Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric Oxygen Therapy (HBOT) or more appropriately, High Dosage Oxygen Treatment is powered by natural healing mechanisms of oxygen set into motion by increased atmospheric pressure inside sealed hyperbaric chambers.

Hyperbaric Oxygen Therapy is considered a medicine because oxygen under elevated pressure starts acting like a drug doing things that under normobaric conditions (e.i. under normal atmospheric pressure) it wouldn’t do. Most conditions associated with hypoxia or ischemia can benefit from HBOT.²¹⁸

Ischemic and poorly perfused hypoxic tissues are immediately and positively affected by hyperoxygenation which is a state achieved inside Hyperbaric Chamber only when oxygen concentrations in body fluids elevated from 10 to 25 times its normal levels.

Comparing to normobaric conditions this equals to approximately 6 times deeper oxygen diffusion/penetration distance from the functioning blood vessels and capillaries while levels of arterial oxygen are elevating up to 1,500 mmHg.

Although this over-delivery of oxygen maintained only while the patient is inside hyperbaric chamber, its beneficial role is of a great significance: it allows triggering a primary and secondary effects of hyperbaric oxygen treatment, it allows to win time in critical conditions for corrective measures to be performed. Hyperoxygenation of tissues and body fluids is undoubtedly the most remarkable among Benefits of Hyperbaric Oxygen Therapy. ^{123, 124, 125}

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Indications for Hyperbaric Oxygen Therapy

Healing of several acute conditions associated with victims of closed head injury (tramatic brain injury), air embolism, decompression sickness, chest injury, blast injury, abdominal injury, carbon monoxide poisoning, strokes, sport injuries and other can be effectively supported by Hyperbaric Oxygen Therapy.

At a cellular level, by revitalizing the mitochondrial DNA and enzymes, Hyperbaric Oxygen (HBO₂) can return damaged cells back to the life, like for example damaged brain cells (neurons) deprived of oxygen as a result of several possible reasons. Regardless of specific cause of the brain injury, e.g. strokes, traumatic brain injury (TBI), carbon monoxide poisoning, brain hypoxia or autism – the mitochondrial biogenesis triggered by Hyperbaric Oxygen Treatment will trigger mechanisms of returning cellular metabolism back to life, healing ischemia by restoring blood flow around hypoxic tissues of the brain.

This video shows HBOT healing effects on a road accident victim Curt Allen sustained traumatic brain injury (TBI). The treatment was performed by Dr. Paul G. Harch of New Orleans.

Certain chronic conditions like diabetic ulcer wounds, radiation burns, necrotizing soft tissue infections, other non healing wounds, as well as multiple sclerosis, cerebral palsy, sleep apnea, autism, alzheimers and many other diseases are also in the list of conditions treated by Hyperbaric Oxygen Therapy.

Some of the indications for hyperbaric oxygen treatment are officially approved by authorized health authorities like FDA, others are still categorized as investigational in spite of considerable positive clinical evidence worldwide.

St. Catharines On -- Aug 14, 2006 -- The broken limbed Argos' running-back Ricky Williams spends several hours a day in a hyperbaric chamber at the Comprehensive Health Clinic in St. Catharines, Ontario., with hopes that the pure oxygen treatment will accelerate his healing process.

Photo courtesy of Glenn Lowson

Today approved and investigational indications for Hyperbaric Oxygen Treatment used in several categories of medicine such as: Traumatology, Neurological Disorders, Peripheral Vascular Disorders, Hematology, Endocrine Disorders, Cardiac Disorders, Orthopedic Disorders, Ophthalmology, Otorhinolaryngology, Plastic and Cosmetic Surgery, Gastrointestinal, Autoimmunity Related Disorders.

Shannon Kenitz walks with daughters Lily (left) and Grace (right) who suffers from a rare mitochondrial disorder called mitochondrial cytochrome c reductase which starves brain cells of oxygen killing most children by the age of two. (PRNewsFoto/International Hyperbarics Association, Inc.) (Newscom TagID: prnphotos079529) [Photo via Newscom]

Photo courtesy of www.d210.tv

Now ten years old, Grace is saved by receiving hyperbaric oxygen therapy at the Ocean Hyperbaric Neurological Center in Florida. Watch this video. Shannon and Grace Kenitz appearing on The Montel Williams show. Shannon is talking about how Hyperbaric Oxygen Therapy (HBOT) helped with her daughter's deadly disease.

