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Alternative Names: Hyperoxygenation, Adjuvant Therapy, HBO, HBOT, Hyperbarics, Therapeutic Hyperbaric Medicine.
Hyperbaric oxygen therapy (HBOT) involves the breathing of pure oxygen while in a sealed chamber that has been pressurized at 1.5 to 3 times normal atmospheric pressure.
Claims about the alternative use of HBOT include that it destroys disease-causing microorganisms, cures cancer, alleviates chronic fatigue syndrome, and decreases allergy symptoms. A few supporters also claim that HBOT helps patients with AIDS, arthritis, sports injuries, multiple sclerosis, autism, stroke, cerebral palsy, senility, cirrhosis, Lyme disease, and gastrointestinal ulcers. There is no scientific evidence to support these claims. The lack of randomized clinical studies makes it hard to judge the value of HBOT for many of its claims.
History
The use of increased atmosphere pressure for medical therapy has intrigued many physicians, scientists, and lay persons for hundreds of years. Vague accounts of increased atmosphere pressures used on humans date to the fifth century BC, and much experimentation continued from the late 1600s until the 1930s, when it fell out of favor in the medical community through lack of scientific evidence of merit.
Despite this downturn in interest, research continued and evidence of the usefulness of Hyperbaric Oxygen in areas such as wound healing grew over time. Foot wounds from diabetes, radiation ulcers, and other ischemic wounds have been manipulated and successfully treated with HBO. Prospective blinded randomized trials and well-executed laboratory studies continue to further define the role of hyperbaric therapy in medical therapeutics.
Function; Reasons For Use
Delivery of hyperbaric pressures generally is accepted through one of two different chambers. Monoplace chambers house one individual placed in the supine position. Current chambers have an acrylic shell, which allows the patient to observe his or her surroundings. Communication devices located within the chamber allow direct conversation between the patient and the hyperbaric medicine technician or physician. Conversely, multiplace chambers can accommodate 2-10 patients.
Gas is piped directly from its source to the chamber. Humidification and heat exchange gases are present in all modern chambers.
The application of HBO depends on the physical properties of gases under pressure, specifically, oxygen at pressure greater than 1 atm. Oxygen is essential in a variety of enzymatic, biochemical, and physiologic interactions that promote normal cellular respiration and tissue function. Mono-oxygenase, intradioxygenase, and interdioxygenase are specific enzymes that recruit oxygen as a cofactor to perform required biologic processes. Collagen deposition and synthesis depend on an oxygen-dependent prolyl-hydroxylase hydroxylation of proline. Angiogenesis and epithelization also are oxygen dependent.
Under normal conditions, 97.5% of oxygen is carried in the bloodstream bound to hemoglobin. The remaining 2.5% is dissolved in plasma.
The effects of Hyperbaric Treatments on the cardiovascular system include decreased heart rate, decreased cardiac output, possible slight increase in blood pressure and arterial vasoconstriction after load increases.
Hyperoxygenation results in greater oxygen carrying capacity by the blood and increased oxygen defusion in tissue fluid. This is helpful in conditions such as severe blood loss anemia (in which the blood is unable to carry much oxygen), crush injuries, compartment syndrome graft, flap salvage and edema.
Vasoconstriction results in decreased blood flow into tissues and decreased edema; this helps with crush injuries, acute burns and compartment syndrome.
Angiogenesis results in increased oxygen supply to wounds, increased collagen deposition and the creation of new blood vessels in arease where there are not enough. This in turn helps with graft and flap salvage, osteoradionecrosis, radiation endarteritis obliterans and healing of chronic wounds.
Fibroblast proliferation helps heal chronic wounds and treat radiation-induced injury. Leukocyte oxidative killing leads to increased oxygen free radicals, which in turn helps with necrotizing soft-tissueinfections and chronic osteomyelitis. Toxin inhibition leads to decreased clostridial alpha toxins, helpful with clostridial gas gangrene and for decreasing cardio toxins.
Increased oxygen being transported across cell membranes helps with sepsis and necrotizing infections.
As a primary therapy, Hyperbaric Oxygen is useful for treating:- Carbon monoxide poisoning
- Cerebral arterial gas embolus
- Decompression sickness
- Osteoradionecrosis
- Clostridial gas gangrene.
