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HBOT Indications

The Undersea & Hyperbaric Medical Society (UHMS) has identified 15 level 1 diagnoses treatable with Hyperbaric Oxygen Therapy (HBOT)

The four most common indications we see:

Problem wounds are those that don’t respond to traditional medical or surgical management. Problem wounds include diabetic ulcers, vascular insufficiency, non-healing traumatic wounds, compromised amputation sites, etc. Approximately 5 million Americans suffer non-healing wounds that can become infected, gangrenous, or require amputation. The elderly more commonly experience impaired healing due to slower epithelialization and in systemically or locally compromised hosts.

Non-healing wounds have varying degrees of low blood and oxygen supply as well as infection. HBOT increases the oxygen supply preventing wound hypoxia, which increases wound healing by promoting collagen production and capillary regrowth. White blood cells also need enough oxygen to kill aerobic bacteria in the infected wound.

Chronic Refractory Osteomyelitis is a recurring bone infection that was treated with appropriate medical and surgical interventions; however, treatments were unsuccessful.

HBOT stops bacteria from reproducing, provides oxygen to the cells that break down dead bone and to the cells that make connective tissue, augments certain antibiotics, and decreases inflammation from surgical treatments.

Radiation damage occurs in every tissue that is radiated to some degree. This damage can lead to progressive inflammation and breakdown to the arteries, which causes tissue ischemia and fibrosis. The most common are osteoradionecrosis of the jaw due to post- radiation tooth removal. Osteoradionecrosis cannot be treated by HBOT alone, but rather in conjunction with appropriate specialists and an overall treatment plan.

HBOT prevents viable tissue from becoming necrotic and triggers new blood vessels to grow.

HBOT is an adjunct treatment for tissue endangered by inadequate oxygen supply. When a patient receives a skin graft, the recipient bed must be healthy enough to accept and nourish a graft.

HBOT can prepare a granulating base in patients with compromised wounds or patients at high risk due to previous failures.

HBOT increases oxygen levels in problem wounds, stimulates the growth of blood vessels and granulation tissue and in some cases can heal the wound enough so that grafts or flaps are unnecessary.

The remaining indications for HBOT are below:

Gas bubbles can enter the arterial blood flow in various ways including lung overpressurization during SCUBA or chamber diving, trauma, and certain medical procedures. These bubbles primarily block arterial flow, but can also cause platelet clumping and micro trauma to blood vessels.

HBOT reduces bubble volume and drives the gas into physical solution. Meanwhile, Oxygen washes out inert gas from the bubbles allowing the body to absorb them. Proper tissue perfusion can then be reestablished, and swelling will begin to subside.

Carbon monoxide (CO) is a poisonous by-product of incomplete combustion from fires, running vehicles and even cigarette smoke. CO is the leading cause of lethal poisonings in the US. When CO enters the bloodstream, it out-competes oxygen by 220 times for a spot on the blood cells, which prevents proper oxygenation of the body’s tissues.

HBOT treatment is best done within 12 hours of exposure to CO. It speeds the removal of CO from the red blood cells, improves tissue oxygenation, inhibits the toxic process, speeds recovery and reduces the number of delayed functional and neurological abnormalities.

Cyanide gas is among the deadliest poisons known. It is produced when products such as plastic, polyurethane, wool, silk and nylon burns and usually accompany CO.

HBOT provides immediate cardiac tissue oxygenation, and oxygen has an antidotal potency when cyanide is at a critical level.

Gas Gangrene is an acute, rapidly progressing infection that can be limb or life threatening usually from a bacteria such as Clostridium, Staphylococcus or Streptococcus. The infection has been known to advance as much as 6 inches per hour. Symptoms include toxemia, sepsis, odor, variable amounts of gas developing under the skin, edema and tissue death.

Treatment includes aggressive antibiotics, aggressive surgery, and HBOT. HBOT stops the production of more bacteria, boosts the immune system response with free radicals and oxygenates viable tissue.

Acute Traumatic Ischemia (ATI) occurs when an injury interrupts blood flow to an extremity due to a fracture, crush injuries from entrapment, tourniquets that were too tight, edema, etc.

HBOT increases oxygenation 10 times in plasma and by reducing edema via vasoconstriction and mechanical pressure. HBOT also reduces the secondary reperfusion injury by preventing the cascade of events that follows ATI.

DCS is caused when SCUBA divers or caisson workers surface too quickly thereby allowing nitrogen bubbles to form in the blood stream. DCS is virtually identical to Arterial Gas Embolism (AGE), and symptoms and treatment are similar. Bubbles can block blood flow as well as damage vasculature and tissues. DCS doesn’t always cause symptoms. Otherwise, symptoms can include pain, confusion, seizures or unconsciousness.

HBOT oxygenates hypoxic tissues, decreases the size of bubbles, washes out nitrogen gas allowing bubbles to dissolve, and reduces the secondary effects of reperfusion injury.

Necrotizing soft tissue infections involve a bacterial invasion causing local tissue trauma, ischemia, and death. This may occur from diabetic foot infections, surgical wounds, puncture wounds and other traumas. Necrotizing infections are often associated with suppressed immune systems due to alcoholism, malnutrition, drug abuse, underlying systemic disease as well as other causes.

HBOT provides oxygen to white blood cells and produces free radicals to aid in the immune response. It also has a bacteria stopping effect on microbes that live without oxygen.

Central retinal artery occlusion (CRAO) is a relatively rare emergent condition of the eye resulting in sudden painless vision loss often in one eye due to occlusion of one or more of the arteries supplying the retina. A wide variety of treatment modalities have been tried over the last one hundred years with little to no success, with the exception of hyperbaric oxygen therapy.

If treated within hours of onset, HBOT can maintain oxygenation of the retina and promote new vascular growth.

ISSHL is the latest addition to diagnoses treatable with HBOT by the UHMS. ISSHL is defined as greater than a 30-decibel hearing loss in more than 3 contiguous frequencies occurring within 12 hours or less and lasting for more than 3 days. This sudden hearing impairment is due to disorders of the cochlear division of the auditory nerve or the retro-cochlear nerve tracts often due to an unknown etiology. Causes may include vascular occlusion, viral infections, trauma, toxins, cochlear and labyrinthine membrane damage, etc. Symptoms include unilateral hearing loss, tinnitus, aural fullness, and vertigo.

HBOT has been shown to improve cochlear metabolism (which requires a high O2 supply) and intracochlear O2 tension via the perilymph supply. There is not enough evidence to support the use of steroids or vasodilators to treat ISSHL alone. However, studies have shown up to 51.6% hearing improvement with HBOT and steroids. (Suzuki, 2011)

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