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

Literatur

• 1 Almeling M, Welslau W (eds.) Hyperbare Sauerstofftherapie - Qualitätsstandards, GTÜM e. V. 2. Aufl. Archimedes Verlag Kiel; 1996
• 2 Haux G. Wie aus der HB die HBO wurde. Archimedes Verlag 1997: 9-23
• 3 Boerema I. et al . Life without blood.  J. Cardiovasc. Surg.. 1960;  (1) 133-146
• 4 Nylander G. et al . Reduktion of the posteschemic edema with hyperbaric oxygen.  Surg.. 1986;  76 596-603
• 5 Hunt T K. The physiology of wound healing.  Ann. Emerg. Med.. 1988;  17 1265-1273
• 6 Hunt T K, Pal M P. The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis.  Surg. Gynecol. Obstet.. 1979;  135 561-567
• 7 Niinikoski J, Gottup F, Hunt T K. The role of oxygen in wound repair. In: Janssen H, Raaman R, Robertson JIS (Editors) Wound healing. Wrightson Biomedical Publishing 1991: 165-174
• 8 Tompach P C, Lew D, Stoll J L. Cell response to hyperbaric oxygen treatment.  Int. J. Oral Maxillofac. Surg.. 1997;  22(2) 82-86
• 9 Roberts G P, Harding K G. Stimulation of glycosaminoglycan synthesis in cultured fibroblasts by hyperbaric oxygen.  Br. J. Dermatol.. 1994;  131(5) 630-633
• 10 Marx R E. et al . Relationship of oxygen dose to angiogenesis induction in irradiated tissue.  Am. J. Surg.. 1990;  160 519-524
• 11 Uhl E. et al . Hyperbaric oxygen improves wound healing in normal and ischemic skin tissue.  Plast. Reconstr. Surg.. 1994;  93 835-841
• 12 Allen D B. et al . Hypoxia and acidosis limit neutrophil bacterial killing mechanisms.  Arch. Surg.. 1997;  132(9) 991-996
• 13 Tibbles P M, Edelsberg J S. Hyperbaric-Oxygen Therapy.  N. Engl. J. Med.. 1996;  334 1642-1648
• 14 Zamboni W A. et al . Morphologic analysis of the microcirculation during reperfusion of ischemic skeletal muscle and the effect of hyperbaric oxygen.  Plast. Reconstr. Surg.. 1993;  91(6) 1110-1123
• 15 Thom S R. Leukocytes in carbon monoxide-mediated brain oxidative injury.  Toxicol. Appl. Pharmacol.. 1993;  123 234-237
• 16 Sirsjo A. et al . Hyperbaric oxygen treatment enhances the recovery of blood flow and functional capillary density in postischemic striated muscle.  Circ. Shock.. 1993;  40(1) 9-13
• 17 Thom S R. et al . Inhibition of human neutrophil beta2-integrin-dependent adherence by hyperbaric O2.  Am. J. Physiol.. 1997;  272(3 Pt 1) C770-7
• 18 Haapaniemi T. et al . Hyperbaric oxygen treatment attenuates glutathione depletion and improves metabolic restitution in postischemic skeletal muscle.  Free Radic. Res.. 1995;  23(2) 91-101
• 19 Pace N, Strajman E, Walker E L. Acceleration of carbon monoxide elimination in man by high pressure oxygen.  Science. 1950;  111 652-654
• 20 Tibbles P M, Perotta P L. Treatment of carbon monoxide poisoning: a critcal review of human outcome studies comparing normobaric oxygen with hyperbaric oxygen.  Ann. Emerg. Med.. 1994;  24 269-276
• 21 Weaver L K, Hopkins R O, Larson-Lohr V. Neuropsychologic and functional recovery from severe carbon monoxide poisoning without hyperbaric oxygen therapy.  Ann. Emerg. Med.. 1996;  27(6) 736-740