As a secondary therapy, Hyperbaric Oxygen assists with:- Radiation tissue damage
- Osteoradionecrosis prophylaxis
- Acute ischemia and/or crush injuries
- Necrotizing infections
- Acute exceptional blood loss
- Acute thermal burns
- Compromised skin grafts or flaps
- Selected problem wounds
- Refractory osteomyelitis.
Side-Effects; Counter-Indicators and Warnings
Elemental oxygen is required to maintain cellular respiration and to allow for normal cellular protein production. Hyperbaric medicine is considered extremely safe under appropriate supervision and utility. Toxic effects of oxygen are observed at extremely high doses over prolonged periods. HBO treatment increases the relative dose of oxygen; thus susceptible patients need to be recognized and modifications made to prevent the manifestations of oxygen toxicity.
Signs and symptoms of oxygen toxicity include: Nausea and vomiting, dry cough, seizures, substernal chest pain, sweating, bronchitis, pallor, shortness of breath, muscle twitching, pulmonary edema, anxiety and/or respiratory changes, pulmonary fibrosis, visual changes, tinnitus, hallucinations, vertigo, hiccups and decreased level of consciousness.
The most common barotrauma is middle ear injury. Parts of the body that can be adversely affected by HBO treatment, with symptoms, include:- Sinuses - Congestion and/or occlusion (Pain, bloody discharge)
- Middle ear - Eustachian tube occluded, failure to equalize pressure within middle ear space (Edema, rupture, or retraction of tympanic membrane, hemorrhage)
- External ear - Wax build-up or ear plugs occlude canal (Pain, bleeding)
- Inner ear - Oval or round window rupture (Ataxia, vertigo, tinnitus, hearing loss)
- GI tract - Gas in bowels, distention on ascent (Vomiting, nausea, flatulence, colicky pain)
- Teeth - Infected or restored teeth since they may harbor gas (Tooth pain, tooth implosion or explosion)
- Gas embolus - Extremely rare emergent decompression with blocked glottis (Sudden decreased level of consciousness; hemiplegia, blown pupil).
Do not use Hyperbaric Oxygen Therapy on patients with the following conditions, for the following reasons:- Claustrophobia - Anxiety
- Pneumothorax - Gas emboli, pneumomediastinum, pneumoperitoneum tension (pneumothorax), subcutaneous emphysema
- A history of spontaneous pneumothorax - Increased lung bleb incidence (pneumothorax)
- Chronic obstructive pulmonary disease (COPD) - Increased oxygen intolerance, increased risk of seizures
- Pneumocystic carinii pneumonia - Questionable fetal teratogen
- Seizure disorders - Barotrauma to sinus/ear/lung
- Pregnancy - Decreased threshold for oxygen-induced seizures (although HBO therapy may be required in pregnancy in situations of carbon monoxide poisoning, cerebral gas embolus, decompression sickness, or clostridial myonecrosis.)
- Upper respiratory infection - Increased hemolysis
- Hyperthermia
- Hereditary spherocytosis
- Optic neuritis - Possible increased optic nerve pathology
- Malignant tumors - possible increased vascularity for tumors
- Acidosis - Decreased threshold for oxygen seizures
- Steroid use - Decreased threshold for oxygen seizure
- Alcohol use - Dehydration (increased risk of decompression sickness)
- Nicotine use - Decreased seizure threshold.
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Hyperbaric Oxygen can help with the following:
KEY | | May do some good |
GLOSSARY
Acidosis
Specifically, the abnormal buildup of acids in the body, classically caused by diabetes or kidney disease. Broadly, the potential caused by increased protein intake or metabolism, coupled with inadequate intake (or loss) of alkali.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
AIDS
Acquired Immune Deficiency Syndrome. An immune system deficiency disorder that suddenly alters the body's ability to defend itself. The AIDS virus invades the T4 helper/inducer lymphocytes and multiplies, causing a breakdown in the body's immune system, eventually leading to overwhelming infection and/or cancer, with ultimate death.
