History
In the 17th century bridge construction demanded workers dive to great underwater depths with the introduction of caissons (a chamber, usually of steel but sometimes of wood or reinforced concrete, used in the construction of foundations or piers in or near a body of water). The air in the chamber is kept under pressure great enough to prevent the entrance of water, while shafts through the bulkhead permit the passage of workers, equipment, and excavated material between the bottom and the surface. Workers frequently suffered from caisson’s disease (the “bends”) and were treated in metallic vessels large enough to hold people and strong enough to hold air under pressure. These vessels, combined with newly-developed air compressors, resulted in the enabled treatment of patients with hyperbaric air decompression. This represented the first reports of decompression sickness; the caisson workers assumed a bent posture (the “bends”) to help relieve the pain caused by nucleation of accrued nitrogen in their joints as they emerged from depths of up to 70 feet.
Conventional western medicine uses HBOT to treat the following:
Uncontrolled Decompression during Diving: results in one of two types of decompression sickness (DCS).
*DCS I involves only the extremities (arms/legs) and the joints
*DCS II involves the central nervous system (brain/spinal cord)
Treatment involves recompressing the patient in 100% oxygen, followed by controlled decompression using data developed by the U.S. Navy.
Carbon Monoxide Poisoning: This colorless, odorless gas passes readily through alveoli (lung tissue air sacs) into the blood where it binds tightly to oxygen-carrying proteins in the blood (hemoglobin). Carbon monoxide also locks up the energy factory machinery (cytochrome system) inside each cell’s mitochondria. This prevents our bodies from being able to use oxygen. The use of HBOT to treat carbon monoxide poisoning is controversial. It is used to prevent/treat the development of neurologic injury in patients with severe exposure to this deadly gas. Usually, patients undergo one or two 90-minute treatments at 2-3 atmospheres (2-3 times the atmospheric pressure at sea level).
Difficult Wounds: Chronic, non-healing wounds are found in a variety of clinical patients. Recent data has supported the use of HBOT in the treatment of non-healing wounds caused by irradiation. There is less data to support the use of HBOT in other clinical settings. However, HBOT is often recommended in patients with difficult clinical problems. For example, diabetes mellitus and vascular disease are notorious for late complications of non-healing wounds. Amputation of an infected lower leg is the end result in many unfortunate cases. These patients have been shown, recently, to benefit from HBOT. One study showed decreased major amputation rate in diabetic patients who underwent HBOT (30 daily 90-minute treatments at 2-3 atmospheres).
Soft Tissue Infections: with anaerobic bacteria had a lower mortality rate in patients who underwent hyperbaric oxygen therapy, according to one study. Another study showed HBOT to have no benefit in these infections. According to one author (Sheridan), HBOT seems a reasonable adjunct to surgery, if it can be safely administered without delaying standard treatment (surgery and antibiotics). Treatment would consist of 90-minute treatments at 2-3 atmospheres once or twice daily.
Alternative Medicine
Stroke: Although HBOT is used conventionally in the United States, its use is reportedly higher in other countries. Stroke patients in Germany may undergo this form of treatment according to David Hughes, D.Sc. of the Hyperbaric Oxygen Institute. Hughes states that HBOT has decreased the aftercare costs for stroke patients in Germany by as much as 71%. As recent as 1995, one French study (Nighoghossian) showed that HBOT may be helpful in the treatment of ischemic stroke. But more recent investigations (Rusyniak et al) have shown that HBOT “does not appear to be beneficial and may be harmful in patients with acute ischemic stroke”.
Peripheral Vascular Disease and Chronic Wounds: Hughes also claims that HBOT is used in France for peripheral vascular disease (PVD); which can be caused by atherosclerosis, arteriosclerosis, and diabetes, and others. PVD oftentimes results in poor wound-healing and chronic ulcers (most often on/around the foot and ankle). HBOT is not part of routine, conventional wound care for diabetic foot ulcers. It may, however, be considered for some patients. The American Diabetes Association recognizes HBOT as a potential adjunctive therapy for complex limb-threatening diabetic foot wounds unsuitable for revascularization procedures.
Multiple Sclerosis: Dr. Hughes also states that HBOT is used in Great Britain to treat Multiple Sclerosis (MS). Based on an unpublished article from 1993 by D. Perrin, Hughes cites that more than 25,000 MS patients have benefited from HBOT. But, according to Kleijnen, patients who have chronic progressive or chronic stable multiple sclerosis showed no consistent positive effects to HBOT (results based on Expanded Disability Status Score [EDSS] and the Functional Status Score). An earlier study by Kindwall (1991) treated patients in accordance with protocols that reported to produce a benefit in multiple sclerosis. Investigators were unable to substantiate any useful long-term effect of hyperbaric oxygen therapy.
