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Definition
Hyperbaric oxygen is Supercharged Oxygen! Hyperbaric (hyper – high; baric – pressure)
oxygen can be defined as inhaling 100% inside a chamber that is pressured to greater than the
pressure at sea level or 1 ATA (atmospheres absolute). Dr. Steenblock uses 100% oxygen by
mask with pressurized air (21%) rather than 100% pressureized oxygen for greater safety. He
also uses pressures of about 1.5 ATA to 2.0 ATA that are recommended by experts in the field
such as Dr. K.K. Jain, as being safe as well as effective for brain injured patients. Using higher
pressures can result in increased oxidative stress that is counterproductive to tissue repair and
healing
Jain, K.K. Textbook of Hyperbaric Medicine, 5th Edition, Hogrefe Publishing, Cambridge,
MA, 2009.
Oxygen is Life!
A continuous, sufficient oxygen supply is essential for cell function. The brain is about 2% of
the body’s mass and utilizes 20% of the body’s oxygen. Oxygen delivery to the brain is highly
dependent on the flow of blood. A lack of oxygen to the brain cells, that lasts for a couple of
minutes, can lead to brain damage. A lack of oxygen beyond five or six minutes, can lead to the
person’s death. The neurons are the most vulnerable to hypoxia (a lack of oxygen) and ischemia
(a lack of blood flow). The second most vulnerable brain cells to a lack of oxygen are the
oligodendrocytes that produce myelin for the nerves. Multiple sclerosis is considered to be a
disorder of the myelin. The third most vulnerable cells are the astrocytes (white matter) that
support the neurons. Next are the microglia that play a protective role in the brain as immune
cells. However, when they become activated, as with hypoxia, ischemia, or inflammation, they
can also be destructive to the brain cells.
Shen J, Liu KJ, Liu S, Miyake M. Chapter 3: Cerebral Tissue Oxygenation: Transportation,
Metabolism, Measurement, and Significance in the Ischemic Brain. In Zhang, John (Ed),
Hyperbaric Oxygen for Neurological Disorders, Best Publishing Company, Flagstaff, AZ, 2008;
pp 67 – 84.
There have been various attempts through the centuries to use oxygen under pressure for
increased healing and well-being. More recently, in 1960, Dr. Ita Boerema at the University of
Amsterdam, Netherlands was able to keep pigs alive in a hyperbaric chamber after the
hemoglobin had been removed from their bodies. As his fame grew, Dr. Boerema was given the
latitude to construct a surgical room inside a hyperbaric chamber where he proceeded to treat
3,300 patients (including infants, the elderly and the comatose) with conditions that included
respiratory distress, gas and drug poisoning, shock, and gas gangrene.1 The hyperbaric chamber
also extended the possibilities for cardiovascular surgery. After hyperbaric oxygen was
introduced to the surgical procedures, the mortality rate for surgery dropped from 66% to 23%.
The world then began to take notice. 2
1) Boerema I. Use of hyperbaric oxygen. American Heart Journal. 1965; 69:289-292.
2)Leopardi LN, Metcalfe MS, Forde A, Maddern GJ. Ite Boerema – surgeon and engineer
with a double-Dutch legacy to medical technology. Surgery 2004; 135(1): 99-103.
Stroke statistics
Stroke is the leading cause of long-term disability and now the second leading cause of death in
the U.S. 1 The direct and indirect costs of stroke exceed $56 billion a year. 2
1) Veltkamp R, Schwab S, Sun L. Chapter 6: HBO for Stroke: Basic Science Studies. In Zhang,
John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best Publishing Company, Flagstaff,
AZ, 2008; pp 135-154.
2) Singhal AB, Lo EH. Chapter 5: Oxygen Therapy for Ischemic Stroke: Clinical Aspects. In
Zhang, John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best Publishing Company,
Flagstaff, AZ, 2008; pp 115-134
1. Sustains cell viability in acute hypoxic tissue, especially in the ischemic penumbra
area that surrounds the infarct core. (Matchett)
One of Neubauer’s early studies on idling neurons:
http://www.ncbi.nlm.nih.gov/pubmed/1617842
2. Increases oxygen (pO2) from 34 mmHg (air-about 21% oxygen) to 90 mmHg (100%
oxygen). HBO also increases the diffusion distance for oxygen1 so the oxygen can reach
the cell from farther distances away. HBO increases oxygen in the plasma tenfold. 2 This
is important in areas where there is blood vessel damage that limit tissue access to the red
blood cells.
