Dose-Response Relationship of Therapeutic Oxygen: More Is Not Necessarily Better and May Be Inferior to No Supplemental Oxygen – Part 1: Proof and Nature

Abstract

In the early 1990s, the authors had consistently positive experience in the treatment of typical sports injuries and cosmetic surgical wounds with hyperbaric oxygen. These treatments generally consisted of oxygen at 2.0 atmospheres absolute (ATA) for 60 minutes. We were thus surprised to find that recognized experts in the field of hyperbaric medicine did not believe this modality to be effective for such normal wounds. Consequently, we asked Eric Kindwall, M.D., a professional acquaintance and published proponent of this prevalent view, what the bases for his beliefs on this matter were. Starting with references provided by Dr. Kindwall, we began an extensive literature review to try to reconcile our practical successes with the prevailing hyperbaric medical dogma. During our analysis, we found that the outcomes of oxygen therapy have a hormetic dose-response relationship. This finding explains the mistaken conclusions drawn concerning the treatment of uncompromised or normal wounds with hyperbaric oxygen as more oxygen will not provide benefits without limit. At some dose point, even below an inspired partial pressure (PiO2) of 3.0 atm, benefits will begin to decline and, in due course, more oxygen will produce negative impact in comparison with no hyperoxic supplementation.