Hyperbaric oxygen therapy
- C Crawford Mechem, MD, FACEP
C Crawford Mechem, MD, FACEP
- Professor of Emergency Medicine
- Perelman School of Medicine, University of Pennsylvania
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
Hyperbaric oxygen (HBO) serves as primary or adjunctive therapy for a diverse range of medical conditions (table 1) [1-4]. In the United States, over 500 hyperbaric facilities offer either single occupant ("monoplace") or multiple occupant ("multiplace") chambers. Information regarding the location of hyperbaric facilities can be accessed through the Undersea & Hyperbaric Medical Society website (www.uhms.org) or via the Divers Alert Network Emergency Hotline (United States phone number: 919-684-8111; website: https://www.uhms.org/resources/chamber-directory.html).
The mechanisms of action, administration, risks, and outcomes of HBO therapy for its currently accepted indications will be reviewed here. Smoke inhalation, carbon monoxide poisoning, and diving complications are discussed separately in greater detail. (See "Carbon monoxide poisoning" and "Complications of SCUBA diving" and "Inhalation injury from heat, smoke, or chemical irritants".)
MECHANISMS OF ACTION
Most of the benefits of hyperbaric oxygen (HBO) are explained by the simple physical relationships determining gas concentration, volume, and pressure . HBO is most commonly used under conditions of tissue hypoxia or to treat decompression sickness or gas embolism, in which gas bubbles obstruct blood flow.
Increased oxygen delivery — Henry's Law states that the amount of an ideal gas dissolved in solution is directly proportional to its partial pressure. Thus, the dissolved plasma oxygen concentration of 0.3 mL/dL at sea level (1.0 atm) increases to 1.5 mL/dL upon administration of 100 percent oxygen, while hyperbaric oxygen delivered at 3.0 atm yields a dissolved oxygen content of 6 mL/dL. The latter figure is sufficient to meet resting tissue oxygen extraction requirements irrespective of the adequacy of the hemoglobin-bound oxygen pool. The ability of HBO to augment oxygen content and independently meet resting tissue oxygen requirements has led to its use in conditions of compromised oxygen delivery, such as profound anemia, carbon monoxide (CO) poisoning, and both acute and chronic ischemia [2,6-9].
Reduction of gas bubble size — The use of hyperbaric oxygen therapy for decompression illness is based upon Boyle's Law, since the volume of nitrogen bubbles is inversely related to the pressure exerted upon it. At 3.0 atm, bubble volume decreases by approximately two-thirds. Further bubble dissolution is accomplished by the replacement of inert nitrogen within the bubbles with oxygen, which is then rapidly metabolized by tissues .
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- MECHANISMS OF ACTION
- Increased oxygen delivery
- Reduction of gas bubble size
- Antagonism of carbon monoxide
- Improved wound healing
- CLINICAL USE
- Carbon monoxide or cyanide poisoning
- Decompression sickness and air embolism
- Acute traumatic or thermal injury
- Radiation injury
- Nonhealing ulcers, skin grafts, and wound healing
- Future directions
- SUMMARY AND RECOMMENDATIONS