Information ⬇
Editors
JariSuvilehto
OlliJ.Arola
MikaValtonen
Hyperbaric Oxygen Therapy (HBOT)
Essentials
- Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen in a treatment chamber where the pressure is increased to greater than normal atmospheric pressure; usually 2.5-2.8 ATA (2.5-2.8 × atmospheric pressure). It corresponds to diving to a depth of 15 msw (= meters of sea water; 2.5 ATA) or 18 msw (2.8 ATA).
- Standard treatment is administered in 90 minute sessions 1-3 times a day on 5-7 days a week.
- HBO therapy for decompression sickness Diving Medicine last 4 h 50 min - 6 h 10 min according to the USN6 table, or 2 h 15 min according to the USN5 table.
Mode of action
- Physiological effects of the increased pressure
- Reduction of the size of gas bubbles that are retained in the body and cause symptoms
- Oxygen dissolves faster in the body fluids.
- The effect of hyperbaric oxygen on tissues
- Oxygen supply to the tissues is increased (oxygen dissolves in the plasma and its diffusion distance from the capillaries is increased by a factor of 3 to 4, and the partial pressure of oxygen in the tissues increases by a factor of 10 to 14).
- Tissue swelling is reduced (vasoconstriction).
- Healing of ischaemic wounds is accelerated (fibroblast activity is restored).
- Capillary angiogenesis in ischaemic areas is increased (intermittent hypoxia/hyperoxia)
- Activity of fibroblasts and osteoclasts as well as collagen synthesis are accelerated.
- The effect of HBOT on infections
- Growth of anaerobic bacteria is inhibited (e.g. Clostridium perfringens).
- Production of toxins is inhibited (e.g. alpha and theta toxins, produced by Clostridium perfringens, that have a haemolytic effect and cause tissue necrosis).
- Leucocyte antibacterial function in ischaemic tissues is improved (enhanced oxidative burst)
- The effect of some antimicrobial drugs (e.g. aminoglycosides, sulphonamides, ciprofloxacin) is enhanced.
- HBOT is the treatment of choice (no alternative treatment available) in
- decompression sickness Diving Medicine
- air or gas embolism.
- HBOT may be beneficial when given < 6-8 hours after air embolism.
- Empirical iIndications for HBOT
- Indications where HBOT appears ineffective and should not be used
- Ligament damage and stress injuries associated with exercise
- Multiple sclerosis
- Acute cerebral infarction and traumatic brain injury
- Chronic tinnitus
- Acute coronary syndrome
- Autism
Contraindications
- Absolute contraindication: untreated pneumothorax
- Relative (can usually be treated)
- Certain medications
- Disulfiram (may increase the toxicity of oxygen)
- Some cytostatic drugs: doxorubicin, cisplatin, bleomycin (both treatment effect and adverse effects increased)
- Severe claustrophobia
- Upper respiratory tract infection if associated with thick, obstructing secretions
- Susceptibility to convulsions
- History of a spontaneous pneumothorax
- Emphysema and CO2 retention
- Sequela to recent thoracic surgery
- Congenital spherocytosis
Complications
- Barotrauma in the air cavities (cf. diving; Diving Medicine)
- Middle ear (tympanocentesis if the patient is unconscious or sedated)
- Maxillary sinuses
- Poor dental health or temporary fillings
- Complications are usually associated with concurrent respiratory infection.
- Oxygen toxicity
- Convulsions
- Occur in about 1.4 cases per 10 000 treatment sessions administered for 90 minutes at 2.5 ATA.
- Drugs, respiratory acidosis, fever and sepsis predispose the patient to convulsions. Sedatives, ganglion blockers and hypothermia offer protection against convulsions.
- Treatment consists of exposure to normal room air and diazepam if indicated
- Lung injury
- Not a problem with modern treatment regimes
- Transient myopia
- May affect up to 30% of patients if the serial treatment continues for several months
- Reversible without treatment
- Accelerated maturation of a cataract
References
- Jain KK. In: Textbook of Hyperbaric Medicine, 6th Edition. Cham: Springer International Publishing 2017.
- Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med 2017;47(1):24-32. [PubMed]
- Game FL, Hinchliffe RJ, Apelqvist J ym. A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 2012;28 Suppl 1():119-41. [PubMed]
- Löndahl M, Katzman P, Nilsson A ym. Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care 2010;33(5):998-1003. [PubMed]
- Garcia-Covarrubias L, McSwain NE Jr, Van Meter K ym. Adjuvant hyperbaric oxygen therapy in the management of crush injury and traumatic ischemia: an evidence-based approach. Am Surg 2005;71(2):144-51. [PubMed]
- Clarke RE, Tenorio LM, Hussey JR ym. Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow-up. Int J Radiat Oncol Biol Phys 2008;72(1):134-143. [PubMed]
- Glover M, Smerdon GR, Andreyev HJ ym. Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomised, double-blind, sham-controlled phase 3 trial. Lancet Oncol 2016;17(2):224-233. [PubMed]
- Ylikoski J, Mrena R, Makitie A ym. Hyperbaric oxygen therapy seems to enhance recovery from acute acoustic trauma. Acta Otolaryngol 2008;128(10):1110-5. [PubMed]
- van der Veen EL, van Hulst RA, de Ru JA. Hyperbaric Oxygen Therapy in Acute Acoustic Trauma: A Rapid Systematic Review. Otolaryngol Head Neck Surg 2014;151(1):42-5. [PubMed]
- Bartek JJr , Jakola AS, Skyrman S ym. Hyperbaric oxygen therapy in spontaneous brain abscess patients: a population-based comparative cohort study. Acta Neurochir (Wien) 2016;158(7):1259-67. [PubMed]
Evidence Summaries ⬆