• 22 Thom S R. Functional inhibition of leukocyte B2 integrins by hyperbaric oxygen in carbon monoxide-mediated brain injury in rats.  Toxicol. Appl. Pharmacol.. 1993;  123 248-256
• 23 Jiang J, Tyssebotn I. Cerebrospinal fluid pressure changes after acute carbon monoxide poisoning and therapeutic effects of normobaric and hyperbaric oxygen in conscious rats.  Undersea Hyperb. Med.. 1997;  24(4) 245-254
• 24 Francis D JR. The Pathophysiology of Decompression Sickness. In: Bennet PB, Moon R (Editors) Diving Accident Management. UHMS/DAN Workshop Bethesda, MD, USA; 1990: 38-56
• 25 Shastri K A, Logue G L, Lundgren C E. In vitro activation of human complement by nitrogen bubbles.  Undersea Biomed. Res.. 1991;  18 157-165
• 26 Loewenherz J A. Clinical Features of Diving Accidents. In: Bennett PB, Moon RE (Editors) Diving Accident Management. UHMS/DAN Workshop Bethesda, MD, USA; 1990: 130-145
• 27 Francis T JR. et al . Central nervous system decompression sickness: Latency of 1070 human cases.  Undersea Biomed. Res.. 1988;  15 403-419
• 28 Ball R. Effect of severity, time to recompression with oxygen, and retreatment on outcome in fourty-nine cases of spinal cord decompression sickness.  Undersea Hyperb. Med.. 1993;  20 133-145
• 29 Thalmann E D. Principles of US Navy Recompression Treatments for Decompression Sickness. In: Moon RE, Sheffield PJ (Editors) Treatment of Decompression Illness. UHMS/DAN ASMA Workshop Palm Beach, FL, USA; 1995: 75-95
• 30 Vann R D. et al . Prognostic Factors in DCI in Recreational Divers. In: Moon RE, Sheffield PJ (Editors) Treatment of Decompression Illness. UHMS/DAN ASMA Workshop Palm Beach, FL, USA; 1995: 352-363
• 31 Broome J R, Dick E J. Neurological Decompression Illness in Swine.  Aviat. Space Environm. Med.. 1996;  67 207-213
• 32 Leitch D R, Hallenbeck J M. Oxygen in the Treatment of Spinal Cord Decompression Sickness.  Undersea Biomed. Res.. 1985;  12 269-289
• 33 Wattel F, Mathieu D (eds.) European Committee for Hyperbaric Medicine: Proceedings of the 2nd European Consensus Conference on Treatment of Decompression Accidents in Recreational Diving. Marseille; 1996: 13-25
• 34 Welslau W, et al. (eds.) Hyperbare Sauerstofftherapie. Archimedes Göttingen; 1998: 46-47
• 35 Plafki C, Welslau W, Almeling M. Die Bedeutung des persistierenden Foramen ovale (PFO) für das Risiko von Dekompressionsunfällen und neurologischen Langzeitshcäden bei Tauchern.  Dt. Zeischr. Sportmed.. 1998;  3 88-92
• 36 Moon R E. Gas Embolism. In: Oriani G, Marroni A, Wattel F (Editors) Handbook on Hyperbaric Medicine. Springer 1996: 229-249
• 37 Moloff A L. Delayed Onset of Arterial Gas Embolism.  Aviat. Space Environm. Med.. 1993;  64 1040-1043
• 38 Dutka A J. A review of the pathophysiology and potential application of experimental therapies for the treatment of cerebral arterial gas embolism.  Undersea Biomed. Res.. 1985;  12 403-421
• 39 McDermott J J. et al . Effects of an increased pO2 during recompression therapy for the treatment of experimental cerebral arterial gas embolism.  Undersea Biomed. Res.. 1992;  19(6) 403-413
• 40 Bitterman H, Melamed Y. Delayed hyperbaric treatment of cerebral air embolism.  Isr. J. Med. Sci.. 1993;  29(1) 22-26
