Stroke Therapy

HBOT and Stroke Recovery

In order to understand how and why hyperbaric oxygen (oxygen under pressure) can help a patient recovering from a stroke it helps to first understand how hyperbaric oxygen therapy (HBOT) works. If you have not read the blog post titled “HBOT: How Does It Work?” please refer to that before you continue on.

The damage caused by stroke typically impacts several zones of the brain: The initial zone where the actual hemorrhage or ischemia occurred and then a zone surrounding that area that will typically become dormant or inactive. This secondary zone is affected primarily due to a loss of blood flow and therefore loss of oxygen to the tissue in question.

This dormant tissue results from a combination of blood vessel damage, decreased blood flow and surrounding inflammation depriving the brain of enough oxygen to complete its typical functions. Without the ability to nourish it with oxygen and remove cellular waste (carbon dioxide) this are of brain tissue needs to effectively shut down.

At the initial onset of a stroke, the goal is to improve blood flow, unblock any occlusions, stop any excess bleeding and return cerebral blood flow to as close to normal as quickly as possible to minimize the size of these zones and therefore the damage done by the stroke itself. Unfortunately for most stroke patients, once the initial crisis is under control, the only modality offered is physical rehabilitation (physical and/or occupational therapy) to try recovering as much function as possible but not much more is offered and little or nothing done to help the actual brain itself to heal.

This is where HBOT can step in. Oxygen under pressure has the ability to super saturate the damaged tissue with oxygen. The reason again for some of the damage and most of the dormant portion of brain tissue post stroke is loss of oxygen. If we can continue to help reduce the amount of swelling, and then provide very high levels of oxygen, enough to provide not only what is needed for normal function, but more importantly higher levels, enough to help promote healing, we can shrink the size of these damaged zones. How far can we shrink them? What symptoms are going to get better and in what order will they improve? We really do not know that answers to those questions. All we know is that if you can expose these patients to higher levels of oxygen, they can heal. As they heal, they will see an improvement in their symptoms and improvement in their overall ability to function and have an improved quality of life. Ease of movement, less spasm, improved cognition, improved vision, improved speaking ability, improved memory are all common improvements seen using Hyperbaric oxygen post stroke.

HBOT & Lyme Disease

HBOT and Lyme Disease

Lyme disease, which is borrelia burgdorferi bacteria transmitted to humans through a tick bite, can have massive and debilitating effects. Some of these include fatigue, joint pain, muscle pain, meningitis, migraines, among many others.

Unfortunately, the traditional treatments for Lyme are limited to basic antibiotic therapy. If caught quickly this is sometimes enough to recover, but often it is not enough. These infections are very strong and often prove resistant to many traditional therapies. Also, most often Lyme is not alone, since there are a multitude of coinfections that exist along with Lyme. A multi-therapeutic approach is needed to treat these infections. Addressing this condition from multiple angles is paramount to successfully healing.

One of the prongs on this multi-therapeutic approach should Hyperbaric Oxygen Therapy (HBOT). HBOT has the capacity to play a major role in healing from Lyme for a few reasons:

  • Lyme disease is in a classification of bacteria called anaerobes, meaning these bacteria thrive in very low oxygen environments.  HBOT, being a very high oxygen environment, has the ability to aid in the killing of the bacteria.

  • Lyme causes a great deal of inflammation throughout the body affecting joints, muscles and the nervous system. One of the primary uses of HBOT in general is to help manage inflammation. The more oxygen our body can absorb, the more inflammation we can process and move out of our body.

  • Oxygen is a major nutrient our body needs to heal from damage. As a result of the infection and associated inflammation, damage can be extensive. HBOT provides exceptionally high amounts of oxygen that the body can use to heal the brain, nerves, muscles and joints.

The use of HBOT as part of the multi-therapeutic approach for Lyme is growing rapidly.  Lyme experts are coming to see the obvious benefits of including HBOT as part of their patients’ recovery from this debilitating disease. For more info please read a case study below.

Case Study:

In April 2003, our patient was a 31-year-old healthy man who worked in the financial industry and lived in Taipei City, who began suffering from intermittent low- and high-grade fever. These symptoms were accompanied by fatigue and multiple bone pain, especially in the sternum, ribs, and lower back, which made it difficult for the patient to walk. Since that time, the patient had only received symptomatic medications such as painkillers. In January 2004, some erythema migrans lesions were found over the patient’s legs. In addition, he suffered from joint pain in both knees, the shoulders, and temporomandibular joints. Tracing back the patient’s history 2 years prior to clinical presentation, it was noted that he was a frequent hiker in the Yang-Ming Mountains in Taipei, Taiwan, where he often sat on the grass and had contact with wild cattle. He had previously visited infection and dermatology clinics, where his Borrelia serology IgG was positive, and Lyme disease was strongly suspected. Soon thereafter, 500 mg amoxicillin twice daily was prescribed for 1 month, which caused the patient’s symptoms to subside partially. However, in the next 3 years, he was bothered by symptoms including: (1) nervous system, comprised of irritability, mood swings, poor concentration, loss of short-term memory, sleep disturbance, facial tingling, blurred vision, and photophobia; (2) cardiovascular system, consisting of chest pains and palpitations; (3) musculoskeletal system, associated with migrating arthralgias; and (4) other problems, including headache and pelvic pain.

