Imagine a patient with diabetic foot ulcers, enduring the persistent agony of non-healing wounds while facing the looming threat of amputation. When conventional treatments fail and hope dims, hyperbaric oxygen therapy (HBOT) emerges as a potential lifeline. Yet this promising intervention carries its own paradox—the dual nature of oxidative stress that can both heal and harm.
First proposed as an adjunct treatment in 1879, HBOT has expanded its therapeutic reach across multiple medical conditions. Today, it serves as an effective intervention for radiation-induced tissue damage, diabetic foot ulcers, carbon monoxide poisoning, decompression sickness, and arterial gas embolism. The Undersea and Hyperbaric Medical Society (UHMS) defines HBOT as breathing near-100% oxygen in a pressurized chamber at ≥1.4 absolute atmospheres (ATA). While UHMS currently recognizes 14 approved indications, novel applications continue emerging—including preoperative preparation for surgical procedures.
Multiple cohort studies and randomized controlled trials demonstrate that preoperative HBOT can reduce postoperative complications and shorten ICU stays in various surgeries—from abdominoplasty to pancreaticoduodenectomy. Given how surgical complications correlate with poor short- and long-term outcomes, diminished mental health, and increased healthcare costs, HBOT's preventive effects could significantly improve overall recovery trajectories.
The therapy's perioperative benefits stem primarily from its infection-prevention and wound-healing capacities. Oxidative stress—a key mechanistic pathway—appears to play an activating role in HBOT's surgical preconditioning effects. Elevated reactive oxygen species (ROS) enhance pathogen clearance while simultaneously stimulating growth factor production (VEGF, PGF, Ang1/2) and bone marrow stem cell recruitment to promote angiogenesis.
However, HBOT faces legitimate concerns regarding its potential to induce harmful oxidative stress. Excessive ROS and reactive nitrogen species (RNS) may trigger oxidative/nitrosative damage, mitochondrial aging, genotoxicity, and chronic inflammation. This delicate balance between therapeutic benefit and pathological risk remains a critical consideration in clinical applications.
Current research aims to systematically evaluate HBOT's impact on human oxidative stress markers, inflammatory responses, and angiogenesis—areas lacking comprehensive synthesis in existing literature. Understanding these mechanisms could optimize HBOT applications while mitigating potential harms.
Evidence reveals that HBOT influences oxidative stress through complex, dynamic interactions—not simple stimulation or suppression. Three key factors modulate these effects:
HBOT demonstrates context-dependent immunomodulation—enhancing antimicrobial inflammation in infections while suppressing pathological inflammation in autoimmune conditions. Its pro-angiogenic effects occur through multiple pathways:
As research elucidates HBOT's complex biological interactions, clinicians must remain vigilant in balancing its remarkable healing potential against the ever-present specter of oxidative harm—a true double-edged sword in medical therapeutics.
Imagine a patient with diabetic foot ulcers, enduring the persistent agony of non-healing wounds while facing the looming threat of amputation. When conventional treatments fail and hope dims, hyperbaric oxygen therapy (HBOT) emerges as a potential lifeline. Yet this promising intervention carries its own paradox—the dual nature of oxidative stress that can both heal and harm.
First proposed as an adjunct treatment in 1879, HBOT has expanded its therapeutic reach across multiple medical conditions. Today, it serves as an effective intervention for radiation-induced tissue damage, diabetic foot ulcers, carbon monoxide poisoning, decompression sickness, and arterial gas embolism. The Undersea and Hyperbaric Medical Society (UHMS) defines HBOT as breathing near-100% oxygen in a pressurized chamber at ≥1.4 absolute atmospheres (ATA). While UHMS currently recognizes 14 approved indications, novel applications continue emerging—including preoperative preparation for surgical procedures.
Multiple cohort studies and randomized controlled trials demonstrate that preoperative HBOT can reduce postoperative complications and shorten ICU stays in various surgeries—from abdominoplasty to pancreaticoduodenectomy. Given how surgical complications correlate with poor short- and long-term outcomes, diminished mental health, and increased healthcare costs, HBOT's preventive effects could significantly improve overall recovery trajectories.
The therapy's perioperative benefits stem primarily from its infection-prevention and wound-healing capacities. Oxidative stress—a key mechanistic pathway—appears to play an activating role in HBOT's surgical preconditioning effects. Elevated reactive oxygen species (ROS) enhance pathogen clearance while simultaneously stimulating growth factor production (VEGF, PGF, Ang1/2) and bone marrow stem cell recruitment to promote angiogenesis.
However, HBOT faces legitimate concerns regarding its potential to induce harmful oxidative stress. Excessive ROS and reactive nitrogen species (RNS) may trigger oxidative/nitrosative damage, mitochondrial aging, genotoxicity, and chronic inflammation. This delicate balance between therapeutic benefit and pathological risk remains a critical consideration in clinical applications.
Current research aims to systematically evaluate HBOT's impact on human oxidative stress markers, inflammatory responses, and angiogenesis—areas lacking comprehensive synthesis in existing literature. Understanding these mechanisms could optimize HBOT applications while mitigating potential harms.
Evidence reveals that HBOT influences oxidative stress through complex, dynamic interactions—not simple stimulation or suppression. Three key factors modulate these effects:
HBOT demonstrates context-dependent immunomodulation—enhancing antimicrobial inflammation in infections while suppressing pathological inflammation in autoimmune conditions. Its pro-angiogenic effects occur through multiple pathways:
As research elucidates HBOT's complex biological interactions, clinicians must remain vigilant in balancing its remarkable healing potential against the ever-present specter of oxidative harm—a true double-edged sword in medical therapeutics.
