Scientific References

Acute Carbon Monoxide Poisoning

Bartlett, R: Carbon monoxide poisoning. Clinical management of poisoning and drug overdose. WB Saunders, Lester M Haddad, James F Winchester editors; 3rd edition; 1997
General review article, emphasizing both the modern appreciation of the complex pathophysiology involved, and the multifactorial benefits of HBO therapy.

Thom, SR: Carbon monoxide-mediated brain lipid peroxidation in the rat.  J. Appl. Physiol. 1990;68(3): 997-1003
A publication that advanced the pathophysiology of CO poisoning from the simple concept of inhibition of hemoglobin function. This data indicates that critical cellular toxicity occurs.

Decompression Illness

Anon: U.S. Navy Diving Manual, Volume 1 (Air Diving) 1993; Revision 3:8-22--8-28. Best Publishing Company, Flagstaff, Arizona.
The authoritative text of the United States military government. It states, among other things, that "Any decompression sickness that occurs must be treated with recompression (hyperbaric oxygen therapy)"

Anon: NOAA Diviing Manual, Diving for Science and Technology 1991; 20-8--20-9.
The authoritative text of the United States civilian government. It states, among other things, "The only adequate treatment for & gas embolism in divers is recompression in a recompression (hyperbaric) chamber".

Gas Embolism

Anon: U.S. Navy Diving Manual, Volume 1 (Air Diving) 1993, Revision 3:8-18--8-20. Best Publishing Co., Flagstaff, Arizona.
The authoritative text of the United States military government. It notes, among other things, that "& unless treated promptly and properly by recompression (hyperbaric oxygen therapy), arterial gas embolism is likely to result in death or permanent brain damage".

Anon: NOAA Diving Manual, Diving for Science and Technology 1991, 20-9--20-13.
The authoritative text of the United States civilian government. It states, among other things, that "Prompt recompression (hyperbaric oxygen therapy) is the only treatment for gas embolism". 

Gas Gangrene

Bakker DJ: Clostridial myonecrosis. In Problem Wounds, The Role of Oxygen, Eds. Davis JC and Hunt TK 1988:153-172, Elsevier Publishing Co., New York.
A comprehensive review article from the institution that has pioneered the medical and surgical management of gas gangrene over the past four decades. This reported case series involving bacterially-proven clostridium perfringens gas gangrene is the largest in the world,. The report demonstrates that early application of HBO therapy:

  • is life-saving
  • is limb- and tissue-saving
  • clarifies the demarcation    

Van Unnik AJM: Inhibition of toxin production in Clostridium perfringens in vitro by hyperbaric oxygen. Antonie Van Leeuwenhoek 1965;31:181-186.
An historically important in-vitro study that demonstrated the critical role that Alfa-toxin plays in the pathophysiology of Clostridium perfringens (gas gangrene) infections. Further, HBO therapy inhibited production of this toxin.

Acute Traumatic Peripheral Ischemia

Bouachour MD, Cronier P, Gouello JP, et al.: Hyperbaric oxygen therapy in the management of crush injuries: A randomized double-blind placebo-controlled clinical trial. The Journal of Trauma: Injury, Infection, and Critical Care 1996; 41(2): 333-339
A placebo-controlled randomized and blinded clinical trial in acute limb-threatening trauma to the extremities. Statistically significant improvement in outcome occurred in the HBO group. HBO therapy improved wound healing, reduced the number of surgical procedures, and likewise reduced the number of amputations that became necessary.

Strauss MB, Hart GB.: Crush injury and the role of hyperbaric oxygen. Topics in Emergency Medicine 1984; 6: 9-24
An early review article of HBO's therapeutic impact in crush injury. It predated our knowledge of HBO's effect on ischemia-reperfusion injury. Consequently, HBO's role is even more comprehensivet than described herein.

Progressing Necrotizing Infections

Green RJ, Dafoe DC, Raffin TA: Necrotizing fasciitis. Chest 1996;110(1)219-229.
A recent review of necrotizing fasciitis, published in CHEST. With regard to hyperbaric oxygen, the authors conclude that where available, "it should be considered as a treatment adjunct in patients with necrotizing fasciitis".

