Hyperbaric Oxygen Therapy is an Adjunct to Other Therapies

Important factors in healing any wound or infection are, of course, an accurate diagnosis, along with selection of appropriate medical therapy. Hyperbaric oxygen therapy (HBOT) enhances the effectiveness of antibiotics and other treatments as well as their ability to reach the desired target destination. Several problems that have been identified in horses where the application of HBOT would be useful are:

  • Wounds (traumatic, surgical, etc)
  • Traumatic injuries with soft tissue swelling
  • Skin, muscle, tendinous or ligamentous injury
  • Severe muscle swelling (myositis or exertional rhabdomyolysis-tie up)
  • Post-injection reactions or infections (Clostridial myositis)
  • Spider bites
  • Bone and tendon sheat infection  (osteomyelitis & tenosynovitis)
  • Bone and soft tissue healing after orthopedic procedures
  • Head and spinal injury
  • Birth asphyxia or Dummy Foal Syndrome (Hypoxic-ischemic encephalopathy)
  • Chronic infections
  • Lung and abdominal abscesses
  • Intestinal diseases (Colitis, enteritis)
    • Prevention of ischemia reperfusion injury post colon torsion
    • Gastric ulcers
  • Laminitis or founder

Wound Applications for HBOT

HBOT is effective for many types of wounds including massive degloving injuries to the lower leg, large surface wounds from trauma, injection reactions, spider bites and pressure sores from prolonged recumbency as with debilitated animals or neonatal foals. HBOT decreases tissue swelling and therefore salvages damaged tissues when used in the case of traumatic injuries. In the case of chronic wounds, HBOT assists the epithelium covering the wound and stimulates fibroblast production of collagen.

Bone Infections

Situations where bone infections can occur in horses include the following:

  • Complication of bacterial septicemia in foals
  • Complication following joint injections
  • Complication following orthopedic surgery in foals or adults
  • Involucrums/Sequestrums

The pathophysiology of bone infection involves the following:

  • Bacteremia (blood borne bacteria) or local invasion
  • Bacterial localization in sinusoidal capillaries
  • Suppurative inflammatory response within the medullary space
  • Destruction of capillary structure
  • Increased intraosseous pressure
  • Decreased tissue partial pressure of oxygen (pO2)
  • Necrosis of tissue
  • Destruction of supportive structure and growth centers

Along with the above, the following alterations occur to impair the bone’s ability to respond:

  • Impaired blood flow
  • Tissue hypoxia
  • Tissue necrosis and destruction
  • Ineffective leukocyte function
  • Impaired antibiotic delivery
  • Impaired antibiotic function (as many antibiotics require specific amounts of oxygen to be effective)
  • Poor bone “wound” healing

Uses of HBOT in bone infections include the following:

  • Increased diffusion of oxygen from the blood vessels
  • Enhancement of neovascularization (angiogenesis)
  • Stimulation of collagen production to build new bone
  • Improvement of blood flow by reduction of edema via vasoconstriction
  • Enhancement of leukocyte ability to kill bacteria
  • Enhancement of delivery and activity of antibiotics

Applications of HBOT for Chronic Infectious Processes

Internal abscesses may occur in the lungs (Rhodococcus equi) or in the abdomen (Rhodococcus equi, Streptococcus equi) and are rarely diagnosed early in the course of the disease. When these abscesses are diagnosed, there is a thick-walled fibrous connective tissue capsule surrounding them that impairs antibiotics from reaching the affected area.

This results in prolonged antibiotic treatment often with no resolution of the illness at a high cost to the owner and potentially fatal consequences for the animal. HBOT enhances the effectiveness of antibiotics and other treatments as well as their ability to reach the desired target destination.

HBOT for Neurologic Injuries

Head and spinal trauma often result in severe loss of body function. The neurologic deficits are thought to result from swelling of tissue within a confined space, the loss of blood and oxygen supply and the sequential biochemical effects of these on the nervous tissue.

Hypoxic-ischemic encephalopathy, a common syndrome in foals (often termed the “dummy foal syndrome”), is considered to be related to the loss of blood flow and/or oxygen at some point during the birthing process. Any of the above mentioned problems benefit from the application of HBOT in an effort to reduce the swelling of tissue and salvage the injured nervous tissue.

Other Applications for HBOT

HBOT can be used for training injuries in equine athletes. The beneficial effects would include reduction of tissue swelling, reduction of pain associated with swelling and inflammation, and enhancement of the connective tissue repair process.

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