Hyperbaric treatment

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Hyperbaric Oxygen Therapy: Efficacy and Applications

Introduction to Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at pressures higher than atmospheric pressure. This treatment aims to enhance oxygen delivery to tissues, thereby promoting healing and reducing inflammation. HBOT has been explored for various medical conditions, including chronic wounds, acute surgical and traumatic wounds, necrotizing fasciitis, and late radiation tissue injury.

HBOT for Chronic Wounds

Diabetic Foot Ulcers and Venous Ulcers

HBOT has shown promise in the treatment of chronic wounds, particularly diabetic foot ulcers. A meta-analysis of ten trials involving 531 participants with diabetic foot ulcers revealed that HBOT significantly increased the rate of ulcer healing at six weeks (risk ratio (RR) 2.35) but did not show long-term benefits at one year. Additionally, a study on venous ulcers indicated a significant reduction in ulcer area at six weeks with HBOT.

Non-Diabetic Chronic Leg Ulcers

A randomized double-blind study involving 16 patients with non-diabetic chronic leg ulcers demonstrated that HBOT significantly reduced wound size over six weeks compared to a control group receiving air at the same pressure. This suggests that HBOT can be a valuable adjunct to conventional therapies for non-diabetic wounds.

HBOT for Acute Surgical and Traumatic Wounds

Burn Wounds and Crush Injuries

HBOT has also been investigated for acute surgical and traumatic wounds. One trial involving burn wounds undergoing split skin grafts reported significantly higher complete graft survival with HBOT. Another trial on crush injuries found that HBOT led to more wounds healed and fewer additional surgical procedures compared to sham HBOT. However, the studies were small and had a high risk of bias, indicating the need for further high-quality research.

HBOT for Necrotizing Fasciitis

Necrotizing fasciitis (NF) is a severe infection that can lead to significant morbidity and mortality. Despite the theoretical benefits of HBOT in reducing morbidity and mortality in NF, a systematic review found no randomized controlled trials (RCTs) meeting the inclusion criteria to support or refute the effectiveness of HBOT for this condition. High-quality clinical trials are needed to define the role of HBOT in NF treatment.

HBOT for Late Radiation Tissue Injury (LRTI)

Osteoradionecrosis and Radiation Cystitis

HBOT has been suggested as a treatment for late radiation tissue injury (LRTI), which can occur months or years after radiotherapy. Studies indicate that HBOT may improve outcomes for conditions such as osteoradionecrosis and radiation cystitis . For instance, HBOT has been associated with a significant reduction in wound dehiscence following head and neck soft tissue surgery and a modest reduction in pain scores for osteoradionecrosis. However, HBOT also carries risks, including temporary reduction in visual acuity and ear barotrauma.

Mechanisms of Action and Biochemical Effects

HBOT's therapeutic effects are attributed to its ability to reduce oxidative stress and inflammation while increasing growth factors that promote healing. In patients with chronic diabetic wounds, HBOT has been shown to decrease pro-inflammatory mediators and oxidative stress biomarkers while increasing growth factors such as platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF-β). These biochemical changes support the healing process and improve tissue viability.

Conclusion

Hyperbaric oxygen therapy offers potential benefits for various types of wounds and tissue injuries, particularly in enhancing short-term healing of diabetic foot ulcers and reducing wound size in chronic leg ulcers. However, the evidence is mixed for other conditions such as necrotizing fasciitis and late radiation tissue injury, and the risk of adverse effects must be considered. Further high-quality research is essential to establish the optimal use of HBOT, including patient selection, treatment duration, and long-term outcomes.