In 2007, the patient again visited another infection clinic, where he received antibiotic agents such as doxycycline, amoxicillin 250 mg + clavulanic acid 125 mg (Augmentin), parenteral penicillin, and oral cefuroxime over the following 4 years. Because the above symptoms had not improved significantly, in October 2011 the patient visited us for HBOT. Before HBOT, some residual symptoms such as elbow and joint pain, numbness of the extremities, perioribital twitch, sleep disorder, and affected thinking ability persisted. After we excluded other infectious and noninfectious etiologies that can mimic certain appearances of the typical multisystem illness seen in CLD, HBOT at 2.5 ATA with treatment duration of 1.5 hours for 30 sessions was given. In the first 10 sessions of HBOT, nervous-system-associated symptoms such as loss of thinking ability and sleep disorder disappeared. In the second 10 sessions of HBOT, additional nervous system symptoms such as numbness of the extremities and perioribital twitch also disappeared. In the third 10 sessions of HBOT, musculoskeletal system symptoms such as migrating arthralgia also vanished. Overall, completion of 30 sessions of HBOT caused noted longstanding Lyme-disease-related symptoms affecting most of the previously affected bodily areas to disappear.

How HBOT Works

HBOT: How Does It Work?

Everyone knows we need oxygen for our survival. It is a critical nutrient for our cells in order to function and produce energy.

So what is the difference between the air you and I we breathe, using medical grade green tank oxygen and using hyperbaric oxygen therapy (HBOT)?

The air we breathe is 21% oxygen. The rest is primarily Nitrogen. As we breathe air in, our body is able to take the oxygen (our body’s fuel source) from the air, dissolve it through our lungs and then carry it though our whole circulatory system (using red blood cells) to oxygenate every single cell we have (about 10 trillion). Once the oxygen has left the red blood cells, they picks up carbon dioxide (our cells waste product) and carries that back to our lungs for removal during an exhale. It’s a pretty amazing process actually!

If you have ever been in the hospital or perhaps at your annual physical, the doctor has put that little instrument on your finger that measures your pulse and oxygen saturation. If you are relatively healthy –  especially without lung or other breathing issues (COPD) – you would be about 98-100% saturated with oxygen. This means your red blood cells are currently maxed out and carrying as much oxygen as they possibly can. If there is some type of lung condition, that number will drop into the low 90s and possibly into the 80s. This would mean the lungs were not pulling enough oxygen out of the air in order to fill those red blood cells with oxygen. In those cases, medical grade green tank oxygen can be a miracle. Now instead of breathing 21% oxygen from the air, we can breathe 100% oxygen from a tank (or oxygen concentrator machine) and increase how much oxygen we can use to fill those red blood cells. In many cases, this is sufficient enough to help many COPD-type patients.

 

Becoming more than 100% Saturated

In certain cases, a patient may already be 100% saturated with oxygen (because there is NO pulmonary/lung disease), but one of the following conditions is present:

  • There is a blockage somewhere preventing the oxygen from getting where it needs it to go (TBI, neuropathy, stroke, trauma, excessive swelling). These patients cannot bring anymore oxygen in (they are 100% saturated, but, they cannot get oxygen to the area in need due to some other issue,trauma or condition.

OR

  • These patients really need a much higher amount of free floating oxygen (more than 100% saturation) in order to help heal from a certain condition (fibromyalgia, dementia, Lyme, CP, MS, ALS, etc ).  If the body had access to this “extra” oxygen, it would have more of what it needs to further promote healing and reduce inflammation and toxicity.

In these cases, HBOT is the necessary tool to administer the proper type and amount of oxygen. Simply put, HBOT does not rely on the red blood cell system carrying oxygen for the body. It will fill those cells, but even more, due to the pressure inside the chamber, it will dissolve “extra” oxygen into the plasma of the blood and directly into our tissues. In this case, we are able to effectively be 110-140% saturated, delivering 10-40% more oxygen to tissues that have literally been starving for more oxygen.

Most importantly it meets my standard of “safety to effectiveness” ratio. HBOT is one of the safest healthcare modalities that exists and yet is enormously effective in helping to heal from a large variety of conditions. Risk to benefit ratio is very clearly high benefit, low risk! It is a shame that HBOT is not on the front line of therapies for some of the above conditions.

