Hyperbaric oxygen therapy

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

• Mainly case series and case reports
• Not strongly supported by evidence
  • Some support for difficult wounds
  • Some support for diabetic foot disease
  • Some support for severe soft tissue infections
  • Not much support for carbon monoxide poisoning