Hyperbaric Medicine

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (1 January 2022) | Viewed by 53970

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Guest Editor
Haute Ecole Bruxelles-Brabant (HE2B), Université Libre de Bruxelles, Brussels, Belgium
Interests: extreme environments; oxygen; integrative physiology; diving; space physiology; pathophysiology; hyperbaric medicine; personalized medicine; cellular responses
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Guest Editor
Medical University of Gdańsk, Gdańsk, Poland
Interests: hyperbaric medicine; hyperbaric oxygen therapy; critical care; saturation decompression; diving physiopathology; decompression sickness

Special Issue Information

Dear Colleagues,

The usual path in medical sciences is almost always the same: understanding mechanisms, cellular tests, tissues, small animals, larger animals, human studies, clinical studies, etc.

It seems totally useless to be reminded that, albeit normal path, hyperbaric medicine has been developed in an unusual way.

In fact, during the 1950s, a Dutch cardiac surgeon (Ite Boerema) started to use a system that was considered efficient in curing divers affected with the so-called “caissons’ disease” to help his young patients called “blue babies”. The procedure to mend cardiac septal defects needed a cardiac arrest, and the time for such a cardiac arrest to secure a cardiovascular restart was a matter of minutes (Boerema et al., 1960).

At that moment, an unacceptable amount of such patients were not surviving the surgery, and this surgeon wanted to find a way that would allow him to achieve better outcomes. In order to have the chance to increase the survival rate, a longer period of cardiac arrest with good recovery chances was needed.

Increasing circulating oxygen level in the body by increasing barometric pressure in the operating room will permit survival even after a more prolonged cardiac arrest. Of course, some years after, extracorporeal circulation has become available and the “hyperbaric operating room” was no longer an option.

Since that very moment, a lot of hyperbaric centres have been developed and a long list of indications and procedures were produced.

This medical field was so “dispersive” that some reactions rose, and hyperbaric medicine was even “coined” a: “therapy in search of diseases” (Phillips, 2000).

Very important progress has been made since 1960, when Life without Blood was published, mechanisms that are underlying oxygen variations have been rewarded by a Nobel prize in 2019 (Lopez-Barneo and Simon, 2020) and this is an important milestone in the field since today we have enough understanding to tackle two major points that still need to be investigated in Hyperbaric Medicine: how much and how often. Hyperbaric medicine should be called “oxygen medicine”, a large range of oxygen levels may be used and, according to these levels, repetitions of sessions have to be adapted. Today, the dose (pressure) and repetitions of hyperbaric medicine are regulated mostly to cope with pulmonary and neurological toxicity, mainly calculating OTUs (Oxygen Toxicity Units) or UTPDs (Units of Pulmonary Toxicity Doses) to stay on the safe side and not harm the patient; these calculations accepted by everyone are nowadays increasingly challenged by new approaches (Arieli, 2020; Arieli and Aviner, 2020; Aviner et al., 2020; Wingelaar et al., 2020).

We therefore have the opportunity to get “back to basics” since hyperbaric medicine, and in parallel diving medicine, is getting out of its infancy.

However, as in real life, with infancy the certainties also disappear. It is now our task, as researchers, to reflect upon these uncertainties and distil out of them coherent, balanced advice towards researchers, physicians and patients. Let us not jump to conclusions too quickly, as our new “certainties”, again, may very well prove to be “not the whole story” (Balestra et al., 2019). This Special Issue is dedicated to increase knowledge in this very interesting field which investigates oxygen on the whole range of its use.

Prof. Costantino Balestra
Prof. Jacek Kot
Guest Editors

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Keywords

  • Cancer
  • Oxidative Stress
  • Critical Care
  • Environmental Stresses
  • Nitric Oxide
  • Hypoxia
  • Oxygen
  • Medical Research
  • Extreme Environments
  • Diving
  • Aerospace

Published Papers (12 papers)