1) Ostrowski RP, Zhang JH. Chapter 4: Mechanisms of HBO for Neurological
Disorders. In Zhang, John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best
Publishing Company, Flagstaff, AZ, 2008; pp 85-114.
2) Singhal AB, Lo EH. Chapter 5: Oxygen Therapy for Ischemic Stroke: Clinical
Aspects. In Zhang, John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best
Publishing Company, Flagstaff, AZ, 2008; pp 115-134
7. Reduces inflammation.
Hyperbaric oxygen reduces pro-inflammatory cyclooxygenase-2 mRNA (COX-2). COX-
2 stimulates pro-inflammatory prostanoids, prostaglandins, prostacyclins and throm-
boxane. Hyperbaric oxygen also reduces inflammatory mediators such as Tumor
Necrosis Factor-alpha, Interleukin 1 and Interleukin 6. (Matchett)
Supportive article by Vlodavsky and associates:
http://www.ncbi.nlm.nih.gov/pubmed/16409552
Hyperbaric oxygen therapy stimulates the production of glial cell derived neurotrophic
factor in a rat model of spinal cord injury.
Tai PA, Chang CK, Niu KC, Lin MT, Chiu WT, Lin CM. Attenuating experimental
spinal cord injury by hyperbaric oxygen: stimulating production of vasculendothelial and
glia cell line-derived neurotrophic growth factors and interleukin-10. J Neurotrauma.
2010, 27(6): 1121-7. http://www.ncbi.nlm.nih.gov/pubmed/20334467
Criticism: Thirty-three subjects within 24 hours of stroke onset were divided into
two groups. One group received 100% oxygen at 1.14 ATA for 60 minutes (the
“sham” group) and the other group received 100% oxygen at 2.5 ATA for 60
minutes. The patients were then evaluated three months later on a battery of
stroke tests. The test scores were better for the sham group. The authors
concluded that HBO offers no benefit and may even be harmful in stroke. This
study provided heparin and standard medical practice. The study also omitted
hemorrhagic stroke patients. However, Rusyniak has been heavily criticized for
using 2.5 ATA for acute stroke patients, especially since Jain has been
recommending 1.5 ATA as safe for acute stroke patients for over twelve years.
The 1.5 ATA level avoids complications resulting from increased lipid
peroxidation and seizures. The 1.14 ATA was, in fact, closer to Jain’s
recommended pressures. 12 According to Jain, the design of the study invalidates
any conclusions.5 A 1.5 ATA group should have been included and the 2.5 ATA
changed to perhaps 2 ATA for the wellbeing of the patients.
Criticisms about this design include a small sample size and the inclusion of TBI subjects
where immediate HBOT treatment is imperative to outcome.
1) Ostrowski RP, Zhang JH. Chapter 4: Mechanisms of HBO for Neurological Disorders.
In Zhang, John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best Publishing
Company, Flagstaff, AZ, 2008; pp 85-114.
2) Singhal AB, Lo EH. Chapter 5: Oxygen Therapy for Ischemic Stroke: Clinical Aspects.
In Zhang, John (Ed), Hyperbaric Oxygen for Neurological Disorders, Best Publishing
Company, Flagstaff, AZ, 2008; pp 115-134
Sarno’s study on the mental and verbal improvements of stroke patients after HBOT.
Free Article: http://www.ncbi.nlm.nih.gov/pubmed/5008300
Overview
HBOT is suggested as an additional option in conditions that include problem wounds, spinal
cord injury and cerebral ischemic injury. http://www.ncbi.nlm.nih.gov/pubmed/20636981
Colonic anastomosis
(rat study) HBOT reduced interstitial edema and increased hydroxyproline at the anastomotic
site, resulting in greater healing of anastomotic ischemia.
http://www.ncbi.nlm.nih.gov/pubmed/21226391
Tracheal anastomosis
(rat study) Animals treated with HBOT showed excellent healing at the anastomosis.
http://www.ncbi.nlm.nih.gov/pubmed/21110272
Anti-Aging
Aging is associated with impaired wound healing and reduced blood vessel growth to ischemic
tissue. Gene expression was analyzed before and after hyperbaric oxygen. There was an
upregulation of genes for antioxidant production and an increased resistance to lethal oxidative
stress in endothelial cells. HBOT is suggested as a treatment to help promote healthy aging.
