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December 1994, Vol 129, No. 12 >
ARTICLE | December 1994

Treatment of Burned Mice With Hyperbaric Oxygen Reduces Mesenteric Bacteria but Not Pulmonary Neutrophil Deposition FREE

Mayer Tenenhaus, MD; John F. Hansbrough, MD; Ramon Zapata-Sirvent, MD; Tom Neumann, MD
Arch Surg. 1994;129(12):1338-1342. doi:10.1001/archsurg.1994.01420360128018
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Objective:  Hyperbaric oxygen (HBO) is used but unproven for many conditions, including burns. We hypothesized that HBO therapy might increase oxygen delivery to intestine during burn shock and decrease mucosal injury.

Setting:  University research laboratory.

Design and Study Participants:  We studied the effects of HBO therapy (100% oxygen at 2.4 atm absolute) on mesenteric bacterial colonies (MBCs) in mice following 32% total body surface area burns. MBCs were counted 24 or 48 hours postburn by culturing mesenteric tissue. Intestinal histologic features were examined, acid-base balance was measured, and pulmonary neutrophil deposition was estimated by lung myeloperoxidase content.

Interventions:  HBO delivered in a compression chamber.

Main Outcome Measure:  Numbers of mice with MBCs.

Results:  With twice-daily HBO treatments, each treatment lasting 1.5 or 2 hours, fewer burned mice had MBCs. Three HBO treatments within 24 hours produced seizures, death, and increased numbers of mice with MBCs. Numbers of mice with MBCs were not influenced when compressed air (2.4 atm absolute) or 100% oxygen (1 atm absolute) was used. Villus histologic findings showed less damage in burned mice that received HBO therapy than in controls. Metabolic acidosis was not affected by HBO therapy, nor were lung myeloperoxidase levels.

Conclusion:  HBO therapy was associated with reduced numbers of mice with MBCs after burn injury and reduced histologic evidence of mucosal damage, but lung myeloperoxidase levels and metabolic acidosis were not affected. HBO therapy may increase oxygen delivery to ischemic intestine and improve cellular metabolism; alternatively, increased tissue oxygen may augment killing of translocated bacteria by phagocytic cells. HBO deserves further investigation for burn treatment, but because of the narrow therapeutic window and continued neutrophil sequestration in the lungs, we should proceed cautiously.(Arch Surg. 1994;129:1338-1342)