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Editorial

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6 pages, 6190 KiB  
Editorial
Oxygen: A Stimulus, Not “Only” a Drug
by Costantino Balestra and Jacek Kot
Medicina 2021, 57(11), 1161; https://doi.org/10.3390/medicina57111161 - 25 Oct 2021
Cited by 8 | Viewed by 3032
Abstract
Depending on the oxygen partial pressure in a tissue, the therapeutic effect of oxygenation can vary from simple substance substitution up to hyperbaric oxygenation when breathing hyperbaric oxygen at 2.5–3.0 ATA. Surprisingly, new data showed that it is not only the oxygen supply [...] Read more.
Depending on the oxygen partial pressure in a tissue, the therapeutic effect of oxygenation can vary from simple substance substitution up to hyperbaric oxygenation when breathing hyperbaric oxygen at 2.5–3.0 ATA. Surprisingly, new data showed that it is not only the oxygen supply that matters as even a minimal increase in the partial pressure of oxygen is efficient in triggering cellular reactions by eliciting the production of hypoxia-inducible factors and heat-shock proteins. Moreover, it was shown that extreme environments could also interact with the genome; in fact, epigenetics appears to play a major role in extreme environments and exercise, especially when changes in oxygen partial pressure are involved. Hyperbaric oxygen therapy is, essentially, “intermittent oxygen” exposure. We must investigate hyperbaric oxygen with a new paradigm of treating oxygen as a potent stimulus of the molecular network of reactions. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
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Research

