Oxygen/ozone therapy is a term that describes a number of different practices in which oxygen, ozone, or hydrogen peroxide are administered via gas or water to kill disease microorganisms, improve cellular function, and promote the healing of damaged tissues. The rationale behind bio-oxidative therapies, as they are sometimes known, is the notion that as long as the body's needs for antioxidants are met, the use of certain oxidative substances will stimulate the movement of oxygen atoms from the bloodstream to the cells. With higher levels of oxygen in the tissues, bacteria and viruses are killed along with defective tissue cells. The healthy cells survive and multiply more rapidly. The result is a stronger immune system.
Ozone itself is a form of oxygen, O3, produced when ultraviolet light or an electric spark passes through air or oxygen. It is a toxic gas that creates free radicals, the opposite of what antioxidant vitamins
do. Oxidation, however, is good when it occurs in harmful foreign organisms that have invaded the body. Ozone inactivates many disease bacteria and viruses.
Oxygen and ozone therapies are thought to benefit patients in the following ways:
- stimulating white blood cell production
- killing viruses (ozone and hydrogen peroxide)
- improving the delivery of oxygen from the blood stream to the tissues of the body
- speeding up the breakdown of petrochemicals
- increasing the production of interferon and tumor necrosis factor, thus helping the body to fight infections and cancers
- increasing the efficiency of antioxidant enzymes
- increasing the flexibility and efficiency of the membranes of red blood cells
- speeding up the citric acid cycle, which in turn stimulates the body's basic metabolism
The various forms of oxygen and ozone therapy have been in use since the late nineteenth century. The earliest recorded use of oxygen to treat a patient was by Dr. J. A. Fontaine in 1879. In the 1950s, hyperbaric oxygen treatment was used by cancer researchers. The term "hyperbaric" means that the oxygen is given under pressure higher than normal air pressure. Recently, oxygen therapy has also been touted as a quick purification treatment for mass-market consumers. Oxygen bars can be found in airports and large cities, and provide pure oxygen in 20-minute sessions for approximately $16. While proponents claim that breathing oxygen will purify the body, most medical doctors do not agree. What is more, oxygen can be harmful to people with severe lung diseases, and these people should never self-treat with oxygen.
Ozone has been used since 1856 to disinfect operating rooms in European hospitals, and since 1860 to purify the water supplies of several large German cities. Ozone was not, however, used to treat patients until 1915, when a German doctor named Albert Wolff began to use it to treat skin diseases. During World War I, the German Army used ozone to treat wounds
and anaerobic infections
. In the 1950s, several German physicians used ozone to treat cancer
alongside mainstream therapeutic methods. It is estimated that as of the late 1990s, about 8,000 practitioners in Germany were using ozone in their practices. This figure includes medical doctors as well as naturopaths and homeopaths.
Hydrogen peroxide is familiar to most people as an over-the-counter preparation that is easily available at supermarkets as well as pharmacies, and is used as an antiseptic for cleansing minor cuts and scrapes. It was first used as an intravenous infusion in 1920 by a British physician in India, T. H. Oliver, to treat a group of 25 Indian patients who were critically ill with pneumonia
. Oliver's patients had a mortality rate of 48%, compared to the standard mortality rate of 80% for the disease. In the 1920s, an American physician named William Koch experimented with hydrogen peroxide as a treatment for cancer. He left the United States after a legal battle with the FDA. In the early 1960s, researchers at Baylor University studied the effects of hydrogen peroxide in removing plaque from the arteries as well as its usefulness in treating cancer, but their findings were largely ignored.
Oxygen, ozone, and hydrogen peroxide are used therapeutically in a variety of different ways.
Hyperbaric oxygen therapy (hbo)
Hyperbaric oxygen therapy (HBO) involves putting the patient in a pressurized chamber in which he or she breathes pure oxygen for a period of 90 minutes to two hours. HBO may also be administered by using a tight-fitting mask, similar to the masks used for anesthesia. A nasal catheter may be used for small children.
Ozone therapy may be administered in a variety of ways.
- Intramuscular injection: A mixture of oxygen and ozone is injected into the muscles of the buttocks.
