Rationale for Testing Hyperbaric Oxygen

The rationale for testing hyperbaric oxygen (HBO) is that irradiated tissues are characterized by hypocellularity, fibrosis, low oxygen tensions, and shallow oxygen gradients.33 At the pathological level, irradiated tissues have a capillary density 20 to 30% that of unirradiated areas.33'34 During HBO exposure, there is a 7- to 10-fold rise in oxygen tension and a steep oxygen gradient across the damaged zone. Steep oxygen gradients appear to stimulate angiogenesis, fibroplasia, and other features of tissue restructuring.35-37 In the early stage of HBO therapy, capillary budding and cellular collagen synthesis occur in animal systems.34 This is followed by a rapid rise in the number of lumenized capillaries to 75 to 80% that of normal tissues. As new capillaries form, hypoxia is reversed and the oxygen gradient is lost, with down-regulation of angiogenesis. No increase in vascularity is seen in adjacent undamaged tissue. Further increases in oxygen tension abolish these effects and are toxic. How these physiological responses impact on functional disability is unclear. Take rectal injury, for example. It is not difficult to imagine how a renewed capillary network restores the integrity of the rectal epithelium and reduces rectal bleeding from telangiectatic vessels. It is also possible that reduced capillary leakage leads indirectly to improved rectal compliance via a reduction of edema in the rectal wall and ischiorectal fossa. It is also possible that restoration of tissue perfusion reverses a chronic stimulus of fibrogenesis perpetuated by radiation-induced vasculitis and hypoxia.

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