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14 pages, 2062 KiB  
Article
Pulmonary Effects of One Week of Repeated Recreational Closed-Circuit Rebreather Dives in Cold Water
by Emmanuel Gouin, Costantino Balestra, Jeremy Orsat, Emmanuel Dugrenot and Erwan L’Her
Medicina 2023, 59(1), 81; https://doi.org/10.3390/medicina59010081 - 30 Dec 2022
Cited by 2 | Viewed by 2715
Abstract
Background and Objectives: The use of closed-circuit rebreathers (CCRs) in recreational diving is gaining interest. However, data regarding its physiological effects are still scarce. Immersion, cold water, hyperoxia, exercise or the equipment itself could challenge the cardiopulmonary system. The purpose of this [...] Read more.
Background and Objectives: The use of closed-circuit rebreathers (CCRs) in recreational diving is gaining interest. However, data regarding its physiological effects are still scarce. Immersion, cold water, hyperoxia, exercise or the equipment itself could challenge the cardiopulmonary system. The purpose of this study was to examine the impact of CCR diving on lung function and autonomous cardiac activity after a series of CCR dives in cold water. Materials and Methods: Eight CCR divers performed a diving trip (one week) in the Baltic Sea. Spirometry parameters, SpO2, and the lung ultrasonography score (LUS) associated with hydration monitoring by bioelectrical impedance were assessed at the end of the week. Heart rate variability (HRV) was recorded during the dives. Results: No diver declared pulmonary symptoms. The LUS increased after dives combined with a slight non-pathological decrease in SpO2. Spirometry was not altered, and all body water compartments were increased. Global HRV decreased during diving with a predominant increase in sympathetic tone while the parasympathetic tone decreased. All parameters returned to baseline 24 h after the last dive. Conclusions: The lung aeration disorders observed seem to be transient and not associated with functional spirometry alteration. The HRV dynamics highlighted physiological constraints during the dive as well as environmental-stress-related stimulation that may influence pulmonary changes. The impact of these impairments is unknown but should be taken into account, especially when considering long and repetitive CCR dives. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
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13 pages, 1533 KiB  
Article
Vascular Function Recovery Following Saturation Diving
by Jean-Pierre Imbert, Salih-Murat Egi and Costantino Balestra
Medicina 2022, 58(10), 1476; https://doi.org/10.3390/medicina58101476 - 17 Oct 2022
Cited by 3 | Viewed by 2559
Abstract
Background and Objectives: Saturation diving is a technique used in commercial diving. Decompression sickness (DCS) was the main concern of saturation safety, but procedures have evolved over the last 50 years and DCS has become a rare event. New needs have evolved [...] Read more.
Background and Objectives: Saturation diving is a technique used in commercial diving. Decompression sickness (DCS) was the main concern of saturation safety, but procedures have evolved over the last 50 years and DCS has become a rare event. New needs have evolved to evaluate the diving and decompression stress to improve the flexibility of the operations (minimum interval between dives, optimal oxygen levels, etc.). We monitored this stress in saturation divers during actual operations. Materials and Methods: The monitoring included the detection of vascular gas emboli (VGE) and the changes in the vascular function measured by flow mediated dilatation (FMD) after final decompression to surface. Monitoring was performed onboard a diving support vessel operating in the North Sea at typical storage depths of 120 and 136 msw. A total of 49 divers signed an informed consent form and participated to the study. Data were collected on divers at surface, before the saturation and during the 9 h following the end of the final decompression. Results: VGE were detected in three divers at very low levels (insignificant), confirming the improvements achieved on saturation decompression procedures. As expected, the FMD showed an impairment of vascular function immediately at the end of the saturation in all divers but the divers fully recovered from these vascular changes in the next 9 following hours, regardless of the initial decompression starting depth. Conclusion: These changes suggest an oxidative/inflammatory dimension to the diving/decompression stress during saturation that will require further monitoring investigations even if the vascular impairement is found to recover fast. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
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13 pages, 1458 KiB  
Article
Effect of SCUBA Diving on Ophthalmic Parameters
by Laurent Deleu, Janet Catherine, Laurence Postelmans and Costantino Balestra
Medicina 2022, 58(3), 408; https://doi.org/10.3390/medicina58030408 - 09 Mar 2022
Cited by 3 | Viewed by 3400
Abstract
Background and Objective: Several cases of central serous chorioretinopathy (CSC) in divers have been reported in our medical retina center over the past few years. This study was designed to evaluate possible changes induced by SCUBA diving in ophthalmic parameters and especially [...] Read more.
Background and Objective: Several cases of central serous chorioretinopathy (CSC) in divers have been reported in our medical retina center over the past few years. This study was designed to evaluate possible changes induced by SCUBA diving in ophthalmic parameters and especially subfoveal choroidal thickness (SFCT), since the choroid seems to play a crucial role in physiopathology of CSC. Materials and Methods: Intraocular pressure (IOP), SFCT, pachymetry, flow-mediated dilation (FMD), blood pressure, and heart rate were measured in 15 healthy volunteer divers before diving, 30 and 60 min after a standard deep dive of 25 m depth for 25 min in a dedicated diving pool (NEMO 33). Results: SFCT reduces significantly to 96.63 ± 13.89% of pre-dive values (p = 0.016) 30 min after diving. It recovers after 60 min reaching control values. IOP decreases to 88.05 ± 10.04% of pre-dive value at 30 min, then increases to 91.42 ± 10.35% of its pre-dive value (both p < 0.0001). Pachymetry shows a slight variation, but is significantly increased to 101.63 ± 1.01% (p = 0.0159) of the pre-dive value, and returns to control level after 60 min. FMD pre-dive was 107 ± 6.7% (p < 0.0001), but post-dive showed a diminished increase to 103 ± 6.5% (p = 0.0132). The pre-post difference was significant (p = 0.03). Conclusion: Endothelial dysfunction leading to arterial stiffness after diving may explain the reduced SFCT observed, but SCUBA diving seems to have miscellaneous consequences on eye parameters. Despite this clear influence on SFCT, no clear relationship between CSC and SCUBA diving can be drawn. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
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17 pages, 3859 KiB  
Article
Clinical Assessment of the Hyperbaric Oxygen Therapy Efficacy in Mild to Moderate Periodontal Affections: A Simple Randomised Trial
by Alexandru Burcea, Laurenta Lelia Mihai, Anamaria Bechir, Mircea Suciu and Edwin Sever Bechir
Medicina 2022, 58(2), 234; https://doi.org/10.3390/medicina58020234 - 04 Feb 2022
Cited by 6 | Viewed by 2288
Abstract
Background and Objectives: Gum disease represents the condition due to the dental plaque and dental calculus deposition on the surfaces of the teeth, followed by ulterior destruction of the periodontal tissues through the host reaction to the pathogenic microorganisms. The aim of study [...] Read more.
