PURPOSE: Hyperbaric oxygen (HBO) has well documented as well as potentially beneficial effects with respect to managing sepsis. Well documented effects include providing an environment so neutrophils can kill bacteria though their oxygen dependent mechanisms, augmenting the effects of certain antibiotics and static/cidal effects on microorganisms especially anaerobes. Recent reports show potentially beneficial effects of HBO in mediating the effects of sepsis that are elaborated through sub-cellular mechanisms. This presentation examines these new potentially clinically beneficial roles of HBO.
METHODS: A Medline search using the key words “hyperbaric oxygen” and “sepsis” discovered 150 publications. Of these, 11 were experimental studies and 5 clinical trials. From this information, we discovered 8 different mechanisms of HBO that have potential roles in mediating the effects of sepsis and are herein reported.
RESULTS: The following mechanisms of HBO at the sub-cellular level have potential applications for mediating the effects of sepsis: 1) Protection through the interleukin-10 mechanism, 2) “Super-induction” of heme oxygenase-1 by pretreatment with HBO, 3) Inhibition of pulmonary-inducible nitric oxide (NO) synthase expression to attenuate lipopolysaccharide-induced acute lung injury, 4) Attenuation of inflammatory mediators and free radicals with repeated exposures of HBO, 5) Modification of the nuclear factor-kappa B activation in the intestinal mucosa with attenuation of sequential NO overproduction and myeloperoxidase activation, 6) Reduction of bacterial proliferation and translocation in the small intestine, 7) Preservation of RBC deformability and 8) Production of scavengers to mediate the effects of reactive oxygen species.
CONCLUSION: At this time insufficient data is available to justify the routine use of HBO in sepsis based on the subcellular mechanisms listed above.
CLINICAL IMPLICATIONS: We feel that there is a potential role for HBO in severe sepsis and septic shock when tissue oxygenation is severely impaired.
DISCLOSURE: Igor Aksenov, No Financial Disclosure Information; No Product/Research Disclosure Information