Hyperbaric Oxygen Therapy for Acute Ischemic Stroke

During a stroke event, hypoxic changes can occur slowly enough in some patients to suggest that the close management of factors designed to maintain oxygenation might be beneficial. Intensive stroke management protocols and antiplatelet therapy have been established on this basis with some success. Hyperbaric oxygen therapy (HBOT) was first proposed as an adjunct in the treatment of ischemic stroke 40 years ago because of the ability of this therapy to deliver a greatly increased partial pressure of oxygen to the tissues.1 HBOT is the therapeutic administration of 100% oxygen at pressures 1 atmosphere (101.3 kPa). Typically, treatments involve pressurization to between 152 and 304 kPa for periods between 60 and 120 minutes daily. The potential benefits of HBOT include a reduction of cerebral edema, decreased lipid peroxidation, inhibition of leukocyte activation, and restoration of the functional blood–brain barrier.2,3 Conversely, oxygen in high doses may increase oxidative stress through the production of oxygen free-radical species, and the brain is particularly at risk.4