Background and Objectives: Gum disease represents the condition due to the dental plaque and dental calculus deposition on the surfaces of the teeth, followed by ulterior destruction of the periodontal tissues through the host reaction to the pathogenic microorganisms. The aim of study was to present aspects regarding the efficacy of hyperbaric oxygen therapy (HBOT) as an adjuvant therapy for the treatment of periodontal disease, started from the already certified benefits of HBOT in the general medicine specialties. Materials and Methods: The participant patients in this study (71) required and benefited from specific periodontal disease treatments. All patients included in the trial benefited from the conventional therapy of full-mouth scaling and root planing (SRP) within 24 h. HBOT was performed on the patients of the first group (31), in 20 sessions, of one hour. The patients of the control group (40) did not benefit from HBO therapy. Results: At the end of study, the included patients in HBOT group presented significantly better values of oral health index (OHI-S), sulcus bleeding index (SBI), dental mobility (DM), and periodontal pocket depth (PD) than the patients of the control group. Conclusions: HBOT had beneficial effects on the oral and general health of all patients, because in addition to the positive results in periodontal therapy, some individual symptoms of the patients diminished or disappeared upon completion of this adjuvant therapy. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
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14 pages, 1556 KiB  
Article
Analysis of the Increase of Vascular Cell Adhesion Molecule-1 (VCAM-1) Expression and the Effect of Exposure in a Hyperbaric Chamber on VCAM-1 in Human Blood Serum: A Cross-Sectional Study
by Katarzyna Van Damme-Ostapowicz, Mateusz Cybulski, Mariusz Kozakiewicz, Elżbieta Krajewska-Kułak, Piotr Siermontowski, Marek Sobolewski and Dorota Kaczerska
Medicina 2022, 58(1), 95; https://doi.org/10.3390/medicina58010095 - 08 Jan 2022
Cited by 1 | Viewed by 2430
Abstract
Background and Objectives: Vascular cell adhesion molecule-1 (VCAM-1) was identified as a cell adhesion molecule that helps to regulate inflammation-associated vascular adhesion and the transendothelial migration of leukocytes, such as macrophages and T cells. VCAM-1 is expressed by the vascular system and can [...] Read more.
Background and Objectives: Vascular cell adhesion molecule-1 (VCAM-1) was identified as a cell adhesion molecule that helps to regulate inflammation-associated vascular adhesion and the transendothelial migration of leukocytes, such as macrophages and T cells. VCAM-1 is expressed by the vascular system and can be induced by reactive oxygen species, interleukin 1 beta (IL-1β) or tumor necrosis factor alpha (TNFα), which are produced by many cell types. The newest data suggest that VCAM-1 is associated with the progression of numerous immunological disorders, such as rheumatoid arthritis, asthma, transplant rejection and cancer. The aim of this study was to analyze the increase in VCAM-1 expression and the impact of exposure in a hyperbaric chamber to VCAM-1 levels in human blood serum. Materials and Methods: The study included 92 volunteers. Blood for the tests was taken in the morning, from the basilic vein of fasting individuals, in accordance with the applicable procedure for blood collection for morphological tests. In both groups of volunteers, blood was collected before and after exposure, in heparinized tubes to obtain plasma and hemolysate, and in clot tubes to obtain serum. The level of VCAM-1 was determined using the immunoenzymatic ELISA method. Results: The study showed that the difference between the distribution of VCAM-1 before and after exposure corresponding to diving at a depth of 30 m was at the limit of statistical significance in the divers group and that, in most people, VCAM-1 was higher after exposure. Diving to a greater depth had a much more pronounced impact on changes in VCAM-1 values, as the changes observed in the VCAM-1 level as a result of diving to a depth of 60 m were statistically highly significant (p = 0.0002). The study showed an increase in VCAM-1 in relation to the baseline value, which reached as much as 80%, i.e., VCAM-1 after diving was almost twice as high in some people. There were statistically significant differences between the results obtained after exposure to diving conditions at a depth of 60 m and the values measured for the non-divers group. The leukocyte level increased statistically after exposure to 60 m. In contrast, hemoglobin levels decreased in most divers after exposure to diving at a depth of 30 m (p = 0.0098). Conclusions: Exposure in the hyperbaric chamber had an effect on serum VCAM-1 in the divers group and non-divers group. There is a correlation between the tested morphological parameters and the VCAM-1 level before and after exposure in the divers group and the non-divers group. Exposure may result in activation of the endothelium. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
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11 pages, 2463 KiB  
Article
Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe Frostbite Compared to Iloprost Alone
by Marie-Anne Magnan, Angèle Gayet-Ageron, Pierre Louge, Frederic Champly, Thierry Joffre, Christian Lovis and Rodrigue Pignel
Medicina 2021, 57(11), 1284; https://doi.org/10.3390/medicina57111284 - 22 Nov 2021
Cited by 8 | Viewed by 5576
Abstract
Background and Objectives: Frostbite is a freezing injury that can lead to amputation. Current treatments include tissue rewarming followed by thrombolytic or vasodilators. Hyperbaric oxygen (HBO) therapy might decrease the rate of amputation by increasing cellular oxygen availability to the damaged tissues. [...] Read more.
Background and Objectives: Frostbite is a freezing injury that can lead to amputation. Current treatments include tissue rewarming followed by thrombolytic or vasodilators. Hyperbaric oxygen (HBO) therapy might decrease the rate of amputation by increasing cellular oxygen availability to the damaged tissues. The SOS-Frostbite study was implemented in a cross-border program among the hyperbaric centers of Geneva, Lyon, and the Mont-Blanc hospitals. The objective was to assess the efficacy of HBO + iloprost among patients with severe frostbite. Materials and Methods: We conducted a multicenter prospective single-arm study from 2013 to 2019. All patients received early HBO in addition to standard care with iloprost. Outcomes were compared to a historical cohort in which all patients received iloprost alone between 2000 and 2012. Inclusion criteria were stage 3 or 4 frostbite and initiation of medical care <72 h from frostbite injury. Outcomes were the number of preserved segments and the rate of amputated segments. Results: Thirty patients from the historical cohort were eligible and satisfied the inclusion criteria, and 28 patients were prospectively included. The number of preserved segments per patient was significantly higher in the prospective cohort (mean 13 ± SD, 10) compared to the historical group (6 ± 5, p = 0.006); the odds ratio was significantly higher by 45-fold (95%CI: 6-335, p < 0.001) in the prospective cohort compared to the historical cohort after adjustment for age and delay between signs of freezing and treatment start. Conclusions: This study demonstrates that the combination of HBO and iloprost was associated with higher benefit in patients with severe frostbite. The number of preserved segments was two-fold higher in the prospective cohort compared to the historical group (mean of 13 preserved segments vs. 6), and the reduction of amputation was greater in patients treated by HBO + iloprost compared with the iloprost only. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
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Review