- Rectal insufflation: A mixture of oxygen and ozone is introduced into the rectum and absorbed through the intestines.
- Autohemotherapy: Between 10-15 mL of the patient's blood is removed, treated with a mixture of oxygen and ozone and reinjected into the patient.
- Intra-articular injection: Ozone-treated water is injected into the patient's joints to treat arthritis, rheumatism and other joint diseases.
- Ozonated water: Ozone is bubbled through water that is used to cleanse wounds, burns, and skin infections, or to treat the mouth after dental surgery.
- Ozonated oil: Ozone is bubbled through olive or safflower oil, forming a cream that is used to treat fungal infections, insect bites, acne, and skin problems.
- Ozone bagging: Ozone and oxygen are pumped into an airtight bag that surrounds the area to be treated, allowing the body tissues to absorb the mixture.
Hydrogen peroxide may be administered intravenously in a 0.03% solution. It is infused slowly into the patient's vein over a period of one to three hours. Treatments are given about once a week for chronic illness but may be given daily for such acute illnesses as pneumonia or influenza. A course of intravenous hydrogen peroxide therapy may range from one to 20 treatments, depending on the patient's condition and the type of illness being treated. Injections of 0.03% hydrogen peroxide have also been used to treat rheumatoid and osteoarthritis. The solution is injected directly into the inflamed joint.
Hydrogen peroxide is also used externally to treat stiff joints, psoriasis
, and fungal infections. The patient soaks for a minimum of 20 minutes in a tub of warm water to which 1 pint of 35% food-grade hydrogen peroxide (a preparation used by the food industry as a disinfectant) has been added.
Oxygen is usually delivered to the patient as a gas; ozone as a gas mixed with oxygen or bubbled through oil or water; and hydrogen peroxide as an 0.03% solution for intravenous injection or a 35% solution for external hydrotherapy
Patients interested in oxygen/ozone therapies must consult with a physician before receiving treatment. Hyperbaric oxygen treatment should not be given to patients with untreated pneumothorax, a condition in which air or gas is present in the cavity surrounding the lungs. Patients with a history of pneumothorax
, chest surgery, emphysema
, middle ear surgery
, uncontrolled high fevers, upper respitory infections, seizures, or disorders of the red blood cells are not suitable candidates for oxygen/ozone therapy. In addition, patients should be aware that oxygen is highly flammable. If treatments are administered incorrectly or by an unskilled person, there is a risk of fire.
Typical side effects of oxygen or ozone therapy can include elevated blood pressure and ear pressure similar to that experienced while flying. Side effects may also include headache
, numbness in the fingers, temporary changes in the lens of the eye, and seizures.
Research and general acceptance
Oxygen/ozone therapies are far more widely accepted in Europe than in the United States. The most intensive research in these therapies is presently being conducted in the former Soviet Union and in Cuba. In the United States, the work of the Baylor researchers was not followed up. In 2000, the Office of Alternative Medicine of the National Institutes of Health (presently the National Center for Complementary and Alternative Medicine, or NCCAM) indicated interest in conducting clinical trials of oxygen/ozone therapies; as of 2003, however, these studies have not been carried out.
Recent European research in ozone therapy includes studies in the oxygenation of resting muscles, the treatment of vascular disorders, and the relief of pain
from herniated lumbar disks. No corresponding studies are being done in the United States as of late 2003.
— A form of ozone therapy in which a small quantity of the patient's blood is withdrawn, treated with a mixture of ozone and oxygen, and reinfused into the patient.
— A colorless, unstable compound of hydrogen and oxygen (H2
). An aqueous solution of hydrogen peroxide is used as an antiseptic and bleaching agent.
— A form of oxygen with three atoms in its molecule (O3
), produced by an electric spark or ultraviolet light passing through air or oxygen. Ozone is used therapeutically as a disinfectant and oxidative agent.
Andreula, C. F., L. Simonetti, F. De Santis, et al. "Minimally Invasive Oxygen-Ozone Therapy for Lumbar Disk Herniation." American Journal of Neuroradiology 24 (May 2003): 996-1000.
Clavo, B., J. L. Perez, L. Lopez, et al. "Effect of Ozone Therapy on Muscle Oxygenation." Journal of Alternative and Complementary Medicine 9 (April 2003): 251-256.
