditions Benefits:

  • Stroke
  • Closed head injury
  • Traumatic Brain Injury
  • Carbon Monoxide
  • Drowning
  • Multiple Sclerosis
  • Parkinson’s

How can your patients benefit?

  • Relieves Hypoxia
  • Improves microcirculation
  • Relieves cerebral edema by vasoconstrictive effect
  • Preserves partially damaged tissue and prevents fur-ther progression of secondary effects of cerebral lesions
  • Improves cerebral metabolism

Many patients, when following closely the prescribed protocol for Hyperbaric Oxygen Therapy notice the following cumulative benefits from the oxygen:

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neourology_graph

Blood flow and oxygen delivery to the brain are vital for the maintenance of normal function and tissue viability. Therefore, oxygen delivery to the mitochondria is important in maintaining aerobic cellular respiration and energy production (Calvert and Zhang, 2005).””The Hyperoxygenation effect of HBO therapy adequately compensates for the decreased CBF so that the net effect is improved oxygenation (Niinikoski, 2004).””Additionally, due to the vasoconstriction and reduced CBF, the red blood cells will align themselves in a column instead of moving randomly (Lim et al., 2001).”

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Figure 18. Mechanisms of hyperbaric oxygen neuroprotection. Adapted from Zhang, et al. 2005.

Oncology

Conditions Benefits:

  • Post Radiation effects
  • Osteoradionecrosis

How can your patients benefit?

HBOT effects Radiation injury in the following ways:

  • Saturates the effected area as well as ALL tissues in the body with oxygen
  • Fibroblastic proliferation begins
  • Initiates efficient collagen synthesis
  • Reduces inflammation and swelling
  • Reduces pain and discomfort
  • Heals damaged tissue with less scarring and no major side effects for most patients

Many patients, when following closely the prescribed protocol for Hyperbaric Oxygen Therapy notice the following cumulative benefits from the oxygen:

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Following Medical protocol for HBOT and radiation injury is VITAL

Hypoxia has been noted in malignant tumors (Gray et al 1953). Anemia is common in the cancer population and is suspected to contribute to intratumoral hypoxia. The theoretical basis for the use of HBO as an adjunct to radiotherapy is as follows:

  • A number of proliferating cells in many tumors are under severely hypoxic or anoxic conditions.
  • The reproductive integrity of such cells is substantially more resistant to damage by radiation than that of cells oxygenated to normal physiological levels.
  • The larger the number of cells that lose their reproduc- tive capability, the greater the chance of cure or palliation.

Sergeev et al(1977) concluded: “Hyperbaric Oxygen employed in radiotherapy increases the rate of neoplasm damage and reduces the rate of recurrences… No rise in percentage of distant metastases was noted in cases irradiated under hyperbaric oxygenation.”

Experimental studies of the effect of HBO on tumor radiosensitivity

  • Fukimura (1974) Rabbits with implanted VX2 maxillary car cinoma. Two groups: Experimental radiotherapy under HBO
  • Control radiotherapy without HBO1 tumor disappeared in 53% of the experimental group as compared to 13% in control group. 2 DNA synthesis inhibited more markedly in the experimental than in the control group.
  • McDonald et al (1996)Twenty golden Syrian hamster cheek-pouch carcinomas were induced with an estab lished chemical carcinogen. Half of these underwent 30 HBO sessions (2.8 ATA/1h) while the other half served as controls.At necropsy, animals receiving HBO therapy had significantly smaller tumors and fewer metastases.

Clinical studies of HBO as an adjunct to the radiotherapy of head and neck cancer

  • Glanzmann et al (1974) Malignant tumors of oropharynx and laryngopharyn. Combined radiation and HBO. Results compared with literature reports of treatment by radiation alone. Improvement observed in the healing quotient in advanced tumors particularly those of the oropharynx.
  • Nelson and Holt (1978) Advanced head and neck cancer.

Three groups:

  1. Colbalt radiotherapy
  2. Cobalt radiotherapy
  3. Radiotherapy & HBO & microwave hyperthermia
  • Group, Resolution, 3-yr survivalGroup 1: 36.5% /w 19%
  • Group 2: 62.5% /w 29%
  • Group 3: 94.0% /w 54%

Darialova et al (1985) Laryngeal cancer. Randomized. Method of mean fractionation to overcome tumor hypoxia and to raise selective radiosensitivity.