• 41 Kindwall E P. Use of Short Versus Long Tables in the Treatment of Decompression Sickness and Air Embolism. In: Moon RE, Sheffield PJ (Editors) Treatment of Decompression Illness. UHMS/DAN ASMA Workshop Palm Beach, FL, USA; 1995
• 42 Gorman D. The Treatment of Arterial Gas Embolism. In: Moon RE, Sheffield PJ (Editors) Treatment of Decompression Illness. UHMS/DAN/ASMA Workshop Palm Beach, FL, USA; 1995: 96-100
• 43 Tirpitz D. HBO-Therapie in der Behandlung nekrotisierender Weichteilinfektionen. In: Almeling M, Böhm, Welslau W (Editors) Handbuch der Tauch- und Hyperbarmedizin. Ecomed Verlags-GmbH Landsberg/Lech; 1998: 1-26
• 44 Camporesi EM (ed.) Clostridial myonecrosis (gas gangrene). In: Hyperbaric Oxygen Therapy: A Committee Report. Undersea And Hyperbaric Medical Society Kensington; 1996: 11-13
• 45 Bakker D J, van der Klij A J. Clostridial Myonecrosis. In: Oriani G, Marroni A, Wattel F (Editors) Handbook on Hyperbaric Medicine. Springer 1996: 362-385
• 46 Roggenthin T. et al . An immunoassay for the rapid and specific detection of three sialidase producing clostridia causing gas gangrene.  J. Immunol. Meth.. 1993;  157 125-133
• 47 van Unnik A JM. Inhibition of toxin production in Clostridium perfringens in vitro by hyperbaric oxygen.  Antonie Van Leeuwenhoek. 1965;  31 360-366
• 48 Kaye D. Effect of hyperbaric oxygen on Clostridia in vitro and in vivo.  Proc. Soc. Exp. Biol. Med.. 1967;  124 360-366
• 49 Holland J A. et al . Experimental and clinical experience with hyerbaric oxygen in the treatment of clostridial myonecrosis.  Surgery. 1975;  77(1) 75-85
• 50 Demello F J, Haglin J J, Hitchcock C R. Comparative study of experimental Clostridium perfringens infection in dogs.  Surgery. 1973;  73 936-941
• 51 Erttmann M, Havemann D. Ergebnisse einer retro- und prospektiven Analyse des unfallchirurgischen Krankenguts aus 20 Jahren.  Unfallchirurg. 1992;  95 471-476
• 52 Hart G B, Strauss M B. Gas Gangrene - Clostridial Myonecrosis: A Review.  J. Hyperbaric Medicine. 1990;  5(2) 131-144
• 53 Mader J. Mixed anaerobic and aerobic soft tissue infections. In: Davis JC, Hunt TK (Editors) Problem Wounds: The Role of Oxygen. Elsevier New York; 1988: 153-172
• 54 Bakker D J. Selected aerobic and anaerobic soft tissue infections. In: Kindwall EP (Editor) Hyperbaric medicine practice. Best Publishers Flagstaff; 1999
• 55 Chanteleau E, Kleinfeld H, Paetow P. Das Syndrom des diabetischen Fußes - Neue therapeutische und diagnostische Aspekte.  Diabetes und Stoffwechsel. 1992;  1 18-23
• 56 Reike H, Angelkort B. Einteilung und Epidemiologie des diabetischen Fußsyndroms. In: Reike H (Editor) Das diabetische Fußsyndrom. Upjohn Medical 1993
• 57 Caputo G M. et al .Assessment and Management of Foot Disease in Patients with Diabetes. N. Engl. J. Med. 1994 : 854-860
• 58 Wagner F W. Treatment of the diabetic foot.  Compr. Ther.. 1984;  10 29
• 59 Stiegler H. et al . Failure of reducing lower extremity amputations in diabetic patients: result of two subsequent population based surveys 1990 and 1995 in Germany.  VASA. 1998;  27 10-14
