What is Hyperbaric Therapy?

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FAQ

 

What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy (HBO) is defined as breathing 100% oxygen while in an enclosed system pressurized to greater than one atmosphere (sea level). Breathing 100% oxygen at atmospheric pressure or applying topical oxygen without enclosing the entire patient in a pressurized chamber does not produce the same effects and is not recognized as hyperbaric oxygen therapy. (top of page)
How is HBO effective?
Hyperbaric oxygen therapy delivers oxygen quickly and in high concentrations to injured areas systemically. The increased pressure changes the normal cellular respiration process and causes oxygen to dissolve in the plasma. This results in a substantial increase in tissue oxygenation. HBO is beneficial because it stimulates the growth of new blood vessels and increases oxygenation that can arrest certain types of infections, and enhance wound healing.
HBO is also used in the treatment of certain critical care acute disorders such as carbon monoxide poisoning, gas gangrene, necrotizing infections, gas embolism and decompression sickness. (top of page)
What are the mechanisms of action associated with HBO?
The following beneficial mechanisms have been identified that serve to enhance the healing of treatment conditions.
Hyperoxygenation. The elevated pressure (1.5 to 3.0 atmospheres) increases the amount of oxygen present in the bloodstream and available to tissues, 10 to 13 times over normal conditions. HBO provides immediate support to compromised tissue areas with marginal blood flow. Elevated levels of oxygen can also purge toxins, including carbon monoxide, from the body.
Direct Pressure. HBO shrinks the size of gas bubbles so that they may be reabsorbed. HBO is important in the treatment of arterial gas embolism and decompression sickness.
Vasoconstriction. Elevated levels of oxygen cause vasoconstriction that leads to reduced blood flow without significantly affecting tissue oxygenation. HBO is used to control compartment pressures in crush injuries and to treat thermal burns.
 
Bactericidial/Bacteriostatic. Super oxygen saturation of tissue stops the spread of certain toxins and enhances the killing of bacteria. This is important in the treatment of gas gangrene and necrotizing tissue infection.
Angiogensis and Neovascularization. HBO promotes the growth of new blood vessels, enriching the area with oxygen carrying blood. Although decreased oxygen tensions stimulate angiogensis , for it to be effective, there must be an underlying scaffolding of collagen to support it. Overall, therefore, hyperoxygenation stimulates useful angiogensis. (top of page)
Are there any side effects?
The risks associated with HBO are minimal, however, patients may experience a few side effects. The most common complications include sinus squeeze, temporary changes in vision and fatigue. (top of page)
What does a patient experience during treatment?
The first stage of treatment is compression, in which the pressure inside the system is gradually increased. The temperature will rise and later be adjusted to a comfortable level. The patient will feel a fullness in the ears, but instruction is provided to help clear the pressure and relieve temporary discomfort. Inside the chamber, the patient can sleep, watch TV or a video tape, listen to music, read or just relax. When the treatment is completed, normal pressure is restored slowly. (top of page)
What are some of the different kinds of chambers?
Monoplace chambers accommodate one patient and are pressurized with 100% oxygen that the patient breathes directly. The chamber is capable of providing biomedical monitoring, fluid resuscitation and ventillary support as required.
Dualplace chambers accommodate two seated patients, or one supine patient and an attendant and are pressurized with air. Patients breathe oxygen through a built-in-breathing system. A dualplace offers the advantage of a separate entry lock chamber which allows the attendant or physician to have access to the patient at all times.
Multiplace chambers accommodate between four and twenty-four patients and can be designed to specification based on anticipated patient load. The systems are pressurized with air and patients breathe oxygen through a built-in-breathing system. These systems are large enough to allow for gurneys, critical care patients and accompanying medical staff. (top of page)
How often is HBO administered?
A variety of factors determine treatment protocol. Acute conditions may require a treatment period of ten days or less, while chronic conditions may require therapy over a few months. Although treatment schedules will vary, most treatments will be administered during two hour sessions, once or twice a day, several times a week. (top of page)
Does HBO therapy require hospitalization?
No, HBO therapy can be administered on an outpatient basis.  (top of page)
Is HBO reimbursable?
Almost all health care plans/third party payers reimburse for HBO treatments performed on currently accepted disorders approved by the Hyperbaric Oxygen Therapy Committee of the UHMS. (top of page)
What are the currently accepted indications for HBO?
Primary:
  • Air/Gas Embolisms
  • Carbon Monoxide Poisoning and Smoke Inhalation
  • Decompression Sickness
  • Adjunctive Hyperbaric Oxygen in Intracranial Abscess
  • Gas Gangrene
  • Crush Injuries
  • Necrotizing Soft Tissue Infection
  • Enhanced Healing of Selected Wounds
  • Exceptional Blood Loss
  • Osteomyelitis
  • Radiation Tissue Damage
  • Skin Grafts and Flaps
  • Thermal Burns (top of page)
What are some of the research indications for HBO?
HBO is performed in certain instances that are life and/or limb threatening, but that are still considered experimental and not approved as accepted conditions. These include:
  • Carbon Tetrachloride Poisoning (Acute)
  • Cerebrovascular Accident (Acute-Thrombotic or Embolic)
  • Head Injury (Cerebral Edema)
  • Fracture Healing and Bone Grafting
  • Hydrogen Sulfide Poisoning
  • Pyoderma Gangrenosum Retinal (Central)
  • Artery Insufficiency Acute
  • Selected Refractory Mycoses:
    • Mucormycosis, Candidiobolus Coronato
  • Invasive Aspergillosis
  • Sickle Cell Anemia Crises
  • Spider Bite (Brown Recluse, Loxasceles reclusa)
  • Spinal Cord Injury (Acute) (top of page)
What is the history behind HBO?
Hyperbaric chambers have been in use for centuries, as early as 1662. However, hyperbaric oxygen therapy has been used clinically since the mid 1800's.
HBO was tested and developed by the U.S. Military after World War I. It has been used safely since the 1930's to help treat deep sea divers with decompression sickness.
Clinical trials in the 1950's uncovered a number of beneficial mechanisms from exposure to hyperbaric oxygen. These experiments were the forerunners of contemporary applications of HBO in the clinical setting.
In 1967, the Undersea and Hyperbaric Medical Society (UHMS) was founded to foster the exchange of data on the physiology and medicine of commercial and military diving. The Hyperbaric Oxygen Committee was developed by the UHMS in 1976 to oversee the ethical practice of hyperbaric medicine.
Today, there are thirteen reimbursable indications approved by the UHMS as primary or adjunctive treatment modalities. HBO has proved to be life and limb saving, as well as cost effective and therapeutic in a variety of clinical conditions.
What is the Undersea and Hyperbaric Medical Society (UHMS)?
The Undersea and Hyperbaric Medical Society (UHMS) is an international scientific organization founded in 1967 to foster exchange of data on the physiology and medicine of commercial and military diving. The results of ongoing research and clinical aspects of undersea and hyperbaric medicine are reported annually at scientific meetings and in the quarterly journal, Undersea and Hyperbaric Medicine.   (top of page)