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Hyperbaric Oxygen Therapy Of Ischemia And Reperfusion Injury

Medical information reviewed by: EMANUEL VOINEA, Fizioterapeut

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Discover the hyperbaric medicine center opened in our clinic. Centrokinetic has the top-performing hyperbaric chamber in Bucharest, with multiple medical and anti-aging uses. The Baroks chamber has 5 seats, and operates at a constant pressure of 2.5 atmospheres, being fully automated and having protocols for each condition, and can be used individually for each patient. 

Hyperbaric oxygen therapy - benefits

Patients who use the clinic's hyperbaric therapy services benefit from:

  • The only medically accredited hyperbaric therapy chamber in Bucharest, which operates at 2.5 atmospheres (those for aesthetic use go to 1 atmosphere and have no medical benefits).
  • A safe medical procedure, without irradiation, without pain, without other side effects. 
  • The specialized medical team consists of recovery doctors, orthopedists, rheumatologists, neurologists, and neurosurgeons, meaning a multidisciplinary team specialized in all diseases that can be treated with hyperbaric therapy. 
  • Premium conditions at a fair price. Our clinic is recognized for the conditions offered and for the care of each patient. But we do not need to pay exorbitant prices to have access to quality medical services. At Centrokinetic you can find an affordable and fair price. But note that we do not have a contract with the National Health Insurance House (we do not offer state reimbursed services)

Centrokinetic is keeping contact with prestigious clinics and universities in Belgium, the Netherlands, France, and Greece to constantly update treatments to provide patients with the best medical solutions.

Introduction

Ischemia-reperfusion (I/R) injury is a well-recognized phenomenon that may follow virtually any ischemic episode to tissues from interrupted blood flow, including direct traumatic tissue injuries, pressure-induced injuries, and cold injuries or burns, embolic, thrombotic, or localized inflammatory occlusion insults. It is also described following vascular or cardiovascular reperfusion procedures and post compartment syndrome fasciotomies. 

Tissue injury and/or death from this initial ischemic insult is determined by a combination of degree and duration of the occlusion and extent and type of tissue involved by the affected watershed area of capillary or arteriolar distribution. When circulation is restored, the occlusion is relieved, or the vessel is re-cannulated, a recurrent ischemic effect may occur within the following 4 to 8 hours, and cell death can continue for up to 3 days after the reperfusion. The release of endothelial chemotactic substances initiated by the original injury or insult creates an intravascular inflammatory response. 

This inflammatory response is at least partially responsible for further vascular occlusion of downstream tissues from edema. It is worsened by additional release from the second round of reactive oxygen species generated by the freshly oxygenated blood in an affected region depleted of protective free radical scavengers responding to the initial insult.

If initiated early, hyperbaric oxygen therapy has been found to ameliorate the damaging effects of reperfusion by early modulation of inflammation, maintenance of metabolic function in downstream tissues, and reintroduction of oxidation scavengers.

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Function

The initial microvascular injury may be caused indirectly by upstream vascular occlusion or directly from a traumatic crush injury. Either mechanism results in varying degrees of endothelial insult. The initial ischemia triggers hypoxia-inducible factors (HIF) that stimulate vascular endothelial growth factor (VEGF) release, associated with the enhanced permeability of capillaries and arterioles. Neutrophil aggregation and adhesion to sensitized endothelial cells result in further cellular permeability and the relaxation of the cell-to-cell junctions (diapedesis). 

The increased permeability leads to a greater diffusion of fluid across the tissues (edema) and extracellular extravasation of leukocytes. This leukocyte activation is part of the inflammatory response, concentrating and utilizing reactive oxygen species for the phagocytic process of killing bacteria. Ischemic hypoxia drives the affected tissue into anaerobic metabolism, resulting in adenosine 5´ triphosphate depletion and decreased intracellular pH with lactic acid accumulation.

Further ischemic injury may occur at the cellular level when calcium ion efflux occurs from inactivated adenosine triphosphatases, accompanied by the opening of the mitochondrial permeability transition pore, further impairing adenosine 5' triphosphate production. Other biochemical events occur that don’t directly relate to tissue injury, but when fueled by the reintroduction of oxygen when circulation is restored, trigger a cascade event of elements that exacerbates further injury and sometimes full end-organ failure in downstream flow.

