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The role of hyperbaric oxygen therapy in septic shock: is it time for human studies?

Sepsis is a life-threatening condition for which new therapies are needed. The objective of this literature review was to compile evidence related to the use of hyperbaric oxygen (HBO2) therapy in sepsis. The goal of this analysis was to determine whether human trials are indicated. The study was designed as a narrative review of literature for studies of HBO2 therapy in sepsis. Literature was reviewed to understand potentially beneficial and harmful clinical and physiological effects of HBO2 therapy in animals with sepsis. HBO2 has several physiologic mechanisms which may be beneficial in sepsis, including restoration of mitochondrial function, improved microvascular function and organ perfusion, decreased capillary leak, improved cytokine profile, direct antimicrobial effects, and enhanced antibiotic function. The studies reviewed suggest that HBO2 therapy may be most effective if administered early and in high doses. Animal trials also show that HBO2 may provide protection to the gut mucosa by preventing bacterial translocation in sepsis. HBO2 has a potential to reduce organ failure through novel sepsis mechanisms not used in other therapies. Further human studies should be performed to better elucidate the role of HBO2 in improving sepsis clinical outcomes.