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What is Hyperbaric Oxygen Therapy?
What Are Accepted Indications?
What Are Reasonable Utilization Parameters?
Is Physician Supervision Required?
What Are the Treatment Protocols?
How Does a Doctor Prescribe HBOT?
What is the Hyperbaric chamber?
What should I do to prepare for a treatment?
What Are Treatment Schedules Like?
How does Hyperbaric oxygen therapy work?
What Does the Physician or Technician Need to Know Before Giving HBOT?
What is Hyperbaric Oxygen Therapy?
Hyperbaric oxygen therapy is a medical treatment administered by delivering 100 percent oxygen at pressures greater than atmospheric (sea level) pressure to a patient in an enclosed chamber. Hyperbaric oxygen acts as a drug, eliciting varying levels of response at different treatment depths, duration's, and dosages and has been proven effective as adjunctive therapy for specifically indicated conditions.
What Are Accepted Indications?
The following is a partial list of conditions that have been determined to be acceptable indications for hyperbaric oxygen therapy by Medicare, the Undersea and Hyperbaric Medical Society (UHMS), and the American College of Hyperbaric Medicine (ACHM). It is very important to note that each organization has its own list of approved indications and the following list is a combination of those lists and not an approved list from any one organization listed here. In most cases, medical insurance carriers (including Medicare and Medicaid) provide coverage for hyperbaric oxygen therapy:
Acute / Emergent
·Cyanide / Carbon monoxide poisoning
·Cerebral arterial gas embolism
·Decompression sickness
·Exceptional blood loss anemia
·Necrotizing soft tissue infections (necrotizing fasciitis)
·Gas gangrene
·Crush injury; compartment syndrome
·Reattachment and suturing of limbs
·Peripheral ischemia, including compartment syndrome
·Thermal burns
·Brown Recluse spider bite
Chronic
·Actinomycosis
·Enhancement of healing in selected problem wounds
·Compromised skin graft flaps
·Radiation necrosis
·Refractory osteomyelitis
·Refractory mycoses
Research
·Closed Head Injury
·Traumatic Brain Injury
·Cerebral Palsy / Stroke
·Near Drowning
·Myocardial Infarction (heart attack)
·Chronic Fatigue (in HIV)
What Are Reasonable Utilization Parameters?
Hyperbaric Oxygen therapy should not be a replacement for other standard successful therapeutic measures. Depending on the response of the individual patient and the severity of the original problem, treatment may range from less than 1 week to several months, the average being 3 to 6 weeks. Reviewing and documenting the medical necessity for use of hyperbaric oxygen should be standard for any patient receiving more than 2 months of therapy regardless of the condition of the patient.
Is Physician Supervision Required?
For Hyperbaric Oxygen therapy to be covered under the Medicare program in the United States, the physician must be in constant attendance during the entire treatment. This is a professional activity that cannot be delegated in that it requires independent medical judgment by the physician. The physician must be present, carefully monitoring the patient during the Hyperbaric Oxygen therapy session and be immediately available should a complication occur. This requirement applies in all settings and no payment will be made by Medicare unless the physician is in constant attendance during the Hyperbaric Oxygen therapy procedure.
What Are the Treatment Protocols?
Treatment protocols are established by the attending physician. Oxygen when breathed under increased atmospheric pressure is a potent drug. Besides beneficial effects, hyperbaric oxygen can produce noticeable toxic effects if administered inappropriately. Safe time, dose, and depth limits have been established for hyperbaric oxygen exposure, and these limitations form the basis for today's treatment protocols. With the exception of carbon monoxide and/or cyanide poisoning, decompression sickness and cerebral arterial gas embolism, treatments last approximately two hours. These treatments may be given once, twice, or occasionally three times daily. Treatment for the most acute cases is approximately 10 days, while chronic cases may require treatment for 30 days or more. Treatments can be administered on an outpatient or inpatient basis with no relevant difference. While receiving therapy, the critically ill patient may be provided with mechanical ventilation, IV therapy and invasive and noninvasive physiologic monitoring.
How Does a Doctor Prescribe HBOT?
Hyperbaric oxygen therapy is usually offered as a referral and consultation service. A consultation appointment will be made for the patient once appropriate case documentation has been received. Copies of treatment documents are mailed to referring physicians. An extensive medical library of key laboratory studies and supportive clinical research is also available to interested health care professionals.
What is the hyperbaric chamber?
The hyperbaric chamber is a steel, aluminum, or clear plastic room in which air can be compressed to a pressure that is greater than sea level. Most patients are treated at a pressure equivalent to two or two and a half times normal atmospheric pressure. Chambers can have port holes (small windows) or be made out of a special thick strong plastic shell. They can be equipped with comfortable reclining chairs or stretch out to a completely flat position. To enhance patient comfort, music or movies can played during treatments, which are usually provided through a headset or an interior speaker. Whenever the chamber is in use, medical personnel trained in hyperbarics are in constant contact via visual or audio communications.
What should I do to prepare for a treatment?