REFERENCES

1 +
Foster JH.  Hyperbaric oxygen therapy: contraindications and complications . J Oral Maxillofac Surg . 1992;;50:1081-1086.
2 +
Kindwall EP, Gottlieb LJ, Larson DL.  Hyperbaric oxygen therapy in plastic surgery: a review article . Plast Reconstr Surg . 1991;;88:898-908.
3 +
Zamboni WA, Roth AC, Russell RC, Smoot EC.  The effect of hyperbaric oxygen on reperfusion of ischemic axial skin flaps: a laser Doppler analysis . Ann Plast Surg . 1992;;28:339-341.
4 +
Sirsjo A, Lehr HA, Nolte D, et al.  Hyperbaric oxygen treatment enhances the recovery of blood flow and functional capillary density in postischemic striated muscle . Circ Shock . 1993;;40:9-13.
5 +
Nylander G, Lewis DH, Nordstrom H, Larsson J.  Reduction of post-ischemic edema with hyperbaric oxygen . Plast Reconstr Surg . 1985;;76:596-601.
6 +
Nylander G, Nordstrom H, Lewis HG, Larsson H.  Metabolic effects of hyperbaric oxygen in post-ischemic muscle . Plast Reconstr Surg . 1986;;79:91-96.
7 +
Asch MJ, Meserol PM, Mason AD Jr, et al.  Regional blood flow in the burned unanesthetized dog . Surg Forum . 1971;;22:55-56.
8 +
Schmeling DJ, Caty MG, Oldham KT, et al.  Evidence for neutrophil-related acute lung injury after intestinal ischemia-reperfusion . Surgery . 1989;;106:195-202.
9 +
Koike K, Moore FA, Moore EE, et al.  Endotoxin after gut ichemia/reperfusion cuses irreversible lung injury . J Surg Res . 1992;;52:656-662.
10 +
Maejima K, Deitch EA, Berg RD.  Bacterial translocation from the gastrointestinal tracts of rats receiving thermal injury . Infect Immun . 1984;;43:6-10.
11 +
Carter EA, Udall JN, Kirkham SE, Walker WA.  Thermal injury and gastrointestinal function: small intestinal nutrient absorption and DNA synthesis . J Burn Care Rehab . 1986;;7:469-474.
12 +
Carter EA, Tompkins RG, Schiffrin E, Burke JF.  Cutaneous thermal injury alters macromolecular permeability of rat small intestine . Surgery . 1990;;107:335-341.
13 +
Granger DN.  Role of xanthine oxidase and granulocytes in ischemia-reperfusion injury . Am J Physiol . 1988;;255:H1269-H1275.
14 +
Klausner JM, Paterson IS, Goldman G, et al.  Postischemic renal injury is mediated by neutrophils and leukotrienes . Am J Physiol . 1989;;256:F794-F802.
15 +
Barmann TE.  Peroxidase . In: Barmann TE, ed. Enzyme Handbook . New York, NY: Springer-Verlag NY Inc; 1969;;1:234-235.
16 +
Mader JT. Hyperbaric Oxygen Therapy: A Committee Report . Bethesda, Md: Undersea and Hyperbaric Medical Society; 1989;.
17 +
Davis JC, Elliott DH.  Treatment of the decompression disorders . In: Bennett PB, Elliott DH, eds. The Physiology and Medicine of Diving . 3rd ed. San Pedro, Calif: Best Publishing; 1982;:473-487.
18 +
Myers RAM, Snyder SK, Linberg S, et al.  Value of hyperbaric oxygen in suspected carbon monoxide poisoning . JAMA . 1981;;246:2478-2480.
19 +
Heimbach RD.  Gas gangrene: review and update . Hyperbaric Oxygen Rev . 1980;; 1:41-61.
20 +
Riseman JA, Zamboni WA, Curtis A, et al.  Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements . Surgery . 1990;; 108:847-850.
21 +
Gozal D, Ziser A, Shupak A, et al.  Necrotizing fasciitis . Arch Surg . 1986;;121: 233-235.
22 +
Shupak A, Gozal D, Ariel A, et al.  Hyperbaric oxygenation in acute peripheral post-traumatic ischemia . J Hyperbaric Med . 1987;;2:7-14.
23 +
