What is Hyperbaric Oxygen Therapy (HBOT) prescribed for?

Please note: A United States based hospital center will treat only the current list of FDA approved conditions for HBOT treatments. (The list changes every 2 years) Most Insurance Companies require FDA approval of a treatment before authorizing reimbursements.

However, Hyperbaric Recovery & Rejuvenation Center is a freestanding center, and is not restricted to treating only these conditions. (See a wider range of "Indications Justified Internationally", below.)

• Acute Traumatic Ischemia

• Acute Traumatic Ischemias: Crush Injury, Compartment Syndrome

  Acute traumatic ischemia occurs when an injury interrupts blood flow to an extremity.  Examples are open fractures that tear major arteries, or crush injuries and skeletal muscle compartment syndromes which starve the microcirculation. This can lead to infection, nonhealing wounds, united fractures, and necrosis, which can require amputation.  Problems are compounded in compromised patients such as those with diabetes, malnutrition, advanced peripheral vascular disease, or collagen vascular diseases.

  Signs of it are pain, edema, anuria (stopped urine formation) pallor and no distal pulses.

  Benefits of Hyperbaric Oxygen Therapy and Traumatic Ischemias

  Hyperbaric Oxygen Therapy at 2 ATA increases blood oxygen content by 25%, but increases plasma and tissue oxygen tension 10-fold. The net effect is a threefold increase in oxygen diffusion through tissue fluids.

  Increased oxygen reduces edema through vasoconstriction, which further promotes oxygenation.  Increased oxygen tensions in hypoxic tissues allow healing and helps prevent spread of infection and damage to adjacent, non-involved tissue, decreasing complication rates and cost of management.

  Hyperbaric Oxygen Therapy speeds demarcation of non-viable tissue, and reduces reperfusion injury by preventing lipid peroxidation, neutrophill adherence, and free radical buildup.

  Keywords: Ischemias, Crush, Injury, trauma, injury, bone, soft tissue, nerve, vascular, Compartment Syndrome, treatment

• Air or Gas Embolism

• Air Gas Embolism (AGE)

  Air embolism occurs when gas bubbles (emboli) block arterial blood flow. Secondary effects of air embolism include platelets clumping all over and damage to blood vessel walls. Obstructed vessels leak fluid into surrounding tissues. The resulting swelling further reduces tissue blood flow.

  Although AGE is a major cause of death in diving, it far more often results iatrogenically (caused by medical care) from surgical, treatment, and diagnostic procedures.

  The Benefits of Hyperbaric Oxygen Therapy and AGE

  Early recompression therapy reduces bubble volume and drives gas into physical solution, while high oxygen pressure washes out inert gas from the bubbles.

  Higher oxygen levels create a large diffusion gradient for inert gas to leave bubbles.

  With restored blood flow, poorly oxygenated tissues receive more oxygen, and local swelling subsides.

  Hyperbaric Oxygen Therapy reduces ischemic-reperfusion injury.

  You MUST NOT DELAY treatment and diagnostic work-up and clinical evaluation for Air Gas Embolism. Get treatment ASAP!!

  Keywords: Embolism, Air, Gas, bubbles, blocked, treatment

• Anemia - Exceptional Blood Loss

• Anemia - Exceptional Blood Loss

  Exceptional blood loss  anemia occurs when so many red blood cells are lost that oxygen delivery to tissues is compromised.

  Many patients cannot be treated by transfusion to restore red blood cell mass for medical or religious reasons.  Medical reasons include inability to cross match blood. Some may refuse transfusions for fear of a communicable disease.

  Some signs and symptoms of exceptional blood-loss are:  CNS: Mental confusion, slowed thought, Cardiac: Abnormal EKG, Intestional Ischemia: Abdominal pain, can't digest food properly.  Physically weak, paleness.

  Benefits of Hyperbaric Oxygen Therapy and Exceptional Blood-Loss Anemia

  In 1956 Dr. Ite Boerma removed the red blood cells from pigs and found they could survive with oxygen dissolved in the plasma by use of hyperbaric oxygen.  Hyperbaric oxygen can temporarily support life without hemoglobin.  The increased oxygen carrying capacity of blood during Hyperbaric Oxygen Therapy is enough to support basal metabolic needs at rest.

  The advantages of Hyperbaric Oxygen Therapy (HBOT) as an adjunct to cardiac surgery can be summarized as follows:

  HBOT increases the safe time of induced cardiac arrest under normothermia.

  HBOT reduces the impact of hypoxic complications and metabolic disturbances associated with cardiac surgery.

  HBOT enables surgery to be performed without blood transfusion in some cases.

  HBOT  is the treatment of choice for air embolism as a complication of cardiac surgery.