After referral by your doctor and evaluation by a hyperbaric medicine specialist you will be given detailed instructions. You will be asked not to wear the following materials while in the chamber: hair oils, hair spray, perfumes, make-up, nylons (panty hose), ointments, liniments, petroleum or Vaseline products, wigs or hair pieces, aftershave, synthetics (i.e. rayon, nylon, etc.), or salves. Watches should not be worn in the chamber because they may break under the increased pressure. Because the therapy involves 100 percent oxygen, any form of smoking material, lighters or matches are STRICTLY prohibited in the chamber and should not be used for at least an hour after treatment. Books, magazines, and writing pads may be allowed in a multi-person chamber; newspapers and loose papers should not be taken in. Anything not specifically allowed in the chamber must not be taken in under any circumstances.
How Will the Treatment Feel?
The first few minutes of the treatment (commonly referred to as a dive) can be quite noisy. It may get warm at first, and then the temperature will be adjusted to a comfortable setting. You will feel the change in pressure in your ears (similar to the feeling you have while in an airplane); otherwise it should be unnoticeable. To equalize the pressure and avoid a feeling of fullness in your ears, you will be instructed how to equalize the pressure in your ears. By holding your nose and attempting to blow through it, or simply swallowing, air can be allowed to enter the middle ear cavity via the eustachian tube. It is only necessary to do this during the first few minutes of the treatment. The remainder of your treatment should be a time for you to read, sleep, watch TV, or just relax. Patients of all ages generally tolerate the treatments very well.
Are there any side effects?
The most common side effect is barotrauma to the ears and sinuses caused by pressure changes. To minimize this risk, patients learn techniques to promote adequate clearing of the ears during compression. Other side effects are more rare, but may include oxygen toxicity, claustrophobia, and accelerated maturation of cataracts. Occasionally some patients experience visual changes after several treatments that cause them to have changes in their visual acuity. This is usually only temporary and should disappear three to four months after the treatments stop. Other side effects are extremely rare. Any feeling out of the ordinary should be reported to the treating attendants immediately.
What if I am a smoker?
To receive the maximum benefit from hyperbaric oxygen therapy, patients are encouraged not to smoke during the course of therapy. Smoking (even one cigarette) causes blood vessels to constrict, which decreases the blood and oxygen supply to tissue, counteracting the benefits of hyperbaric oxygen.
What Are Treatment Schedules Like?
It greatly depends on the nature of the illness and the facility. Patients with wound healing problems usually require about 40 treatments, usually Monday through Friday (sometimes on Saturdays). Patients with acute diseases such as decompression illness or carbon monoxide poisoning usually need only 1-2 treatments. Treatments are not usually scheduled on Sunday or holidays. Emergency treatments are administered at any time, 365 days per year.
Where Are Chambers Located?
Hyperbaric chambers are located around the world. A list of hyperbaric facility's is located on this web site under Hyperbaric Registry? (make this a link to the page)
How does hyperbaric oxygen therapy work?
Hyperbaric oxygen therapy saturates the patient's plasma with oxygen resulting in increased oxygen delivery to tissues. Specifically, hyperbaric oxygen therapy:
Dissolves oxygen in to the plasma.
Increases oxygen tension in hypoxic areas.
Enhances white blood cell activity at the wound site.
Reduces edema by vasoconstriction.
Blocks cytotoxic effects of carbon monoxide and hypoxia associated with cyanide poisoning. Starts the formation of new peripheral vascular vessels and nerve endings (Angiogenesis) in damaged area of the body
Are There Contraindications?
Yes; Untreated pneumothorax, congenital spherocytosis, Disulfiram (Antabuse), Doxorubicin (Adriamycin), Cis-Platinum, and Mafenide Acetate (Sulfamylon) may be contraindications. Each patient is evaluated to determine the relative risks and benefits of hyperbaric oxygen therapy.
What Does the Physician or Technician Need to Know Before Giving HBOT?
We need to know when:
you experience a cold, flu symptoms, sinus or nasal congestion, or chest congestion
there may be a possibility of pregnancy
your medications have changed
you have skipped a meal prior to HBO treatment
you are a diabetic and did not take your insulin prior to treatment
you have any concerns or anxiety
Diving Medicine is a specialized area of medical science dealing with the biological effects of the undersea environment on health and safety. In addition to treating diving injuries, a diving physician must also make decisions regarding the "fitness" of an individual to dive. A number of courses in diving medicine are offered each year that allow physicians and other professionals the opportunity to stay current in diving medical issues. Usually the courses are sponsored by organizations that maintain high standards of educational quality. Among the most highly regarded of these organizations are the Undersea and Hyperbaric Medical Society (UHMS) , the Divers Alert Network (DAN), the American Academy of Underwater Sciences (AAUS), the South Pacific Undersea Medical Society (SPUMS) and the British Subaqua Club. Of course, U.S. Military training in Undersea Medicine is highly regarded and the National Oceanic and Atmospheric Administration (NOAA) provides excellent training for both military and civilians alike. This is not a complete list, but for all practical purposes this is a fairly complete listing of the relevant diving organizations in the western world. We welcome information about organizations committed to diving medicine and dive safety that we might have inadvertently omitted.
Hyperbaric Medicine is another specialized area of medical science that overlaps with Diving Medicine. It specifically deals with the administration of Hyperbaric Oxygen (HBO) as a medical treatment for certain diseases. For the diver, HBO is the specific cure for Decompression Illness (DCI), and is life saving in the treatment of Air Embolism. Aviators also suffer decompression illness due to rapid changes in altitude or cabin pressure and occasionally require HBO therapy. Due to the serious nature of some HBO responsive diseases, Hyperbaric Specialists tend to also be Intensive Care Medicine Specialists.
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