Assessment of tissue oxygenation.

A continuous supply of oxygen to all tissues is necessary for the efficient production of ATP, and this supply is considered sufficient when aerobic metabolism is maintained. Nonhealing wounds, necrotizing infections, radiation-induced necrosis, crush injury, decompression illness, and CO poisoning all exhibit impaired tissue oxygenation. The need for efficacy of HBO therapy in such conditions is in part determined by the prevailing state of tissue oxygen supply and demand. The methods currently available or under development for assessing the adequacy of tissue oxygenation include blood gas analysis, transcutaneous oxygen measurement, gastric tonometry, pulse oximetry, near-infrared spectroscopy, functional MR imaging, MR spectroscopy, electron paramagnetic resonance, positron emission tomography, and single photon emission computed tomography. The clinical and experimental applications of these methods are discussed and emphasis is placed on their role in hyperbaric medicine.