 

What Is HBOT

Hyperbaric oxygen therapy (HBOT) is a medical treatment which enhances the body’s natural healing process by inhalation of 100% oxygen in a total body chamber, where atmospheric pressure is increased and controlled.  It is used for a wide variety of treatments usually as a part of an overall medical care plan.

Under normal circumstances, oxygen is transported throughout the body only by red blood cells. With HBOT, oxygen is dissolved into all of the body’s fluids, the plasma, the central nervous system fluids, the lymph, and the bone and can be carried to areas where circulation is diminished or blocked.  In this way, extra oxygen can reach all of the damaged tissues and the body can support its own healing process.  The increased oxygen greatly enhances the ability of white blood cells to kill bacteria, reduces swelling and allows new blood vessels to grow more rapidly into the affected areas.  It is a simple, non-invasive and painless treatment.

It has long been known that healing many areas of the body cannot take place without appropriate oxygen levels in the tissue.  Most illnesses and injuries occur, and often linger, at the cellular or tissue level.  In many cases, such as: circulatory problems; non-healing wounds; and strokes, adequate oxygen cannot reach the damaged area and the body’s natural healing ability is unable to function properly.  Hyperbaric oxygen therapy provides this extra oxygen naturally and with minimal side effects.

Hyperbaric oxygen therapy improves the quality of life of the patient in many areas when standard medicine is not working.  Many conditions such as stroke, cerebral palsy, head injuries, and chronic fatigue have responded favorably to HBOT.

The Benefits Of HBOT

We know that oxygen is essential to normal cellular physiology. Cancer cells have an altered metabolism and no longer depend upon oxygen. In fact, high oxygenated environments are toxic to cancer cells and both slows their growth and triggers cell death mechanisms within them. Is there a way to increase oxygen in the body to support healthy cell function while being a detriment to cancer cell function?

Our bodies rely on the constant supply of oxygen intake to survive. Our atmosphere is approximately 21% oxygen. This element is required by every cell in the human body to produce cellular energy via the mitochondria. High flow oxygen therapy can deliver 100% oxygen in a pressurized atmosphere and results in extraordinary healing benefits.

When oxygen is administered at high pressure rates, up to 20 times more oxygen can be absorbed by the bloodstream. This oxygen is transported to damaged organs and tissue which speeds up both healing and recovery time. Hyperbaric oxygen therapy delivers pure oxygen up to 3 times the normal atmospheric pressure. Sessions typically ranges from 30 to 90 minutes.

What is Hyperbaric Oxygen Therapy?

Hyperbaric oxygen therapy (HBOT) refers to breathing in conditions of 100% pure oxygen under high pressure. This process encourages oxygen to be quickly absorbed and dissolved into the bloodstream at an expedited rate. Infection can slow healing because the blood supply to the affected site is damaged. HBOT increases the oxygen supply to these damaged tissues.

This form of hyperbaric therapy which utilizes 100% of oxygen requires a prescription under FDA guidelines due to its classification as a drug. Mild hyperbaric therapy or mHBOT has also shown significant health benefits and administers 95% oxygen in a small range of 1.3 to 1.4 atmospheric pressure. Requiring no doctor’s prescription, providing incredible health benefits and a process that has minimal to zero risks, mHBOT is a much more affordable treatment option.

Systems range in cost from as low as $5 to $25,000. You can also get treatments at around $50 to $100 a session. HBOT that provide more than 1.5 times the atmospheric pressure and administers 100% oxygen are about $200 per treatment session.

Benefits of Hyperbaric Oxygen Therapy

HBOT can benefit any patient who is healing from a condition triggered by inflammation in the body. The healing process can be improved using HBOT to deliver a higher rate of oxygen to damaged tissue. In fact, oxygen controls more than 8,000 genes and is one of the most natural forms of antibiotics. Twenty sessions of therapy improves the function of stem cells by eightfold.

HBOT has also been shown to help with the following:

  • Stimulates new blood vessel growth and increase blood flow
  • Elevates the body’s natural immune defenses to fight infection and bacteria
  • Reduces swelling that may occur around damaged areas
  • Speeds up healing by increasing tissue oxygen levels to areas in the body where they are reduced due to injury or illness

HBOT cancer treatment

What is a hyperbaric chamber? It is a device that a person enters in order to have oxygen under pressure given to them.

There is definite research showing the benefits of hyperbaric for a variety of complaints from decubitus ulcers (bedsores) and diabetic non-healing wounds to cancer treatment [1, 2] For cancer treatment, oxygen makes cancer cells weaker and less resistant to treatment. [3, 4]

Dominic D’Agostino of the University of South Florida has done research for the Department of Defense for work with Navy SEALS. His work shows that a ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer. [5] In fact, this work shows a ketogenic diet with hyperbaric oxygen stops the tumor growth progression.

