Hyperbaric Oxygen Therapy: Emerging Role In Acute And Chronic Illness By Gail Szakacs, MD & Nancy O’Hara, MD P


ositive clinical outcomes and evolving research suggest a potential adjunctive role for Hyperbaric Oxygen (HBO)


Therapy in the effective management of various types of medical injury and illness. Although HBO therapy often enhances treat- ment and recovery from acute problems, mounting clinical experience shows that it may also help long after an injury occurs or with chronic disease in general. HBO involves the therapeutic adminis-


tration of up to 100% oxygen at greater than atmospheric pressure (up to 3 atmosphere absolute or ATA). The majority of oxygen is usually delivered to body tissues bound to hemoglobin, but HBO increases overall oxygen delivery by significantly elevating the plasma oxygen content and not chang- ing hemoglobin-bound oxygen levels. It has been shown that the boost in plasma oxygen content with HBO at 100% oxygen and 2 ATA drives more oxygen down physiologic gradients and into areas of the body that cannot be reached by hemoglobin-bound oxygen. Both hard and soft chambers can be effective, but hard chambers (monoplace or multiplace) can reach higher pressure and oxygenation than soft chambers. Neither is without risk and those details should be discussed at length with a physician, taking into account a person’s history, as part of the evaluation when considering HBO therapy.


Underlying mechanisms by which HBO is thought to promote positive clinical out- comes include:


1. Hyperoxic (not hypoxic) vasoconstric- tion – Decreasing local blood flow helps to decrease inflammation and the increased plasma oxygen content under hyperbaric conditions allows this to occur without cor- responding hypoxia. 2. Antimicrobial effect: a. Inhibitory effect on growth of cer- tain organisms – For instance, in 2004, Jain reported that HBO is known to block the production of two known clostridial tox- ins (alphatoxine, which is hemolytic and increases tissue necrosis; and thetatoxine, which causes vascular injury and also in- creases tissue necrosis). b. Increased phagocytosis. 3. Anti-inflammatory and immune stimulatory effects – HBO can affect the


white blood cells involved in the inflamma- tory reaction/response to injury (inflamma- tion is associated with polymorphonuclear and other immune cell infiltration, increased oxidative stress, and prevents maximal up- take of oxygen by cells).


4. Decrease in tissue lactic acid level and help maintaining more optimal cellular energy function. 5. Neovascularization and collagen


production by fibroblasts (cells necessary for wound healing)


a. Hypoxia helps trigger angiogenesis but the collagen deposition that is needed for growth of new capillary beds needs oxygen – in a 2004 article, Jain noted, “the alteration of states of hypoxia (during HBO break) and hyperoxia (during HBO treatment)… is responsible for maximum stimulation of fibroblast activity in ischemic tissues and producing the development of the matrix of collagen that is essential for neovascularization.” Many professional athletes, and a


growing number of sports teams, use HBO therapy to speed recovery from injury and enhance performance. There are many sports teams that even travel with portable units so the benefits of HBO therapy can be immediately available. Clinicians also are implementing HBO therapy into their general practices to help with sports and post-concussive injuries, as well as the other problems noted below. Although most of the research on HBO to-date is flawed due to various aspects of poor study design and has yielded mixed results, the research is emerg- ing to support the tremendous and mounting positive clinical outcomes seen by clinicians and patients worldwide.


Reported and emerging uses for HBO Therapy include: • Traumatic brain injury, post-concussive injury • Sports injuries, headaches • Sleep disturbances


• Enhanced athletic performance (reducing fatigue and increasing endurance) • Musculoskeletal injuries (primarily muscle- tendon junctions & ligament injuries)


• Autism (improved overall functioning, receptive language, social interaction, eye contact, sensory/cognitive awareness) • Cerebral palsy, Multiple sclerosis, Psoriasis


NaturalNutmeg.com 23


• Inflammatory bowel disease, Lyme Disease • Anti-aging • Post-traumatic stress disorder


The following indications for HBO


Therapy have already been approved: 1. Air or gas embolism


2. Carbon monoxide poisoning and carbon monoxide poisoning complicated by cyanide poisoning 3. Gas Gangrene 4. Crush injury, compartment syndrome, and other acute ischemias 5. Decompression sickness 6. Exceptional anemia (acute severe blood loss and the inability or lack of permission to transfuse blood)


7. Intracranial abscess


8. Necrotizing soft tissue infections 9. Osteomyelitis (refractory) 10. Delayed radiation injury 11. Poor wound healing 12. Skin grafts and flaps 13. Thermal burns


Although more research is needed, one should consider further medical evaluation about the potential use of HBO as adjunctive therapy in the various acute or chronic injury and illness noted above.


Dr. Nancy O’Hara and Dr. Gail Szakacs dedicate their practice to the integrative care of children and adults with Autism Spec- trum Disorder, other Neurodevelopmental disorders, various chronic medical illnesses, and acute problems such as post-concussive injury. Their comprehensive center offers a variety of functional medicine interventions, including hyperbaric oxygen therapy for use in a primary or adjunctive role in the treat- ment of many acute and chronic medical problems. Dr. O’Hara is board certified in Pediatrics and Dr. Szakacs is board certified in Internal Medicine. Their practice in Wilton, CT has been serving the local and global communities since 1999. See ad page 35.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52