Hyperbare Oxygenationstheapie (HBO): eine Standortbestimmung

Zusammenfassung.

Seit mehr als dreißig Jahren gehört die hyperbare Oxygenationstherapie (HBO) zu dem therapeutischen, schulmedizinischen Repertoire bei speziellen Indikationen. Die Verbesserung der Gewebeoxygenierung, Stimulation wesentlicher am Wundheilungsprozeß beteiligter Vorgänge und Beeinflussung anderer Prozesse auf biochemischer und zellulärer Ebene durch die HBO sind wissenschaftlich belegt. Diese bilden die Rationale für die hyperbare Oxygenierung als Therapie der Wahl bei schwerer Kohlenmonoxid-Intoxikation, Dekompressionserkrankung und arterieller Gasembolie sowie als adjuvante Therapie zur Behandlung von Osteoradionekrosen, nekrotisierenden Weichteilinfektionen und kritischen Haut-/Muskeltransplantaten. Der Nutzen einer adjuvanten HBO-Therapie in der Behandlung des therapierefraktären diabetischen Fuß-Syndroms kann ebenfalls als gesichert gelten. Der therapeutische Benefit bei anderen Indikationen ist wissenschaftlich wenig untermauert und bedarf weiterer Klärung. Unter Beachtung der von den Fachgesellschaften festgelegten Standards ist die HBO bei ausgewählten Indikationen eine sichere und nebenwirkungsarme Therapie.

Hyperbaric Oxygen Therapy (HBO): Current Standing.

For more than thirty years hyperbaric oxygen therapy (HBO) has been an important and ultimate therapeutic tool in special indications. Hyperbaric oxygen improves tissue oxygenation, stimulates important mechanisms in wound healing and exerts beneficial effects on other biochemical and cellular processes. The properties of hyperbaric oxygen have built the rationale for its use as therapy of choice in patients with severe carbon monoxide poisoning, decompression sickness and arterial gas embolism, and as adjunctive therapy for the treatment of osteoradionecrosis, necrotizing fasciitis and compromised skin grafts and flaps. The efficacy of adjunctive hyperbaric oxygen in the treatment of lower extremity problem wounds in diabetic patients seems to be proven. There is little scientific support for other uses of hyperbaric oxygen and its therapeutical benefit should be further investigated. When used according to standard protocols hyperbaric oxygen treatment is a safe therapy with little adverse effects.

Schlüsselwörter:

Hyperbare Oxygenation - - Kohlenmonoxid-Intoxikation - - Dekompressionserkrankung - - Arterielle Gasembolie - - Clostridiale Myonekrose - - Wundheilung - - Problemwunde

Key words:

Hyperbaric oxygen - - Carbon monoxide poisoning - - Decompression sickness - - Arterial gas embolism - - Clostridial myonecrosis - - Wound healing - - Problem wound

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