http://www.ncbi.nlm.nih.gov/pubmed/20536847
Bone/Skeletal Conditions
Cervical spondylotic amyotrophy
Beneficial in cervical spondylotic amyotrophy - http://www.ncbi.nlm.nih.gov/pubmed/21243002
Disc degeneration
(lab study) Inflammatory changes in intervertebral disc degeneration may be due to interleukin
1B and p38 MAPK signal pathways. HBOT improved tissue balance and is suggested for
slowing the course of disc degeneration. http://www.ncbi.nlm.nih.gov/pubmed/20661932
Osteonecrosis
Bisphosphonates are used for metabolic or malignant bone diseases but also promote
osteonecrosis of the jaw bone. Moderate osteonecrosis of the upper jaw was treated with
platelet-rich plasma, HBOT and the cessation of bisphosphonates.
http://www.ncbi.nlm.nih.gov/pubmed/21119470
(rat study) The combination of hypothermia and HBOT can be effective in reducing secondary
damage in spinal cord tissue.
Bronchitis (ischemic)
Beneficial in postoperative ischemic bronchitis after lung cancer treatment in 82% of the cases.
http://www.ncbi.nlm.nih.gov/pubmed/21256268
Cancer
(laboratory study) The combination of HBOT and artemisinin is suggested as an anticancer
chemotherapy strategy. http://www.ncbi.nlm.nih.gov/pubmed/21115894
Liver Cancer
HBOT after liver resection reduced complications in patients who experienced major bleeding or
showed severe hepatic hypoxia during surgery. Improved immune function and long term
survival were additional benefits.
http://www.ncbi.nlm.nih.gov/pubmed/21069381
Nasopharyngeal carcinoma
(lab study) The combination of HBOT and 5-fluorouracil was effective in inhibiting metastasis.
http://www.ncbi.nlm.nih.gov/pubmed/20568543
Ovarian cancer
Cardiovascular Disease
Vascular Degeneration
Matrix metalloproteinase-9 (MMP-9) is an enzyme involved in extracellular matrix degradation.
It helps with matrix remodeling but excessive amounts are detrimental to the tissue. MMP-9
over-expression is associated with stroke, cell death, non-healing wounds, TBI, aneurysms and
blood vessel leakage in atherosclerosis. This is a case report of a patient’s MMP-9 levels
dramatically increasing after surgery and hyperbaric oxygen significantly reduced the MMP-9
expression. http://www.ncbi.nlm.nih.gov/pubmed/20824409
Hypertension
(rat study) Normotensive rats (WKY) and genetic rat models for hypertension (SHR) were
subjected to hyperbaric oxygen. The hypertensive rats showed reduced systolic blood pressure
after three weeks and lower diastolic blood pressure after seven weeks of treatment compared to
a normobaric rat group. Both the normotensive and hypertensive rats who received HBOT
showed lower levels of reactive oxygen metabolites than the control group and the hypertensive
rats receiving HBOT showed higher antioxidant levels than the control SHR rats. The results
suggest that HBOT may be effective in reducing genetically-induced hypertension.
http://www.ncbi.nlm.nih.gov/pubmed/20504127
Dementia (Vascular)
Diabetes
Atherosclerosis and glycemic control
Twenty-eight diabetic patients undergoing HBOT for foot ulcers received improvements in their
fasting blood glucose, hemoglobin A1c, insulin resistance (HOMA-IR), C-reactive protein (hs-
CRP), uric acid mean platelet volume, complete blood count and lipid profile.
Free article: http://www.ncbi.nlm.nih.gov/pubmed/20602302
Hyperlipidemia
(mice study) Six weeks of hyperbaric air (21% oxygen) significantly reduced free fatty acids
and triglycerides in diabetic mice. The results suggest that hyperbaric air treatments can improve
lipid metabolism in type 2 diabetes patients.