  Keywords: red blood cell, blood Loss, anemia, oxygen, delivery, treatment

• Carbon Monoxide Poisoning

• Carbon Monoxide Toxicity

  Carbon monoxide (CO) is a colorless, odorless poison gas formed by incomplete combustion.  Carbon monoxide is a rare cause of diving problems, and is the most common cause of death in fire victims.  Carbon monoxide poisoning is easily missed and underdiagnosed as a cause of headaches, fatigue, dizziness, and other neurologic complaints.

  Sources of Carbon Monoxide:  Exhaust gases from cars, propane heaters, furnaces, barbecue grills, house fires, smoking and even paint stripper which is a source of methylene chloride - which is metabolized into CO.

  CO mainly affects the heart and brain. CO poisoning has many components including hypoxia, cellular toxicity, and brain injury from leukocytes behaving badly.

  Some Signs and symptoms of CO poisoning are:

  Headaches, dizziness, weakness, nausea, tachycardia, tachypnea and occasionally retinal changes just to name a few.

  Benefits of Hyperbaric Oxygen Therapy with Carbon Monoxide Toxicity

  HBOT (Hyperbaric Oxygen Therapy) speeds the carboxyhemoblobin dissociation and improves tissue oxygenation.

  HBOT reduces cerebral edema and intracranial pressure by constricting brain vessels.

  HBOT inhibits the toxic process, speeds recovery, reduces the number delayed functional and neurologic abnormalities and reduces mortality.  HBOT stops lipid peroxidation, a component of reperfusion injury, helping prevent brain injury.

  Keywords: Monoxide, Carbon, Poison, Toxicity, Poisoning, Treatment

• Compromised Skin Flaps

• Compromised Skin Grafts and Flaps

  Hyperbaric Oxygen Therapy (HBOT), is not necessary for normal, uncompromised skin grafts or flaps.  HBOT is an adjunct treatment of tissue endangered by irradiation, decreased perfusion, or hypoxia.

  Skin grafts immediately become ischemic or hypoxic on harvest.  The recipient bed must be healthy enough to accept and nourish a graft.  The goal is to identify wounds that have failed usual therapy, and flap coverage that can respond locally to HBOT.

  Indications for adjunctive HBOT for flaps and grafts include preparing a granulating base in selected patients with compromised wounds (diabetic ulcer, venous stasis ulcer, arterial insufficiency ulcer) or flaps, and patients at high risk due to previous failures.

  Compromised Skin Grafts and the Benefits of Hyperbaric Oxygen Therapy

  Oxygen availability is critical to skin grafting success.  HBOT increases tissue oxygen levels in hypoxic and ischemic wounds.  HBOT stimulates formation of blood vessels and granulation tissue, and prepares the recipient bed for grafts or flaps.

  In some cases, HBOT will be enough to make skin grafting unnecessary, or reduce regrafting and repeat flap procedures.

  Keywords: Infection, Skin Grafts, Flaps, treatment

• Cyanide Poisoning

• Cyanide Poisoning

  Cyanide may be taken deliberately for suicide. Accidental exposures occur in fumigation, fires, the electroplating industry, in some laboratory procedures, and are produced from combustion of plastics, polyurethane, wool, silk, nylon, nitriles, rubber, and even some paper products.

  Either inhaled or ingested, cyanide blocks cell metabolism by binding to the ferric ion on cytochrome A3, which is a molecule that cells need to use oxygen.  The cells starve for oxygen and the anaerobic metabolism that cells use to try to function at all creates lactate acidosis.

  How Hyperbaric Oxygen Therapy helps with Cyanide Poisoning

  In a cyanide poisoned animal model, immediate oxygen administration on cardiac tissue was shown to be effective, and to augment the effectiveness of the antidotes - sodium nitrite and sodium thiosulfate.

  Oxygen has an antidotal potency when the dose of cyanide is at or just over the critical level for cell respiratory function.  HBOT is recommended particularly when supportive measures and other cyanide antidotes fail.  Increased plasma-dissolved O2 offers a direct benefit.

  Keywords: Cyanide, Poisoning, treatment

• Decompression Sickness

• Decompression Sickness (DCS)

  Most common with diving accidents, the prevailing theory of DCS is bubble formation when local gas partial pressure exceeds ambient pressure on ascent.  This is in spite of observations that bubbles can form without producing DCS and DCS can occur without apparent bubbles.

  Early detection of DCS is important in the management of DCS as well as other adjunctive therapies. Immediate treatment with Hyperbaric Oxygen Therapy is primary. In the US , DCS therapy is usually by Navy Treatment Tables.

  Decompression Sickness and the Benefits of Hyperbaric Oxygen Therapy

  Volume of bubbles in tissues and blood is reduced immediately according to Boyle's Gas Law. HBOT diffuses gas out of bubbles. Diffusion improves by decreasing inert gas concentration in the inhaled mixture.  Oxygen replacing the inert gas in the bubble is consumed metabolically.