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9 pages, 318 KiB  
Review
Critical Flicker Fusion Frequency: A Narrative Review
by Natalia D. Mankowska, Anna B. Marcinkowska, Monika Waskow, Rita I. Sharma, Jacek Kot and Pawel J. Winklewski
Medicina 2021, 57(10), 1096; https://doi.org/10.3390/medicina57101096 - 13 Oct 2021
Cited by 26 | Viewed by 6674
Abstract
This review presents the current knowledge of the usage of critical flicker fusion frequency (CFF) in human and animal model studies. CFF has a wide application in different fields, especially as an indicator of cortical arousal and visual processing. In medicine, CFF may [...] Read more.
This review presents the current knowledge of the usage of critical flicker fusion frequency (CFF) in human and animal model studies. CFF has a wide application in different fields, especially as an indicator of cortical arousal and visual processing. In medicine, CFF may be helpful for diagnostic purposes, for example in epilepsy or minimal hepatic encephalopathy. Given the environmental studies and a limited number of other methods, it is applicable in diving and hyperbaric medicine. Current research also shows the relationship between CFF and other electrophysiological methods, such as electroencephalography. The human eye can detect flicker at 50–90 Hz but reports are showing the possibility to distinguish between steady and modulated light up to 500 Hz. Future research with the use of CFF is needed to better understand its utility and application. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
25 pages, 10351 KiB  
Review
A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities
by Miguel A. Ortega, Oscar Fraile-Martinez, Cielo García-Montero, Enrique Callejón-Peláez, Miguel A. Sáez, Miguel A. Álvarez-Mon, Natalio García-Honduvilla, Jorge Monserrat, Melchor Álvarez-Mon, Julia Bujan and María Luisa Canals
Medicina 2021, 57(9), 864; https://doi.org/10.3390/medicina57090864 - 24 Aug 2021
Cited by 80 | Viewed by 17519
Abstract
Hyperbaric oxygen therapy (HBOT) consists of using of pure oxygen at increased pressure (in general, 2–3 atmospheres) leading to augmented oxygen levels in the blood (Hyperoxemia) and tissue (Hyperoxia). The increased pressure and oxygen bioavailability might be related to a plethora of applications, [...] Read more.
Hyperbaric oxygen therapy (HBOT) consists of using of pure oxygen at increased pressure (in general, 2–3 atmospheres) leading to augmented oxygen levels in the blood (Hyperoxemia) and tissue (Hyperoxia). The increased pressure and oxygen bioavailability might be related to a plethora of applications, particularly in hypoxic regions, also exerting antimicrobial, immunomodulatory and angiogenic properties, among others. In this review, we will discuss in detail the physiological relevance of oxygen and the therapeutical basis of HBOT, collecting current indications and underlying mechanisms. Furthermore, potential areas of research will also be examined, including inflammatory and systemic maladies, COVID-19 and cancer. Finally, the adverse effects and contraindications associated with this therapy and future directions of research will be considered. Overall, we encourage further research in this field to extend the possible uses of this procedure. The inclusion of HBOT in future clinical research could be an additional support in the clinical management of multiple pathologies. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
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Other