In the group with HBO plus radiation:

  • Less frequent radiation reactions
  • Less metastases.

Denham et al (1987) Squamous cell carcinoma arising from: anterior two-thirds of the tongue, oropharynx, hypopharynx, supraglottic larynx. Radiotherapy under HBO versus air. Five-year survival was higher in the HBO group than in the group treated in air. Whittle et al (1990) Glottic cancer. Retrospective analysis of 397 patients. 240 treated in air and 157 under HBO. Local tumor control rate showed significant improvement in favor of HBO: Stage I, 10%; Stage II, 37%; Stage III, 73%. Haffty et al (1999) Randomized trial on 48 patients evaluating HBO at 4 ATA in combination with hypofractionated radiation therapy in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Long-term outcome from this study demonstrates substantial improvements in response rate with the use of HBO.

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Advantages of HBOT as an adjunct to radiotherapy

  • Combination of HBO with radiotherapy is considered to be useful for the following reasons:It allows a more uniform kill by improving the oxygenation, and therefore the radiosen sitivity, at the cellular level.
  • It is useful as an adjunct to surgical repair after radiation.

HBO is considered to be the most effective method for counteracting tumor hypoxia for enhancing the effect of radiotherapy on cancer). The advantages of HBO combined with radiotherapy are:

  1. HBO is also a useful therapy for radiation-induced necrosis of normal tissues.
  2. In a controlled study of patients with or without HBO, the survival has shown to be higher in the HBO control group. The greatest advantage was seen in the less advanced tumors).
  3. In experimental bladder tumor, tissue oxygen tension has been shown to be higher in the bladder trigone region (Nakada 1988). HBO was shown to enhance the effect of combined chemotherapy and radiotherapy in this model (Akiya et al 1988).

Machin et al (1997) have reviewed the survival outcome from the randomized Phase III trials in solid tumors published on behalf of, or in collaboration with, the Cancer Therapy Committee (CTC) of the British Medical Research Council over a 30-year period to 31 December 1995. In all, 32 trials, involving over 5000 deaths in more than 8000 patients, have been published. Tumor types have included bladder, bone, brain, cervix, colon and rectum, head and neck, kidney, lung, ovary, prostate and skin. The MRC trials have made an impact on both clinical practice and research activities. Trials of HBO have defined the biological activity of this approach, and the appropriate dose of radiotherapy in patients with brain tumors has been found.

There is considerable evidence for the presence of hypoxia in human tumors.Vascular insufficiency has been demonstrated on histopathology of the tumors, direct oxygen measurements, and mapping of hypoxic areas by imaging techniques. It appears that hypoxia is probably responsible for failure to cure some tumors such as squamous cell carcinoma, but even within tumors of the same stage and type, hypoxia does not occur to the same extent. Response to modifying agents also depends upon whether hypoxia is acute or chronic. New methods to detect hypoxic tumor cells (hypoxic cell stains) are being developed. The future prospects for the control of these tumors where hypoxia is a problem appear to be good. Of the various adjuvants to radiotherapy, HBO appears to be the best (Henk 1981). It can be combined with other radiation enhancers. The effect of HBO in enhancing radiosensitivity is most pronounced in head and neck tumors.

ONLY with a hard sided hyperbaric chamber and 100% oxygen can you achieve the above results. ONLY medical grade HBOT can reverse damage that radiation can cause to:

  • Blood vessels
  • Soft tissues
  • Nervous system
  • Bone

Orthopedics

Conditions Benefits:

  • Bone Grafts
  • Fracture repair, delayed non-union
  • Inflammatory arthritis
  • Osteoperosis
  • Post surgical instability
  • Sacroiliac Syndrome
  • Aid to prosthesis rehabilitative care

How can your patients benefit?

HBOT provides adequate oxygen for fibroblasts—cells that make connective tissue- and so promote healing in hypoxic tissue. Cells that remove dead bone (osteoclasts) need oxygen to function, and intermittent oxygen tensions of 30-40 mmHg are needed to grow new blood vessels.”The generation of oxygen-derived free radicals in cultured bone is associated with the formation of new osteoclasts and enhanced bone resorption, identical to the effects seen when bones are treated with hormones, such as parathyroid hormone (PTH) and interleukin (IL-1). When free oxygen radicals are generated adjacent to bone surfaces in vivo, osteoclasts are formed.” (Hyperbaric medicine practice, pg 51)