Allergy (Allergies)
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Arterial (Arteries, Artery)
Blood that leaves the heart. When it leaves the right ventricle, it is venous blood; and when it leaves the left ventricle, through the aorta, it is fresh and oxygenated. After it has passed out to the capillaries and started to return, it is venous blood.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Ataxia (Ataxic)
Failed muscular coordination, irregular muscular action.
Bronchitis
Inflammation of the mucous membrane of the bronchial tubes, frequently accompanied by cough, hypersecretion of mucus, and expectoration of sputum. Acute bronchitis is usually caused by an infectious agent and of short duration. Chronic bronchitis, generally the result of smoking, may also be known as Chronic Obstructive Pulmonary Disease (COPD) or Emphysema.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Cardiac
Pertaining to the heart, also, pertaining to the stomach area adjacent to the esophagus.
Cardiovascular
Pertaining to the heart and blood vessels.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Chronic Fatigue Syndrome (CFS, Chronic Fatigue)
A disorder of unknown cause that lasts for prolonged periods and causes extreme and debilitating exhaustion as well as a wide range of other symptoms such as fever, headache, muscle ache and joint pain, often resembling flu and other viral infections. Also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Chronic Epstein-Barr Virus (CEBV), Myalgic Encephalomyelitis (ME), "Yuppy Flu" and other names, it is frequently misdiagnosed as hypochondria, psychosomatic illness, or depression, because routine medical tests do not detect any problems.
Cirrhosis (Liver Cirrhosis)
A long-term disease in which the liver becomes covered with fiber-like tissue. This causes the liver tissue to break down and become filled with fat. All functions of the liver then decrease, including the production of glucose, processing drugs and alcohol, and vitamin absorption. Stomach and bowel function, and the making of hormones are also affected.
Cofactor (Cofactors)
A substance that acts with another substance to bring about certain effects, often a coenzyme.
Collagen
The primary protein within white fibers of connective tissue and the organic substance found in tendons, ligaments, cartilage, skin, teeth and bone.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Discharge (Discharges)
A secretion, of pus for example, from a wound or bodily orifice.
Distention (Distended)
An excess expansion of a tissue or organ, either from inflammation, injury or gas.
Edema
Abnormal accumulation of fluids within tissues resulting in swelling.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Fibroblast (Fibroblasts)
Any cell or corpuscle from which connective tissue is developed. Fibroblasts produce collagen and elastin.
Flatulence
Abnormal amount of gas in the stomach and intestines.
Free Radical (Free Radicals)
A free radical is an atom or group of atoms that has at least one unpaired electron. Because another element can easily pick up this free electron and cause a chemical reaction, these free radicals can effect dramatic and destructive changes in the body. Free radicals are activated in heated and rancid oils and by radiation in the atmosphere, among other things.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Hallucination (Hallucinations)
A false or distorted perception of objects or events, including sensations of sight, sound, taste, smell or touch, typically accompanied by a powerful belief in their reality.
Hemoglobin
The oxygen-carrying protein of the blood found in red blood cells.
Hemolysis
The breakdown of old red blood cells into recycleable constituents, with particular importance given to the reuse of the heme part of hemoglobin.
Hemorrhage (Hemorrhaging)
Profuse blood flow.
Ischemia (Ischemic)
Localized tissue anemia due to obstruction of the inflow of arterial blood. A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels.
Leukocyte (Leukocytes)
A white blood cell which appears 5,000 to 10,000 times in each cubic millimeter of normal human blood. Among the most important functions are destroying bacteria, fungi and viruses and rendering harmless poisonous substances that may result from allergic reactions and cell injury.
Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.
Malignant (Cancerous)
Dangerous. Mainly used to describe a cancerous growth -- when used this way, it means the growth is cancerous and predisposed to spreading.
