Hyperbaric Oxygen Therapy (HBO) at
Pacific Medical Center of Hope
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Hyperbaric Medicine is the fascinating use of barometric pressure for delivering increased oxygen dissolved in plasma to body tissues. Hyperbaric oxygen therapy (HBO) is a form of treatment in which a patient breathes 100% oxygen at higher than normal atmospheric pressure that is greater than 1 atmosphere absolute (ATA). Therapy is given in special therapeutic chambers, which were earlier used primarily to treat illnesses of deep sea divers. In the sixties HBO went out of practice because of its use without adequate scientific validation. Over the last two decades, animal studies, clinical trials and well-validated clinical experience has proved the efficacy of HBO in many indications and there is recently a renewed interest in this field all over the world. Acute traumatic wounds, Crush injuries, Burns, Gas gangrene and compartment syndrome are indications where the addition of Hyperbaric oxygen may be life and limb saving. Patients who have been suffering with non healing ulcers, Decubitus Ulcers (Bed sores) and all late sequelae of Radiation therapy are also benefited with HBO therapy. Acute hearing loss and many neurological illnesses are also now known to possibly benefit from Hyperbaric Oxygen Therapy. With continuing growth all over the world Hyperbaric Medicine has found a distinct role in the modern era of evidence-based medicine. This article aims to give a brief overview of the rationale, existing trends and applications of this therapy.
There is promising data being published about the usage of Hyperbaric Oxygen in Diabetes, to the point that even medical insurances now pay for this type of treatment in certain indications, diabetic foot being one of them.

Alternative uses of HBOT include destroying disease-causing microorganisms, such as Lyme spirochete, Cancer, Chronic fatigue syndrome, and Fibromyalgia and interstitial cystitis and many other conditions. A few supporters also claim that HBOT helps patients with AIDS, arthritis, sports injuries, multiple sclerosis, autism, stroke, cerebral palsy, senility, cirrhosis, Lyme disease, and gastrointestinal ulcers.
Looking into the literature being published by highly validated institutions across the world, points into the usefulness of this highly advanced technique in a variety of conditions. Understanding the concept of such care facilitates the comprehension of its usage. Oxygen in higher pressures than normal can cause constriction of vessels and lowers the inflammation. At the same time, enhancing the immune system and sesitizing the cancer cell against radiation and chemotherapy has been shown in many studies. Such cancer cells are sometimes killed easier and with less side effects compared to conventional treatments. Breast, ovaries, cervical, and even brain cancer cells have shown promising results to this modality (refer to literature).

Autistic children and teenagers, adults with ADHD, and patients with Fibromyalgia and depression may suffer from similar immune imbalances contributing to their disease. By administering the HBO therapy some have improved significantly. There are double blinded randomized controlled trials and studies that reveal the implication of hyperbaric oxygen in some of these conditions, with impressive results.
Recently the U.S. Food and Drug Administration (FDA) has approved photosensitizing agents to treat or relieve the symptoms of esophageal cancer and non-small cell lung cancer. This treatment is approved to relieve symptoms when the cancer obstructs the esophagus or when the cancer cannot be satisfactorily treated with a laser alone. In such circumstances HBO can also be helpful in augmenting the therapy.

In Diabetes, impaired circulation caused by micro and macro vascular complications and inflammation results in extremity wounds and ulcers. Poor circulation and atherosclerosis is common for heart and by using hyperbaric therapy the circulation can improve with healing wounds and ulcer sand improved circulation and inflammation.
In Multiple Sclerosis and Parkinson Disease there is strong evidence showing the correlation of free radicals and inflammatory disease involvement. Over activity of the immune system puts MS in the autoimmune category of diseases and most of the conventional therapies are targeted to lower the immune response (such as steroids and interferone). HBO can offer a positive effect on both conditions by reducing the inflammation and lowering the gamma interferone.