Tylicki, L., T. Nieweglowski, B. Biedunkiewicz, et al. "The Influence of Ozonated Autohemotherapy on Oxidative Stress in Hemodialyzed Patients with Atherosclerotic Ischemia of Lower Limbs." International Journal of Artificial Organs 26 (April 2003): 297-303.
International Bio-Oxidative Medicine Foundation (IBOMF). P.O. Box 891954. Oklahoma City, OK 73109. (405) 634-7855. Fax (405) 634-7320.
International Ozone Association, Ind. Pan American Group. 31 Strawberry Hill Ave. Stamford, CT 06902. (203) 348-3542. Fax (203) 967-4845.
NIH National Center for Complementary and Alternative Medicine (NCCAM). NCCAM Clearinghouse. P. O. Box 8218. Silver Spring, MD 20907-8218. TTY/TDY: (888) 644-6226. http://nccam.nih.gov.
Oxygen Healing Therapies. http://www.oxygenhealingtherapies.com.
oxygen (O) [ok´sĭ-jen]
a chemical element, atomic number 8, atomic weight 15.999. (See Appendix 6.) It is a colorless and odorless gas that makes up about 20 per cent of the atmosphere. In combination with hydrogen, it forms water; by weight, 90 per cent of water is oxygen. It is the third most abundant of all the elements of nature. Large quantities of it are distributed throughout the solid matter of the earth because it combines readily with many other elements. With carbon and hydrogen, oxygen forms the chemical basis of much organic material. Oxygen is essential in sustaining all kinds of life. Among the land animals, it is obtained from the air and drawn into the lungs by the process of respiration
. See also blood gas analysis
Oxygen Balance and
.” The need of every cell for oxygen requires a balance in supply and demand. But this balance need not be exact at all times. In fact, in strenuous exercise the oxygen needs of muscle cells are greater than the amount the body can absorb even by the most intense breathing. Thus, during athletic competition, the participants make use of the capacity of muscles to function even though their needs for oxygen are not fully met. When the competition is over, however, the athletes will continue to breathe heavily until the muscles have been supplied with sufficient oxygen. This temporary deficiency is called oxygen debt.
Severe curtailment of oxygen, as during ascent to high altitudes or in certain illnesses, may bring on a variety of symptoms of hypoxia
, or oxygen lack. A number of poisons, such as cyanide
and carbon monoxide
,, as well as large overdoses of sedatives
, disrupt the oxygen distribution system of the body. Such disruption occurs also in various illnesses, such as anemia
and diseases of lungs, heart, kidneys, and liver.
an artificial radioactive isotope of oxygen having a half-life of 2.04 minutes and decaying by positron emission. It is used as a tracer
in the measurement of regional blood volume and flow and oxygen metabolism by positron emission tomography
oxygen analyzer an instrument that measures the concentration of oxygen in a gas mixture. There are three types of handheld analyzers: physical/paramagnetic, electric, and electrochemical analyzers.
oxygen blender a device used to mix oxygen with other gases to any concentration between 21 per cent and 100 per cent.
oxygen concentrator an electronic device that removes nitrogen from room air, thus increasing the oxygen concentration; commonly used by patients who require long-term oxygen administration at home.
oxygen consumption the amount of oxygen consumed by the tissues of the body, usually measured as the oxygen uptake in the lung. The normal value is 250 ml/min (or 3.5 to 4.0 ml/kg/min), and it increases with increased metabolic rate.
oxygen hood a device that fits over the head of an infant or small child for administration of oxygen or aerosolized medications.
hyperbaric oxygen oxygen under greater than atmospheric pressure.
liquid oxygen oxygen in liquid form, a common storage form of oxygen; one liter of liquid oxygen will produce 860 liters of gas.
oxygen therapy 1.
in the nursing interventions classification
, a nursing intervention
defined as administration of oxygen and monitoring of its effectiveness.
a form of respiratory care
involving administration of supplemental oxygen for relief of hypoxemia and prevention of damage to the tissue cells as a result of oxygen lack (hypoxia
). Oxygen can be toxic and therefore, as with a drug, its dosage and mode of administration are based on an assessment of the needs of the individual patient. Although many types of hypoxia can be treated successfully by the administration of oxygen, not all cases respond to this therapy. There also is the possibility that the injudicious use of oxygen can produce serious and permanent damage to the body tissues. The administration of oxygen should never be considered a “routine” or harmless procedure.