  Reduces edema, platelet aggregation, and the coagulation cascade occurring at the blood-bubble interface.

  Blocks white cells from sticking to vessel walls.

  Corrects hypoxia.  Oxygen reduces CNS edema and provides a high oxygen gradient for ischemic tissues.

  Keywords: Decompression, Sickness, Bends, bubble, bubbles, gas, caisson disease, nitrogen, DCS, Treatment

• Gas Gangrene

• Gas Gangrene

  Gangrene is tissue death occurring in a wound, usually one infected with various bacteria. Gas Gangrene is acute, rapidly progressing, and not pus-producing. Effects can be both local and systemic.

  Gangrene can occur with compound fractures, complicated fractures, extensive soft tissue injury after street accidents, war wounds, and appendicitis.  Many marine organisms can cause gangrenous infections that begin with only a small cut or scrape while swimming, surfing, or diving. People with liver disease, diabetes, who are immunocompromised or taking immunosuppressive medication are at increased risk.

  Symptoms of clostridial gangrene occur 1 to 6 hours after injury, with severe and sudden pain in the infected area.  Skin overlaying the wound appears shiny and tense in the early phases, then dusky, progressing to bronze. It can advance at a rate of  6 inches per hour (fast).  Exotoxin causes vasodilation and vascular collapse.  Pronounced swelling and edema occur in the infected area.

  Hemorrhagic bullae (large bleeding blisters) or vesicles may be noted.  Muscles appear dark red to black or greenish, are noncontractile and do not bleed when cut.  Destruction may be localized to a small area or involve an entire extremity or organ (such as the bowel) and may be wet or dry.  The person is usually very sick.

  A physician needs to immediately examine the patient if Gangrene of any kind is suspected. Delay in recognition or treatment can be limb-threatening or fatal. Early treatment is vital.

  Gas Gangrene and the Benefits of Hyperbaric Oxygen Therapy

  Exotoxin production stops if tissue partial pressure is higher than approximately 300mmHg.

  Compression reduces gas bubble size and tissue pressure, improving perfusion and reducing pain.  HBOT is considered life-saving because less "heroic" surgery is needed in gravely ill patients, and the alpha-toxin production is rapidly stopped.

  HBOT is limb and tissue saving because no major amputations or excisions are done prematurely.  It clarifies the demarcation, so that within 24 to 30 hours there is a clear distinction between dead and still living tissue.

  Keywords: Gas Gangrene, infection, exotoxin, Clostridium perfringens, necrotizing myositis, Clostridium perfringens, C perfringens, Clostridium septicum, C septicum, clostridial myonecrosis, emphysematous gangrene, gangrenous emphysema, progressive emphysematous necrosis, sepsis, myonecrosis, treatment

• Necrotizing Infections

• Necrotizing Soft Tissue Infections

  Necrotizing soft tissue infections involve bacterial invasion causing local tissue trauma, ischemia, and death.  The infection may stem from diabetic foot infection, surgical wound infection, puncture wounds, and trauma like lawn mower accidents where dirt and debris is forced into the wound.

  Necrotizing infections are often associated with reduced body defenses from alcoholism, malnutrition, or drug abuse, and from underlying systemic disease, such as diabetes, cancers, and vasculopathy. Local tissue oxygen demand increases with growing infection, increasing the anaerobic environment.  Oxygen tension below 30 mmHg impairs leukocyte ability to kill bacteria.  A downward cycle continues.

  Necrotizing Soft Tissue Infections and the Benefits of Hyperbaric Oxygen Therapy

  Leukocytes can kill bacteria only when they have enough oxygen available to them.  Improved oxygenation improves white cell function to clear bacteria.  Organisms most affected by oxidation are those involved in abscess formation and wound infection.  HBOT provides oxygen at the cellular level, promoting wound healing.

  Increased Partial Pressures of Oxygen may decrease neutrophil adherence (white blood cells sticking to blood vessel linings) which damages the vessel linings.

  Keywords: Necrotizing, Soft Tissue, Infection, Treatment

• Radiation Effects

• Radiation Injury Effects, Thermal Burns

  Radiation damage occurs in every tissue and organ radiated, to varying degrees, leading to a progressive obliterative endarteritis (inflammation of the insides of arteries.) that causes tissue ischemia and fibrosis.

  The endarteritis, fibrosis, and hypoxia may also cause other problems: radiated bowel syndrome, radiation mucositis,  soft tissue radionecrosis, laryngeal radionecrosis, dermatitis, radiation cystitis, osteoradionecrosis, enteritis, laryngeal radionecrosis, and surgical wounding in radiation-damaged tissues (late radiation effects).

  After radiation a small percentage of patients develop soft tissue or bone necrosis; progressive, disabling, painful, and potentially fatal due to tissue breakdown and loss of protective barriers.

