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What is it?

Hyperbaric Oxygen theraphy means overpressure or high-pressure. So in Hyperbaric oxygen therapy (HBOT), you will be breathing in 100% oxygen while under increased atmospheric pressure. You will be resting in a pressurized chamber to a higher level than atmospheric pressure. In an HBOT chamber, the air pressure is increased from two to three times higher than normal air pressure. This pressurized condition allows the lungs to receive more oxygen than under normal air pressure. This therapy is used clinically in different ways to treat several medical conditions.

HBOT as a treatment arose in the 1600s. A British clergyman named Henshaw built the first hyperbaric chamber and used it to treat many diseases. A French surgeon Fontaine continued with his version of treating patients under increased pressure in 1879. In 1928, Dr. Orville Cunningham, a professor of anaesthesia, erected a pressurized structure that was known as the “Steel Ball Hospital.” The clinical setting could reach up to 3 atmospheres of pressure. This pressurized oxygen cured a patient of flu.

HBOT has gained acceptance in recent years as an adjunctive treatment in human medicine. Today, there is a surge in the research on the physiology of pressure and access to hyperbaric equipment. The clinical application of hyperbaric therapy has grown with these demands.

How does it work?

Blood carries oxygen throughout our body. An adequate supply of oxygen is essential for body tissues to function. Damaged or harmed tissues demand an increased oxygen level to promote healing and to fight infections.

The cardio-respiratory system plays a vital role in maintaining adequate oxygen levels in the body. It allows the cells to meet their ongoing demand both in health and disease. Under normal conditions, oxygen delivery is a demand-driven process. Meaning, the amount of oxygen delivered is controlled by the amount of oxygen required by the cells.

Sometimes, due to pathological conditions, the cardio-respiratory system may be unable to provide enough oxygen to the tissues. This is why intensive care patients must receive bulk oxygen transport frequently. However, this is only the first part of the process involved in the ultimate delivery of oxygen. The rest of it makes sure the oxygen reaches the tissues.

Microcirculation is the circulation of blood in the smallest of blood vessels. It can be affected by damaged tissue capillaries due to therapeutic radiation, diabetes, burns, infection, and other injuries. Impaired microcirculation can prevent red blood cells from reaching tissues and delivering oxygen, resulting in tissue hypoxia, tissue breakdown, and impaired healing. In HBOT, the high dissolved oxygen levels can overcome even the impaired microcirculation.

Oxygen in the plasma can travel much farther into the tissues than the oxygen carried by haemoglobin in the red blood cells. This stimulates the release of substances called growth factors and stem cells to fight against infection and tissue trauma. HBOT helps maintain the storage of gases in the blood under normal conditions. It stimulates tissue function and promotes healing.

It involves the following steps:
  • Oxygen from the atmosphere reaches the alveolus, which is the gas-fluid interface in the lungs. Here it diffuses to the capillary blood where it gets transported to all parts of the body. Now, the heart’s pumping distributes oxygen to the body till the smallest blood vessels.
  • Finally, oxygen is released from haemoglobin and diffuses into the cells where it helps maintain cell functions.

Thus, HBOT is hypothesized as an alternative means to increase oxygenation of tissues than standard respiratory and ventilator treatments.

Hyperbaric chamber

It is a pressurized chamber in which people can undergo Hyperbaric Oxygen Therapy. Patients can sit or lie comfortably in these chambers. They can relax and take deep breaths during these sessions. Each session may last up to 2 hours.

Hyperbaric chambers are of two major categories based on their construction:

  • A mono-place hyperbaric chamber can accommodate a single person at a time and is pressurized with 100% oxygen
  • A multi-place hyperbaric chamber can hold more than one person at a time. Here, the patient inside the pressurized chamber will inhale oxygen through either a head tent or a mask.

In both types, the patient breathes 100% oxygen while subject to increased ambient pressure. The session is monitored under precautionary measures by a qualified hyperbaric technician. The treatment is painless as the patient lies on the bed or rests on a seat.

Some patients might experience mild discomfort during the pressurization stage. Due to increased air pressure, your ears might feel blocked, similar to when on an airplane. There are ways like simple swallowing or chewing gum to relieve this ear pressure. There have been no major side effects except for temporary lightheadedness or ear pain in some people after the session.

Benefits of HBOT

 

Hyperbaric oxygen normalizes and regulates all biological functions as it prevents or corrects hypoxia, which is the underlying factor for almost all ailments. HBOT also stimulates the immune system and strengthens skin.

A person undergoing HBOT can heal wounds anywhere in the body, decrease wound healing time through increased efficiency, enhance the brain’s ability to regain neurologic function, reducing swelling/pain and lead an improved quality of life

Some of the commonly applied medical benefits of HBOT are:

Better Wound Healing
Prevents reperfusion injury
Boosts the immune system

Better Wound Healing

The blood vessels in our body often get damaged by wound injuries. They release fluids that accumulate into the tissues and cause swelling. This swelling deprives the damaged cells of oxygen and leads to cell death.

