Abstract

Ozone therapy is presented like an alternative therapy in critically ill patients. After ozone therapy, an improvement in the hemo-dynamic parameters with an increase in tissue oxygenation were demonstrated. No modifications in the cardiac output were reported. A modulating effect of ozone therapy in certain biochemical parameters was observed. Also, microbiologic cultures were negative and leukocyte figure became normal. An ozone therapy preventive effect in the appearance of generalized sepsis was observed. With all these results we conclude that ozone therapy can be considered as a prophylactic therapy in critically ill patients.

Introduction

Critically ill patients that are submitted to the Intensive Care Unit (ICU), represent a challenge for the multidisciplinary teamwork. Because of the wide variety of physiological elements that are involved, a great number of deaths per year are present in the whole world.

In the United States for example, sepsis develops in more than 750,000 critically patients each year with only 50 to 70 % survival rate. Unfortunately, because of the high mortality rate associated with sepsis, there are in excess of 600 patients per day dying of sepsis-related complications in the United States alone (1).

Despite a long history of efforts to produce efficacious therapeutic interventions just like intensive medical care, antibiotic treatments and surgery when indicated, the condition remains a major cause of hospital-based mortality and morbidity (2-4). Several therapeutic strategies have been used in order to minimize this problem with variable results.

Ozone therapy is presented like an alternative therapy due to its different biological effects. Specifically: improvement in the oxygen metabolism, modulation in the biological oxidative stress and in the immunologic system (Figure 1) (5-9).

All the effects above mentioned are closely linked with the recovery and prognosis of critical patients. Taking into account all these aspects and also preliminary experiences (10,11), the results, using ozone therapy in a group of patients hospitalized in the ICU, are presented.

Materials and Methods

Patients and Treatment

A multi-center study in 20 patients hospitalized in the ICU was performed. Patients presented the following inclusion criteria: less than 65 years old, cranial and/or thoracic trauma, submitted to surgery or not, with mechanical ventilation or not, without humoral, radiologic or microbiologic evidence of clinical infection, without criteria of brain death.

Prophylactic ozone was administered, daily, by major autohemotherapy (200 ml of blood with anticoagulant mixture with 200 ml of ozone/oxygen, at a concentration of 45 mg/l) during 5 sessions. Prophylactic antibiotic therapy was not indicated.

Clinical laboratory test and radiologic studies were performed, daily, in each patient, during the first 5 days of evolution. To 13 patients that needed mechanical ventilation, hemodynamic determinations were performed using thermodilution with Swan Ganz catheter, before ozone therapy and after each hour up to 4 hours. This was repeated every day during the 5 days of ozone therapy.

Results

From the 13 patients that needed ventilator support, 10 were weaning from the machine. The other 3 patients died, due to the magnitude of the cranial trauma (Table I).

After ozone therapy, an improvement in the hemodynamic parameters with an increase in tissue oxygenation were demonstrated. A shift of the HbO2/Hb balance to the right, towards deoxygenated hemoglobin, improving peripheral oxygen supply was observed. Also, an increase in hemoglobin saturation with high oxygen partial pressure figures and normalization of the difference alveolus-capillary oxygen (DA-a02) were found. No modifications in the cardiac output (CO) were reported (Figures 2, 3, 4 and 5).