Emerging indications for hyperbaric oxygen

Abstract

Purpose of review To identify and discuss emerging trends in the therapeutic use of hyperbaric oxygen. Recent findings There has been a maturing of the clinical evidence to support the treatment of sudden hearing loss, a wide range of problematic chronic wound states and the prevention and treatment of end-organ damage associated with diabetes mellitus. On the other hand, the controversy continues concerning the use of hyperbaric oxygen therapy (HBOT) to treat sequelae of mild traumatic brain injury. HBOT remains poorly understood by many medical practitioners despite more than 50 years of clinical practice. Pharmacological actions arise from increased pressures of oxygen in the blood and tissues. Most therapeutic mechanisms identified are not the simple result of the reoxygenation of hypoxic tissue, but specific effects on immunological and metabolic pathways by this highly reactive element. HBOT remains controversial despite biological plausibility and a solid clinical evidence base in several disease states. Summary Multiple proposals for new indications for HBOT continue to emerge. Although many of these will likely prove of limited clinical importance, some show significant promise. Responsible practitioners remain acutely aware of the need for high-quality clinical evidence before introducing emerging indications into routine practice.

Adjunctive Hyperbaric Oxygen Therapy in Refractory Crohn’s Disease: An Observational Study

“…There is growing interest in the application of HBOT in patients with IBD. This therapeutic option has been commonly used in chronic wounds, decompression sickness, diabetic foot, Fournier's gangrene, and carbon monoxide poisoning [ 19 ]. Recently, it has been used in emerging indications such as CD-associated complications [ 12 , 19 ].…”

“…This therapeutic option has been commonly used in chronic wounds, decompression sickness, diabetic foot, Fournier's gangrene, and carbon monoxide poisoning [ 19 ]. Recently, it has been used in emerging indications such as CD-associated complications [ 12 , 19 ]. In vitro and in vivo studies have demonstrated that hypoxia is an important factor that triggers and maintains inflammation [ 20 , 21 ].…”

Hyperbaric oxygen therapy ameliorates pain in overweight or obese patients diagnosed with fibromyalgia

“…One fifth of the patients were diagnosed with secondary fibromyalgia, which implies comorbidities, such as stroke, mood disorders or diabetes (10). The baseline perception in this subgroup comprised high levels of pain intensity (VAS scores between 8 and 9) and fatigue (FATIC-F between 42-52), suggesting that these women cope with severe levels of pain and fatigue daily (10,14). Previous studies have reported a close association between chronic pain intensity or fatigue and high BMI (14-17), which may explain the results of the present study.…”

Revisiting the expanded use of hyperbaric oxygen therapy for treatment of resistant migraines

“…6,7 Indications currently include adjuvant therapy in wound ischemia, thermal burn treatment, blood loss anemia, air embolisms, carbon monoxide poisoning, clostridial myonecrosis, crush injury, decompression sickness, chronic refractory osteomyelitis, necrotizing soft-tissue infections, radiation tissue injury, ischemic skin grafts and flaps, and intracranial abscess ( Table 1), but does not include neurologic conditions. 5,[8][9][10] The 2016 European Consensus Conference on Hyperbaric Medicine resulted in a list of 9 indications for HBO to be used as a primary therapy, with an additional 13 indications where there is acceptable evidence that HBO may be used as treatment, as well as 6 indi-cations where HBO may be considered as an optional modality. Amongst the 13 FDA-approved indications and the 28 indications that resulted from the 2016 European Consensus Conference on Hyperbaric Medicine, neither group includes treatment for neurological conditions such as migraines with aura.…”

“…Amongst the 13 FDA-approved indications and the 28 indications that resulted from the 2016 European Consensus Conference on Hyperbaric Medicine, neither group includes treatment for neurological conditions such as migraines with aura. 5,8,9,11 Current treatments for migraines and other headaches are based around relieving the symptoms through the reduction of cerebral blood flow. 12 HBO substantially increases the amount of arterial oxygen and therefore effectively achieves cerebral vasoconstriction, thus treating the migraine.…”