Hyperbaric Oxygen Therapy

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.