Many patients, when following closely the prescribed protocol for Hyperbaric Oxygen Therapy notice the following cumulative benefits from the oxygen:

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The effect of HBO on the healing of standardized metaphyseal defects in the cortices of rat femurs was studied by Barth et al. Once-a-day treatment appeared to accelerate bone repair and vessel ingrowth.””In a prospective randomized study by Lindström et al., 20 consecutive patients, with closed and simple tibial shaft fractures treated with reamed intramedullary nailing, were assigned randomly to HBO or control groups. HBO therapy was given postoperatively at 2.5 ATA for 90 minutes daily for a total of five treatments. The first HBO therapy was given 1 hour after the operation. There was a significant improvement in the tibialis posterior arterial peak signal (TPA) in the nailed legs in the HBO group after the first postoperative day, and these values remained at a significantly higher level until the end of the study when compared to the nailed legs in the control group. Further, there was a significant improvement in the PtcO2 values in the nailed legs of the HBO group after the third HBO treatment. The improvement in the TPA and ptCO2 values may result from the vasoconstrictive and edema reductive effect of HBO.”

Plastics/Wound

Conditions Benefits:

  • Non-healing wounds
  • Necrotizing infections
  • Acute traumatic ischemia
  • Compromised Skin flaps/grafts
  • Post surgical soft tissue infections
  • Non-healing post surgery, reconstruction and cosmetic surgery
  • Pre and post surgery healing, reconstruction and cos-metic surgery

How can your patients benefit?

HBOT effects wound healing in the following ways:

  • HBO2 promotes growth of new blood vessels (neovascularization).
  • New vasculature for healing needs a supporting struc-ture of collagen. The collagen production and incorpo ration process needs oxygen.
  • Increased oxygen tension in tissue increases oxygen-dependent killing of anaerobes by leukocytes, and also has direct toxic effects.
  • Increased oxygen tension allows greater capillary oxygen diffusion distances.

Many patients, when following closely the prescribed protocol for Hyperbaric Oxygen Therapy notice the following cumulative benefits from the oxygen:

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HBOT & Wounds

wounds

  • Oxygen availability is critical to skin grafting success. HBO2 increases tissue oxygen levels in hypoxic and ischemic wounds.
  • HBO2 stimulates formation of blood vessels and granu-lation tissue, and prepares the recipient bed for grafts or flaps.
  • In some cases, HBO2 will be enough to make skin graft-ing unnecessary, or reduce regrafting and repeat graft procedures.

Physical Therapy

Conditions Benefits:

  • Stroke
  • Peripheral Vascular disease
  • Head injury
  • Toxic encephalopathy, e.g., CO poisoning
  • Multiple Sclerosis
  • Paraplegia
  • Sports injuries
  • Coronary heart disease

Physical therapy is an essential part of rehabilitation in many chronic diseases and in dealing with the sequelae of Cerebrovascular insufficiency and myocardial ischemia, as well as in many neurological disabilities. Physical exercise in various forms is an important component of physical therapy and preventative medicine programs. Hyperbaric oxygenation (HBO) has also proven useful in many medical problems, such as infections and gangrene. There has been very little work on the combination of HBO and physical exercise.

Rehabilitation is a multidisciplinary undertaking to aid the functional recovery of patients and their integration into society. It has an important role to play in all branches of medicine, and particularly so in neurological disorders; rehabilitation is not only physical but psychological as well.

Rehabilitation uses the techniques of physical medicine, and currently these include ultraviolet light, electrotherapy, and ultrasound. HBO can be added to these. Traditionally, rehabilitation therapy has followed recovery from an acute illness. In some cases rehabilitation measures should already start during the acute phase of an illness and should also aim to preventing further recurrences of the disease process.

How can your patients benefit?

The combination of HBO (1.5 ATA) with physical therapy has the following advantages.:

Biochemical improvement. Excess concentrations of lactate, pyruvate, and ammonia, particularly in older people, and detrimental to fitness and contribute to fatigue, and there is significant increase of these substances during exercise. HBO reduces this.

Increase of capacity for strenuous exercise. HBO allows more strenuous and prolonged exercise than is possible under normobaric conditions. This is of particular advantage in the rehabilitation of chronic ischemic heart disease patients, for treatment of mild hypertension, and for lowering blood lipids.

