There is a good NEJM article from 1996 which goes through the various applications of hyperbaric oxygen therapy. It also describes it as "a good treatment in search of a disease". Hilariously, ventilation of a hypoxic patient is not among these. So exotic and uncoordinated the application of this therapy, that I could not find any other place to put this chapter, even among the miscellaneous entries. It has only come up once, in Question 2 from the second paper of 2003.

Rationale for the use of hyperbaric oxygen

  • 100% FiO2 at 3 times the normal atmospheric pressure equates to a tissue oxygen tension ~ 400mmHg
  • This has been proposed as a treatment for conditions in which tissue oxygenation is for whatever reason reversibly and dangerously impaired.
  • Anaerobic bacteria are unable to reproduce at such a high oxygen tension, and HBOT may improve the effectivenes of antibiotics in such infections.

Indications for the use of hyperbaric oxygen

  • Carbon monoxide poisoning
  • Arterial gas embolism, eg. decompression sickness
  • Clostridial myonecrosis
  • Necrotising fasciitis
  • Refractory osteomyelitis
  • Compromised skin grafts/flaps
  • Severe burns
  • Catastrophic anaemia (life without haemoglobin is possible)
  • Compartment syndrome
  • Burns
  • Radiation necrosis

Contraindications to the use of hyperbaric oxygen

  • Untreated tension pneumothorax
  • Therapy with the following drugs:
    • Doxorubicin
    • Cisplatin
    • Disulfiram
    • Mafenide

Adverse effects

  • Safe when limited 120 minutes
  • Myopia (revrsible)
  • Cataract formation
  • Rupture of the middle ear and cranial sinuses
  • Seizures
  • Claustrophobia
  • Pulmonary irritation and pulmonary oedema

Evidence

References

Shaw, Joshua J., et al. "Not Just Full of Hot Air: Hyperbaric Oxygen Therapy Increases Survival in Cases of Necrotizing Soft Tissue Infections." Surgical infections (2012).

 

Buckley, Nick A., et al. "Hyperbaric oxygen for carbon monoxide poisoning."Cochrane Database Syst Rev 4 (2011).

 

Stoekenbroek, R. M., et al. "Hyperbaric Oxygen for the Treatment of Diabetic Foot Ulcers: A Systematic Review." European Journal of Vascular and Endovascular Surgery 47.6 (2014): 647-655.

 

Eskes, Anne M., et al. "Hyperbaric oxygen therapy: solution for difficult to heal acute wounds? Systematic review." World journal of surgery 35.3 (2011): 535-542.

 

Tibbles, Patrick M., and John S. Edelsberg. "Hyperbaric-oxygen therapy." New England Journal of Medicine 334.25 (1996): 1642-1648.

 

Thom, Stephen R. "Hyperbaric oxygen–its mechanisms and efficacy." Plastic and reconstructive surgery 127.Suppl 1 (2011): 131S.