Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy, or HBOT, is a type of treatment used to speed up healing of carbon monoxide poisoning, gangrene, stubborn wounds, and infections in which tissues are starved for oxygen.

If you undergo this therapy, you will enter a special chamber to breathe in pure oxygen in air pressure levels 1.5 to 3 times higher than average. The goal is to fill the blood with enough oxygen to repair tissues and restore normal body function.

Facts about hyperbaric oxygen therapy

Hyperbaric oxygen therapy was first used in the U.S. in the early 20th century. This was when Orville Cunningham used pure oxygen to successfully treat someone dying from the flu. He developed a hyperbaric chamber, but dismantled it after his use of the therapy for other conditions failed.

The therapy was tried again in the 1940s when the U.S. Navy used hyperbaric oxygen to treat deep-sea divers who had decompression sickness. By the 1960s, the therapy was also used to combat carbon monoxide poisoning.

Today, it's still used to treat sick scuba divers and people suffering from carbon monoxide poisoning, including firefighters and miners. It has also been approved for more than a dozen conditions ranging from burns to bone disease:

  • Carbon monoxide poisoning

  • Cyanide poisoning

  • Crush injuries

  • Gas gangrene (a form of gangrene in which gas collects in tissues)

  • Decompression sickness

  • Acute or traumatic inadequate blood flow in the arteries

  • Compromised skin grafts and flaps

  • Infection in a bone (osteomyelitis)

  • Delayed radiation injury

  • Flesh-eating disease (also called necrotizing soft tissue infection)

  • Air or gas bubble trapped in a blood vessel (air or gas embolism)

  • Chronic infection called actinomycosis

  • Diabetic wounds that are not healing properly

Medicare, Medicaid,  and many insurance companies generally cover hyperbaric oxygen therapy for these conditions, but may not do so in every circumstance. Check with your insurance plan before treatment.

How does HBOT work?

  • HBOT helps wound healing by bringing oxygen-rich plasma to tissue starved for oxygen. Wound injuries damage the body's blood vessels, which release fluid that leaks into the tissues and causes swelling. This swelling deprives the damaged cells of oxygen, and tissue starts to die. HBOT reduces swelling while flooding the tissues with oxygen. The elevated pressure in the chamber increases in the amount of oxygen in the blood. HBOT aims to break the cycle of swelling, oxygen starvation, and tissue death.

  • HBOT prevents "reperfusion injury." That's the severe tissue damage that happens when the blood supply returns to the tissues after they have been deprived of oxygen. When blood flow is interrupted by a crush injury, for instance, a series of events inside the damaged cells leads to the release of harmful oxygen radicals. These molecules can do damage to tissues that can't be reversed and cause the blood vessels to clamp up and stop blood flow. HBOT encourages the body's oxygen radical scavengers to seek out the problem molecules and allow healing to continue.

  • HBOT helps block the action of harmful bacteria and strengthens the body's immune system. HBOT can disable the toxins of certain bacteria. It also increases oxygen concentration in the tissues. This helps them resist infection. In addition, the therapy improves the ability of white blood cells to find and destroy invaders.

  • HBOT encourages the formation of new collagen (connective tissue) and new skin cells. It does so by encouraging new blood vessel formation. It also stimulates cells to produce certain substances, like vascular endothelial growth factor. These attract and stimulate endothelial cells necessary for healing.

Types of hyperbaric oxygen chambers

Hyperbaric oxygen therapy uses 2 types of chambers:

  • Monoplace chamber. This is a chamber built for one person. It's a long, plastic tube that resembles an MRI machine. The patient slips into the chamber. It is slowly pressurized with 100% oxygen.

  • Multiplace chamber. This chamber, or room, can fit two or more people at once. The treatment is largely the same. The difference is that people breathe pure oxygen through masks or hoods.

What happens during HBOT

Only a healthcare provider should prescribe hyperbaric oxygen therapy. A number of hospitals offer hyperbaric oxygen chambers. People relax, sit, or lie comfortably in these chambers and take deep breaths in sessions that last up to 2 hours.

Your ears may feel plugged as the pressure is raised, like when you're in an airplane or the mountains. Simple swallowing or chewing gum will "pop" the ears back to normal hearing levels.

Your blood carries the extra oxygen throughout the body, infusing the injured tissues that need more oxygen so they can begin healing. When a session is complete, you may feel lightheaded. Mild side effects include claustrophobia, fatigue, and headaches.

Several sessions may be needed, so check beforehand to see whether your insurance company, Medicaid, or Medicare covers the cost.

Precautions

Hyperbaric oxygen therapy is not for everyone. It should not be used by people who have had a recent ear surgery or ear trauma, a cold or fever, or certain types of lung disease. 

The most common complication after HBOT is trauma to the middle ear. Other possible complications are eye damage and sinus problems. In rare, severe cases, a person can get oxygen poisoning. This can lead to seizures, fluid in the lungs, lung failure, or other problems. Considering the possible risks and benefits, the decision to use hyperbaric oxygen therapy must be carefully made after a detailed discussion with your healthcare provider.