• 60 Welslau W, et al. (eds.) Hyperbare Sauerstofftherapie. Archimedes Verlag Göttingen; 1998: 96-97
• 61 Doctor N, Pandya S, Supe A. Hyperbaric oxygen therapy in diabetic foot.  J. Postgrad. Md.. 1992;  38(3) 111-114
• 62 Faglia E. et al . Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomised study.  Diabetes Care. 1996;  19(12) 1338-1343
• 63 Baroni G. et al . Hyperbaric oxygen in diabetic gangrene treatment.  Diabetes Care. 1987;  10 81-86
• 64 Oriani G. et al . Hyperbaric oxygen therapy in diabetic gangrene. In: Proc. of the 10th Int. Congress on Hyperbaric Medicine. Best Publishers Amsterdam; 1990
• 65 Oriani E, Faglia F. Hyperbaric oxygen treatment in the diabetic gangrene.  Undersea Hyperb. Med.. 1995;  22 (Suppl.) 11
• 66 Zamboni W A. et al . Evaluation of hyperbaric oxygen for diabetic wounds: a prospective study.  Undersea Hyperb. Med.. 1997;  24(3) 175-179
• 67 Cianci P, Hunt T K. Long-term results of aggressive management of diabetic foot ulcers suggest significant cost effectiveness.  Wound Rep. Reg.. 1997;  5 141-146
• 68 Brown G L. et al . Enhancement of wound healing by topical treatment with epidermal growth factor.  N. Engl. J. Med.. 1989;  321 76-79
• 69 Zhao L L. et al . Total reversal of hypoxic wound healing deficit by hyperbaric oxygen plus growth factors.  Am. Coll. of Surgeons. 1993;  43 711-714
• 70 Marx R E. Radiation injury to tissue. In: Kindwall PE (Editor) Hyperbaric medicine practice. Best Publishers Flagstaff, Ariz.; 1994: 447-504
• 71 Mustoe T A, Porras-Reyes B H. Modulation of wound healing response in chronic irradiated tissues.  Clin. Plast. Surg.. 1993;  20 465-472
• 72 Ehler W J, Marx R E, Peleg M J. Oxygen as a drug: a dose response curve for radiation necrosis.  Undersea Hyperb. Med.. 1993;  20 (Suppl.) 44-45
• 73 Bevers R FM, Bakker D J, Kurth K H. Hyperbaric oxygen treatment for hemorrhagic radiation cystitis.  Lancet. 1995;  346 803-805
• 74 Favre C. et al . Hyperbaric oxygen therapy in a case of post-total body irradiation colitis.  Bone Marrow Transplant.. 1998;  21(5) 519-520
• 75 Woo T C, Joseph D, Oxer H. Hyperbaric oxygen treatment for radiation proctits.  Int. J. Radiat. Oncol. Biol. Phys.. 1997;  38(3) 619-622
• 76 Colombel F J. et al . Hyperbaric oxygenation in severeperineal Crohn's disease.  Dis. Colon Rectum. 1995;  38(6) 609-614
• 77 Lavy A. et al . Hyperbaric oxygen for perineal Crohn's disease.  J. Clin. Gastroenterol.. 1994;  19(3) 202-205
• 78 Sterling D L. et al . Hyperbaric oxygen limits infarct size in ischemic rabbit myocardium in vivo.  Circulation. 1993;  8(4 Pt 1) 1931-1936
• 79 Shandling A H. et al . Hyperbaric oxygen and thrombolysis in myocardial infarction: the “HOT MI” pilot study.  Am. Heart J.. 1997;  134(3) 544-550
• 80 Radice S. et al . Hyperbaric oxygen worsens myocardial low flow ischemia-reperfusion injury in isolated rat heart.  Eur. J. Pharmocol.. 1997;  320(1) 43-49
• 81 Mink R B, Dutka A J. Hyperbaric oxygen after global cerebral ischemia in rabbits reduces brain vascular permeability and blood flow.  Stroke. 1995;  26(12) 2307-2312
