What is HBO ?
Hyperbaric Oxygen Therapy (HBO, HBOT) is a special medical treatment that has been successfully applied for decades and worldwide. In a hyperbaric oxygen therapy chamber, patients inhale pure oxygen through respiratory masks at a higher than atmospheric pressure. It has been proved scientifically that the amount of oxygen dissolved in blood-plasma and lymph particularly increases throughout this form of treatment compared to any other method using oxygen. Especially inflamed tissue that is insufficiently supplied with oxygen can be cured by means of this treatment which stimulates the body’s production of small blood vessels, bones and connective tissue, as well as its natural defense mechanisms. In addition, edema becomes reduced and the cells’ metabolism normalized.
These are only a few of the healing effects of Hyperbaric Oxygen Therapy (HBO).
Several therapeutic principles are made use of in HBOT:
The increased atmospheric pressure in the chamber is of therapeutic value when HBO is used in the treatment of decompression sickness and air embolism.
For many other conditions, the therapeutic principle of HBO lies in a drastically increased partial pressure of oxygen in the tissues of the body. The oxygen partial pressures achievable under HBO are much higher than those under breathing pure oxygen at normal atmospheric pressure.
A related effect is the increased oxygen transport capacity of the blood. Under normal atmospheric pressure, oxygen transport is limited by the oxygen binding capacity of hemoglobin in red blood cells and very little oxygen is transported by blood plasma. Because the hemoglobin of the red blood cells is almost saturated with oxygen under normal atmospheric pressure, this route of transport can not be exploited any further. Oxygen transport by plasma however is significantly increased under HBO only dependant of the pressure applied.
When do you use HBO?
- To support other measures for treatment of diseases
When standard treatments are not possible (contraindications etc.)
To save life, to avoid amputation and invalidity
To reduce the time for healing and hospitalisation
According to the recommendations of the involved medical scientific societies as
Undersea and Hyperbaric Medical Society (UHMS), USA
Club Francais de Medicine Hyperbare
European Council of Hyperbaric Medicine (ECHM)
European Baromedical Society ( EUBS )
German Society for Diving- and Hyperbaric Medicine (GTÜM)
German Professional Society of Hyperbaric Chambers (VDD)
Strongly recommended indications
decompression sickness
air or gas embolism
carbonmonoxyd poisoning ( specially during pregnancy) to prevent neurological, psychiatric and psychological symptoms - irrespective of COHb
necrotising infections of soft tissues ( gas-gangrene, necrotising fasciitis, fournier-gangrene)
diabetic foot ulcers (selected cases)
Recommended indications
crush wounds, comparment syndrome and acute ischaemia (traumatic or vascular basis)
skin grafts and flaps (Compromised)
exceptional blood loss anaemia
refractory osteomyelitis - specially scull and sternum
acute acoustic trauma
otitis externa maligna (necroticans)
sudden deafness
ischaemic lesions in diabetes (after vascular reconstruction)
ischaemic atherosclerotic lesions (after vascular reconstruction)
bone and soft Tissue radiation necrosis (after vascular reconstruction)
neuroblastoma stadium IV – recidiv (after vascular reconstruction)
brain abscess (selected cases) (after vascular reconstruction)
prevention of osteoradionecrosis after tooth extraction in radiated jaws (after vascular reconstruction)
late radiation injury (soft tissue and bone i.e. proctitis, cystitis, breast swelling)
osteoradionecrosis spec. jaws
Optional indications
enhancement of healing in certain problem wounds
thermal burns (second degree or more)
post anoxic encephalopathy
acute opthalmologic ischaemia
support of implantations in radiated jaws
radiation necrosis (intestinal and other)
Investigational indications
migraine
cerebral palsy
sequelae of traumatic brain injuries
borreliosis (Lyme disease)
Compromised skin grafts and flapss
Reconstructing complex wounds is accomplished by shifting or transferring tissues to the wound from a different part of the body. When operative repair is necessary, surgeons turn to the reconstructive ladder, a series of graft and flap options of increasing complexity. For skin grafts to be considered, the recipient bed must be of the health and quality to accept and nourish a graft. This is critical, as such grafts are immediately rendered ischemic/hypoxic upon harvest. Availability of oxygen is critical to the success of any skin grafting procedure, and subsequent graft durability. Many scientific publications chronicle the role of oxygen in the healing process, and conclude with the application of HBO therapy in wound healing and limb salvage. Such application is designed to either:
prepare the recipient bed for definitive coverage (grafts or flaps)
it is recognized that, in some cases, the therapeutic effect of HBO will be such that skin grafting may be unnecessary
support skin graft or skin flap procedures, in the immediate post-operative setting
Skin grafts survive as oxygen and nutrients diffuse into them from the underlying wound bed. Long-term survival depends on a new blood supply forming from the wound to the graft. When the wound bed does not have enough oxygen supplied to it, the skin graft will at least partially fail. Common causes for this are previous radiation to the wound area, diabetes mellitus, and certain infections. In these situations, the availability of oxygen in the wound bed can be increased with hyperbaric oxygen therapy in preparation for skin grafting. Additionally, HBO can be used after skin grafting to increase the amount of the graft that will survive in these compromised settings.
Flaps also require oxygen and nutrients to survive. The outer, visible portion (usually skin) is furthest from the source of blood supply for the flap. This is the area most likely to be compromised by inadequate oxygen. Factors such as age, nutritional status, smoking, and previous radiation result in an unpredictable pattern of blood flow to the skin. If a flap is found to have less than adequate oxygen after it has been transferred, HBO can help minimize the amount of tissue which does not survive and also reduce the need for repeat flap procedures.
Partial or complete failure of the wound reconstruction is very difficult for a patient and also very expensive. HBO can help by assisting in the preparation and salvage of skin grafts and compromised flaps.
See also: (http://en.wikipedia.org/wiki/Hyperbaric_oxygen_therapy)
