Hyperbaric oxygen therapy refers to the medicinal use of oxygen respiration at 100% concentration and elevated pressures. These treatments usually are carried out in devices that allow compression, such as hyperbaric chambers. The effects of hyperbaric oxygen therapy are multiple and are mainly explained by three mechanisms: 1. Hydrostatic pressure and removal of inert gases from the tissues. 2. The pharmacological effect of high blood oxygen concentrations. 3. Oxygenation of hypoxic tissues. All this translates into antiischemic, regenerative, and even antimicrobial effects that facilitate its use in multiple diseases.
Among the routine indications are:
1. Gas embolism/decompression sickness: reducing the size of the bubbles (air or nitrogen), thus reducing the risk of heart attack.
2. Carbon monoxide poisoning: reducing its half-life to approximately 20 minutes, which prevents damage from taking place.
3. Gas gangrene: the use of hyperbaric oxygen therapy limits the production of aflatoxins due to the increase in oxygen tension, which increases success with other measures such as anti-biotherapy and surgery.
4. Traumatic ischemias and compartment syndrome: increasing reperfusion, also due to increased oxygen tension.
5. Wounds that do not heal: with increased oxygen tension, bacterial proliferation decreases, and leukocyte antimicrobial activity increases. It also increases graft survival.
6. Blood loss: increasing the oxygen concentration ensures that there is better delivery to the tissues.
7. Necrotizing soft tissue infections: increasing the oxygen supply to the wound, decreases bacterial proliferation, especially anaerobes, and increases leukocyte antimicrobial activity.
8. Refractory osteomyelitis: favoring angiogenesis, tissue oxygenation, and increasing osteoclast activity, which facilitates the removal of necrotic tissue.
9. Radiation injuries (soft tissues or bone necrosis): due to the high doses of radiation, endarteritis can occur, which decreases the flow of oxygen to the tissues. Hyperbaric oxygen therapy induces angiogenesis that improves the healing process.
10. Heat burns: The therapy reduces fluid retention, guarantees that the edges remain viable, and improves the microvasculature, favoring the healing process.
11. Idiopathic acute sensorineural hearing loss: increasing the supply of oxygen to the cochlea, improves the results of other adjuvant therapies.
Regarding emerging uses, there are some reports of improvement in patients with post-concussion symptoms following concussions or mild CTE. Based on preclinical studies, it has been suggested that this may happen by preventing cell death as a result of reduced inflammation and stabilization of the blood-brain barrier.
Hyperbaric oxygen therapy has been reported to be useful for acute management of migraine and cluster headache. As well as trigeminal neuralgia and Complex Regional Pain Syndrome. It has been suggested that this pain control is achieved by altering the release of nitric oxide-dependent neuronal opioid peptides.
Different groups have additionally shown that patients suffering from fibromyalgia have decreased pain intensity and fewer trigger points when undergoing hyperbaric oxygen therapy.
The effects of hyperbaric oxygen therapy have been evaluated on liver health. Thus, it has been seen that this therapy helps the regeneration of the liver after surgeries such as hepatectomy, as it happens in donor patients of this organ.
The effects of this therapy have also been evaluated in different urological conditions. As is the case of interstitial cystitis, decreasing submucosal edema, inflammation, and fibrosis in the bladder walls. Which has led to symptomatic improvement that has been reported up to 12 months after finishing the therapies.
As can be seen, hyperbaric oxygen therapy has a variety of medical applications that can benefit from its use, reducing the concomitant use of medications such as anti-inflammatory drugs that can produce adverse effects on the body. The only absolute contraindication of hyperbaric oxygen therapy is the presence of pneumothorax, so there should always be a prior medical evaluation to identify if there are alterations that proscribe its use.
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