But a good hard shell hyperbaric chamber will cost around $75,000. (That’s the price of a very nice new BMW!) Taking time out of the day to drive to a clinic and paying for the use of a hard shell? Who has that much time? So what are the alternatives?

Manfred von Ardenne, a student of Otto Warburg, investigated the delivery of oxygen to the patient in what he called the “Oxygen Multistep Therapy” or O2MT which evolved into at home therapy called “Exercise With Oxygen Therapy” or EWOT. Dr. Ardenne found that this therapy stimulated the immune system, impacts microcirculation, increases oxygen status and improves the overall energetic status. [6]

This work is so impressive that Warburg wrote a letter to von Ardenne stating: “In these last few years you have certainly reached the peak of cancer research; I certainly know of no single book in the whole of cancer research in which anyone else has tackled the therapy problem with the same energy and breadth. My instinct tells me that, in the long run, your victory is certain.” [6]

 

Studies

. 1998 Oct 24; 317(7166): 1140–1143.
PMCID: PMC1114115
PMID: 9784458
ABC of oxygen

Hyperbaric oxygen therapy

Over the past 40 years hyperbaric oxygen therapy has been recommended and used in a wide variety of medical conditions, often without adequate scientific validation of efficacy or safety. Consequently a high degree of medical scepticism has developed regarding its use. The Undersea and Hyperbaric Medical Society approves use of hyperbaric oxygen for a few conditions for which there is thought to be reasonable scientific evidence or well validated clinical experience. In these conditions early referral is essential.

Therapeutic uses of hyperbaric oxygen

Strong scientific evidence

Main treatment

  • Decompression sickness
  • Arterial gas embolism
  • Severe carbon monoxide poisoning and smoke inhalation

Adjunctive treatment

  • Prevention and treatment of osteoradionecrosis
  • Improved skin graft and flap healing
  • Clostridial myonecrosis

Suggestive scientific evidence

Adjunctive treatment

  • Refractory osteomyelitis
  • Radiation induced injury
  • Acute traumatic ischaemic injury
  • Prolonged failure of wound healing
  • Exceptional anaemia from blood loss

Hyperbaric oxygen has been shown ineffective in diseases such as multiple sclerosis and dementia, but it continues to be used despite the risks of the treatment. For conditions where its use remains unproved—for example, rheumatoid arthritis, cirrhosis, and gastroduodenal ulcer—hyperbaric oxygen should be used only in the context of well controlled clinical trials.

Biochemical and physiological effects

At sea level the plasma oxygen concentration is 3 ml/l. Tissues at rest require about 60 ml of oxygen per litre of blood flow (assuming normal perfusion) to maintain normal cellular metabolism, although requirements vary between tissues. At a pressure of 3 atmospheres (304 kPa) dissolved oxygen approaches 60 ml/l of plasma, which is almost sufficient to supply the resting total oxygen requirement of many tissues without a contribution from oxygen bound to haemoglobin. This has advantages in situations such as carbon monoxide poisoning or in severe anaemia where difficult crossmatching or religious belief prevents blood transfusion.

Cellular and biochemical benefits of hyperbaric oxygen

  • Promotes angiogenesis and wound healing
  • Kills certain anaerobes
  • Prevents growth of species such as Pseudomonas
  • Prevents production of clostridial alpha toxin
  • Restores neutrophil mediated bacterial killing in previously hypoxic tissues
  • Reduces leucocyte adhesion in reperfusion injury, preventing release of proteases and free radicals which cause vasoconstriction and cellular damage

Oxygen at 300 kPa increases oxygen tension in arterial blood to nearly 270 kPa and in tissue to about 53 kPa. This improves the cellular oxygen supply by raising the tissue-cellular diffusion gradient. The hyperoxia has potential benefits including improved angiogenesis. The formation of collagen matrix is essential for angiogenesis and is inhibited by hypoxia. In irradiated tissue hyperbaric oxygen is more effective than normobaric oxygen at raising tissue partial pressure of oxygen and promoting angiogenesis and wound healing. The healing process may also be helped in non-irradiated tissues with compromised perfusion, but this requires further validation.

Advice on the nearest suitable UK unit and help to coordinate the management can be obtained from the Institute of Naval Medicine, Gosport (24 hour emergency number 0831 151523, daytime inquiries 01705 768026)

The value of hyperbaric oxygen therapy in decompression illness and arterial gas embolism depends on the physical properties of gases. The volume of a gas in an enclosed space is inversely proportional to the pressure exerted on it (Boyle’s law). At 300 kPa bubble volume is reduced by about two thirds. Any intravascular bubbles causing obstruction move to smaller vessels, which reduces extravascular tissue damage. Dissolution of the gas bubble is enhanced by replacing the inert gas in the bubble with oxygen, which is then rapidly metabolised by the tissues.

