Hyperbaric Oxygen Therapy 101

Boris Volshteyn, MD, MS
Article by
East Brunswick Plastic Surgeon

Hyperbaric oxygen therapy (HBOT) is breathing 100% pure oxygen while being under increased atmospheric pressure of 2-3 atmospheres.

The history behind the HBOT can be traced back to the 1600s. The first known chamber was built and used by a British national named Henshaw. This idea of treating patients under pressure was continued by the French surgeon Fontaine. He built a pressurized operating room. Over 100 years ago Dr. Orville Cunningham noticed that some people with some heart diseases did better if they lived closer to sea level than if they lived at high altitudes. He reportedly treated a dying patient with influenza , and later developed a hyperbaric chamber. Dr. Orville Cunningham, former professor of anesthesia, ran a "Steel Ball Hospital." This structure, which was erected in 1928, was about 6 stories high and could reach up 3 atmospheres. Unfortunately, the unique hospital facility was closed in 1930 because of the lack of scientific evidence.

Later Paul Bert demonstrated the toxic effects of oxygen (grand mal seizures), J. Lorrain-Smith demonstrated pulmonary oxygen toxicity. Both of these discoveries were used by US Navy divers.

Medical Hyperbaric Oxygen Treatment Chambers

When patient receives 100% oxygen under higher then normal pressure, hemoglobin is fully saturated, but also the amount of oxygen delivery to the tissues can be additionally increased by dissolving oxygen within the plasma. The blood can be hyper-oxygenated by increasing the pressure . That is the basic mechanism of action for all Medical Hyperbaric Oxygen Treatment Chambers.

There are 2 types of chambers:
Type A, multiplace;
Type B, monoplace.

Multiplace, or type A, chambers treat several patients at the same time within the same room or vessel. Usaually, a nurse or another assistant monitors the patients inside the chamber and assists them with equipment manipulation or emergencies. Patients treated in a multiplace type chamber breathe 100% oxygen via a mask or hood.

A monoplace chamber treats one patient at a time, usually in a reclining or supine position. There are 2 available systems: the patient is pressurized with either air (an breathes 100% oxygen via mask) or with 100% oxygen (no mask is needed). The technicians usually attend to the patient from outside of the chamber.

There are also some Duoplace chambers that can hold up to 2 people at a time.

Medical Hyperbaric Oxygen Treatment Chambers Physiology

Medical Hyperbaric Oxygen Treatment Chambers produce the effects on the human tissues by the following mechanisms:
Hyperoxygenation,
Decrease gas bubble size,
Vasoconstriction,
Angiogenesis,
Fibroblast proliferation and increased collagen production,
Activation of Leukocyte oxidative killing,
Reduces intravascular leukocyte adherence
Reduces lipid peroxidation
Toxin inhibition
Antibiotic synergy

The conditions that can be treated with Medical Hyperbaric Oxygen Treatment Chambers 
We offer HBOT treatment for the standard indications (diagnoses) that are currently approved by the FDA. These include the following:

1 Air or gas embolism
2 Carbon monoxide poisoning and smoke inhalation
3 Clostridial myonecrosis (gas gangrene)
4 Crush injury, compartment syndrome, other acute traumatic ischemias
5 Decompression sickness
6 Enhancement of healing in selected problem wounds
7 Exceptional blood loss (anemia)
8 Necrotizing soft tissue infections
9 Osteomyelitis (refractory)
10 Skin grafts and flaps (compromised)
11 Thermal burns
12 Intracranial abscess
13 Radiation tissue damage

We also treat conditions covered by Medicare and other federal programs:

1 Acute carbon monoxide intoxication,
2 Decompression illness,
3 Gas embolism,
4 Gas gangrene,
5 Acute traumatic peripheral ischemia.
6 Crush injuries and suturing of severed limbs.
7 Progressive necrotizing infections
8 Acute peripheral arterial insufficiency,
9 Preparation and preservation of compromised skin grafts
10 Chronic refractory osteomyelitis
11 Osteoradionecrosis as an adjunct to conventional treatment,
12 Soft tissue radionecrosis as an adjunct to conventional treatment
13 Cyanide poisoning,
14 Actinomycosis.

To the best of our knowledge all other conditions are not covered by the Medicare Program. Medicare coverage may vary from state to state by Medicare administrative entity and may be modified by federal government at any time.

After discussion with your treating physician we can also offer HBOT therapy for conditions that are considered non-traditional or experimental indications for the use of HBOT therapy, and currently are not officially approved by the FDA or Meicare for the treatment. These include conditions, diagnoses, and diseases such as:

1 Stroke
2 Autism
3 Cerebral palsy
4 Multiple sclerosis
5 Lyme disease
6 Chronic fatigue syndrome
7 Chronic infectious diseases
8 Migraine and cluster headaches
9 RSD
10 Elective plastic and reconstructive surgery
11 Sports injuries
12 Peripheral vascular ulcer
13 Crohn's disease
14 Brain injuries of all types, and others

Absolute Contraindications to Hyperbaric Oxygen Therapy Treatments include pneumothorax,
Pneumomediastinum, Bleomycin, Cisplatin, Disulfiram, Doxorubicin, Sulfamylon.

Relative Contraindications to Hyperbaric Oxygen Therapy Treatments include
Asthma, Claustrophobia, Congenital spherocytosis, Chronic obstructive pulmonary disease (COPD), Eustachian tube dysfunction, High fever, Pacemakers or epidural pain pump, Pregnancy.

Boris Volshteyn MD
Sierra Plastic Surgery
Reno Hyperbaric Center