Hyperbaric Oxygen Therapy (HBOT) is a medical treatment in which the patient is entirely enclosed in a pressure chamber breathing 100% pure oxygen (O2) at greater than one-atmosphere pressure. Air contains nearly 21% oxygen and approximately 78% nitrogen. In hyperbaric oxygen therapy (HBO), the oxygen percentage breathed by the patient is nearly or actually 100%, almost five times more than in air. The pressure of the oxygen breathed by the patient in a hyperbaric oxygen chamber is usually more than 1.5 times (and can be as much as 3 times) greater than atmospheric pressure. HBOT can deliver nearly 15 times as much oxygen as there is in the air at normal pressure.
Hyperoxygenation: HBOT physically dissolves extra oxygen into the blood plasma, which is then delivered to the tissues. Breathing pure oxygen at two to three times normal pressure delivers 10-15 times as much physically dissolved oxygen to tissues. This can increase the tissue oxygen in compromised tissues to greater-than-normal values. Hyperoxygenation has been demonstrated to induce the formation of new capillaries in ischemic or poorly perfused wounds. Therefore, it is useful in the treatment of ischemic-based compromised wounds, flaps, and grafts. It is also helpful in some infections by allowing white cell (leukocytic) activity to resume function.
Mechanical Effect of Increased Pressure: Any gas in the body will decrease in volume as the pressure on it increases. With a threefold increase in pressure, a bubble trapped in the body is reduced by two-thirds. Thus, reduction in gas volume resolves air embolism and decompression illness when the diagnosis to treatment is done in a timely manner.
Vasoconstriction: High-pressure oxygen causes constriction of the blood vessels in normal tissues without creating hypoxia. It does not cause constriction in previously oxygen-deprived tissues. The vasoconstriction decreases edema which is helpful in the treatment of burns, crush injuries, compartment syndromes, and other acute traumatic ischemias. Even though the blood flow that contributes to edema is reduced, oxygen delivery to the tissues is maintained through the hyperoxygenation effect.
Antimicrobial Activity: HBOT inhibits alpha toxin production as seen in anaerobic infections such as clostridium perfringens (gas gangrene). The most common cause of gas gangrene is clostridium perfringens; however, there are several gas-producing organisms (aerobic and anaerobic) that require surgical debridement initially. It also enhances the white cell killing activity which provides an excellent adjuvant to I.V. antibiotics and local wound care.
Mass Action of Gases: The flooding of the body with any one gas tends to “wash out” others. This action occurs more rapidly under pressure than under ordinary conditions and makes HBOT an indicated treatment for decompression sickness.
Reduction of Reperfusion Injury: Following an ischemic interval, indirect injury occurs, which is mediated by the inappropriate activation of leukocytes. HBOT prevents such activation. Adherence of white blood cells to capillary walls is markedly reduced, thus mitigating the “no-reflow” phenomenon. This is why HBOT therapy is indicated in carbon monoxide poisoning and is considered the treatment of choice.
HBOT has been proven effective for many medical conditions, and as a result the Undersea and Hyperbaric Medicine Society, one of the premier research institutes, has approved the following indications:
In addition, Medicare coverage determinations will reimburse in the U.S. for the following conditions:
Monoplace Chambers: In a monoplace chamber, hyperbaric oxygen therapy is administered to one person at a time. The patient lies comfortably inside a clear acrylic tube, and the entire chamber is filled with 100% oxygen. As the chamber is gradually pressurized to about two to three times normal atmospheric pressure (2.0–3.0 ATA), the patient breathes in pure oxygen directly from the environment without the need for a mask or hood. Each session typically lasts between 60 to 90 minutes, during which the patient can relax, listen to music, or even watch TV. This setup is commonly used for both acute and chronic medical conditions and allows for a private, individualized treatment experience.
Multiplace Chambers: In a multiplace chamber, several patients can be treated at the same time. Instead of filling the chamber with pure oxygen, it is pressurized with compressed air, and each patient breathes 100% oxygen through a mask or hood. The pressure is again maintained at around 2.0–3.0 ATA, and sessions usually last 90 minutes to 2 hours. A trained medical attendant is often present inside the chamber to ensure patient safety and provide assistance if needed. Multiplace chambers are particularly suitable for hospitals and specialized centers where multiple patients require treatment simultaneously.
Except for decompression sickness and arterial gas embolism, the typical treatments are approximately two hours long. Treatments are administered on an in-patient or out-patient basis. In some acute cases, treatments may be administered every eight to twelve hours.
Treatment protocols are established by the attending physician. Safe treatment times, dose, and pressure limits have been established for hyperbaric oxygen exposure and these limitations form the basis for all treatment protocols. While receiving therapy, the critically ill patient may be provided with mechanical ventilation, IV therapy and invasive and noninvasive physiological monitoring.
It varies depending on the wellness and illness condition.
The timeline for experiencing results from Hyperbaric Oxygen Therapy (HBOT) can vary depending on the individual and the condition being treated. However, here are some general guidelines:
For example:
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