REVIEW ARTICLES HYPERBARIC-OXYGEN THERAPY (original) (raw)
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The elevation of tissue pO 2 induced by hyperbaric oxygen (HBO) is a physiological stimulus that elicits a variety of cellular responses. These effects are largely mediated by, or in response to, an increase in the production of reactive oxygen and nitrogen species (RONS). The major consequences of elevated RONS include increased oxidative stress and enhanced antioxidant capacity, and modulation of redox-sensitive cell signaling pathways. Interestingly, these phenomena underlie both the therapeutic and potentially toxic effects of HBO. Emerging evidence indicates that supporting mitochondrial health is a potential method of enhancing the therapeutic efficacy of, and preventing oxygen toxicity during, HBO. This review will focus on the cellular consequences of HBO, and explore how these processes mediate a delicate balance of cellular protection versus damage.
Hyperbaric oxygen enhances neutrophil apoptosis and their clearance by monocyte-derived macrophages
Biochemistry and Cell Biology, 2015
Neutrophil apoptosis and clearance by macrophages are essential for wound healing. Evidence suggests that hyperbaric oxygen (HBO) exposure may enhance neutrophil apoptosis, but HBO effects leading to neutrophil clearance by macrophages are still unclear. In the current study, bovine neutrophils and monocyte-derived macrophages (MDMΦ) were co-cultured under HBO (97.9% O2, 2.1% CO2 at 2.4 atm absolute (ATA)) (1 atm = 101.325 kPa), hyperbaric normoxia (8.8% O2 at 2.4 ATA), normobaric hyperoxia (95% O2, 5% CO2), normoxia (air), and normobaric hypoxia (5% O2, 5% CO2). Phagocytosis of fresh and 22 h aged neutrophils by MDMΦ was increased after HBO pre-treatment, assessed using flow cytometry and light microscopy. Enhanced clearance of neutrophils was accompanied by an increase in H2O2 levels following HBO pre-treatment with upregulation of IL-10 (anti-inflammatory cytokine) mRNA expression in LPS-stimulated MDMΦ that had ingested aged neutrophils. TNF-α (pro-inflammatory cytokine) gene ex...
An Update on the Appropriate Role for Hyperbaric Oxygen: Indications and Evidence
Plastic and reconstructive surgery, 2016
Among advanced therapeutic interventions for wounds, hyperbaric oxygen therapy (HBOT) has the unique ability to ameliorate tissue hypoxia, reduce pathologic inflammation, and mitigate ischemia reperfusion injury. Most of the conditions for which it is utilized have few successful alternative treatments, and the morbidity and mortality associated with treatment failure are significant. Data on the efficacy and effectiveness of HBOT were reviewed, comparative effectiveness research of HBOT was explained, and a new paradigm for the appropriate use of HBOT was described. Systematic reviews and randomized controlled trials that have evaluated HBOT were reviewed. Although numerous small randomized controlled trials provide compelling support for HBOT, the physics of the hyperbaric environment create significant barriers to trial design. The electronic health record infrastructure created to satisfy mandatory quality and registry reporting requirements as part of healthcare reform can be h...
Hyperbaric oxygenation as the pretreatment and therapy in ischemia-reperfusion injury
Zdravstvena zastita
Tissue ischemia means insufficient blood flow to a certain area of the body. Interruption of the arterial blood supply leads to an imbalance between metabolic supply and demand and the development of tissue hypoxia. Tissue hypoxia induces metabolic changes that result in inflammation, increased production of reactive oxygen species, and cell death. If adequate blood flow is established in the ischemic tissue, there will be an increase in cellular damage, which is referred to as ischemic-reperfusion injury. Ischemia and ischemia-reperfusion injury are at the root of numerous diseases widely present in modern society, such as myocardial infarction, cerebral insult, acute kidney injury. For now, there is no way to directly affect cellular hypoxia, but the clinical treatment of hypoxic conditions is aimed at modulating global hypoxemia and increasing the amount of oxygen dissolved in the blood. Hyperbaric oxygenation (HBO) is a treatment during which the patient breathes 100% oxygen und...