Migraine (Migraine Headache, Migraine Headaches, Migraines)
Not just a headache, but a disorder affecting the whole body, characterized by clearly defined attacks lasting from about 4 to 72 hours, separated by headache-free periods; progresses through five distinct phases. Prodrome: experienced by about 50% of migraineurs and starting up to 24 hours before the headache - changes in mood, sensory perception, food craving, excessive yawning, or speech or memory problems. Aura: experienced by about 15% and starting within an hour before the headache - disruption of vision (flashing lights, shimmering zigzag lines, blind spot) or sensation (numbness or 'pins and needles' around the lips or hand), or difficulty speaking. Headache: usually pulsating and occurring on one side of the head, it may occur on both sides of the head and alternate from side to side. Muscles in the neck and scalp may be tender; there may be nausea and the desire not to eat, move, see or hear. Resolution: the headache disappears and the body returns to normal. Resolution may occur over several hours during sleep or rest; an intense emotional experience or vomiting may also end the headache. Postdrome: After the headache stops, the sufferer feels drained, fatigued and tired. Muscles ache, emotions are volatile and thinking is slow.
Multiple Sclerosis (MS)
Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g. muscle weakness, loss of vision, and mood alterations.
Nausea
Symptoms resulting from an inclination to vomit.
Neuritis
Nerve inflammation, commonly accompanying other conditions such as tendonitis, bursitis or arthritis. Neuritis is usually accompanied by neuralgia (nerve pain).
Pathology (Pathologist)
Disease, particularly one with clear and obvious changes in structure or function; the study of same.
Pneumonia (Pneumonitis)
Inflammation, usually infectious, of the lungs. Unless the result of only moderate chemical or smoke irritation, it is a potentially life-threatening condition. There are so many defenses against an infection this deep in the body that the very presence of pneumonia signals a pathogen of great virulence or impaired or exhausted immunity, or all three. Pneumonitis: Inflammation of the lungs, from whatever cause. It may be concurrent with pneumonia or pleurisy.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Pulmonary Edema
Accumulation of fluid in the lung.
Seizure (Seizures)
While there are over 40 types of seizure, most are classed as either partial seizures which occur when the excessive electrical activity in the brain is limited to one area or generalized seizures which occur when the excessive electrical activity in the brain encompasses the entire organ. Although there is a wide range of signs, they mainly include such things as falling to the ground; muscle stiffening; jerking and twitching; loss of consciousness; an empty stare; rapid chewing/blinking/breathing. Usually lasting from between a couple of seconds and several minutes, recovery may be immediate or take up to several days.
Sepsis (Blood Poisoning, Septicemia)
Like septicemia, an infection that has moved deeply into the body, involving the subcutaneous or submucosal layers, connective tissue, lymph system, or blood. Septicemia: The presence of pathogenic bacteria or other microbes in the blood stream - a serious business, since most defenses are focused outside the bloodstream and the infection has bypassed them either due to its virulence, the depth and severity of the original focal infection or the weakened state of the body's immunity and life energy. Blood poisoning.
Sinuses (Sinus)
Four pairs of air pockets lined with membranes in the bones around the nose. The ethmoid sinuses are located on each side of the nose between the eyes; the maxillary sinuses are located in the cheek above the teeth and below the eyes; the sphenoid sinuses are located deeply behind the eyes; the frontal sinuses are located in the forehead.
Spherocytosis (Spherocytes)
A disease of the blood characterized by the production of red blood cells (erythrocytes), that are sphere-shaped, rather than donut-shaped. It is caused by a molecular defect in one or more of the proteins of the red blood cell cytoskeleton. Because the cell skeleton has a defect, the blood cell contracts to its most surface-tension efficient and least flexible configuration, a sphere, rather than the more flexible donut-shape. The sphere-shaped red blood cells are known as spherocytes.
Steroid (Steroids)
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Stroke (Stroke-Type Event)
A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.
Subcutaneous (Subdermal)
Below the surface of the skin. Subdermal: Below the surface of the skin, and below subcutaneous, but definitely higher up than the muscles.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Teratogen (Teratogens)
Any substance, agent, or process that blocks normal growth of the fetus, causing one or more developmental abnormalities in the fetus.
Tinnitus (Tinnitis)
A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.
Ulcer (Ulceration, Ulcers)
Lesion on the skin or mucous membrane.
Vasoconstriction (Vasoconstrictor, Vasoconstrictors)
A narrowing of any blood vessel, especially the arterioles and the veins in the blood reservoirs of the skin and the abdominal viscera.
Vertigo
The sensation of spinning or whirling; a state in which you or your surroundings seem to whirl dizzily.
Last updated: Jul 12, 2008
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