HBOT brings oxygen-rich plasma to oxygen-deprived tissues. Flooding of these tissues with oxygen reduces their swelling. HBOT aims to break the cycle of swelling, oxygen starvation, and tissue death.

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Prevents reperfusion injury

When blood supply returns to the tissues after they have been oxygen-deprived, there is severe tissue damage, also called reperfusion injury. The sudden interruption of blood flow to these tissues leads to a series of events inside the damaged cells resulting in the release of harmful free oxygen radicals. These radicals can cause irreversible tissue damage, leading to blocked blood vessels and cessation of blood flow and healing.

When exposed to pressurized oxygen, the body’s scavengers feed on free oxygen radicals and thus allow the healing of cells.

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Impedes the action of harmful microbes and boosts the immune system

Increased oxygen concentration in tissues can restrict certain pathogens and resist infection. Also, HBOT improves the ability of white blood cells to search and destroy invaders.

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Promotes collagen formation
Hyperventilation
Improves Glasgow Coma Score (GCS)
Decompression

Promotes collagen formation

Pressurized oxygen encourages the growth of blood vessels as it stimulates cells to produce certain substances like vascular endothelial growth factors. Endothelial cells thus activated, are necessary for collagen production.

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Hyperventilation

Increased levels of oxygen and decreasing levels of carbon dioxide in the blood can significantly enhance respiratory symptoms.

HBOT dissolves oxygen into the blood, body fluids, cerebrospinal fluid, bone tissue, and lymph nodes. Oxygen-rich fluids in the body can then travel to areas where blood circulation is blocked.

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Improves Glasgow Coma Score (GCS)

In people with traumatic brain injury and suffering acute neurocognitive impairments, the usage of HBOT has been safe and effective in improving brain function. HBOT has reduced the risk of death and boosted the final GCS and reduced the duration of hospital stay.

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Decompression

A hyperbaric chamber is also known as a decompression or recompression chamber. For instance, when a diver ascends too quickly, they suffer damages from an increased difference in pressure formed in a short time. It can lead to decompression sickness.

HBOT eliminates nitrogen bubbles from the blood and encourages the cells of the body to repair themselves. The hyperbaric chamber decompresses under emergency medical situations. It is the definitive treatment for pressure-related diving wounds.

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Conditions Treated

Recent scientific studies have proven that many injuries and illnesses involve the lack of oxygen-rich blood. As a result, oxygen is unable to travel to affected areas of the body. This lack of oxygen is called hypoxia.

The most prevalent condition is the case of diabetes. Here, slowed circulation makes it difficult for oxygen-rich red blood cells to reach wounded areas of the skin. As a result, these injuries heal slowly or do not heal at all.

HBOT is being used to treat many different medical conditions and injuries by increasing the level of oxygen in the tissues. Hyperbaric oxygen therapy is a stand-alone treatment or a procedure that can enhance the action of medicines, such as antibiotics. In all circumstances, it is advisable to consult a doctor or health care professional before undergoing HBOT.

Treatment of COVID-19

As per the limited recent research conducted on severely ill patients suffering from COVID-19 and severe shortness of breath and those on ventilator, HBOT has proved as a life saving therapy. For patients with severe shortness of breath, five sessions of HBOT and for those on ventilator, twenty sessions of HBOT were done. After the sessions, the patients were out of the critically ill status and recovered.

Anti Aging

Body cells (including skin cells) get damaged as the body ages and also due to the toxic environment that we get exposed to. HBOT helps by combating these degenerative conditions by putting the life back into such cells and tissues and helps in regeneration and growth of new cells and tissues. Hyperbaric Oxygen Therapy helps in stem cell proliferation and mobilization that helps in reducing the speed at which a body ages.

Severe Anemia

Reduction in the haemoglobin cells (due to any medical condition) of the blood in the body results in lesser oxygen carrying capacity of the blood to muscles and tissues. Such people become perfect candidates for Hyperbaric Oxygen Therapy. Making them inhale more oxygen than they would normally get from the atmosphere, fills up their blood cells with more oxygen effectively reducing the risks associated with lack of haemoglobin cells.

Treating Fibromyalgia with HBOT

As the currently available treatment options are partially effective, HBOT helps patients suffering from fibromyalgia by relieving some of their symptoms. HBOT therapy significantly reduced pain, symptoms of anxiety, fatigue and overall severity of symptoms in 87% of the test subjects in a study.

Sport Injuries treatment with HBOT

A study performed to evaluate the effectiveness of HBOT for treating injuries caused during sports has revealed that HBOT helped in early recovery from muscular injury by accelerating cell recovery and tissue repair. A significant improvement in muscular enzymes in the patients pointed towards the positive effects of HBO Therapy.