Free article: http://www.ncbi.nlm.nih.gov/pubmed/20847521
Foot Ulcer
Hyperbaric oxygen improves ulcer healing and consequently patient quality of life
http://www.ncbi.nlm.nih.gov/pubmed/21219427
HBOT is suggested for foot ulcer cases that are resistant to antibiotics.
http://www.ncbi.nlm.nih.gov/pubmed/21135264
Baseline transcutaneous oximetry correlated more with healing from HBOT than toe blood
pressure or ankle-brachial index. http://www.ncbi.nlm.nih.gov/pubmed/20957342
HBOT for infected diabetic feet can improve healing and reduce the amputation rate in diabetic
patients. http://www.ncbi.nlm.nih.gov/pubmed/20483142
Ears/Hearing
Ear and HBOT Side Effects
Middle-ear barotrauma can be a side effect of hyperbaric oxygen. In 130 patients receiving
HBOT, barotraumas occurred in 13.6% of the patients.
http://www.ncbi.nlm.nih.gov/pubmed/20737927
Severe Deafness
HBOT combined with drug treatment can be effective in moderate and severe cases of deafness.
http://www.ncbi.nlm.nih.gov/pubmed/21174751
Otitis (infection)
Beneficial in fungal malignant external otitis (can result from prolonged antibiotoic treatment)
http://www.ncbi.nlm.nih.gov/pubmed/21237200
Embolism
Risks in divers, compressed air workers, aviators, astronauts, patients with cardiac shunts, etc.)
Beneficial in arterial gas embolism and decompression sickness
http://www.ncbi.nlm.nih.gov/pubmed/21215883
Encephalitis
With acute lymphoblastic leukemia
Granulomatous amebic encephalitis is usually fatal. A child with brain abscesses from the
Acanthamoeba
Received antimicrobial chemotherapy and HBOT and had complete resolution of symptoms.
http://www.ncbi.nlm.nih.gov/pubmed/21084511
Eyes/Vision
Age-related macular degeneration
Fourteen patients with advanced AMD underwent a one hour session of HBOT at either 1.5 or
1.75 ATA that resulted in significant improvements in visual acuity and/or visual field and daily
living vision.
http://www.ncbi.nlm.nih.gov/pubmed/20462142
Gangrene
Beneficial in ulcerative pyoderma gangrenosum -
http://www.ncbi.nlm.nih.gov/pubmed/21276167
Gastrointestinal toxicity
Hyperbaric oxygen is a suggested option for cancer treatments that include radiation, surgery
and/or chemotherapy. http://www.ncbi.nlm.nih.gov/pubmed/20709653
Heatstroke
(mice study) Hyperbaric oxygen protected against heatstroke-induced ischemia and neuronal
damage to the hypothalamus and its temperature regulation function.
Free article: http://www.ncbi.nlm.nih.gov/pubmed/20625500
Kidney disease
Renal cyst infections
A patient with polycystic kidney disease experienced a severe infection after surgery. A large
abscess had developed. There was no improvement with antibiotics. After 26 HBOT sessions,
the inflammation was gone and has not returned.
http://www.ncbi.nlm.nih.gov/pubmed/20886361
Pancreatitis (acute)
(rat study) Seven days of HBOT improved immune function, balanced the T lymphocyte profile
and significantly reduced the pathology associated with acute pancreatitis.
http://www.ncbi.nlm.nih.gov/pubmed/20854730
(rat study) The combination of HBOT and ulinastatin was more effective in treating acute
necrotizing pancreatitis than either treatment by itself. Full article:
http://www.ncbi.nlm.nih.gov/pubmed/20646397
Periodontal disease
Twenty patients with severe generalized chronic periodontitis underwent scaling and root
planning. Ten patients also underwent five HBOT sessions. The combination treatment
program was more effective for up to three months. Five sessions of HBOT has a short-term
benefit in pocket reduction and bacterial elimination in chronic periodontitis.
http://www.ncbi.nlm.nih.gov/pubmed/20462143
Snake bite
Beneficial for preventing infection and enhancing healing –
http://www.ncbi.nlm.nih.gov/pubmed/21226390
Testosterone Levels
Urology
Beneficial in necrotizing fasciitis, radiation-induced cystitis and urgency and frequency
syndrome.
http://www.ncbi.nlm.nih.gov/pubmed/21234869
Cystitis (non-bacterial)
HBOT is beneficial for cystitis http://www.ncbi.nlm.nih.gov/pubmed/21082515
In 62 patients, the combined treatment of anti-inflammatory therapy and 7-10 HBOT sessions,
there were improvements in microcirculation and long-term remission from interstitial cystitis.
http://www.ncbi.nlm.nih.gov/pubmed/20886727
Wound healing
Overview
Oxygen promotes blood vessel growth, collagen, renewal of the epithelial lining, kills bacteria
and reduces infections. http://www.ncbi.nlm.nih.gov/pubmed/20216492
Appears effective in acute, difficult to heal wounds, that include crush wounds and burn wounds.
http://www.ncbi.nlm.nih.gov/pubmed/21184071