Knighton DR, Halliday B, Hunt TK: Oxygen as an antibiotic: the effect of inspired oxygen on infection. Arch Surg 1984;119:199-204.
This reference is included to emphasize an important feature of HBO therapy in infectious diseases. Hyperbaric doses of oxygen take on antibiotic-like properties. The paper stresses the importance of sufficient local oxygen tension in order that bacterial killing by leukocytes can be accomplished.

Preparation and Preservation of Compromised Skin Grafts

Sheffield PJ: Tissue oxygen measurements with respect to soft-tissue wound healing with normobaric and hyperbaric oxygen. HBO Review 1985;6(1):18-43.
Evidence that hyperbaric doses of oxygen increase tissue oxygen levels in otherwise hypoxic and ischemic wounds. This work represents a fundamental rationale for the application of HBO therapy in the setting of non-healing lesions, where an underlying hypoxia is demonstrated.

Padberg FT, Back TL, Thompson PN, et al.: Transcutaneous oxygen (TcP02) estimates probability of healing in the ischemic extremity. J Surg Res 1996;60(2):365-369.
A more recent evaluation of the relationship between availability of oxygen and probability of healing in the ischemic extremity. Transcutaneous oximetry "alone" is sufficient for objective risk stratification of arterial ischemia in the lower extremity.

Osteoradionecrosis

Myers RAM, Marx RE: Use of hyperbaric oxygen in postradiation head and neck surgery. NCI Monogr 1990; 9: 151-157
One paper from the proceedings of the National Cancer Institute Consensus Development Conference on Oral Complications of Cancer Therapies: Diagnosis, Prevention, and Treatment. This paper clarified the pathophysiology of radiation-induced tissue injury, and the evidence supporting a peri-operative role for hyperbaric oxygen therapy. One significant consequence of this paper was that the resulting National Cancer Institute Consensus Statement included the following statements:

Marx RE: Osteoradionecrosis: A new concept of its pathophysiology. J Oral Maxillofac Surg 1983; 41: 283-288
A landmark publication, in that it clarified the underlying pathophysiological process of late radiation tissue injury. This data paved the way for studies, many conducted by the same author(s), to determine the therapeutic mechanism of HBO (see next paper).

Soft Tissue Radionecrosis

Kindwall EP: Hyperbaric oxygen's effect on radiation necrosis. Clinics in Plastic Surgery 1993;20(3):473-483.
A comprehensive review, directed at the Plastic Surgery specialty.

Anon.: Hyperbaric oxygen therapy for treatment of soft tissue radionecrosis and osteoradionecrosis. Health Technology Assessment Reports 1982; DHHS Publication No. (PHS) 84.3371.
A United States Department of Health and Human Services Public Health Service "Health Technology Assessment Report" on the Treatment of Soft Tissue Radionecrosis &" Even as early as 1982 this report concluded that "there is little controversy in the medical community regarding the safety and effectiveness of HBO as an adjunctive therapy in the treatment of soft tissue radionecrosis&" Of course, in 1999 we have a greater appreciation of the precise pathophysiology of this disorder. So, too, the therapeutic effects of HBO therapy. Equally important is the evolution to a protocol-driven approach, in common practice today.

Cyanide Poisoning

Hall AH, Rumack BH: Clinical toxicology of cyanide. Ann Emerg Med 1986;15:1067-1074.
A comprehensive review of the subject, written by Rocky Mountain Poison and Drug Center physicians (highly respected national experts on poisoning and overdoses). With regard to its treatment the authors advocate HBO therapy, particularly when supportive measures, and other cyanide antidotes fail.

Gonzales J, Sabatini S: Cyanide poisoning: pathophysiology and current approaches to therapy. The Internat J Artificial Organs 1989;12(6):347-355.
A second review, in which the authors again recommend the use of HBO therapy in selected cases. Given the date of this paper (1969) the authors rule out its use in infants and children due to potential risk factors, (risks not borne out in modern hyperbaric practice).