Following reperfusion, the endothelial cells in their activated state produce more reactive oxygen species but less nitric oxide, a highly effective regulator of vascular tone, leukocyte adhesion, and platelet aggregation. The mechanisms leading to reperfusion injury are complex and still not fully understood but are likely related to a combination of factors, including:

  • The rapid reintroduction of oxygen increases reactive oxygen species such as the potent superoxide anion and reactive nitrogen species (RNS), and reactive nitric oxide species (RNOS), overwhelming the already depleted source of antioxidant catalases.
  • Intracellular calcium overload with the opening of the mitochondrial permeability transition pore leads to mitochondrial swelling and apoptosis.
  • Endothelial dysfunction with a pronounced inflammatory reaction occurs.

Precautions

Hyperbaric oxygen promotes the VEGF-induced enhancement of endothelial nitric oxide synthase. In addition to the scavenger effect of this antioxidant, this catalase may affect the mitogenic and anti-apoptotic actions of VEGF in preserving the integrity of the endothelium, thereby improving blood supply to the ischemic tissues. Hyperbaric oxygen therapy can reduce leukocyte adherence on the endothelium of venules and block the progressive arteriolar vasoconstriction associated with reperfusion injury.

Fragile tissues may have a greater risk of a total loss of function due to cellular apoptosis following the second hypoxic insult presented by the Ischemia-Reperfusion injury. These tissues include nervous tissue, lung parenchyma, or any other previously damaged connective tissue.

What are the effects of oxygen therapy on the body?

  • Decreases inflammation
  • Increases the body's oxygen saturation by 20-30%
  • Increases the body's immunity
  • Increases blood circulation and stimulates the formation of new capillaries
  • Decreases toxins in the body
  • Stimulates the production of new blood cells
  • Increases healing rate
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Clinical significance

Most nontraumatic ischemic events are related to vascular occlusion from atherosclerosis or other thromboembolic diseases. This risk is usually from hereditary factors that, along with advanced age and gender, cannot be controlled by preventive measures. Many associated risk factors can be controlled, often with the management of a primary care provider. Diet, activity, alteration of nutritional balance for weight loss as needed, and moderation of alcohol intake may help mitigate some additional risk. Medication may be appropriate to help diabetic patients maintain good glycemic control. 

Iatrogenic causes can also contribute to ischemic tissue occlusive events, including postoperative reactive inflammatory responses or sudden hypotensive responses to medical management. Air-gas embolisms can arise from insufflation during endoscopic procedures or delivery of anesthetic gases due to over-pressurization of poorly compliant lungs. Any of these actions may be enough to cause a vaso-occlusive occurrence.

Additional endothelial damage may occur with the complete occlusion of flow, thereby inhibiting oxygen delivery in any concentration to the affected tissue. Early intervention with oxygenated hemoglobin may mitigate some of this risk by activation and increased production of protective antioxidants such as superoxide dismutase, catalase, heme oxygenase-1, nitric oxide synthase, and heat shock proteins.

Hyperbaric oxygen therapy is a relatively safe treatment with a primary risk (greater than 1%) of barotrauma to the middle ear and sinus cavities. The only direct contraindication for treatment is the presence of a pneumothorax. The risk for treatment-induced pneumothorax, however, is less than 0.01%. The potential benefits of hyperbaric oxygen therapy outweigh the risks.

Source: https://www.ncbi.nlm.nih.gov/books/NBK513221/

IN CASE YOU HAVEN'T ALREADY HEARD ABOUT US

Centrokinetic is the place where you will find clear answers and solutions for your motricity problems. The clinic is dedicated to osteoarticular diseases and is divided into the following specialized departments:

  • Orthopedics , a department composed of an extremely experienced team of orthopedic doctors, led by Dr. Andrei Ioan Bogdan, primary care physician in orthopedics-traumatology, with surgical activity at Medlife Orthopedic Hospital, specialized in sports traumatology and ankle and foot surgery. .
  • Pediatric orthopedics , where children's sports conditions are treated (ligament and meniscus injuries), spinal deformities (scoliosis, kyphosis, hyperlordosis) and those of the feet (hallux valgus, hallux rigidus, equine larynx, flat valgus, hollow foot).
  • Neurology , which has an ultra-performing department, where consultations, electroencephalograms (EEG) and electromyography (EMG) are performed. 
  • Medical recovery  for adults and  children , department specialized in the recovery of performance athletes, in spinal disorders, in the recovery of children with neurological and traumatic diseases. Our experience is extremely rich, treating over 5000 performance athletes.
  • Medical imaging , the clinic being equipped with ultrasound and MRI, high-performance devices dedicated to musculoskeletal disorders, and complemented by an experienced team of radiologists: Dr. Sorin Ghiea and Dr. Cosmin Pantu, specialized in musculoskeletal imaging.

Find the latest news by following the Facebook and YouTube accounts of the Centrokinetic clinic.  

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