Adverse Effects of Oxygen
. Although it is true that all living organisms require oxygen to maintain life, an environment of 100 per cent oxygen inhibits growth of living tissue cultures, and laboratory experiments have shown that hyperoxygenation of body tissues can cause irreversible damage. It is known that high concentrations of inhaled oxygen can result in collapse of alveoli because of displacement of nitrogen by oxygen. retinopathy of prematurity
in premature infants was found to be caused in part by excessively high levels of oxygen in the blood.
Another serious complication of high-oxygen concentration therapy is the development of a hyaline membrane
because of a deficiency of pulmonary surfactant
; surfactant is vitally important to normal expansion and deflation of the alveoli. Prolonged exposure to inspired oxygen concentrations in excess of 50 per cent can impair the production of this surfactant in a patient of any age. The result is a loss of lung compliance and reduction of the transport of oxygen across the alveolar membrane.
The danger of oxygen toxicity can be minimized by careful assessment of each patient's need for oxygen therapy and systematic blood gas analysis
to determine patient response and effectiveness of treatment. Symptoms of oxygen toxicity are substernal distress, nausea and vomiting, malaise, fatigue, and numbness and tingling of the extremities.
Indications for Oxygen Therapy
. In general, the clinical situations in which the administration of supplemental oxygen is indicated are: (1) Profound but potentially reversible hypoxia that appears amenable to the short-term administration of high concentrations of oxygen. Examples would include the patient who is apneic, is suffering from cardiovascular collapse, or is a victim of carbon monoxide poisoning. (2) Conditions in which there is a need to reduce the work load of the cardiovascular and pulmonary systems and at the same time assure an adequate supply of oxygen to the tissues. Congestive heart failure, myocardial infarction, and such acute pulmonary diseases as pulmonary embolism and pneumonia are examples of the types of clinical situations that are best treated by the administration of moderate levels of oxygen concentration. (3) Evidence of hypoventilation, whether from anesthesia and sedation, chronic obstructive pulmonary disease
, or other conditions. The patient who is hypoventilating is in danger of suffering from an adverse effect of oxygen therapy because increased oxygenation can lead to decreased respiratory effort. In other words, the oxygen acts as a respiratory depressant and may produce an increase in partial pressure of carbon dioxide in the arterial blood, thus contributing to rather than overcoming the problem of hypoxia. If there is evidence that the patient is hypoventilating, it may be necessary to administer the oxygen by assisted or controlled ventilation.
The delivery of appropriate and effective oxygen therapy requires frequent monitoring of arterial blood gases. An initial blood gas analysis at the time the therapy is started provides baseline data with which to evaluate changes in the patient's status.
In addition to monitoring blood gases to assess the patient's need for and response to supplemental oxygen, it is helpful to observe the patient closely for signs of hypoxemia. However, these signs are not as reliable as blood gas analysis because the clinical manifestations of hypoxemia vary widely in individual patients. The typical clinical manifestations of hypoxemia are confusion, impaired judgment, restlessness, tachycardia, central cyanosis, and loss of consciousness.
Dosage and Method of Administration
. It must be kept in mind that oxygen is considered a drug and should be prescribed and administered as such; thus it is apparent that vague orders about its administration are never acceptable. There must be specific written orders for flow rate and mode of administration. Decisions about the initial dosage, as well as any changes in mode of administration and dosage, including the discontinuance of oxygen therapy, should be based on evaluation of the PO2
, the PCO2
, and the blood pH. (See also transcutaneous oxygen monitoring
and pulse oximeter
The clinical signs and symptoms of hypoxemia may vary from patient to patient, and they should not be depended upon as valid indications of oxygen insufficiency. This is especially true of cyanosis, a symptom that depends on local circulation to the area, the red cell count, and hemoglobin level. In addition to the data obtained from blood gas analyses, an oxygen analyzer should be used occasionally to check inspired oxygen concentration.
