Also Known As: Hyperbaric oxygen, Hyperbaric medicine, Hyperbaric oxygen therapy
Hyperbaric medicine, also known as hyperbaric oxygen therapy (HBOT), is the medical use of oxygen at a level higher than atmospheric pressure. The equipment required consists of a pressure chamber, which may be of rigid or flexible construction, and a means of delivering 100% oxygen. Operation is performed to a predetermined schedule by trained personnel who monitor the patient and may adjust the schedule as required. HBOT found early use in the treatment of decompression sickness, and has also shown great effectiveness in treating conditions such as gas gangrene and carbon monoxide poisoning. More recent research has examined the possibility that it may also have value for other conditions such as cerebral palsy and multiple sclerosis, but no significant evidence has been found. CureCrowd.com aims to find the truth about what works. Please complete the survey at the bottom if you have used Hyperbaric oxygen for a specific purpose.
Several therapeutic principles are made use of in HBOT:
- The increased overall pressure is of therapeutic value when HBOT is used in the treatment of decompression sickness and air embolism as it provides a physical means of reducing the volume of inert gas bubbles within the body;
- For many other conditions, the therapeutic principle of HBOT lies in its ability to drastically increase partial pressure of oxygen in the tissues of the body. The oxygen partial pressures achievable using HBOT are much higher than those achievable while breathing pure oxygen at normobaric conditions (i.e. at normal atmospheric pressure);
- A related effect is the increased oxygen transport capacity of the blood. Under normal atmospheric pressure, oxygen transport is limited by the oxygen binding capacity of hemoglobin inred blood cells and very little oxygen is transported by blood plasma. Because the hemoglobin of the red blood cells is almost saturated with oxygen under atmospheric pressure, this route of transport cannot be exploited any further. Oxygen transport by plasma, however is significantly increased using HBOT as the stimulus.
- Recent evidence notes that exposure to hyperbaric oxygen (HBOT) mobilizes stem/progenitor cells from the bone marrow by a nitric oxide (·NO) -dependent mechanism. This mechanism may account for the patient cases that suggest recovery of damaged organs and tissues with HBOT.
In the United States the Undersea and Hyperbaric Medical Society, known as UHMS, lists approvals for reimbursement for certain diagnoses in hospitals and clinics. The followingindications are approved (for reimbursement) uses of hyperbaric oxygen therapy as defined by the UHMS Hyperbaric Oxygen Therapy Committee: However, these are reimbursement decisions based on cost of medical treatments vs HBOT at the average U.S. hospital charge of $1,800.00 per 90 minute HBOT treatment. China and Russia treat more than 80 maladies, conditions and trauma with HBOT, since costs are insignificant in those countries.
- Air or gas embolism;
- Carbon monoxide poisoning;
- Clostridal myositis and myonecrosis (gas gangrene);
- Crush injury, compartment syndrome, and other acute traumatic ischemias;
- Decompression sickness;
- Enhancement of healing in selected problem wounds;
- Exceptional blood loss (anemia);
- Intracranial abscess;
- Necrotizing soft tissue infections (necrotizing fasciitis);
- Osteomyelitis (refractory);
- Delayed radiation injury (soft tissue and bony necrosis);
- Skin grafts and flaps (compromised);
- Thermal burns.
HBOT is recognized by Medicare in the United States as a reimbursable treatment for 14 UHMS "approved" conditions. A 1-hour HBOT session may cost between $108 and $250 in private clinics, and over $1,000 in hospitals. U.S. physicians (either M.D., D.C. or D.O.) may lawfully prescribe HBOT for "off-label" conditions such as stroke, and migraine. Such patients are treated in outpatient clinics. In the United Kingdom most chambers are financed by the National Health Service, although some, such as those run by Multiple Sclerosis Therapy Centres, are non-profit. In Australia, HBOT is not covered by Medicare as a treatment for multiple sclerosis.
Other reported applications include:
- Autism. A small 2009 double-blind study of autistic children found that 40 hourly treatments of 24% oxygen at 1.3 atm provided significant improvement in the children's behavior immediately after treatment sessions. The study's effect has not been independently confirmed. Research conducted by the Center for Autism and Related Disorders (CARD) found that hyperbaric oxygen therapy does not have a significant effect on symptoms of autism.
- Cerebral Palsy;
- Epidural abscesses;
- Certain kind of hearing loss;
- multiple sclerosis
- Radiation-induced hemorrhagic cystitis;
- Inflammatory bowel disease.
The toxicology of the treatment has recently been reviewed by Ustundag et al. and its risk management is discussed by Christian R. Mortensen, in light of the fact that most hyperbaric facilities are managed by departments of anaesthesiology and some of their patients are critically ill.