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
- Radiation necrosis
Contraindications to the use of hyperbaric oxygen
- Untreated tension pneumothorax
- Therapy with the following drugs:
- Safe when limited 120 minutes
- Myopia (revrsible)
- Cataract formation
- Rupture of the middle ear and cranial sinuses
- Pulmonary irritation and pulmonary oedema