The Emergency Use of Hyperbaric Oxygen Therapy for Upper Airway Obstruction in a Bulldog
Peter Brofman, DVM, MS, ACVIM (Neurology & Internal Medicine)
The nervous system can respond to an injury to the spinal cord and brain in only a limited number of ways; and, similarly, there are only a few medical treatments available to us that may aid in the body’s recovery. Due to this limited arsenal of treatments, as a veterinary neurologist and neurosurgeon I am always looking outside of the box for additional treatment options. Sometimes this thinking takes me back to ancient treatments (I am a big proponent of acupuncture); but sometimes it takes us forward to newer treatment options. Recently I have become interested in hyperbaric oxygen therapy (HBOT). Briefly, hyperbaric oxygen is the medical use of oxygen at a level higher than atmospheric pressure. Hyperbaric oxygen therapy allows you to breathe 100% pure oxygen under increased pressure. This level is much higher than the 21% oxygen found in room air. The air inside the hyperbaric chamber can be compressed up to three times the pressure found at sea level. The combination of high pressure and pure oxygen drives oxygen into the bloodstream at a very high concentration so that it can spread deep into the body tissues to help fight many types of illness. It is also quite effective at reducing pain, inflammation and swelling, due to several mechanisms. I have been somewhat frustrated by the limited number of treatment options available for my patients with strokes, spinal or brain trauma, disk disease, etc…, so I initiated incorporating HBOT into our hospital. I soon found out how effective it could be for other conditions as well. Some of the other conditions include snake bites, trauma, skin burns and crush injuries, inflammatory diseases, anemia, etc… A recent case of an English bulldog with a large spinal tumor was a great example of the usefulness of HBOT for conditions outside of the nervous system. English Bulldogs are known to have difficulty breathing after anesthesia because their head and facial conformation make it difficult for them to take good breaths; this is often exacerbated after the breathing tube used for anesthesia is removed because the tube causes swelling of the larynx (airway entrance). This often results in a need to heavily sedate the patient, place them in an oxygen cage, and sometimes even replace the breathing tube. This may result in a vicious cycle causing worsening of the swelling. In the case of my patient, when we removed the breathing tube after performing an MRI he had a lot of trouble breathing and required sedation and being placed in an oxygen chamber. He quickly calmed down and recovered without further incident. The following day, however, I performed surgery to remove a spinal tumor. During placement of the breathing tube the swelling of his larynx was already quite noticeable. Following surgery, he again had difficulty breathing when the tube was removed but the conservative care that was successful the previous day was not effective this time and he required having the tube placed again. To avoid the vicious cycle of replacing the tube and causing more swelling I removed the tube and placed him in our HBOT chamber. Upon placement in the chamber his oxygen levels in his blood were low and he had very loud noises as he tried to take each breath. Within a few minutes of treatment he was resting more comfortably as his oxygen levels rose. The treatment lasted an hour and when he was removed from the pressurized tank he was wagging his tail, breathing with ease, had normal oxygen levels in his blood, and was actually barking. It was such a relief to finally have this treatment modality available to us to avoid the life threatening swelling of the larynx that we so commonly see in this breed. Our hyperbaric oxygen chamber is the only one of its kind in Charleston, the state of South Carolina, and all of the bordering states. It makes me proud to be a member of such a progressive and advanced veterinary team at Veterinary Specialty Care to be able to provide such a unique and successful treatment modality for your pets.