Neurological disorders. HBO is beneficial in the acute stages of head injury with cerebral edema, and the evidence for HBO therapy in the rehabilitation of the head-injury patient is summarized in Table 35.3. Rehabilitation starts when the patient has regained consciousness and can be moved. The usefulness of HBO in the management of spinal cord injury is described in Chapter 20, and its role in intensive rehabilitation is summarized in Table 35.4.

HBO has been found useful in the rehabilitation of patients with postoperative neurological deficits. In many neurological conditions, where the effect of HBO on the course of the disease remains uncertain, rehabilitation is greatly facilitated by conducting physical therapy during an HBO session, for example, in cases of multiple sclerosis and muscular dystrophy. The physical performance capacity of neurologically disabled patients is thus improved.

Many patients, when following closely the prescribed protocol for Hyperbaric Oxygen Therapy notice the following cumulative benefits from the oxygen:

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Table 35.3

Role of HBO in the Rehabilitation of Head Injury

  • Decreases cerebral edema in acute stage
  • Decreases spasticity
  • Accelerates recovery
  • Improves cognitive function recovery in combination with brain jogging
  • Relieves post-traumatic headaches

Table 35.4

  • HBO in Rehabilitation of Paraplegia
  • Relieves spasticity
  • Improves vital capacity
  • Increases exercise capacity
  • Decreases hyperammonemia resulting from exhaustive exercise

Myocardial infarction. Exercise therapy is popular for the rehabilitation of patients who have recovered from acute episodes. Most of the beneficial effects of HBO in cardiovascular disease are associated with increased capacity for physical exercise. This is particularly true in cases with hypertension, where exercise therapy has been shown to reduce blood pressure. The role of HBO in rehabilitation of myocardial ischemia is shown in Table 35.5.

Table 35.5

HBO in Rehabilitation of Myocardial Ischemia

  • Improves exercise capacity
  • Prevents recurrence of ischemic episodes
  • Decreases BP in hypertensives
  • Long-term use reverses atherosclerosis

Peripheral vascular disease. Exercise therapy for patients with ischemic leg pain is facilitated by the use of HBO in situations where it is possible to extend the limit of performance by the use of normobaric oxygen. A treadmill controlled by the patient can be installed in a hyperbaric chamber for training therapy for those suffering ischemic leg pain. The benefits of exercise under HBO conditions are summarized in Table 35.6.

Table 35.6

Benefits of Exercise under HBO in Patients with Ischemic Leg Pain

  • Increases painless exercise capacity
  • Relieves pain both at rest and on activity
  • Reduces biochemical disturbances resulting from exercise of ischemic muscles
  • Counteracts the vasoconstricting effect of HBO
  • Improvement is maintained after cessation of HBO when the ceiling effect is reached

Infectious Disease

Clostridial myositis and myonecrosis (gas gangrene)

Gas Gangrene is an acute, rapidly progressing infection that can be limb or life threatening usually from a bacteria such as Clostridium, Staphylococcus or Streptococcus. The infection has been known to advance as much as 6 inches per hour. Symptoms include toxemia, sepsis, odor, variable amounts of gas developing under the skin, edema and tissue death.
Treatment includes aggressive antibiotics, aggressive surgery and HBOT. HBOT stops the production of more bacteria, boosts the immune system response with free radicals and oxygenates viable tissue.

Necrotizing soft tissue infections

Necrotizing soft tissue infections involve a bacterial invasion causing local tissue trauma, ischemia and death. This may occur from diabetic foot infections, surgical wounds, puncture wounds and other traumas. Necrotizing infections are often associated with suppressed immune systems due to alcoholism, malnutrition, drug abuse, underlying systemic disease as well as other causes.
HBOT provides oxygen to white blood cells and produces free radicals to aid in the immune response. It also has a bacteria stopping effect on microbes that live without oxygen.

Intracranial abscess

Hyperbaric oxygen therapy (HBOT) is used as an adjunct to surgery and antibiotic therapy for intracranial abscess. The bacteria involved in brain abscess are mainly anaerobic, meaning they thrive in low-oxygen environments. HBOT inhibits anaerobic and some other bacteria from replicating, spreading, and releasing damaging toxins. Hyperbaric oxygen may also help reduce brain swelling, boost the effect of antibiotics, and enhance the body’s natural defenses against bacteria and other microbial organisms.
Hyperbaric oxygen may be especially useful for multiple abscesses in deep or dominant locations, in patients with immune compromise, and when the infection does not respond well to traditional surgery and antibiotics. UHMS guidelines recommend daily or twice-daily treatment of 60-90 minutes at 2.0 to 2.5 atmospheres of absolute pressure (ATA).