Dr. Thomas M. Bozzuto, in the introduction to his article The Role of Hyperbaric Oxygen Therapy in Emergency Medicine gives the following historical perspective and the  morden age developments of HBOT…

Hyperbaric oxygen therapy (HBOT) has been alternately called “highly effective”¹ and “a therapy in search of diseases”.² Modern use of hyperbaric oxygen in clinical medicine began in 1965 with the work of Churchill-Davidson³ and Borema.⁴

Following its initial successful use in cardiac surgery, carbon monoxide poisoning, and gas gangrene, researchers were eager to treat a variety of other conditions in hyperbaric chambers, often without much scientific rationale. Because of this, hyperbaric oxygen therapy fell into disfavor until the 1970’s when several significant events took place.

Medicare convened a panel of members in the Undersea Medical Society (UMS) to help establish guidelines in 1972. The same society convened a workshop in 1975 after which Davis and Hunt edited the first clinical textbook in hyperbaric medicine.⁵

An ad hoc committee of the UMS was convened in 1976 which led to the formation of the Hyperbaric Oxygen Committee that now publishes a report of accepted medical conditions every two years. Potential indications for HBOT are rigorously screened for data “at least as convincing as that for any other treatment modality for that disorder”.⁶

Studies into the physiologic effects of oxygen under pressure have elucidated much more information over the past twenty years concerning the mechanism of action of HBOT. Research in the effects of HBOT at the cellular level have provided enough data that the majority of rational physicians no longer consider HBOT as magic, voodoo, or merely a waste of time and money…

--Thomas M. Bozzuto, D.O.

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Rationale Behind Hyperbaric Oxygen Therapy

During the last century treatment in hyperbaric/decompression chambers proved to be an effective method to heal cerebral arterial gas embolism and decompression sickness ^{142, 143, 144, 145, 146} - both conditions are very well known among Scuba Divers, Navies and Pilots.

An injured diver is helped from a Royal Navy Sea King Helicopter on arrival at Millport on the Island of Cumbrae for treatment at the Hyperbaric Chamber at the islands University Marine Biology Station.

Photo courtesy of "Sea Pigeon"

Angiogenesis, the growth of new blood vessels in damaged tissues is another permanent effect of Hyperbaric Oxygen Treatment boosting oxygen delivery to the hypoxic tissues. It is the most significant clinical benefit in the healing improvement of certain hypoxic wounds. Exposure to hyperbaric oxygen improves collagen synthesis by fibroblasts and stimulates angiogenesis.

By opening up the blood circulation into damaged tissues Hyperbaric Oxygen (HBO₂) also helps with the tissue detoxification. By normalizing various enzyme systems HBO₂ helps with the detoxification because metabolically healthy cells are able to accelerate required chemical processes thus promoting and expanding detoxification.

During the 1980's several scientific papers reported beneficial effects from HBO (Hyperbaric Oxygenation Therapy) for chronic MS (Multiple Sclerosis) patients and so self-help centres were set up to provide Hyperbaric Oxygen Treatment.

Healing effects of Hyperbaric Oxygen Treatment of life-threatening gas poisoning such as by carbon monoxide (CO) ^{154, 155, 156} , which binds to hemoglobin 200 times more intensively then oxygen forming so-called carboxyhaemoglobin is well known. Hyperoxygenation achieved in Hyperbaric Chamber significantly reduces the half-life of carboxyhaemoglobin, based on the fact the oxygen molecules displace CO molecules from hemoglobin.

Other beneficial effects of HBOT on brain cells damaged by carbon monoxide are reduction in lipid peroxidation, endothelial leukocyte migration, and other post-hypoxic events. The quick admission of the CO₂ poisoned patients to the Hyperbaric Chamber is crucial for patient's survival and rehabilitation.

Intermittent increases in arterial PO₂ to levels promoted by hyperbaric oxygen have a variety of delayed (prolonged) effects which may be beneficial in certain clinical conditions.

Vasoconstriction which reduces the caliber of blood vessels is caused by the arterial hyperoxia which occurs during Hyperbaric Oxygen Treatment but increased perfusion maintained by hyperbaric oxygen produces most sufficient tissue PO₂ level resulting in reduction of tissue edema in acute medical conditions such as crush injury, reperfusion after ischemic injury, compartment syndrome, etc...

Mississauga--March 16/2005--Jack Hunter lost his right leg from below the knee and several toes on his left foot due to complications stemming from diabetic ulsers. He is now undergoing treatment in a hyperberic chamber which promotes faster healing with pure oxygen. His doctor thinks that 75% of amputations due to diabetic ulsers could be avoided with the preventative use of the Hyperbaric Chamber.

