The following is a list of applications of Hyperbaric Oxygen Therapy
(HBOT) that are possibly accepted by Medicare and other insurance within
the United States. For a list of conditions being treated worldwide,
click here.
Air or Gas Embolus: When the natural channels
for gases expanding within the lungs becomes obstructed the tissues
may be subjected to pressures sufficient to cause rupture. The free
gas bubbles may spread into the body; into the pleural space causing
pneumothorax; into the chest and travel into the neck area; but
most seriously into the bloodstream eventually reaching the brain
and heart. The sudden arrival of Air or gas bubbles in the brain,
lungs or other organs is ideally treated with rapid hyperbaric Oxygen,
which is the primary treatment. Compression reduces the bubble size
in accordance with Boyles law permitting the reestablishment of
normal blood flow. This bubble compression in association with increased
blood Oxygen levels, increases the gradient of Nitrogen and other
dissolved gases in accordance with Henry?s Law permitting them to
dissolve into solution where they can be eliminated without danger.
In addition, cerebral edema is markedly reduced due to Oxygen induced
arterial vaso-constriction.
Decompression Illness: This condition arising
from a too-rapid depressurization associated with diving activities,
flying or compressed air working, is caused by Nitrogen or other
inert components of the breathing gas. Bubble formation is the result
of this inadequate decompression. Gas coming out of solution due
to decreased ambient pressure forms bubbles within the body tissues,
and gives rise to a wide range of symptoms. The above condition
of gas embolus is present in more serious cases. The most generally
presented symptoms include, neurological deficit, muscle and joint
pain, and general lethargy. However any change from the norm in
an individual who has been exposed to increased ambient pressure
should be investigated to eliminate the possibility of decompression
illness. Presentation of decompression illness, particularly in
recreational divers is often delayed although the patients normally
suspect the problem themselves. Hyperbaric Oxygen treatment is the
definitive treatment, with similar rationale for the treatment of
Air or gas embolus. Treatment protocols and schedules are well documented
and standardized.
Carbon Monoxide Poisoning: About 50% of all incidents
are due to para-suicide with car exhaust, many of the remainder
arise from faulty domestic heating systems and fires. Hyperbaric
Oxygen is indicated in cases where there has been significant contact
with smoke, or where there is a neurological abnormality, cardiac
ischaemia, or pregnancy. A COHb level of > 25% is conventionally
regarded as severe, although high blood gas levels are very unreliable
prognostically. Signs such as abnormal EKG, confusion, apathy and
coma respond to HBO. Hyperbaric Oxygen supplies to ischemic tissues
compete with CO at binding sites on hemoglobin, myoglobin, and intracellular
cytochromes, where increased blood Oxygen tension displaces the
chemically stable carboxyhaemoglobins. Late complications such as
memory loss and coordination disturbances are reduced with HBO by
its capability of blocking endothelium derived microcirculatory
damage, reducing cerebral edema due to Oxygen induced arterial vasoconstriction
and reversing free radical attack on cerebrosides (brain lipids).
Clostridal Myonecrosis (Gas Gangrene): Deep tissue
and muscle infection with clostridia is always mixed with other
organisms, and generally in partially or totally ischemic areas.
Clostridal alpha toxin leads to systemic illness and multi-organ
failure. The treatment of this condition involves a combination
of resuscitation, surgery, antibiosis, and hyperbaric Oxygen. Hyperbaric
Oxygen is bacteriostatic against anaerobes and stops exo-toxin production.
Used prior to or in association with surgery, it can limit systemic
collapse and can help to define viable tissues, which will allow
the planing and limitation of amputation levels. Patients suffering
from this complaint commonly require critical care, and as a result
should only normally be treated in facilities which have these facilities.
Necrotizing Fascilitis (Fourniers Gangrene and Others):
Superficial skin and facial necrosis can be at least as devastating
as gas gangrene, here also, Hyperbaric Oxygen Therapy is an adjunctive
to other treatment, including resuscitation, surgery and antibiosis.
The rationale is based on interrupting the cycle of inflammation,
edema and ischemia, which allow the rapid spread of infection. Hyperbaric
Oxygen while not antibiotic, may facilitate the effects of amnioglycosides,
which in conjunction with the increased activity and killing power
of leukocytes caused by HBO, enhance the successful prognosis of
conventional treatments, when offered at an early stage. For this
reason the treatment is effectively used against Progressive Bacterial
Gangrene.
