Hyperbaric Oxygen Therapy (HBOT) New evidence has been accumulated
By Pavel I. Yutsis, MD and Iosif N. Dimant, PhD
The concept of putting patients in a decompression chamber and raising the ambient pressure around them for therapeutic purposes was at first without scientific basis. Perhaps intuitively it “seemed like a good idea” to b British clergyman, Henshaw, who in 1662, build a sealed chamber he called a “Domiciulium.” Chamber pressure was controlled by valves which could either raise or lower pressure. He felt that acute disease of all kinds would respond to increased ambient pressure whereas chronic diseases were better treated with more rarefied air.
In 1873 Fontaine, a French surgeon, built a mobile operating room on wheels which could be pressurized. Over 20 surgical procedures were performed in this unit using nitrous oxide as the anesthetic. Deep surgical anesthesia was possible because its increased effective percentage accompanied by a higher oxygen partial pressure, rendered it safer. According to the law of physics, compressed air at low atmospheres gives an effective level of 42% inhaled oxygen. Hernias were seen to reduce more easily and the patient did not have cyanotic color when coming out of anesthesia.
In 1891, J.L. Corning, the first physician to administer spinal anesthesia, introduced compressed air therapy to the United States and was the first to operate his compressor with electric power.
Orville J. Cunningham, a professor of anesthesia at the University of Kansas in Kansas City, was a great compressed air enthusiast. He noted that people with heart disease and certain other circulatory disorders did poorly when living at altitude, but improved on return to sea level. Taking this concept one step further, he felt that increased atmospheric pressure would be still more beneficial. During the flu epidemic of 1918, he placed a moribund young resident physician in a chamber which had been used for animal studies, and by compressing him to two atmospheres was able to successfully oxygenate him during his hyposixic crisis, thereby proving to himself that his concept was sound. He constructed an 88 foot long chamber, 10 feet in diameter, in Kansas City and began to treat a multitude of d diseases.
Mr. Timkin of the Rollerbearing Company came under his care and apparently had a spontaneous recovery from a uremia while in Cunningham’s chamber. In gratitude to Dr. Cunningham, Timkin build him the largest hyperbaric chamber ever constructed. It was a steel sphere six stories high and 64 feet in diameter. T This “steel ball hospital,” located in Cleveland, Ohio, accommodated a smoking room on the top floor, plush carpeting, dining rooms and individual rooms. It could reach three atmospheres pressure.
Cunningham felt that some anaerobic-organism “s\which could not be cultured” was responsible for a host of diseases including hypertension, uremia, diabetes and cancer and that compressed air therapy helped inhibit this organism. The AMA and the Cleveland Medical Society, failing to receive any scientific evidence for his rationale, finally forced him to close in 1930. Unfortunately, the steel ball hospital was broken up for scrap during World War II. It would have made magnificent museum.
Basic and advanced knowledge in hyperbaric medicine was accumulated by Boerema and co-workers in the Netherlands. During their experiments with pigs they found that life can be sustained in the absence of hemoglobin. Subsequently, it was established by many researchers that hyperbaric oxygen therapy can provide great beneficial effects in the treatment of chronic refractory osteomyelitis (Perrins), hemmorhagic shock (Cowley), myocardial infarction (Ledingham and others), carbon monoxide poisoning, burns, wound healing, etc.
It has been suggested by many researchers that the therapeutic effects of Hyperbaric Oxygenation in ischemic processes is based upon adequate oxygenation and improvement of oxygen diffusion and restoration of blood circulation in different tissues and organs, including the brain and its oxygen-sensitive neurons. In fact, the majority of neurons die within 5-8 minutes of oxygen starvation (anoxia).
Oxygen plays an important role in (1) regulation of brain metabolism (2) vascular and cellular permeability (3) enzymatic activity (4) functional activity of neuromediators (5) functioning of blood-brain barrier and spinal fluid. Basic pathogenic factors that determine severity of brain pathology are hypnosis and metabolic derangement caused by circulatory dysfunctions (strokes, thrombosis, brain injuries) followed by brain swelling, infarcts and elevated intracranial pressure. It is important to point out that restoration of the brain cell tissues are caused by disturbances in brain circulation and can become a long-lasting process. In fact even in 10-15 years following an acute event, hyperbaric oxygen therapy can still produce a great deal of benefits. It has become obvious that adequacy of brain oxygenation plays a key role. As it turned out the death of brain cells takes place only in the areas where the blood flow is severely restricted, wherein brain regions of moderately or mildly damaged tissues are not dead but not functional either, and they can remain in such state for many years. These brain regions with poor blood flow that resulted from stroke or brain injuries are known as the “ischemic penumbra.” They remain in the “ischemic state” due to inadequate supply of oxygen and nutrients to accumulate enough ATP from both aerobic or anaerobic metabolism to provide nerovasculariztion in the “penumbra.” Therefore, “ischemic penumbra” will remain ischemic until oxygen delivery from capillaries into the neurons and brain tissues are completely restored. In the areas of “ischemic penumbra,” anaerobic glycolysis produces only 2 moles of ATP per mole of glucose metabolized, whereas in the normal brain region 36 moles of ATP are formed.
Hyberbaric oxygen forces oxygen into the plasma. When the plasma reaches into “ischemic penumbra” it brings enough oxygen to provide for aerobic metabolism (metabolism that utilizes oxygen surges of ATP production while patient remains in the chamber.) As soon as tissues of ischemic penumbra are adequately oxygenated the repair of their “idling neurons,” glial cells and extra cellular matrix begins.