Availability and administration

Multiplace chambers are available in a few NHS hospitals (Aberdeen, Craigavon, Newcastle upon Tyne), Royal Navy centres, private units, police diving units, professional diver training schools, and sites associated with the North Sea oil industry. The United States has over 250 facilities.

Comparison of monoplace and multiplace hyperbaric oxygen chambers

Monoplace

  • Claustrophobic environment;limited access to patient
  • Whole chamber containshyperbaric oxygen,increasing fire risk
  • Lower cost
  • Portable

Multiplace

  • More room; assistant canenter to deal with acuteproblems such aspneumothorax
  • Hyperbaric oxygen via tightfitting mask—chamber gascan be air (reduced fire risk)
  • Risk of cross infection whenused for ulcers etc

Often early treatment is essential for maximum benefit. This poses appreciable practical problems as severely ill patients may have to be transported long distances and may require intensive medical support, including mechanical ventilation, between treatment sessions. It is important to discuss the potential benefits and risks for each patient with the regional hyperbaric oxygen facilities.

Multioccupancy chambers are required for critically ill patients who require an attendant within the chamber and are usually used for acute problems. Monoplace chambers can be used to treat patients with chronic medical conditions. Hyperbaric oxygen is inhaled through masks, tight fitting hoods, or endotracheal tubes.

Inside the chambers pressure is usually increased to about 250-280 kPa, equivalent to a depth of 15-18 m of water. The duration of treatment varies from 45 to 300 min and patients may receive up to 40 sessions. Appropriate monitoring is essential during treatment, and facilities for resuscitation and immediate mechanical ventilation should be available.

Dangers of hyperbaric oxygen

The potential risks and risk-benefit ratio of hyperbaric oxygen have often been underemphasised in therapeutic trials. The side effects are often mild and reversible but can be severe and life threatening. In general, if pressures do not exceed 300 kPa and the length of treatment is less than 120 minutes, hyperbaric oxygen therapy is safe. Overall, severe central nervous system symptoms occur in 1-2% of treated patients, symptomatic reversible barotrauma in 15-20%, pulmonary symptoms in 15-20%, and reversible optic symptoms in up to 20% of patients.

Reversible myopia, due to oxygen toxicity on the lens, is the commonest side effect and can last for weeks or months. Epileptic fits are rare and usually cause no permanent damage. A suggested carcinogenic effect of hyperbaric oxygen has not been substantiated in extensive studies.

Risks of hyperbaric oxygen

Fire hazard

Most common fatal complication

General features

  • Claustrophobia
  • Reversible myopia
  • Fatigue
  • Headache
  • Vomiting

Barotrauma

  • Ear damage
  • Sinus damage
  • Ruptured middle ear
  • Lung damage

Oxygen toxicity

  • Brain
    •  Convulsions
    •  Psychological
    • •  Lung
    •  Pulmonary oedema,haemorrhage
    •  Pulmonary toxicity
    •  Respiratory failure (may beirreversible when due topulmonary fibrosis)

Decompression illness

  • Decompression sickness
  • Pneumothorax
  • Gas emboli

Pneumothoraces must be adequately drained before treatment with hyperbaric oxygen. Pulmonary oxygen toxicity with chest tightness, cough, and reversible falls in pulmonary function may occur with repeated treatment, particularly in patients exposed to high oxygen levels before treatment. Oxygen toxicity can be prevented in most tissues by using air in the chamber for 5 minutes every 30 minutes. This allows antioxidants to deal with free oxygen radicals formed during the hyperoxic period.

Therapeutic uses

Decompression sickness and arterial gas embolism

When divers surface too rapidly the partial pressure of nitrogen dissolved in the tissues may exceed the ambient atmospheric pressure sufficiently to form gas bubbles in the blood and the tissues. Although less common, rapid ascent to over 5500 m can result in high altitude decompression sickness.

Decompression sickness may produce mild problems such as rash or joint pain or be more serious with paralysis, confusion, convulsions, and ultimately death secondary to blockage of vital blood vessels. Hyperbaric oxygen is the main treatment, and its efficacy has been validated by extensive clinical experience and scientific studies. Recompression rapidly alleviates the symptoms, and tables are available to determine safe periods for subsequent decompression. Treatment should be started as soon as possible and given in sessions of 2-5 hours until the symptoms have resolved.