Crush Injury: The rapid onset of tissue swelling,
compartment syndromes, hypoxia and acute traumatic ischemia can
lead to limb loss within hours. Rapid use of HBO in conjunction
with resuscitation and surgical intervention, can save a limb or
limit the extent of amputation.
Selected Problem Wounds: HBO is indicated where
hypoxia has been demonstrated to be the cause of unsuccessful angiogenisis.
Wounds or ulcers may be selected for HBO treatment using transcutaenous
oxygen measurements, with control and baseline readings taken at
several sites. The indiscriminate use of HBO cannot be justified,
it cannot give optimal benefit without conventional treatments,
nor can it revive dead tissues in all cases.
Compromised Skin Flaps or Grafts: The success
of the majority of skin grafts is due to correct surgical selection
and technical skill. Ischemia may however occur in skin flaps or
grafts, due to underlying tissue damage and hypoxia. Early recognition
of this problem is essential to enable timely rescue of at least
part of a failing graft. HBO accelerates the formation of collagen,
which promotes angiogenesis between the failing graft and its base.
This can be measured in new blood vessel walls.
Refractory Osteomyelitis: Inflamed or infected
bone may not heal due to the removal of sequestrin, and rational
use of antibiotics, due to inadequate perfusion levels and the resulting
hypoxia. Both osteoblasts and osteoclasts are Oxygen dependant,
as is the formation of new bone tissue. HBO used intermittently
raises bone Oxygen tensions, to allow periodic improvement, and
has been shown to have a permanent oxygenating effect as treatments
progress.
Exceptional Anaemia due to Blood Loss: Exceptional
anaemia caused by Hypovolemia and Hemoedilution due to large volumes
of crystalloid or colloid intravenous infusion after trauma, can
be improved by the administration of HBO. It is also useful in treating
shock and hypoxia. HBO benefits members of religious groups who
refuse transfusions. HBO works by elevating the plasma Oxygen level
in proportion to the partial pressure of inspired Oxygen. This allows
maximum blood Oxygen transport with minimal plasma and hemoglobin.
Osteoradionecrosis: The infected necrosis of irradiated
bone, especially in the head and neck can cause intolerable pain
and disability, which when combined with the difficulty of seating
grafts and prothesis, lead to disfiguring resections, and a distressing
patient outlook due to the inability to swallow when the necessary
muscles are no longer anchored to bone. HBO has been shown to improve
both bone formation and the survival of grafts and prothesis, while
helping to prevent occurrence and reocurrence of osteoradionecrosis.
In addition there is evidence to show that it assists in recovery
from irradiation induced xerostomia
Thermal Burns and Radiation Tissue Damage: The
early use of HBO in the treatment of skin and deep tissue burns,
has ben demonstrated to limit the area and depth of subsequent necrosis.
This must be combined with conventional resuscitation and treatment
of the burned patient. However particular attention must be given
to ensuring correct hydration.
Diabetic Wounds and Circulatory Efficiency Enhancement:
It is estimated that 7.2% of all hospitalizations in the USA involve
diabetes with more than 20% of these due to peripheral vascular
disease and its related tissue damage. Although HBOT may not be
of sufficient benefit in the most extreme cases, its benefit in
the marginally perfused wound may be significant. The increased
wound Oxygen tension achieved with HBOT promotes wound healing,
increases the host anti-microbial defenses and has a direct bacteriostatic
effect on anaerobic micro-organisms.
Intra-Cranial Abcess: The beneficial theraputic
effects of HBOT are derived from the predominantly anaerobic flora
found in ICA?s, the reduction of a perifocal brain swelling, the
enhancement of host defense mechanisms and the well documented beneficial
effects in cases of concomitant skull osteomyelitis.
High Altitude Sickness ( Pulmonary and Cerebral
Edema): HBO works by elevating the plasma Oxygen level in proportion
to the partial pressure of inspired Oxygen. This allows maximum
blood Oxygen transport with minimum plasma and hemoglobin. In all
HBO treatment, raised arterial PO2 causes vaso-constriction, reducing
blood flow and edema, while paradoxically improving Oxygen delivery
to the tissues. There are simple pressure bags available that permit
the patient or a high altitude explorer to be exposed to 3 psi (0.2
Bar) to elevate the partial pressure of the Air being breathed to
equal standard atmospheric pressure.
-Excerpts taken from Hyperbaric Chamber Operator, Training and
Reference Manual, © January 2003, ANDI International