Foot wound healing in diabetic patients

In diabetic patients suffering from foot ulcers or wounds, it becomes difficult for the wounds to heal and many times lead to amputation. Hyperbaric Oxygen Therapy comes to the rescue of such patients. Various cellular and biomechanical processes that help in wound healing require adequate supply of oxygen. Applying HBOT, supplies enough oxygen to such areas and help in healing the wounds preventing the need of amputation.

Stroke recovery with HBOT

Strokes cause damage to the brain cells and leads to their death by disrupting the flow of oxygen. Depending on the area of the brain that is affected, that particular functionality of the body may be lost. HBOT has proven to restore the damaged cells and generate new connections in the brain there by bringing back the normal functionality of the damaged brain parts. Even after several years after suffering from stroke, HBOT has reversed or reduced the disabilities.

Heart disease treatment with HBOT

When the arteries that supply blood to the heart are blocked, that results in acute heart attack and severe heart pain. Based on a research done on a small set of people who have suffered heart attack, hyperbaric oxygen therapy has shown that the death rate among them has significantly reduced. It has also shown that they experienced rapid pain relief and the chances of them facing adverse events in future also went down.

Infertility treatment with HBOT

In women, HBOT has shown improvement of endometrial oxygenation and vascularisation with better egg quality, better embryo quality, better response to ovarian stimulation and higher pregnancy rate. In men, higher motility of sperms and less DNA fragmentation has been shown with the application of Hyperbaric Oxygen Therapy.

Erectile Dysfunction treatment with HBOT

HBOT has shown a significant improvement in 80 to 88% of men suffering from Erectile Dysfunction. HBO Therapy induced angiogenesis (development of new blood vessels that feed the tissues in the penis) that helped the patients recover from Erection problems. HBOT has also shown that that ED that was acquired many years ago can also be cured.

Acute traumatic ischemia

This happens when an injury interrupts blood flow to a part of the body, mostly an extremity. For example, open fractures may tear major arteries and affects microcirculation. HBOT shows promise when used with orthopaedic surgery by decreasing complications from severe crush injuries. HBOT increases oxygen delivery to the injured tissues, reduces swelling, and provides an environment enhanced for healing and fighting infection.

Diabetic wounds and ulcers

HBOT improves wound tissue hypoxia, among other effects, making it useful in clinical practice for problem wounds such as diabetic foot ulcers. These benefits can powerfully reduce the risk of lower-extremity amputation in diabetic patients with foot wounds.

Thermal burns

HBOT is beneficial in reducing edema, decreasing fluid requirements, preserving dermal structures with improved vascularity. It also increases the immune response that can improve healing, reduce hospital stay, and decrease the need for surgery.

Actinomycosis

It is a chronic bacterial disease that causes wounds or abscesses in the soft tissues. HBOT is effective in eliminating the microorganisms that cause actinomycosis by stimulating the body's immune system.

Necrotizing soft tissue infection

It is a rare but serious bacterial infection that affects the tissue beneath the skin and surrounding muscles and organs. The infected tissue is known to be hypoxic as there is impaired diffusion and edema. Here, HBOT can improve the functioning of the immune system, by increasing the oxygen levels within the infected tissue.

Refractory Osteomyelitis

It is a recurring bone infection that lasts longer than six months. HBOT works uniquely by stimulating the system that maintains bone growth. Since this system is oxygen dependent, HBOT provides a win-win situation.

Smoke inhalation and carbon monoxide poisoning

HBOT can instantly reduce the carbon monoxide level in the blood. Oxygen therapy can reduce the amount of carbon monoxide in the blood and restore the oxygen level to normal as quickly as possible.

Radiation injury

HBOT is the best treatment for patients who suffer from the effects of radiation exposure, such as in cancer treatment. It prevents irreversible bone, tissue loss and prepares them to undergo life-improving reconstructive procedures.

Peripheral arterial occlusive disease

It is a common disease that results in critical limb ischemia, non-healing ulcers, and amputation. Exposure to hyperbaric oxygen improves immune response, clears infection, enhances tissue growth, and angiogenesis. This leads to continuous improvement in local tissue oxygenation and the healing of hypoxic wounds.

Skin grafts and flaps

Here there is decreased diffusion of oxygen or hypoxia. Hyperbaric oxygen can help maximize the viability of the compromised tissue, thereby reducing the need for re-grafting or repeat surgical flap procedures.

Gas gangrene

It is a grave spread of infections produced by a group of bacteria of the clostridial group. The addition of HBOT for managing gas gangrene is cooperative in reducing morbidity and mortality.

Traumatic brain injury

A brain injury results in a temporary or permanent impairment of cognitive, emotional, and physical function. The addition of HBOT in the management can significantly improve outcomes and quality of life and reduce the risk of complications.