Air may also enter the circulation during placement of arterial and venous catheters, cardiothoracic surgery, haemodialysis, or mechanical ventilation. Although no formal trials support the use of hyperbaric oxygen in air embolism, the well established physical properties of gases and extensive clinical experience justify its use as the primary treatment. Treatment should begin immediately at pressures of 250-300 kPa for 2-5 hours. Benefit is reported when hyperbaric oxygen therapy begins several hours after the onset of air embolism but further trials are required to establish the delay after which hyperbaric oxygen is no longer of value.

Carbon monoxide poisoning

Carbon monoxide poisoning is an important cause of death from poisoning, particularly in the United States. Carbon monoxide binds to haemoglobin with an affinity 240 times that of oxygen. This reduces the oxygen carrying capacity of the blood. Unoccupied haemoglobin binding sites have an increased affinity for oxygen, further reducing the availability of oxygen to the tissues. In addition, carbon monoxide binds to the large pool of myoglobin increasing tissue hypoxia. Hyperbaric oxygen provides an alternative source of tissue oxygenation through oxygen dissolved in the plasma. It also facilitates dissociation of carbon monoxide from the haemoglobin and myoglobin; the carboxyhaemoglobin half life is 240-320 min breathing air, 80-100 min breathing 100% oxygen, and about 20 min with hyperbaric oxygen. In addition, hyperbaric oxygen dissociates carbon monoxide from cytochrome c oxidase, improving electron transport and cellular energy state.

Symptoms of carbon monoxide poisoning

  • Loss of consciousness
  • Neurological abnormalities
  • Myocardial ischaemia
  • Pulmonary oedema
  • Metabolic acidosis
  • Headache
  • Nausea
  • Delayed neuropsychological features (often permanent)

Controlled studies comparing hyperbaric oxygen and normobaric 100% oxygen in the acute and delayed effects of carbon monoxide poisoning have produced conflicting results, although some benefit was seen in patients who experienced loss of consciousness or neurological abnormality.

The clinical severity of carbon monoxide poisoning does not correlate well with carboxyhaemoglobin concentrations

If carbon monoxide poisoning results in unconsciousness, convulsions, neurological impairment (including abnormal gait or mental state test results) or severe metabolic acidosis the case should be discussed with the nearest regional centre. A single session of hyperbaric oxygen therapy will usually reverse the acute, potentially life threatening effects of carbon monoxide poisoning, but additional treatments may be needed to reduce the delayed neuropsychological sequelae. Patients with less severe poisoning should be treated with 100% oxygen.

Necrotising infections and osteomyelitis

The primary treatment of myonecrosis and gas gangrene of soft tissues resulting from clostridial infection and alpha toxin production is surgical debridement and antibiotics. However, experimental evidence and clinical experience suggest that adjunctive treatment with hyperbaric oxygen improves systemic illness and decreases tissue loss by demarcating the border between devitalised and healthy tissue. This reduces the extent of surgical amputation or debridement. Controlled trials of hyperbaric oxygen and normobaric 100% oxygen are not available. In necrotising fasciitis (rapidly progressive skin infection without muscle disease) retrospective studies suggest that hyperbaric oxygen is beneficial in combination with surgical debridement but prospective controlled trials are lacking.

Hyperbaric oxygen is also claimed to be helpful in refractory osteomyelitis. Animal experiments show improved healing of osteomyelitis compared with no treatment, but the effect is no better than that with antibiotics alone and the two treatments have no synergistic effect. Uncontrolled trials of surgery and antibiotics combined with hyperbaric oxygen in refractory osteomyelitis have reported success rates of as high as 85%, but controlled trials are needed.

Post radiation damage

Soft tissue radionecrosis and osteonecrosis after surgery on irradiated mandibles are reduced by hyperbaric oxygen. In a controlled study comparing osteoradionecrosis at six months postoperatively, the incidence was 5% in patients receiving 30 preoperative hyperbaric oxygen treatments compared with 30% in patients who received only preoperative antibiotics. A similar improvement in wound healing after surgery has been shown in patients with irradiated tissue who receive preoperative hyperbaric oxygen therapy. Normobaric 100% oxygen does not seem to confer the same benefits. The higher partial pressures achieved with hyperbaric oxygen may stimulate new vessel growth and healing in damaged irradiated tissue which has lost the capacity for restorative cellular proliferation.

To prevent mandibular osteonecrosis after surgery on irradiated facial and neck tissue 30 preoperative 90 minute sessions and 10 postoperative sessions are recommended

Skin grafts, flaps, and wound healing

In poorly vascularised tissue hyperbaric oxygen improves both graft and flap survival compared with routine postoperative surgical care alone. The effect of normobaric 100% oxygen was not examined in these studies. In the United States problem wounds are the commonest indication for a trial of adjunctive hyperbaric oxygen therapy and include diabetic and other small vessel ischaemic foot ulcers. Several studies have shown improved healing and a lower incidence of amputation with 4-30 sessions.