Conclusively, evidence is steadily accumulating that with the use of hyperbaric oxygen therapy the chance for a recovery for patients with chronic neurological disorders is considerably higher than it was previously believed.
We have analyzed the medical records of 16 patients with chronic neurological disorders (stroke, traumatic brain injuries, multiple sclerosis, ischemic encephalopathy, etc) the completed treatment at The Yutsis Center for Integrative Medicine, Brooklyn, New York, in 1999. All sixteen patients were treated with hyperbaric oxygen therapy, using pressure of 1.54 – 1.75 ATA. Prior to the treatment patients had their arterial blood pressure, pulse and respiratory rate checked and their tympanic membranes and pupils were examined. Patients were placed into the chamber for 60 minute treatments with twenty minutes for descent and ascent. Neurological examination was done on a weekly basis. Total number of treatments varied from 30 treatments to 220. All these patients required a course physical therapy and acupuncture for the best results. Encouraged by successful results of the treatments, on many occasions patients requested additional treatments in spite of high out-of-pocket expenses. The majority of the patients reported improvement of different degrees in a number of functions (improvement in speech, memory, motor functions, reading and writing.) The majority of patients had a brain SPECT done prior to onset of treatment course and upon its completion. In the cases of acute disturbance of blood circulation, the same efficacy in the treatment was observed. It is established that efficacy of treatment depends upon severity of damage.
Conclusively, in our experience, hyperbaric oxygen therapy provides greater benefits for recovery of different functions in chronic neurological conditions in patients. We have observed improvement in mental status. The same good efficacy in restoration of speech, reading and writing in 75% of our patients, 25% did not demonstrate any improvement. The main difficulties in treatment were observed in restoration of motor functions – 75% of our patients improved in different degrees – 25% reported no improvement.
Here are some case histories:
Patient S.B – Five months prior to the beginning of his hyperbaric oxygen therapy, S.B a 60 year old male developed CVA (major stroke.) He was comatose for about one month and a clot was surgically removed from his cerebellum, however patient was left with blurred speech, bad memory, poor balance and coordination and could not ambulate without using a cane. His hyperbaric oxygen therapy course consisted of 20 treatments of 1.5 ATA and 25 treatments with 1.75 ATA. Upon completion of 45 hyperbaric oxygen therapy treatments, patient improved 100% in all his functions.
Patient J.G. – a 35 year old Italian police officer suffered from hemorrhagic stroke (CVA) 4-1/2 years ago, and underwent hematomectomy in the left temporal region. During his first visit patient presented with sensory aphasia, right sided hemipharesis, poor memory and used a cane for ambulation. J.G had 40 1.5 ATA and 85 1.75 ATA hyperbaric oxygen therapy treatments (total 125 treatments.) During his physical examination patient did not need to use his can anymore. His mental performance has much improved. His speech became understandable and range of motions in his right upper and lower extremities improved about 40%. J.G. started playing baseball with his 9 year old son.
Patient R.Z – a 58 year-old New Jersey pharmacist, a sufferer of hemorrhagic stroke (CVA) 3-1/2 years ago, was brought to our office with difficulties in swallowing and was fed via gastronomy tube. R.Z had a history of cerebral palsy with mild right-sided hemiparesis and left-sided hemiparesis as a result of the stroke. Additionally, motor aphasia of a great severity. Upon completion of 220 hyperbaric oxygen therapy treatments, difficulties with swallowing has been resolved and gastrosomy tube has been removed. R.Z. discontinued using his wheelchair and is able to walk with assistance. His speech is partially improved, his mental clarity is improved and his spasicity has decreased significantly. Finally R.Z can take care of himself.
It has become obvious that conventional methods of management of chronicle neurological disorders including stroke, head trauma, ischemic encephalopathy and multiple sclerosis are not satisfactory. Hyperbaric oxygen therapy showed superior results in improvement of different functions in those affected.
Hyperbaric oxygen therapy is also extremely safe. A body of medical literature and clinical data clearly proves efficacy of hyperbaric oxygen therapy in acute events and even years after event.
Our own experience is identical to JAIN’s results at Fraclinic, Clausenbach Germany. (December 1987 – May 1989,) where improvement in gait, motor functions, speech, writing, reading and mental performance were reported.
The data presented in this article is based upon our clinical observations and should serve as a challenge to initiate a controlled study as more data will be accumulated and become readily available. Both physicians and patients will become encouraged to use hyperbaric oxygen therapy in the treatment of chronic neurological disorders. The good word of this almost miraculous treatment will be spread among American citizens and reach the headquarters of insurance carriers. It will finally force major decision makers to at least pay attention to the benefits of hyperbaric oxygen therapy for stroke, traumatic brain injury and other chronic neurological conditions and hopefully create new reimbursement policies to cover hyperbaric oxygen therapy.
Correspondence:
For further information, please contact Dr. Neuberger at The Ocean Hyperbaric Center, 4001 North Ocean Drive, Suite 105, Lauderdale by the Sea, Florida 33308 USA, 954-771-4000 or Dr. Yutsis at The Yutsis Center for Integrative Medicine, 6413 Bay Parkway, Brooklyn, New York 11204 USA, 718-621-0900.
Hyperbaric Applications 