• 82 Krakowsky M. et al . Effect of hyperbaric oxygen therapy on survival after global cerebral ischemia in rats.  Surg. Neurol.. 1998;  49(4) 412-416
• 83 Neubauer R A, Jamesy P. Cerebral oxygenation and the recoverable brain.  Neurol. Res.. 1998;  20 (Suppl. 1) S33-S36
• 84 Nighoghossian N, Trouillas P. Hyperbaric oxygen in the treatment of acute ischemic stroke: an unsettled issue.  J. Neurol. Sci.. 1997;  150(1) 27-31
• 85 Plafki C. et al . Komplikationen der HBO-Therapie bei elektiven Indikationen.  Caisson, Mitteilungen der Gesellschaft für Tauch- und Überdruckmedizin e. V.. 1997;  12 116-122
• 86 Clark J M. Oxygen toxicity. In: Kindwall EP (Editor) Hyperbaric medicine practice. Best Publishers Flagstaff; 1994: 33-43
• 87 Chavko M, Harabin A L. Regional lipid peroxidation and protein oxidation in rat brain after hyperbaric oxygen exposure.  Free Radic. Biol. Med.. 1996;  20(7) 973-978
• 88 Wood J D. GABA and oxygen toxicity: a review.  Brain Res. Bull.. 1980;  5 777-780
• 89 Kindwall E P, Goldmann R W. Oxygen toxicity. In: Kindwall EP, Goldmann RW (Editors) Hyperbaric medical procedures. Milwaukee; 1995: 118-126
• 90 Bert P. La pression barometrique; recherche de physiologie experimental. Libraire de l¿academie de Medicine Paris; 1878
• 91 Smith J L. The pathological effects due to increase of oxygen tension in air breathed.  J. Physiol.. 1899;  24 19-35
• 92 Clark J M, Lambertson C J. Pulmonary oxygen toxicity: a review.  Pharmocol. Rev.. 1971;  23 37-133
• 93 Palmquist B M, Philipson B, Barr P O. Nuclear cataract and myopia during hyperbaric oxygen therapy.  Br. J. Ophthalmol.. 1984;  68 113-117
• 94 Longobardi P. et al . The Italian National Health Service and the Use of Hyperbaric Oxygen Therapy in Italy.  Pressure. 1999;  28(6) 18-20
• 95 Welslau W, et al. (eds) Hyperbare Sauerstofftherapie. Archimedes Göttingen; 1998: 249-264
• 96 Breinbauer B. et al . Indications for hyperbaric oxygenation in chronic deseases.  Anaesthesiol. Intensivmed. Notfallmed. Schmerztherap.. 1996;  31(2) 102-105
• 97 Hipp R. et al . Technical prerequisites, required personnel and practical implementation of hyperbaric oxygenation.  Anaesthesiol. Intensivmed. Notfallmed. Schmerztherap.. 1996;  31(2) 108-110
• 98 Hipp R, Kochs E. Hyperbaric oxygen therapy - principles and indications.  Anaesthesiol. Intensivmed. Notfallmed. Schmerztherap.. 1996;  31(2) 96-97
• 99 Mielke L. et al . Indications for primary or initial use of hyperbaric oxygenation.  Anaesthesiol. Intensivmed. Notfallmed. Schmerztherap.. 1996;  31(2) 100-102
• 100 Mielke L. et al . Expanding indications for hyperbaric oxygenation - current development and status of clinical evaluation.  Anaesthesiol. Intensivmed. Notfallmed. Schmerztherap.. 1996;  31(2) 106-108
• 101 Rump A FE, Siekmann U, Kalff G. Effects of Hyperbaric and Hyperoxic Conditions on the Disposition of Drugs: Theoretical Considerations and a Review of the Literature.  Gen. Pharmac.. 1999;  32(1) 127-133
• 102 Stahl W, Calzia E, Radermacher P. Function of different ICU ventilators under hyperbaric conditions.  Undersea Hyperb. Med.. 1998;  25 15
• 103 Moon R. Ask the expert. Pressure 1999 28(1)