Hyperbaric oxygen should be considered for problem wounds if the facility is readily available

Other indications

Hyperbaric oxygen has been used successfully to treat haemorrhagic shock in patients who refuse blood on religious grounds or for whom suitable blood was not available. Similarly, there is evidence for benefit in acute traumatic ischaemic injuries including compartmental syndromes and crush injuries.

Conditions which do not benefit

Hyperbaric oxygen has been tried in numerous conditions and is often reported to be beneficial. However, in many of these situations the scientific evidence is flimsy and use should be restricted to randomised controlled trials. Hyperbaric oxygen has been clearly shown not to be beneficial in several diseases including multiple sclerosis and senility.

Summary

  • Lack of randomised controlled trials makes it difficult to assess the efficacy of hyperbaric oxygen in many diseases
  • Side effects are usually mild but can be life threatening
  • Clear evidence of benefit has been found in decompression sickness and a few other conditions
  • Much work remains to be done to establish the timing, indications, and therapeutic regimens required to obtain the best clinical and cost effective results
  • The cellular, biochemical, and physiological mechanisms by which hyperbaric oxygen achieves beneficial results are not fully established

The suggestion that hyperbaric oxygen may be beneficial in multiple sclerosis arose from animal work suggesting that it improved experimental allergic encephalomyelitis and several uncontrolled studies suggesting disease remission in humans with multiple sclerosis. In 1983, a small controlled trial reported significant benefit, and large numbers of patients with multiple sclerosis were treated with hyperbaric oxygen. Since this initial trial at least 14 trials, of which eight are high quality randomised controlled studies, have been published. In the eight high quality studies the patients had chronic stable or chronic progressive multiple sclerosis, had at least 20 sessions of therapy for 90 minutes over four weeks, and were adequately assessed with evoked potentials and for functional and disability state. Only one study showed a benefit from hyperbaric oxygen.

No convincing evidence exists for using hyperbaric oxygen in thermal burns. In the only randomised controlled trial of hyperbaric oxygen and usual burn care the length of hospital stay, need for autografting, and mortality were virtually identical with both treatments.

Footnotes

P Wilmshurst is consultant cardiologist at Royal Shrewsbury Hospital, Shrewsbury.

The ABC of Oxygen is edited by Richard M Leach, consultant physician, department of intensive care, and P John Rees, consultant physician, department of respiratory medicine, Guy’s and St Thomas’s Hospitals Trust, London.

The pictures of the hyperbaric chamber and necrotic heel of diabetic patient were downloaded from the internet with permission from Proteus Hyperbaric Systems. The picture of gas gangrene was downloaded with permission from St Joseph Medical Center, Fort Wayne, Indiana, USA


Articles from The BMJ are provided here courtesy of BMJ Publishing Group

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Exciting News

Exciting New Benefits of Hyperbaric Oxygen Therapy

At Whitaker Wellness, we’ve been using and extolling the benefits of hyperbaric oxygen therapy for decades. But the earliest documented use of hyperbaric therapy dates back to 1662, when a British physician treated patients with respiratory conditions in a chamber filled with compressed air. America’s first hyperbaric chamber was built in 1861, and in 1928 Dr. Orval Cunningham constructed a five-story, 900-ton pressurized spherical chamber, where scores of patients could stay for long periods. Criticism by the American Medical Association, however, undermined enthusiasm for hyperbarics, and the “steel ball hospital” was eventually dismantled for scrap metal.Conventional medicine’s interest faded, but research continued. In 1939, the US Navy began administering 100 percent oxygen under pressure—true hyperbaric oxygen therapy (HBOT)—to treat decompression illness from diving accidents. During the next three decades, European doctors discovered that the benefits of hyperbaric oxygen therapy extended to carbon monoxide poisoning, stroke, radiation injury, multiple sclerosis, wound healing, bone infections, and more.

Although bias among US physicians endures, thousands of scientific papers have been published on hyperbaric oxygen therapy’s benefits for dozens of serious conditions.

Wound- and Injury-Healing Wonder

Cecil came to us in a last-ditch effort to save his leg. Antibiotics, intensive wound care, and amputation of several toes failed to stem a festering diabetic ulcer, and he was told the leg had to go. Within days, the benefits of hyperbaric oxygen therapy were evident. HBOT coupled with sugar dressings worked quickly and the infected ulcer began to close. His wound eventually healed, and amputation was avoided.

This is not an isolated case. Hyperbaric oxygen therapy benefits wounds of all kinds. When 100 percent oxygen is breathed under pressure, it dissolves in all the body’s fluids and saturates tissues with oxygen. This massive influx reduces inflammation, curbs infection, signals the release of reparative stem cells and growth factors, and boosts production of collagen and new blood vessels (angiogenesis).

