There is no known, effective conventional treatment for radiation-induced
tissue death. Narcotics, used to relieve radiation ulcer pain, can result in addiction and do
nothing to resolve the underlying problem. Reconstructive attempts often fail because there is
insufficient blood supply to support healing. But there is treatment.
| Some studies have shown HBOT to provide
significant improvement in 94% of radionecrosis cases (Slade and Cianci, 1998). HBOT appears
to be safe, with few significant adverse effects, and a valuable tool for the prevention and treatment of radiation-induced complications. |
WHEN IS HBOT USED?
Radiation complications can be classified as acute or delayed. Acute complications are the result of direct cellular DNA or mucosal tissue damage, and seldom limit treatment. Most cancer patients experience pain, either because of the disease or as a result of radiation treatment. This secondary, treatment-induced pain is present up to 25% of the time.
There is no known, effective conventional treatment for radiation-induced tissue death. Narcotics, used to relieve radiation ulcer pain, can complicate diagnosis and do nothing to resolve the underlying problem. Reconstructive attempts often fail because there is insufficient blood supply to support healing. But there is treatment.
| Some studies have shown HBOT to provide significant improvement in 94% of radionecrosis cases (Slade and Cianci, 1998). HBOT appears to be safe, with few significant adverse effects, and a valuable tool for the prevention and treatment of radiation-induced complications. |
| It is interesting to note that while many therapies treat symptoms (pain, bleeding, swelling), HBOT is unique in that, in many cases, it accelerates the body’s ability to heal. Rather than temporarily relieving symptoms, compromising the immune system, and possibly worsening the underlying condition, HBOT, with appropriate surgery, can actually resolve the problem. |
HOW IS HYPERBARIC OXYGEN THERAPY DELIVERED?
Hyperbaric Oxygen Therapy (HBOT) provides 100 percent oxygen under increased pressure
to treat a wide range of medical conditions. Because pure oxygen can be toxic if taken for too long a
period of time, the treatments are professionally administered and typically limited to 1-1/2 to 2 hours
five times a week. To reinforce the positive effects, the treatments are given over a period of time,
usually one or two months. The prescribing doctor will work with the patient to determine the best course
of treatment.
The increased pressure of HBOT is administered in a monoplace (one person) chamber
with 100 percent oxygen, or a multiplace chamber (two to twelve patients) with compressed air. In the
multiplace chamber, each patient breathes 100 percent oxygen through a mask or hood. It is the saturation
of body fluids with oxygen during HBOT that delivers the majority of oxygen to areas of the body with
restricted blood supply.
The monoplace chamber has the advantage that non-healed incisions, wounds, and
ulcers are directly exposed to a hyper-oxygenated environment in addition to receiving the oxygen pushed
into the circulatory system through breathing.
HOW HYPERBARIC OXYGEN THERAPY WORKS
Human blood is made up of many parts. At sea level, 98 percent of the oxygen in
the blood is carried in the hemoglobin and red blood cells with the remaining 2 percent dissolved in the
plasma (liquid portion of the blood). The body requires a certain oxygen level to maintain normal cell
functions. Too far below that, the cells may survive, but they cannot perform any healing functions.
When the oxygen is increased from the normal 19 to 21 percent we breathe to a 100
percent saturation, and the atmospheric pressure raised, oxygen is pushed from the circulatory system
into the fluids and tissues of the body. Levels of oxygen can rise from 30 mm Hg to 1,100 or even 1,900
mm Hg. In non-technical terms, that means the body tissues can have 63 times the normal levels of
oxygen—and perhaps as significantly, the oxygen diffuses farther from the capillaries than normal.
Tissues of the body, which may have been starved for healing oxygen, are finally
receiving what they need. Because HBOT minimizes restriction or blockage of blood vessels, it reduces
edema (swelling) while increasing oxygenation. It is the only known methods to accomplish both of these
healing functions simultaneously.
(An interesting note: At 3 times sea level atmospheric pressure and 100 percent
oxygen, experimental animals have been shown to function normally without blood cells.)
BENEFITS OF HBOT
Several benefits are associated with intermittent exposure to hyperbaric doses
of oxygen, either alone or in combination with other medical and surgical procedures.
- HYPEROXYGENATION: The high oxygen level and elevated pressure within the hyperbaric chamber produces
a 10-15-fold increase in plasma oxygen concentration. What this means is that arterial oxygen values
increase from 30 mm Hg to 1,500 or even 2,000 mm Hg. Oxygen diffuses four times as far from the
capillaries. Although the effect is only temporary, this form of hyper-oxygenation provides immediate
support to poorly served tissue in areas where blood flow has been compromised, maintaining tissue
viability until corrective measures can be implemented or a new blood supply established.