2 pages, 253 KiB  
Reply
Reply to Vrijdag et al. Comment on “Mankowska et al. Critical Flicker Fusion Frequency: A Narrative Review. Medicina 2021, 57, 1096”
by Natalia D. Mankowska, Anna B. Marcinkowska, Monika Waskow, Rita I. Sharma, Jacek Kot and Pawel J. Winklewski
Medicina 2022, 58(6), 765; https://doi.org/10.3390/medicina58060765 - 06 Jun 2022
Viewed by 1110
Abstract
Thank you very much for your interest and comments [...] Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
2 pages, 245 KiB  
Comment
Comment on Mankowska et al. Critical Flicker Fusion Frequency: A Narrative Review. Medicina 2021, 57, 1096
by Xavier C. E. Vrijdag, Hanna van Waart, Jamie W. Sleigh and Simon J. Mitchell
Medicina 2022, 58(6), 739; https://doi.org/10.3390/medicina58060739 - 30 May 2022
Cited by 1 | Viewed by 1239
Abstract
We have read with great interest the review by Mankowska et al. [...] Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
12 pages, 652 KiB  
Systematic Review
A Systematic Review to Assess the Impact of Hyperbaric Oxygen Therapy on Glycaemia in People with Diabetes Mellitus
by Sudhanshu Baitule, Aaran H. Patel, Narasimha Murthy, Sailesh Sankar, Ioannis Kyrou, Asad Ali, Harpal S. Randeva and Tim Robbins
Medicina 2021, 57(10), 1134; https://doi.org/10.3390/medicina57101134 - 19 Oct 2021
Cited by 3 | Viewed by 3221
Abstract
Background and Objectives: Hyperbaric oxygen is a recognised treatment for a range of medical conditions, including treatment of diabetic foot disease. A number of studies have reported an impact of hyperbaric oxygen treatment on glycaemic control in patients undergoing treatment for diabetic [...] Read more.
Background and Objectives: Hyperbaric oxygen is a recognised treatment for a range of medical conditions, including treatment of diabetic foot disease. A number of studies have reported an impact of hyperbaric oxygen treatment on glycaemic control in patients undergoing treatment for diabetic foot disease. There has been no systematic review considering the impact of hyperbaric oxygen on glycaemia in people with diabetes. Materials and Methods: A prospectively PROSPERO-registered (PROSPERO registration: CRD42021255528) systematic review of eligible studies published in English in the PUBMED, MEDLINE, and EMBASE databases, based on the following search terms: hyperbaric oxygen therapy, HBO2, hyperbaric oxygenation, glycaemic control, diabetes, diabetes Mellitus, diabetic, HbA1c. Data extraction to pre-determined piloted data collection form, with individual assessment of bias. Results: In total, 10 eligible publications were identified after screening. Of these, six articles reported a statistically significant reduction in blood glucose from hyperbaric oxygen treatment, while two articles reported a statistically significant increase in peripheral insulin sensitivity. Two articles also identified a statistically significant reduction in HbA1c following hyperbaric oxygen treatment. Conclusions: There is emerging evidence suggesting a reduction in glycaemia following hyperbaric oxygen treatment in patients with diabetes mellitus, but the existing studies are in relatively small cohorts and potentially underpowered. Additional large prospective clinical trials are required to understand the precise impact of hyperbaric oxygen treatment on glycaemia for people with diabetes mellitus. Full article
(This article belongs to the Special Issue Hyperbaric Medicine)
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