http://www.hbot.com In the past two years a disturbing trend has become a standard of care in the off-label use of HBOT for chronic pediatric brain injury, the use of 1.75 ATA oxygen. Unfortunately, this is merely the latest re-emergence of the age old illusion and nemesis of HBOT in chronic brain injury: if lower pressure is effective, surely higher pressure is more effective. This is the cruel self-defeating trap/paradox of HBOT in chronic brain injury, the misguided thinking that has plagued hyperbaric physicians since the 1960’s, and the primary reason for the lack of progress of HBOT in brain injury until the recent adoption of 1.5 ATA. It also explains why patients with chronic stroke, traumatic brain injury, and other neurological conditions who have been treated with HBOT at or above 2.0 ATA for wound care in the past 40 years don’t experience simultaneous regression or improvement of their neurological symptomatology.
The fact is, in the modern era of HBOT attempts to treat chronic brain injury with HBOT have repeatedly failed due to physicians’ inability to accept the fact that injured brain is exquisitely responsive to HBOT at pressures around 1.5 ATA. Whenever doctors have been able to resist the allure of higher pressure and the siren call of “MORE IS BETTER”, treatment has succeeded. Multiple sclerosis is the best example. History repeats itself. We are now making the same tragic mistake.
The key to the misperception of MORE IS BETTER is rooted in the failure to realize that HBOT is a drug. Like all drugs, oxygen at pressure has a therapeutic window; too low a dose is ineffective and too high a dose is both ineffective and toxic. In addition, too frequent, too long at depth, and too many treatments in a row are also toxic. For example, the well-known cardiac drug digoxin is ineffective at low dose, powerfully effective at the right dose, and lethal at just a smidgen higher dose. The anti-coagulant (blood thinner) Coumadin is the same, as are all inhalational anesthetics which can and will kill people at doses barely above the therapeutic dose. HBOT is no different.
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