- NEOVASCULARIZATION: The development of a new blood supply system is an indirect and delayed
response to hyperbaric oxygen exposure. Major injuries, surgery, radiation, refreactory osteomyelitis,
ulcerations, and diseases can damage or destroy portions of the circulatory system and the tissue
supported by that blood supply. To rebuild healthy new capillaries requires the building blocks—new
fibroblast cells and collagen—once a blood supploy is re-established, the body can regenerate damaged
tissue. HBOT accelerates the processes, both of growing new capillaries (angiogenesis) and repairing
tissues.
- HYPEROXIA: Increased oxygen levels help kill harmful bacteria and inhibit the development and
activity of toxins (particularly in Clostridial perfringens infections—gas gangrene). The extra oxygen
also makes the body’s immune system function more effectively, increasing efficency in destroying foreign
organisms. Recent research has demonstrated a prolonged post-antibiotic effect when hyperbaric oxygen is
combined with tobramycin against Pseudomonas aeroginosa—HBOT boosts and prolongs the effectiveness of the
medication.
- DIRECT PRESSURE: Boyle’s Law, where pressure and volume are inversely proportional, is used to reduce
the volume of intravascular or other free gas (within the body). This has been used for more than a century
to reduce the blood and tissue gases released when a diver or patient undergoes a pressure reduction too
quickly. Re-pressurization, with a more gradual return to normal pressures is an effective treament for
decompression sickness and cerebral arterial gas embolisms. Untreated decompression sickness results in
significant illness and remains grossly underdiagnosed.
- Hyperoxia-induced VASOCONSTRICTION: With or without causing oxygen deprivation, a swollen circulatory
system is probably less efficient in facilitating tissue healing. HBOT reduces blood vessel swelling,
enabling blood to flow more freely through damaged tissues, bringing healing oxygen and nutrients and
carrying away cellular debris. In intermediate compartment syndrome (caused by tissue swelling in a
limited space), in injured extremites, and in the fluid accumulation associated with grafts, blood vessel
swelling restricts blood flow. Studies have shown a significant decrease in fluid resuscitation requirements
when hyperbaric oxygen therapy is added to standard burn wound management treatment—limiting the tremendous
fluid loss associated with these injuries makes healing a lot faster.
- ATTENUATION OF REPERFUSION INJURY: A traumatic incident causes immediate, recognizable, and often
irreversible damage. Often, when blood flow is restored (reperfusion) after the initial damage, the body
responds by sending out protective leukocytes (white blood cells). Recent theory is that these leukocytes
react inappropriatedly, causing further damage to marginal tissues. mechanism to be discovered. Hyperbaric
oxygen appears to reduce this secondary, indirect injury by preventing such activation. The net effect is
the preservation of marginal tissues that may otherwise be lost to ischemia-reperfusion injury.
CONTRAINDICATIONS
Contraindicadictions to HBOT are not extensive and often temporary. Communication with your HBOT physician about concerns is essential. Contraindications include:
Pneumothorax unless treated with a Heimlich valve.
- Claustrophobia (fear of enclosed spaces, which is usually controllable.
- Acute upper respiratory infection or sinusitis.
- Emphysema, which can usually be treated at lower atmospheric pressure.
- Uncontrolled high fever.
- History of ear complications.
- Thoracic surgery or spontaneous pneumothorax.
Seizures at pressure have been documented at one per 10,000 compressions in
children with Cerbral Palsy (CP), a rate identical with the occurrence in the overall hyperbaric therapy
population. Even though seizures are a frequent symptom CP, most CP children with seizure who have been
treated with HBOT have shown reduced seizure activity.
Patients with seizure disorders may have recurrence of seizures while at pressure.
In China, HBOT is being used to treat seizures in children.
SIDE EFFECTS
The predominant side effect is barotraumas (pressure damage) to the eardrums.
Ear tubes may be required by some patients. Although ruptured eardrums have never occurred in my facilities,
this complication has been reported.
Pure oxygen can produce toxicity, but the treatment parameters used in
clinical HBOT are well within the safe limits. In about one in 10,000 compressions, a patient may have
an epileptic type seizure due to oxygen sensitivity or low blood sugar—these seizures have produced no
long-term effects.
During a prolonged course of treatment, some patients will note a change in
vision caused by the molding of the cornea by the increased pressure—this reverses when HBOT is completed.
©2007 Florida Oxygen
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