Photo courtesy of Glenn Lowson

Hyperbaric Oxygen Therapy is an effective and safe therapy for vasculitis patients suffering from non healing skin ulcers.^{70, 71, 72, 73, 220}

Cutaneous nonhealing ulceration is a threatening manifestation of vasculitis. Hyperbaric oxygen (HBO), frequently used as adjuvant therapy for patients with ischaemic ulcers, exerts additional beneficial effects on the vascular inflammatory response.

Vasculitides are defined by the presence of leucocytes in the vascular vessel wall, with reactive damage to mural structures leading to tissue ischaemia and necrosis. Cutaneous presentation of vasculitis includes purpura, erythema, urticaria, noduli, bullae and skin infarction leading to ulceration. Cutaneous ulceration is usually caused by vasculitis in medium to small-sized vessels.

Most of the benefits of Hyperbaric Oxygen Therapy are explained by the simple physical relationships determining gas concentration, volume and pressure. By altering conditions of local hypoxia, HBO₂ facilitates the wound-healing energy-consumption processes.

HBOT has been used as an adjunct to antibiotics, debridement and revascularization in the therapy of chronic nonhealing wounds associated with diabetes ^{167, 168, 169, 170} or nondiabetic vascular insufficiency. Hyperoxia has an anti-inflammatory effect in the vascular bed.

Hyperbaric Oxygen Therapy can be used as adjuvant therapy for patients with ischaemic ulcers. Using HBO, the circulating haemoglobin is fully oxygenated and the oxygen dissolves in the plasma, correlating with the partial pressure of oxygen. Under HBO of 2–2.5 ATA, the amount of dissolved oxygen in the plasma increases more than 10-fold, exceeding the tissue oxygen requirements. This primary effect of Hyperbaric Oxygen Therapy generates a favourable gradient for oxygen diffusion from functioning capillaries to ischaemic tissue sites.

Doctor S. Efrati, the Head of the Institute of Hyperbaric Medicine and Wound Care Clinic from Assaf Harofeh Medical Center, Zerifin, Israel studied effects of Hyperbaric Oxygen Therapy on nonhealing vasculitic ulcers.

The following graph presents a baseline ulcer tissue oxygenation at room air concentration, after 20 min exposure to 100% oxygen at 1 atmosphere absolute (1 ATA) and after 20 min exposure to 100% oxygen at 2 ATA. The ulcer tissue oxygenation was evaluated by transcutaneous O₂ pressure (TCpO₂) measurements using a pulse oximeter.

By altering conditions of local hypoxia, HBO facilitates the wound-healing processes such as fibroblast proliferation or angiogenesis. The increase in tissue oxygenation, as measured by TCpO₂, is the most important predictive parameter used to identify patients who are likely to benefit from HBO therapy.

At the end of the study 80% of Dr. Efrati's patients demonstrated complete healing and 11.4% showed partial healing. 8.6% did not respond to the basal 20 HBO treatments. The results of their clinical outcome are summarized in the following chart.

The examples of vasculitis ulcers before and after HBOT are presented below. Mean duration of the HBO therapy was 7.08 ± 2.68 weeks (five sessions per week). At the end of the HBO therapy, there was a significant decrease in the daily prednisone dose (from 0.57 ± 0.33 to 0.22 ± 0.18 mg/kg, P ¼ 0.002).

Four patients demonstrated only partial resolution of the ulcer. However, by observation, despite the incomplete healing, the redness and oedema around the ulcer were completely resolved. Moreover, there was significant improvement in the ulcer-related pain, so that the amount of painkillers used could be reduced.

In addition to the physical relationships determining the local gas concentration, volume and pressure, HBO has a beneficial effects on nonischaemic ulcers. The effect of hyperoxia on vascular inflammatory responses has already been studied in a considerable number of experimental models. HBO reduces rolling and adhesion of polymorphonuclear cells in the microcirculation of skeletal muscle, small bowel, brain, skin flaps and liver.

HBO₂ has been reported to exert beneficial effects in other inflammatory conditions, including experimental colitis, Crohn’s disease, carrageenan-induced paw oedema in a rat modelof systemic inflammatory response, and in a model of circulatory shock induced by intraperitoneal injection of zymosan.

HBO₂ therapy is generally safe and well tolerated. Most side-effects are mild and reversible, although adverse events can occur in rare cases (e.g. reversible myopia, symptomatic otic barotraumas, pulmonary barotraumas or pulmonary oxygen toxicity, as well as seizures due to central nervous system oxygen toxicity).

Applying Hyperbaric Oxygen Therapy properly and in time would often mean a return from death to life, from coma to consciousness, from suffering to enjoying a normal life.