Preface

The aim of this book, "Hyperbaric Oxygen Treatment in Research and Clinical Practice - Mechanisms of Action in Focus", is to present the current knowledge of the hyperbaric oxy‐ gen treatment in experimental research and clinical practice. There have been many controversies related to the HBO2 protocols and indications, and our understanding on the mechanisms of HBO2 action is still emerging. In April 2017, the Tenth European Consensus Conference on Hyperbaric Medicine was held, bringing consensus on accepted and non-ac‐ cepted clinical indications and practices of hyperbaric oxygen treatment. Femoral neck ne‐ crosis is one of the indications for treatment with HBO2 that received consensual Type 2 recommendation. This condition is described in the chapter "Therapeutic Mechanisms of Action for Hyperbaric Oxygen on Femoral Head Necrosis" by Gerardo Bosco et al. in this book. Sanja Pekovic et al. in the chapter "Hyperbaric Oxygen Therapy in Traumatic Brain Injury: Cellular and Molecular Mechanisms" describe HBO2 as a potentially neuroprotective treatment and review a number of experimental and clinical studies on the mechanisms of traumatic brain injury. This indication receives Type 3 recommendation by the 10th EU Con‐ sensus Conference on Hyperbaric Medicine and is currently a field of intensive investigation both in basic medical sciences and in clinical trials.

Reduced microvascular perfusion is seen in many diseases, and hyperbaric oxygen treat‐ ment (HBO2) has potentially beneficial effects on the microcirculatory environment. This topic is covered in the chapter "Microcirculation and Hyperbaric Oxygen Treatment" by Fe‐ thi Gul and co-authors. The chapter "Cell Culture Effects of Altered Oxygen Levels and Hy‐ perbaric Treatment *In Vitro*" by Edit Gara deals with cell culture responses to HBO2 and generally demonstrates the beneficial role of HBO2 on proliferation and viability of most cell types. Furthermore, functional characteristics of the investigated cell types, e.g. angiogenesis by endothelial cell, are improved in response to HBO2. Since oxygen is a highly reactive mol‐ ecule and can induce upregulation of many various enzymatic systems in the cell, at the cellular, genetic and molecular level it can affect many cell functions. Particularly, vascular/ endothelial function is affected by HBO2. The chapter "Mechanisms of HBO-Induced Vascu‐ lar Functional Changes in Diabetic Animal Models" by Ivana Jukic et al. describes the vascu‐ lar functional changes affected by HBO2 in animal model of diabetes mellitus.

And finally, as well as exhibiting beneficiary effects on the tissue perfusion, it is known that HBO2 demonstrates high toxicity at higher pressures, due to increased oxidative stress and barotrauma. This is presented in the chapter "Toxic Effects of Hyperbaric Conditions" by Ali Erdal Gunes.

#### XII Preface

This book presents the reader with an overview of the current knowledge on the mecha‐ nisms of HBO2 effects in various experimental models and clinical treatment protocols and open discussion on potentially new indications for HBO2 and attempts to provide a better understanding of how and when HBO2 should be used as an effective therapy without un‐ wanted side effects.

#### **Ines Drenjančević**

**Chapter 1**

**Provisional chapter**

is optional, since it is not

**Introductory Chapter: Hyperbaric Oxygen Treatment:**

conditions that exhibit impaired tissue blood flow. The list of indications is widening as our knowledge and understanding on the mechanisms of HBO<sup>2</sup> action is getting larger. For example, in August 2013, the US Food and Drug Administration declared artery occlusion as

In April 2016, the Tenth European Consensus Conference on Hyperbaric Medicine was held, bringing consensus on accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Recommendations are listed in three levels of indications: from Type 1—strongly suggest that HBO2 is to be accepted as primary treatment (example of accepted indications: carbon monoxide (CO) poisoning, mandibular osteonecrosis, gas embolism, anaerobic or mixed infections, decompression sickness, sudden deafness, etc.); Type 2—HBO<sup>2</sup> is suggested as it is supported by evidences (suggested indications: diabetic foot lesions, fem-

fully supported by evidences (e.g. brain injuries, radio-induced lesions, post-vascular procedure reperfusion syndrome, etc.). This consensus also provided negative recommendations,

At high pressures, the delivery of the dissolved oxygen in plasma is enhanced, which contributes to better tissue oxygenation, cellular metabolism and, ultimately, healing. However, this is not the only potential mechanism for improved outcome of many diseases treated

various enzymatic systems in the cell, at cellular, genetic and molecular level. Particularly,

**Introductory Chapter: Hyperbaric Oxygen Treatment:**

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

, since oxygen is highly reactive molecule and can induce upregulation of many

distribution, and reproduction in any medium, provided the original work is properly cited.

should not be used, such as autism spectrum disorders, placental

) is a widely accepted adjuvant therapy in various health

DOI: 10.5772/intechopen.79866

**Old Treatment with New Understanding**

**Old Treatment with New Understanding**

Additional information is available at the end of the chapter

one of the 13 specific indications for HBO therapy [1].

oral head fracture, ischemic ulcers, etc.) and Type 3—where HBO<sup>2</sup>

insufficiency and cerebral palsy, to list some of them [2].

Ines DrenjančevićAdditional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79866

Hyperbaric oxygen treatment (HBO2

Ines Drenjančević

**1. Introduction**

for example, where HBO<sup>2</sup>

with HBO2

Institute and Department of Physiology and Immunology Faculty of Medicine Osijek Josip Juraj Strossmayer University of Osijek, Croatia Croatian National Scientific Center of Excellence for Personalized Health Care Josip Juraj Strossmayer University of Osijek, Croatia

#### **Introductory Chapter: Hyperbaric Oxygen Treatment: Old Treatment with New Understanding Introductory Chapter: Hyperbaric Oxygen Treatment: Old Treatment with New Understanding**

DOI: 10.5772/intechopen.79866

Ines Drenjančević

This book presents the reader with an overview of the current knowledge on the mecha‐ nisms of HBO2 effects in various experimental models and clinical treatment protocols and open discussion on potentially new indications for HBO2 and attempts to provide a better understanding of how and when HBO2 should be used as an effective therapy without un‐

**Ines Drenjančević**

Faculty of Medicine Osijek

Institute and Department of Physiology and Immunology

Croatian National Scientific Center of Excellence for Personalized Health Care

Josip Juraj Strossmayer University of Osijek, Croatia

Josip Juraj Strossmayer University of Osijek, Croatia

wanted side effects.

VIII Preface

Additional information is available at the end of the chapter Ines DrenjančevićAdditional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79866