Iwatsuki N, Takahashi M, Ono K, Tajima T.  Hyperbaric oxygen combined with nicardipine administration accelerates neurologic recovery after cerebral ischemia in a canine model . Crit Care Med . 1994;;22:858-863.
24 +
Tan CM, Im MJ, Myers RAM, et al.  Effects of hyperbaric oxygen and hyperbaric air on the survival of island skin flaps . Plast Reconstr Surg . 1984;;73:27-28.
25 +
Cianci P, Petrone G, Drager S, et al.  Salvage of the problem wound and potential amputation with wound care and adjunctive hyperbaric oxygen therapy: an economic analysis . J Hyperbaric Med . 1988;;3:127-141.
26 +
Heng MCY.  Topical hyperbaric therapy for problem skin wounds . J Dermatol Surg Oncol . 1993;;19:784-793.
27 +
Strauss MB.  Chronic refractory osteomyelitis: review and role of hyperbaric oxygen . Hyperbaric Oxygen Rev . 1980;;1:231-256.
28 +
Cianci P, Lueders HW, Lee H, et al.  Adjunctive hyperbaric oxygen therapy reduces length of hospitalization in thermal burns . J Burn Care Rehab . 1989;;10:432-435.
29 +
Cianci P, Sato R.  Adjunctive hyperbaric oxygen therapy in the treatment of thermal burns: a review . Burns . 1994;;20:5-14.
30 +
Leitch IOW, Heimbach DM, Tompkins RG.  Use of hyperbaric oxygen in burn treatment . In: Rüedi TR, ed. State of the Art of Surgery 1993/94 . Basel, Switzerland: International Society of Surgery, Buchdruckerei Gasser & Cie AG; 1994;:30-32.
31 +
Heimbach DM.  Editorial response: use of hyperbaric oxygen . Clin Infect Dis . 1993;;17:239-240.
32 +
Stewart RJ, Yamaguchi KT, Cianci PE, et al.  Effects of hyperbaric oxygen on adenosine triphosphate in thermally injured skin . Surg Forum . 1988;;39:87-90.
33 +
Engler RL.  Free radical and granulocye-mediated injury during myocardial ischemia and reperfusion . Am J Cardiol . 1989;;63:19E-23E.
34 +
Welbourn CRB, Goldman G, Paterson IS, et al.  Pathophysiology of ischemia reperfusion injury: central role of the neutrophil . Br J Surg . 1991;;78:651-655.
35 +
Suzuki M, Inauen W, Kvietys PS, et al.  Superoxide mediates perfusion-induced leukocyte-endothelial cell interactions . Am J Physiol . 1989;;257:H1740-H1745.
36 +
Bradley PP, Priebat DA, Christensen RD, Rothstein G.  Measurement of cutaneous inflammation: estimation of neutrophil content with an enzyme marker . J Invest Dermatol . 1982;;78:206-209.
37 +
Lundberg C, Arfors K-E.  Polymorphonuclear leukocyte accumulation in inflammatory dermal sites as measured by 51Cr-labeled cells and myeloperoxidase . Inflammation . 1983;;7:247-255.
38 +
Zamboni WA, Roth AC, Russell RC, et al.  Morphological analysis of microcirculation during reperfusion of ischemic skeletal muscle and the effect of hyperbaric oxygen . Plast Reconstr Surg . 1993;;91:1110-1123.
39 +
Yasu T.  H2O2 generation in rat brain in vivo correlates with oxygen pressure [in Japanese with English abstract] . Masui . 1986;;35:1077-1082.
40 +
Mader JT, Brown GL, Guckian JC, et al.  A mechanism for the amelioration of hyperbaric oxygen of experimental staphylococcal osteomyletis in rabbits . J Infect Dis . 1980;;42:915-922.
41 +
Knighton DR, Halliday B, Hunt TK.  Oxygen as an antibiotic: the effect of inspired oxygen on infection . Arch Surg . 1984;;119:199-204.
42 +
Hendricks PL, Hall DA, Hunter WL, Haley PJ.  Extension of pulmonary O2 tolerance in man by intermittent O2 exposure . J Appl Physiol . 1977;;42:593-599.