More benefits of hyperbaric oxygen therapy include faster recovery from muscle, ligament, and bone injuries and reduced post-exercise muscle fatigue and soreness—which explains HBOT’s popularity with Michael Phelps, Novak Djokovic, Tiger Woods, Terrell Owens, Darren Sharper, and other elite athletes.

Diabetic ulcers lead to 73,000 amputations annually, and who knows how many serious injuries are sustained every day. Just imagine how many limbs could be saved and how much pain and suffering eliminated with routine use of HBOT.

Another Benefit of Hyperbaric Oxygen Therapy: Stroke Recovery

Gary made some progress during his stint in a rehab facility following a serious stroke, but he was unable to drive, walk, or even stand without assistance. So he came to Whitaker Wellness for HBOT. By the time he returned home, hyperbaric oxygen therapy’s benefits were clear: His balance, strength, speech, and swallowing dramatically improved, and he no longer required a wheelchair.

Strokes cut off blood flow in the brain. Deprived of oxygen and glucose, brain cells in the immediate area die and those nearby go into “hibernation”—they’re still alive but nonfunctioning. No therapy can raise the dead, but by flooding the brain with oxygen, HBOT provides the energy needed to revive stunned neurons. It also reduces swelling and activates cell regeneration and angiogenesis, which promote the brain’s ability to develop new connections and compensate for injury.

The ideal time to reap the benefits of hyperbaric oxygen therapy is immediately after a stroke, but that option is rarely offered. Fortunately, HBOT is valuable at any time. Israeli researchers conducted a trial of patients who had enduring deficits from strokes suffered six months to three years earlier. Forty treatments resulted in remarkable improvements in function and quality of life.

Strokes are a leading cause of long-term disability. Don’t all patients deserve a shot at this potentially life-altering treatment?

Hyperbaric Oxygen Therapy Benefits TBIs

Hyperbaric oxygen therapy is, hands down, the best available treatment for another common cause of brain damage: traumatic brain injury (TBI). One of our patients Curtis had lingering problems stemming from a TBI sustained in a childhood bicycle accident. At age 22, his parents brought him to the clinic for HBOT and neurofeedback. After treatment he wrote, “Taking on challenges became easy for me. My coordination was immensely better, and I started using my left hand more. This was an amazing opportunity for me.”

Hall of Fame quarterback Joe Namath is also a proponent of HBOT, based on his own personal experience and his concern about the TBI-related degenerative brain diseases in more and more retired pro football players. Military veterans suffering with TBI or post-traumatic stress disorder (PTSD) rave about HBOT as well.

You’d think neurologists, the Veteran’s Administration, and the National Football League would be on the frontlines promoting the benefits of hyperbaric oxygen therapy, but that isn’t case—for all the wrong reasons. As Kenneth Stoller, MD, explained in a 2015 article, “HBOT is an efficacious, benign and humanitarian way to affect brain repair but it has not been adopted because it lacks patent protection and has no large corporate sponsors. It has also met interference because other agendas are present be they the protection of the status quo, myopic budgetary constraints, or perceived liability issues.”

Hyperbaric Oxygen Therapy Benefits Nearly Everyone

HBOT relieved N.L.’s post-herpetic neuralgia pain and William’s excruciating diabetic neuropathy. It rapidly healed Stephanie’s facial burns and E.B.’s facelift incisions. Cynthia’s Lyme disease-related problems improved dramatically after 40 treatments, and G.G.’s rosacea cleared up with just one. Liam, a six-year-old with autism, became more social and verbal following HBOT and neurofeedback. Ashley had notable improvements in her balance, sensation, vision, and other symptoms of multiple sclerosis.

This therapy has also been demonstrated to improve quality of life in patients with fibromyalgia, terminate acute migraines and cluster headaches, reverse sudden sensorineural hearing loss, and reduce symptoms of ulcerative colitis. HBOT even has an adjunct role in cancer treatment: It sensitizes tumors to radiation and reduces adverse effects of chemo/radiation.

Whitaker Wellness’s hyperbaric department has treated thousands of patients with this safe, versatile therapy. It can cause uncomfortable pressure in the ears and claustrophobia (other safety issues are rare and overblown), but most patients tolerate it well and enjoy their one-hour sessions watching videos, reading, or simply relaxing.

Don’t expect to hear about the benefits of hyperbaric oxygen therapy from your doctor; old biases die hard. But for stubborn conditions that don’t respond to conventional treatments, HBOT is a game changer.

Where to Get Hyperbaric Oxygen Therapy

HBOT is a safe, effective treatment for wounds, strokes, head injuries, and many other conditions.