Osteomyelitis (refractory)

Chronic Refractory Osteomyelitis is a recurring bone infection that was treated with appropriate medical and surgical interventions, however treatments were unsuccessful. HBOT stops bacteria from reproducing, provides oxygen to the cells that break down dead bone and to the cells that make connective tissue, augments certain antibiotics, and decreases inflammation from surgical treatments.

Vascular Surgery

The flow of oxygen through blood vessels into organs and other body tissues is essential to the quality of our lives and to life, itself. When blood flow is restricted, a person’s vital organs may be damaged, non-healing wounds may develop, and numerous other chronic health conditions may affect the person’s quality of life.

Patients who have diabetes or severe peripheral vascular disease (PVD) are at particular risk for wounds related to an inadequate supply of oxygen to their limbs. The result can be amputation of arms, legs or feet, even when they receive aggressive traditional treatments.

Hyperbaric oxygen (HBO) allowing physicians in this area to successfully treat certain patients with chronic wounds that have not responded to traditional surgery or medical treatment. Non-healing ulcers on the legs or feet, chronic infection of surgery sites, or severe vascular disease may need the addition of hyperbaric oxygen.

Ischemic ulcers may develop when affected tissues do not get an adequate supply of oxygen and are more frequent in diabetics. Foot wounds, in particular, often advance to infection, non-healing ulcers, gangrene (death of tissues), and amputation despite intensive treatment by family physicians; endocrinologists, who specialize in treating patients with diabetes; vascular surgeons and others. Traditional treatments may include bypass vascular surgery or angioplasty and stents intended to improve blood flow enough to save the threatened limb.

Carefully selected patients who are at risk for amputation because of non-healing wounds are treated in hyperbaric chambers containing 100 percent pressurized oxygen at 2 to 2.4 atmospheres of pressure. The high oxygen level has been found to stimulate new artery growth which provides oxygen to ischemic feet and leg ulcers.

Podiatry

Diabetic foot care is of extreme importance to those managing diabetes. Foot ulcers are a source of sometimes intolerable pain and long-standing medical problems for people living with the disease. If not properly treated, diabetic foot complications can lead to amputation and an obviously drastic change in associated lifestyle. There is, however, hope on the horizon for anyone dealing with such an issue in the form of an emerging alternative therapy.

A recent study conducted by the “Journal of Foot and Ankle Surgery” cited that Hyperbaric Oxygen (HBO) therapy may have significant benefits in treating foot ulcers and ultimately reducing the number of associated amputations involved with them.
The study simply involved 100 subjects, plenty sufficient, with diabetic foot ulcers and compared HBO therapy with the application of standard therapy. The results of the patients receiving standard therapy were that 48 percent of them needed distal amputation and 34 percent of them required proximal amputation. The patients receiving HBO therapy, however, only included 8 percent receiving distal amputation with ZERO patients requiring proximal amputation.

”The benefits of HBO therapy accrue over time, in part due to savings from averted major amputations. The cost of a series of HBO treatments is less than the cost of a major amputation if HBO is, in fact, limb-saving.” (Dr. Caroline Fife, Associate Professor in the Department of Medicine, Division of Cardiology at the University of Texas Health Science Center in Houston)

Dr. Fife goes on to note that the selection of patients for the time being at least, should be restricted to those that would not have properly healed with the treatment of traditional therapy alone. Nor should HBO be used for patients with severe vascular disease because they will not respond properly to the treatment.

Although not perfect, HBO is a new therapy that shows some promise for those dealing with diabetic foot ulcers. If nothing else, the reduced number of amputations involved is a tremendous benefit that deems HBO suitable for further exploration from the everybody involved with the treatment of this common problem

Nephrology

Calciphylaxis is a difficult problem affecting up to 4% of dialysis patients. Its pathophysiology is not yet fully understood, however, lesions are typically characterized by dermal deposition of calcium resulting in painful ischemic compromise and tissue necrosis. It is frequently progressive leading to overwhelming systemic infection and reported mortality of 80% within 3–6 months. Hyperbaric oxygen therapy has been utilized on occasion to manage ischemic wounds, which have been refractory to traditional wound care management techniques. Its use relates to its known effect of stimulating angiogenesis in hypoxic tissue, hence facilitating new tissue growth. The recent experience in successful management of such a case using hyperbaric oxygen therapy will be reviewed and illustrated.