In brain traumatic injury, HBO has been offered as an effective modality to benefit the victims immediately after the insult. Many year later there is great interest in the current research being dome for such patients coming back from war, or just suffering from an accident.
In  Eye disorders such as Macular degeneration and retinal artery occlusion, there are case reports of actual REVERSING the disease published independently.
Rationale for Hyperbaric Oxygen Therapy in the treatment of neurological illnesses :

The rationale use of Hyperbaric Oxygen in neurological indications is based on the finding in SPECT studies that around the central area of neuronal death is the penumbra: peri-infarct zone having hibernating/idling or sleeping neurons and gliosis (dead neurons) on CT scans may actually be viable tissue for years following the insult. HBO delivers high Oxygen to these “sleeping cells” and reactivates them. It also reduces edemas and reverses the reduced flexibility of erythrocytes. This is the basis of its use in acute stroke, post-traumatic brain injuries and cerebral palsy.

The mechanism of action: The possible mechanism of action of HBO in neurological disorders is relief of hypoxia, improvement of microcirculation and cerebral metabolism, reduced cerebral edema by vasoconstrictive effect, increases the permeability of the blood-brain barrier and preservation of partially damaged tissue and prevention of further progression of secondary effects of cerebral lesions.
 
Indications for HBOT in neurological illnesses
Cerebrovascular accidents (stroke): The reported rate of improvement is 40% to 100%, which is much higher than the natural rate of recovery. It shows a striking reduction in spasticity possibly due to improved function of neurons in affected areas or the brain and secondly to rise of PO2 in the spastic inactive and hypoxic muscle. Additionally there is an improvement in the cognitive and mental performance. The major criticism is that none of the reported studies are random controlled.

Acute traumatic brain injuries: HBO causes a reduction of CBF thus reducing intracranial tension yet providing concomitant high doses of Oxygen to the brain. It interrupts the cycle of Ischemia, Hypoxia, edema and enzymatic derangements. There is improved aerobic metabolism, reduction in lactate levels, an increase in creatinine phosphate and ATP levels. Elevation of partial pressure of Oxygen increases the diffusion distance, and O2 delivery in abnormal areas is enhanced. However, there has to be a responsive cerebral circulation. It is contraindicated when a stage of vasomotor paralysis has developed, and must not have fixed and dilated pupils. Most favorable results are obtained in patients in mid level Glasgow Coma scales.
Spinal cord injury: There is evidence that it is useful in Spinal cord traumas especially if administered within the first 4 hours and for the subsequent rehabilitation of Spinal damage patients.
Cerebral Palsy: Evidence now shows that HBO therapy may dramatically improve some CP symptoms – spasticity, vision, hearing, and speech. However, improvement, if any, will vary from patient to patient. More oxygen may help many children with cerebral palsy, but it is NOT a cure. It is simply a way of ensuring the most complete recovery possible and must be combined with other therapies.
Bell’s Palsy: Steroids and surgical decompression are the only treatment used currently but the results are inconclusive as to their benefit. HBO added to other treatment increases the efficacy of the treatment and reduces the period needed for restoration of complete function of the damaged nerve.

Usage in Cancer: Cancer cell lines have been exposed to hyperbaric oxygen and they have not been able to tolerate such environment due to the fact that relys on anaerobic glycolysis pathways to produce and consume energy. Some studies have shown the radio-sensitizing effect of oxygen (Oxygen makes the cancer cell more sensitive to radiation and even chemotherapy by enhancing tee production of free radicals). Also Oxygen can protect the normal tissue from harm when exposed to radiation. That is why everyone who undergoes radiation therapy receives oxygen therapy at our clinic the same day before his/ her radiation. National Cancer Institute is running clinical trials on usage of HBOT in cancer patients. Invitro studies have shown results in the breast, ovarian, lung, Brain (along with radiation), and many other types of cancer. Please refer to extensive literature available in this website for more information. Just click on Medical Literature.  

                       
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