Safety and efficacy of hyperbaric oxygen therapy in chronic wound management: current evidence
Chronic Wound Care Management and Research, 2015
The breathing of pure oxygen under pressure to treat tissue damage has been employed for almost 45 years and has been investigated in prospective, retrospective, and randomized controlled trials. The physiological effects of oxygen treatment on wound tissue are profound, and include activation of immune cells, changes in cytokine production, and modulation of inflammatory and bactericidal mediators. Hyperbaric oxygen influences the biochemistry of whole cells, altering cell proliferation, angiogenesis, clotting, and tissue regeneration. The precise effects of hyperbaric oxygen on individual cell types and tissues are only beginning to be revealed in both animal and human studies. Many independent studies using hyperbaric oxygen adjunctively with standard wound care have observed improved healing, in particular for diabetic foot ulcers, and can result in a significant reduction in major amputations. Side effects occur infrequently, but myopia, ear barotrauma, and rarely oxygen toxicity have been reported. As antibiotics become less available, and clinician time and complex dressings become more expensive, use of hyperbaric oxygen as a means of treating a variety of wound types may become an increasingly appropriate option for treatment.
Hyperbaric Oxygen Therapy: Side Effects Defined and Quantified
Advances in Wound Care, 2017
Hyperbaric oxygen therapy (HBOT) is an important advanced therapy in the treatment of problem wounds, including diabetic foot ulcers and late effect radiation injury. HBOT remains among the safest therapies used today. Nonetheless, there are side effects associated with HBOT. It is important for providers to be able to identify, understand, and quantify these side effects for prevention, management, and informed consent. Recent Advances: The past two decades have seen significant advancements in our understanding of the underlying mechanisms of HBOT. This has led to a better understanding of the underlying reason for clinical benefit. It has also led to a better understanding of its side effects. Moreover, more recent literature allows for better quantification of these side effects. This review will highlight these side effects. Critical Issues: Wound healing in the case of problem nonhealing wounds requires the use of various advanced treatment modalities, including HBOT. HBOT has been shown to significantly improve healing rates in certain problem wounds, including advanced diabetic foot ulcers and late effect radiation injury. It is provided in a variety of clinical settings by providers with varying levels of expertise. It is important for those providing this therapy to understand the potential side effects. Future Directions: Research in HBOT has led to significant advancements in the area of wound healing. At the same time, there remains a variety of treatment protocols used at different institutions. It is important to quantify risk and benefit at different treatment pressures and times to better standardize treatment and improve patient care.
Life sciences, 2013
Neutrophil apoptosis is important in the resolution of inflammation in chronic wounds. Hyperbaric oxygen (HBO) therapy, an intermittent inhalation of 100% oxygen at greater than atmospheric pressure, appears to be an effective treatment for chronic wounds. The aim was to use HL-60 cells differentiated using all-trans retinoic acid (ATRA) (neutrophil-like cells) to test the hypothesis that an HBO-induced increase in antimicrobial activity might lead to an increase in apoptosis, thereby contributing to neutrophil clearance from chronic wounds. ATRA differentiated HL-60 cells, an in vitro neutrophil model, were used to test the effects of normoxia, hypoxia (5% O2), hyperoxia (95% O2), hyperbaric normoxia (pressure) (8.8% O2 at 2.4 ATA) and HBO (97.9% O2 at 2.4 ATA) on antimicrobial function [NBT staining, superoxide and H2O2 production, and phagocytosis activity] and apoptosis (caspase 3/7 activity and morphological changes observed using SYBR Safe staining). A single 90min HBO exposur...
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 2001
Hyperbaric oxygen (HBO) therapy, that is the administration of 100% oxygen delivered under pressure, has a beneficial effect in several surgical conditions. Its use has been assessed and audited and its pharmacological effects demonstrated. It is appropriate for use in several surgical conditions as evidence-based therapy. These are: (i) gas gangrene; (ii) crush injuries, compartment syndromes and acute traumatic ischemias; (iii) enhancement of healing in selected problem wounds; (iv) exceptional blood loss anaemia; (v) necrotising soft-tissue infections; (vi) refractory osteomyelitis; (vii) radionecrosis; (viii) compromised skin grafts and flaps; (ix) thermal burns; (x) intracranial abscess. HBO therapy has been used inappropriately in the past; there is also lack of knowledge regarding its application, and scarce hyperbaric facilities. Hyperbaric therapy, when properly supervised by a physician trained in its use, working closely with a surgeon, and ethically used for appropriate ...