Hyperbaric oxygenation therapy in healthy individuals

The clinical use of Hyperbaric Oxygenation (HBOT) consists of breathing oxygen (O2) at a high concentration in a pressurized chamber at least 1.4 absolute atmospheres (ATA). Under these conditions, a large amount of O2 is dissolved in the plasma, to be used by all cells, reaching even poorly perfused tissues.

Developed initially for the recovery of carbon monoxide poisoning and infections caused by anaerobic microorganisms, Hyperbaric Medicine is currently used as adjuvant therapy in multiple pathological conditions where the main components are hypoxia and inflammation, and where it is required the tissue regeneration or the healing of chronic wounds refractory to conventional treatment.

The indications of this therapy in different pathologies with an inflammatory, hypoxic and/or ischemic base are widely disseminated and are in permanent development and research. There is a wide range of scientific works and protocols that report their use in different specialties, such as the clinical area, sports medicine, traumatology, neurology, and injuries.

The development of safer hyperbaric oxygenation chambers (that work with a pressure less than 2 atm and does not produce neurotoxicity), has contributed to HBOT, that is also used in the increase of sports performance or in the improvement of general well-being in healthy individuals. The therapeutic mechanism of HBOT is to produce hyperoxia and a temporary increase in the production of reactive oxygen species (ROS).

It resolves adverse conditions such as hypoxia and edema and favors normal or physiological responses to infectious and ischemic processes. Under controlled conditions (pressure and time of exposure), in addition to generating EROs and free radicals (RL), HBOT stimulates the expression and activity of antioxidant enzymes, to maintain the homeostasis of the “redox” state (reductive/oxidative) and to ensure the harmlessness of the treatment.

HBOT is considered a tolerable and safe therapy when it is administered in sessions of up to 120 minutes and at a pressure lower than 3 ATA. The results available in the literature mainly refer to their use at pressures above 1.4 atm. However, from the knowledge of these authors, there is no published data on the safety profile in new generation chambers, that work at 1.45 atm.

With the long-term objective of conducting studies of the effectiveness of HBOT in different pathologies, doctors Liliana Jordá-Vargas and Mariana Cannellotto developed “Hyperbaric oxygenation therapy in healthy individuals: Effect on some biochemical parameters”, a work that was proposed to begin to study its safety profile in biochemical parameters, by analyzing the effects of the treatment of HBOT in healthy adult individuals, that do not present any chronic pathology.

The work methodology consisted essentially of the following stages: a retrospective selection of individuals and analysis of the results of the biochemical parameters studied for the control of patients attending the Center in order to improve their general well-being.

To carry out this retrospective study, all healthy individuals who consulted to improve their general health status were included for the clinical benefits of HBOT from October 2015 to January 2016.

Hyperbaric oxygenation treatment was performed with Revitalair® technology chambers. Individuals received O2 94-95% (administered through masks with reservoir) during 10 or 20 sessions of 60 minutes, 3 to 4 times per week.

The control samples of biochemical parameters were taken at the beginning of the treatment: (t = 0), at 10 sessions (t = 10) and, in the cases that wished to continue with the treatment, at 20 sessions (t = 20) immediately after treatment of HBOT when leaving the chamber. The samples were processed and biochemical determinations performed according to analytical and preanalytical techniques of the biochemical methods.

The results obtained for each biochemical parameter were compared with the reference values for the adult population. To evaluate the differences between the means of the values, the agreement was determined using the Shapiro-Wilks test for the normal distribution (α = 0.05). Then the Student test was applied for paired samples, considering significant differences with p <0.05. The statistical analysis was carried out taking each individual as his own control, obtaining and comparing the paired parameters.

Twenty individuals performed only 10 sessions (group B) and 10 individuals performed a total of 20 sessions with control at 10 sessions (group A). Therefore, results were obtained at the 10 sessions of group A and group B (n = 20) (baseline and 10 sessions). Group B had baseline results, 10 sessions and 20 sessions (n = 10).

Healthy individuals had an age range of 18 to 50 years (6 women, 37.5 years old (95% CI 32.3-42.7), 14 men 34.7 years old (95% CI 26.5-43; 0) The results of the laboratory measurements were analyzed in the 20 samples at time t = 0, t = 10 and t = 20. There were no significant changes in the means of the coagulation parameters, the fibrinogen dose and the values of the partial thromboplastin time activated by kaolin remained practically stable during the 10 and 20 sessions with respect to the baseline value.

The remaining parameters fluctuated between the sessions with a slight non-significant increase in the prothrombin time at 10 sessions, returning to the baseline values at 20. The changes were not statistically significant. The results of the liver profile and hematological profile were always within the reference values.

The acute phase reactants developed different behaviors. Among them, the mean values of ferritin and haptoglobin were stable throughout the sessions. The acute phase reactants evaluated underwent non-significant variations with exposure to HBOT: ceruloplasmin (Cp), C-reactive protein (CRP), alpha-2-macroglobulin (α2Mgb) and especially alpha-1-antitrypsin (α1At).

Although the hematological profile and liver profile were always within the reference values, a particular tendency was found in group B to decrease red blood cells, hematocrit and hemoglobin concentration and the number of leukocytes when compared with the basal values. These data were not statistically significant.

In response to the acute reaction, changes in red blood cells, in the production of leukocytes and platelets, can also occur, since the cells that are released from the bone marrow into the circulation can be modified. In this study, after 10 sessions there were no variations in the total leukocyte quantity, although some studies may only report a qualitative change in lymphocytes (CD4 / CD8 lymphocyte populations) and in leukocyte function in general. The non-significant tendency to decrease in the red blood cell count, hematocrit and hemoglobin concentration can be interpreted by the effect of hyperoxia.

Hyperbaric Oxygen Therapy performed at 1.45 atm does not report statistically significant variations in the biochemical parameters of the hematological, hepatic, coagulation profile and acute phase proteins. The HBOT carried out with the Revitalair® technology cameras showed no adverse clinical or biochemical manifestations in healthy individuals.



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