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1 +
Foster JH.  Hyperbaric oxygen therapy: contraindications and complications . J Oral Maxillofac Surg . 1992;;50:1081-1086.
2 +
Kindwall EP, Gottlieb LJ, Larson DL.  Hyperbaric oxygen therapy in plastic surgery: a review article . Plast Reconstr Surg . 1991;;88:898-908.
3 +
Zamboni WA, Roth AC, Russell RC, Smoot EC.  The effect of hyperbaric oxygen on reperfusion of ischemic axial skin flaps: a laser Doppler analysis . Ann Plast Surg . 1992;;28:339-341.
4 +
Sirsjo A, Lehr HA, Nolte D, et al.  Hyperbaric oxygen treatment enhances the recovery of blood flow and functional capillary density in postischemic striated muscle . Circ Shock . 1993;;40:9-13.
5 +
Nylander G, Lewis DH, Nordstrom H, Larsson J.  Reduction of post-ischemic edema with hyperbaric oxygen . Plast Reconstr Surg . 1985;;76:596-601.
6 +
Nylander G, Nordstrom H, Lewis HG, Larsson H.  Metabolic effects of hyperbaric oxygen in post-ischemic muscle . Plast Reconstr Surg . 1986;;79:91-96.
7 +
Asch MJ, Meserol PM, Mason AD Jr, et al.  Regional blood flow in the burned unanesthetized dog . Surg Forum . 1971;;22:55-56.
8 +
Schmeling DJ, Caty MG, Oldham KT, et al.  Evidence for neutrophil-related acute lung injury after intestinal ischemia-reperfusion . Surgery . 1989;;106:195-202.
9 +
Koike K, Moore FA, Moore EE, et al.  Endotoxin after gut ichemia/reperfusion cuses irreversible lung injury . J Surg Res . 1992;;52:656-662.
10 +
Maejima K, Deitch EA, Berg RD.  Bacterial translocation from the gastrointestinal tracts of rats receiving thermal injury . Infect Immun . 1984;;43:6-10.
11 +
Carter EA, Udall JN, Kirkham SE, Walker WA.  Thermal injury and gastrointestinal function: small intestinal nutrient absorption and DNA synthesis . J Burn Care Rehab . 1986;;7:469-474.
12 +
Carter EA, Tompkins RG, Schiffrin E, Burke JF.  Cutaneous thermal injury alters macromolecular permeability of rat small intestine . Surgery . 1990;;107:335-341.
13 +
Granger DN.  Role of xanthine oxidase and granulocytes in ischemia-reperfusion injury . Am J Physiol . 1988;;255:H1269-H1275.
14 +
Klausner JM, Paterson IS, Goldman G, et al.  Postischemic renal injury is mediated by neutrophils and leukotrienes . Am J Physiol . 1989;;256:F794-F802.
15 +
Barmann TE.  Peroxidase . In: Barmann TE, ed. Enzyme Handbook . New York, NY: Springer-Verlag NY Inc; 1969;;1:234-235.
16 +
Mader JT. Hyperbaric Oxygen Therapy: A Committee Report . Bethesda, Md: Undersea and Hyperbaric Medical Society; 1989;.
17 +
Davis JC, Elliott DH.  Treatment of the decompression disorders . In: Bennett PB, Elliott DH, eds. The Physiology and Medicine of Diving . 3rd ed. San Pedro, Calif: Best Publishing; 1982;:473-487.
18 +
Myers RAM, Snyder SK, Linberg S, et al.  Value of hyperbaric oxygen in suspected carbon monoxide poisoning . JAMA . 1981;;246:2478-2480.
19 +
Heimbach RD.  Gas gangrene: review and update . Hyperbaric Oxygen Rev . 1980;; 1:41-61.
20 +
Riseman JA, Zamboni WA, Curtis A, et al.  Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements . Surgery . 1990;; 108:847-850.
21 +
Gozal D, Ziser A, Shupak A, et al.  Necrotizing fasciitis . Arch Surg . 1986;;121: 233-235.
22 +
Shupak A, Gozal D, Ariel A, et al.  Hyperbaric oxygenation in acute peripheral post-traumatic ischemia . J Hyperbaric Med . 1987;;2:7-14.
23 +
Iwatsuki N, Takahashi M, Ono K, Tajima T.  Hyperbaric oxygen combined with nicardipine administration accelerates neurologic recovery after cerebral ischemia in a canine model . Crit Care Med . 1994;;22:858-863.
24 +
Tan CM, Im MJ, Myers RAM, et al.  Effects of hyperbaric oxygen and hyperbaric air on the survival of island skin flaps . Plast Reconstr Surg . 1984;;73:27-28.
25 +
Cianci P, Petrone G, Drager S, et al.  Salvage of the problem wound and potential amputation with wound care and adjunctive hyperbaric oxygen therapy: an economic analysis . J Hyperbaric Med . 1988;;3:127-141.
26 +
Heng MCY.  Topical hyperbaric therapy for problem skin wounds . J Dermatol Surg Oncol . 1993;;19:784-793.
27 +
Strauss MB.  Chronic refractory osteomyelitis: review and role of hyperbaric oxygen . Hyperbaric Oxygen Rev . 1980;;1:231-256.
28 +
Cianci P, Lueders HW, Lee H, et al.  Adjunctive hyperbaric oxygen therapy reduces length of hospitalization in thermal burns . J Burn Care Rehab . 1989;;10:432-435.
29 +
Cianci P, Sato R.  Adjunctive hyperbaric oxygen therapy in the treatment of thermal burns: a review . Burns . 1994;;20:5-14.
30 +
Leitch IOW, Heimbach DM, Tompkins RG.  Use of hyperbaric oxygen in burn treatment . In: Rüedi TR, ed. State of the Art of Surgery 1993/94 . Basel, Switzerland: International Society of Surgery, Buchdruckerei Gasser & Cie AG; 1994;:30-32.
31 +
Heimbach DM.  Editorial response: use of hyperbaric oxygen . Clin Infect Dis . 1993;;17:239-240.
32 +
Stewart RJ, Yamaguchi KT, Cianci PE, et al.  Effects of hyperbaric oxygen on adenosine triphosphate in thermally injured skin . Surg Forum . 1988;;39:87-90.
33 +
Engler RL.  Free radical and granulocye-mediated injury during myocardial ischemia and reperfusion . Am J Cardiol . 1989;;63:19E-23E.
34 +
Welbourn CRB, Goldman G, Paterson IS, et al.  Pathophysiology of ischemia reperfusion injury: central role of the neutrophil . Br J Surg . 1991;;78:651-655.
35 +
Suzuki M, Inauen W, Kvietys PS, et al.  Superoxide mediates perfusion-induced leukocyte-endothelial cell interactions . Am J Physiol . 1989;;257:H1740-H1745.
36 +
Bradley PP, Priebat DA, Christensen RD, Rothstein G.  Measurement of cutaneous inflammation: estimation of neutrophil content with an enzyme marker . J Invest Dermatol . 1982;;78:206-209.
37 +
Lundberg C, Arfors K-E.  Polymorphonuclear leukocyte accumulation in inflammatory dermal sites as measured by 51Cr-labeled cells and myeloperoxidase . Inflammation . 1983;;7:247-255.
38 +
Zamboni WA, Roth AC, Russell RC, et al.  Morphological analysis of microcirculation during reperfusion of ischemic skeletal muscle and the effect of hyperbaric oxygen . Plast Reconstr Surg . 1993;;91:1110-1123.
39 +
Yasu T.  H2O2 generation in rat brain in vivo correlates with oxygen pressure [in Japanese with English abstract] . Masui . 1986;;35:1077-1082.
40 +
Mader JT, Brown GL, Guckian JC, et al.  A mechanism for the amelioration of hyperbaric oxygen of experimental staphylococcal osteomyletis in rabbits . J Infect Dis . 1980;;42:915-922.
41 +
Knighton DR, Halliday B, Hunt TK.  Oxygen as an antibiotic: the effect of inspired oxygen on infection . Arch Surg . 1984;;119:199-204.
42 +
Hendricks PL, Hall DA, Hunter WL, Haley PJ.  Extension of pulmonary O2 tolerance in man by intermittent O2 exposure . J Appl Physiol . 1977;;42:593-599.

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