  Radiation Injury and the Benefits of Hyperbaric Oxygen Therapy

  A United States Department of Health and Human Services Public Health Service "Health Technology Assessment Report on the Treatment of Soft Tissue Radionecrosis" concluded, "there is little controversy in the medical community regarding the safety and effectiveness of HBO2 as an adjunctive therapy in the treatment of soft tissue radionecrosis..."

  Surgery in previously irradiated tissue is problematic and associated with fatalities.  Adjunctive HBOT has changed this by improving tissue healing, resolving radiation necrosis, preventing radiation necrosis, and supporting reconstructive surgery in irradiated tissues.

  Mechanism of delayed healing following radiation injury involves lack of clear border of injury.  The gradual oxygen gradient is insufficient to trigger healing.  HBOT creates a steep artificial gradient, which triggers growth of new blood vessels and collagen production.

  Keywords: Radiation, Effects, treatment

• Some cases of Osteomyelitis

• Osteomyelitis

  Chronic refractive osteomyelitis is a recurring bone infection despite medical and surgical interventions of antibiotics, drainage, or removal of sequestrating bone.

  Signs & symptoms :  History of past open fracture with non-healing. Chronic discharge from sinuses in the area. Deformity of the area with swelling and tenderness. Radiographic evidence of sequested bone (chewed up pieces of dead bone lying around).

  Benefits of HBOT:

  • HBOT increases oxygen tension in infected tissue including bone, to normal or above normal levels. Can increase oxygen saturations of plasma around infected areas that have some remaining degree of diffusion, encouraging healing.
  • Provides adequate oxygen for fibroblasts-cells that make connected tissues/ and so promote healing and hypoxic tissue. Cells that remove dead bone (osteoclasts) need oxygen to function, and intermittent oxygen tensions of 30-40mmHg are needed to grow new blood vessels.
  • Hyperbaric oxygen is bacteriostatic (bacteria stopping). Neutrophils require PO2 30-40mmHg to do their work against bacteria.
  • Augments in effect of antibiotics such as Aminoglycosides, vancomycin, quinolones, and some sulfonamides.
  • Prevents polymorphonuclar (PMN) leukocytes (a kind of white cell) from adhering to damaged blood vessel linings, increasing the inflammation that often accompanies surgical treatment for refractory osteomyelitis.

  Keywords: Osteomyelitis, Treatment

• Some non-healing wounds

• Problem or Non-Healing Wounds

  Problem wounds are those that don't respond to established medical/surgical management.  Problem wounds include diabetic feet, vascular insufficiency ulcers, non-healing traumatic wounds, and compromised amputation sites.

  Impaired healing is more common in the elderly because of slower epithelialization, and in systemically or locally compromised hosts. Approximately five million American's suffer non-healing wounds that can become infected, gangrenous, or require amputation.

  Non-healing Wounds and the benefits of Hyperbaric Oxygen Therapy

  HBOT promotes growth of new blood vessels (neovascularization). New vasculature for healing needs a supporting structure of collagen.  The collagen production and incorporation process needs oxygen.

  Increased oxygen tension allows greater capillary oxygen diffusion distances and increases oxygen-dependant killing of anaerobes by leukocytes.

  HBOT is appropriate with many of the other adjunct therapies that help in wound healing.

  Keywords: Non-Healing, Wounds, Treatment

• Thermal or Extensive Burns

• Thermal or Extensive Burns

  Thermal burns are a complex, destructive heat injury characterized by a zone of coagulation, a surrounding area of stasis (stagnation of blood or other fluids) and a border of erythema (skin redness from capillary dilation).  Ischemic tissue death quickly follows burns.  Obstructed capillaries block circulation below the injury.

  Edema forms rapidly in injured areas, and in distant, uninjured tissue, dramatically extending damage.  Red cells clump, white cells adhere to venular walls, and platelets clot in the distant microvasculature.  Surrounding tissue fails to supply borderline cells with oxygen and nutrients, continuing tissue damage.

  Thermal Burns and the Benefits of Hyperbaric Oxygen Therapy

  Minimizes edema and provides oxygen to deprived areas.  Blocks white cell from sticking to endothelial cell walls, interrupting the process of blood vessel damage.  Reduces healing time in the major burn injury, particularly if wounds are deep 2 nd degree.

  Fourth degree burns, most often seen in high voltage electrical injuries, benefit from reduced fascial compartment pressures.  Injured muscle swelling is lessened by preserving aerobic glycolysis, and later by reducing risk of anaerobic infection.

  Decreases need for grafting, shortens hospital stay, and reduces total health care cost.

  Keywords: Thermal, Burn, Burns, scalds, fire, electrical, chemical, first-degree, Second-degree, Third-degree, treatment