In general, the dosage and mode of administration fall into the following categories. High concentrations
above 50 per cent usually are prescribed when there is a need for the delivery of high levels of oxygen for a short period of time to overcome acute hypoxemia, as in cardiovascular failure and pulmonary edema. The flow rate may be as high as 12 liters per minute, administered through a close-fitting face mask with or without a rebreathing bag, or via an endotracheal tube.Moderate concentrations
of oxygen are indicated when the patient is suffering from impaired circulation of oxygen, as in congestive heart failure and pulmonary embolism, or from increased need for oxygen, as in thyrotoxicosis, in which the increased metabolic rate creates a need for more oxygen. The rate of flow should be 4 to 8 liters per minute, administered through an air entrainment mask that delivers concentrations above 23 per cent, or in a dosage of 3 to 5 liters per minute through a nasal cannula.Low concentrations
of oxygen are indicated when the patient is receiving oxygen therapy over an extended period of time, as in chronic obstructive pulmonary disease, and there is the possibility of hypoventilation and the danger of increased CO2
retention. The rate of flow should be 1 to 2 liters per minute, administered through a nasal cannula, or via an air entrainment mask that delivers 24 to 35 per cent oxygen.
Other methods of oxygen administration include the nasal catheter and the oxygen tent. The nasal catheter can cause some discomfort to the patient, and since it is no more and no less effective than the cannula, most therapists and patients prefer not to use it. The oxygen tent is considered by many to be obsolete, its use being limited to the administration of oxygen to children who cannot or will not tolerate other modes of delivery, and to children in whom the objective is to provide oxygen and humidity or humidity alone.
Patient Care. No matter what mode of administration is used, it is essential that the inspired air be moisturized. This is necessary to prevent drying of the respiratory mucosa and thickening of secretions that can further inhibit the flow of air through the air passages. Humidity may be provided by humidifying the oxygen with water, or by aerosoling the water into fine particles and adding it to the oxygen. Most patients need 60 to 65 per cent relative humidity at room temperature. Patients with endotracheal tubes require as close to 100 per cent humidity as possible.
Oxygen is not an explosive gas, but it does support combustion and presents a serious fire hazard. All electrical equipment should be checked for defects that could produce sparks. All appliances that transmit house current must be kept outside an oxygen tent, and all equipment with exposed switches and meters must be considered potential sources of fire. Static electricity is a minimal risk which can be further reduced by maintaining a relatively high humidity in the oxygen tent. Smoking in the immediate area of oxygen administration is prohibited and there should be signs informing visitors and others of this restriction.
When the patient is wearing a mask for an extended period of time, discomfort can be minimized by removing the mask and washing and drying the face at least every eight hours. To be effective the mask must fit snugly and follow the contour of the face. This means that reddened areas will appear where the mask has pressed against the skin. These areas should be gently massaged and the skin lightly powdered to reduce friction.
A program of infection control is especially important in the prevention of cross-infection from the equipment that is used to administer oxygen. Humidifiers and nebulizers may serve as sources of infection because they provide a medium for the growth of bacteria and molds. There is less danger of this happening when disposable equipment is used, but this does not preclude the need for a systematic development of policies and procedures to prevent and control the spread of infection. Every person involved in the care of the patient must be aware of this program and cooperate in its implementation.
transcutaneous oxygen monitoring a method for obtaining data about oxygen levels through electrodes attached to the skin. This method is preferred for ill neonates who cannot tolerate frequent drawing of blood samples for blood gas analysis. The PO2 levels obtained by cutaneous monitoring correlate with those obtained from samples of arterial blood and spare the neonate blood loss and interruption of rest.
The transcutaneous electrodes are heated to encourage an adequate supply of blood to the area of skin to which they are attached and remain in place to permit continuous monitoring of arterial oxygen levels. To avoid burns, the electrode site can be changed every two hours. An ongoing record provides information about the neonate's oxygen level at any given moment. It allows caregivers to observe the neonate's response to handling and other procedures that may require modification to avoid severe anoxia. Placing the electrodes at specific sites can also aid the diagnosis of patent ductus arteriosus.