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Oxygen Therapy
Hyperbaric oxygen therapy
Hyperbaric oxygen is the application of pressures greater than 1 atmosphere to an environment of 100% oxygen, which results in the increase in the partial pressure of oxygen, proportional to the increase in pressure based on the two gas laws: Boyle’s and Henry’s laws. In this way the partial pressure of oxygen and oxygen supply to tissues increase. Hyperbaric oxygen augments plasma oxygen concentration so as to meet tissue oxygen requirements. When a patient is placed into a hyperbaric chamber, the oxygen is delivered by the lungs to the whole body.
Hyperbaric oxygen therapy serves as primary or adjunctive therapy for a variety of medical conditions, including carbon monoxide or cyanide poisoning, decompression sickness and air embolism, severe anemia, acute traumatic or thermal injury such as crush injuries, compartment syndrome, vascular compromise, , radiation injury, infections, gas gangrene, brain abscess, necrotizing soft tissue infections, refractory osteomyelitis, nonhealing ulcers, skin grafts and wound healing, sensorineural hearing loss. Further indications for hyperbaric oxygen therapy such as coronary artery disease, the systemic inflammatory response syndrome, traumatic brain or spinal cord injury, sickle cell disease, frostbite, fibromyalgia, stroke have also been conducted, with variable results.
Contraindications to hyperbaric oxygen therapy include untreated pneumothorax, obstructive lung disease, upper respiratory or sinus infections, recent ear or thoracic operation, generally safe and well tolerated. Side effects of hyperbaric oxygen therapy include middle ear barotraumas, sinus barotraumas, reversible myopia, pulmonary barotrauma, pulmonary oxygen toxicity, seizure etc.
Hyperbaric oxygen has anti-inflammatory and anti-oxidant effects, decreases free radical production and increases nitric oxide production. These properties are due to reducing white blood cell recruitment and activation, edema, cellular necrosis, and increasing the efficacy of antioxidant enzymes. Hyperbaric oxygen can improve tissue oxygen and phagocytosis, impair bacterial metabolism, inhibit exotoxin production, and has a synergistic effect with antibiotics. Hyperbaric oxygen induces the formation of reactive oxygen species (ROS) which can damage tumors by inducing excessive oxidative stress.
Similar to ischemic preconditioning, hyperbaric oxygen causes a mild oxidative stress which induces ischemic tolerance and has protective effect against ischemia/reperfusion damage by its antioxidant effect, hyperoxygenation, vasoconstriction, and autophagy (a cellular process to remove wasted cellular materials so as to maintain cellular homeostasis). Preconditioning and postconditioning with hyperbaric oxygen can attenuate the ischemia/reperfusion myocardial, brain, liver and renal injuries, respectively.
Oxygen-Ozone Therapy
Ozone, in common with oxygen itself, is one of the most potent oxidants. Like other gases, ozone must be dissolved in water in order to interact with organic substrates. Ozone instantly decomposes in a cascade of reactive oxygen species (ROS) including hydrogen peroxide, superoxide anion, hydroxyl radical and hypochlorous acid.
The oxidation chemistry of ozone is known to produce hydrogen peroxide that enters cells producing various effects. In red blood cells, it enhances the blood hemoglobin to release oxygen. In white blood cells and endothelial cells, it can stimulate the production of cytokines (mediators for inflammatory and immune responses, such as tumor necrosis factor, interleukin IL-1), interferons (proteins which are resistant to viral infections), growth factors and nitric oxide. In platelets, it favors the release of growth factors. In other cell types such as macrophages (phagocytic cells which originate in the tissues) and respiratory epithelial cells, it stimulates cell activation, cytokine secretion and long-term efficiency of antioxidant systems in adaptation to its pro-oxidant action.
Ischemic preconditioning is an inducible and potent body mechanism by which brief ischemia/reperfusion conditions and protects against subsequent sustained ischemia/reperfusion. On the other hand, it has been demonstrated that low dose of ozone promotes a moderate oxidative stress which, in turn, increases body antioxidant systems. This can conditions and protects against subsequent sustained ischemia/reperfusion. Ozone can induce a useful adaptation to chronic oxidative stress. Ozone can promote an oxidative preconditioning or adaptation to oxidative stress, preventing the damage induced by ROS.
Preconditioning and postconditioning treatments of ozone have shown beneficial effects on ischemia/reperfusion injury in different organs and tissues including heart, lung, kidney, liver, intestine, muscle etc. Ozone elevates nitrous oxide production, decreases tissue oxidative stress parameters (such as lipid peroxidation, protein oxidation and nitrite plus nitrate), and increases antioxidant enzyme activities.
Evidence that antioxidant enzymes, nitric oxide pathways, and other subcellular activities can be modulated by ozone support the therapeutic benefits of ozone therapy in many pathological conditions. Ozone has antioxidant and anti-inflammatory properties, improves blood circulation and oxygen delivery to ischemic tissues, enhances immune function and release of growth factors, enhances general metabolism through improved oxygen delivery, and functions as a signaling (inducing) molecule in physiological processes. Therapeutic applications of ozone therapy include the activation of the immune system in infectious diseases, aging and cancer,chronic degenerative disorders such as neurodegenerative disease, chronic liver disease and rheumatoid arthritis, reduce inflammation and ischemia in vascular disease, low back pain, activate neuroprotective systems, procure wellness and quality of life probably due to stimulation of the neuroendocrine systems.
Ozone has topical therapeutic activity in various skin disease , burns, and wound healing. Ozone is used to sterilize food and water because of its bactericidal properties. Ozone has strong antimicrobial effects against bacteria, fungi and viruses, and may enhance the bactericidal or bacteriostatic effects of antibiotics..
A study using streptozotocin as a diabetic inducer to test the protective effect of ozone was conducted. Ozone treatment improved blood sugar control, increased carbohydrate metabolism, pancreas integrity, and prevented oxidative damage. In addition, ozone antioxidant properties preserved pancreatic beta cell functions and reduced high blood sugar level. These results show that ozone is a potential complement in the treatment of diabetes and its complications.
Ozone enhances oxygen, glucose and ATP delivery to ischemic tissues, and leads to dilatation of blood vessel, increasing the amount of nitric oxide, stimulating blood vessel formation and providing modulation of the immune system. Ozone induces up-regulation of antioxidant enzymes in several cell types, which effectively re-equilibrates the oxidant-antioxidant imbalance.
Ozone has direct toxic and killing effect in human colon cancer cells. Ozone inhibits growth of human cells from lung, breast and uterine tumors, therefore may have therapeutic value in cancers.
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