Calciphylaxis: a favorable outcome with hyperbaric Oxygen

Surrounding tissue can also be affected during irradiation. The small blood vessels and also the mucosa of the bladder and intestines are especially sensitive to radiation during prostata radiation.

These unavoidable side effects can actually lead to serious complaints:

Inflammation of the bladder or radiocystitis with pain when passing water, a regular urge to urinate, urinary incontinence, bleeding, fistula of the bladder and bladder shrinkage Proctitis or radioproctitis with pain when sitting, diarrhoea, passing blood, fistula formation. These complaints compromise quality of life. They often lead to transfusions and other painful interventions. This need not be the case.

Radiation Proctitis and Radiation Cystitis:

HBOT helps in case of urine bladder damage and rectal damage after radiation

These complaints compromise quality of life. Often, they lead to blood transfusions and other painful interventions, such as bladder removal and formation of an artificial anus. This need not be the case.

HBOT — Hyperbaric oxygen therapy or pressure chamber therapy — is able to regenerate tissue damaged by irradiation, including internal tissue. Due to HBOT, more oxygen enters the tissue where also the blood flow is improved because new blood vessel formation is initiated. This way, even chronic wounds in inside body radiation areas can heal. HBOT is able to avoid the slow aggravation of chronic late consequences. This can result in a quality of life which is completely new.

 

Internal Medicine

Conditions Benefits:

  • Chronic Fatigue
  • Anemia
  • Fibromyalgia
  • Lyme disease
  • Rheumatoid arthritis
  • Lupus
  • Diabetes
  • Chrones disease

Hyperbaric Oxygenation Effects on Blood Flow

Normal blood flow

There is 21% oxygen in the air that we breathe, and our lungs transfer this oxygen to our red blood cells (via hemoglobin). These oxygen-filled red blood cells are carried around the body by the plasma (fluid), which travels through the blood vessels. The oxygen diffuses into the surrounding tissue ensuring that it is delivered to where it is needed most.

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Restricted blood flow (ischemia) causes Hypoxia

When there is a restriction (occlusion) in blood flow due to surgery, illness, or injury, the red blood cells block the blood vessel and are unable to transfer oxygen to the cells on the other side of the occlusion. This causes swelling and starves the area of oxygen, causing hypoxia (a lack of oxygen); when this occurs the tissue begins to break down. Hypoxia triggers ‘apoptosis’ (programmed cellular degeneration – clumping and clustering of damaged nerve cells surrounded by healthy neuronal tracts).

Apoptosis modifies the expression of plasticity (the ability of the body to repair). Apoptotic bodies and altered DNA fragmentations are observed in the avascular ischemic region with increased inhibitory biochemical factors (proteins) released into the damaged parts of the brain and spinal cord causing further deterioration. Apoptosis has been identified in all neurodegenerative disorders including brain and spinal cord injury. Apoptosis fosters the cycle of continued dysfunction, degeneration and ultimate neuronal death.

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Hyperbaric Oxygenation

Breathing 100% oxygen under pressure causes the oxygen to diffuse into the blood plasma. This oxygen-rich plasma is able to travel past the restriction, diffusing up to 3 times further into the tissue. The pressurized environment helps to reduce swelling and discomfort, while providing the body with at least 10-15 times its normal supply of oxygen to help repair tissue damaged by the original occlusion or subsequent hypoxic condition. Hyperbaric Oxygenation (HBOT) directly increases the saturation of tissue oxygenation, slowing and reversing hypoxic induced apoptosis – restoring blood supply to the compromised region by the development of new capillary networks (neo-vascularization) enabling the body to alter the course and impact of the disease process.

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Neurovascular Regeneration

HBOT mobilizes the body’s circulating stem cells. American Journal Physiology – Heart and Circulatory Physiology (Nov 05)] reports a single 2-hour exposure to HBOT at 2 ATA doubles circulating CD34+ progenitor stem cells (primordial cells targeted to salvage and restore damaged structures); and at approx. 40-hours of HBOT; circulating CD34+ cells increases eight fold (800%).

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Images by Malcolm R Hooper – HyperMED Australia

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Hyperbaric Oxygen Therapy Process Indications

Many patients, when following closely the prescribed protocol for Hyperbaric Oxygen Therapy notice the following cumulative benefits from the oxygen:

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