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For Physicians

Lisa St. John, Clinic Director Bay Area Hyperbarics

(full video segment - 30 min. duration)

What is Hyperbaric Oxygen Therapy?

Hyperbaric Oxygen Therapy is a treatment that uses pure oxygen under pressure to speed and enhance the body's natural ability to heal. It delivers 100% oxygen at a greater than atmospheric pressure in a certified hyperbaric chamber. Oxygen is a necessary part of cellular life. Hyperbaric oxygen dissolves 400 times more oxygen molecules into the plasma. This process increases oxygen to damaged areas and regrows microvasculature. Hyperbarics has been proven to stimulate osetoblastic and fibroblastic proliferation and angiogenesis, increase collagen tissue matrix, and kill bacteria. Hyperbaric oxygen enhances the body's natural healing process.

The hyperbaric treatment is both non-invasive and painless. A patient undergoing Hyperbarics spends a prescribed amount of time sitting or reclining in one of our private, cylindrical, body-length hyperbaric chambers where pure oxygen is administered and atmospheric pressure is controlled under meticulous conditions. The dosage, which includes pressure, time, and frequency of treatment, is suited to each patient's specific diagnosis. Hyperbarics requires a physician's prescription. During the treatment, a patient can watch movies, listen to music, meditate, or sleep.

Hyperbaric Oxygen Therapy is a Medicare, U.S. Food and Drug Administration (FDA), and American Medical Association (AMA) approved treatment used to treat numerous health conditions, diseases, and illnesses. It uses pure oxygen to speed and enhance the body's natural ability to heal. It has been around for 50+ years as an accepted and effective treatment for many conditions, diseases, illnesses, and health problems. It is safe and effective.

Conditions and diagnoses treated by hyperbarics that are typically covered by health insurance:

Medicare Approved Conditions for Hyperbarics (reimbursable):

  1. Acute carbon monoxide intoxication
  2. Decompression illness
  3. Gas embolism
  4. Gas gangrene
  5. Acute traumatic peripheral ischemia. HBO therapy is a valuable adjunctive treatment to be used in combination with accepted standard therapeutic measures when loss of function, limb, or life is threatened.
  6. Crush injuries and suturing of severed limbs. As in the previous conditions, HBO therapy would be an adjunctive treatment when loss of function, limb, or life is threatened.
  7. Progressive necrotizing infections (necrotizing fasciitis)
  8. Acute peripheral arterial insufficiency
  9. Treatment of compromised skin grafts
  10. Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management
  11. Osteoradionecrosis as an adjunct to conventional treatment
  12. Soft tissue radionecrosis as an adjunct to conventional treatment
  13. Cyanide poisoning
  14. Actinomycosis, only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment.

Other Treatable Conditions:

Contraindications

Absolute Contraindications

Doxorubicin (Adriamycin®) – Upton and co-workers (30), while investigating the possible use of hyperbaric oxygen among other non-surgical “antidotes” for tissue damage caused by extravasation of doxorubicin, found that this chemotherapeutic drug produced an 87% mortality rate in rats when combined with HBO. Presumably this was due to cardiac toxicity. The animals were on a b.i.d. treatment schedule, but even when shifted to a once-a-day regimen, there was no significant decrease in mortality. Doxorubicin is probably inactivated and cleared from the tissues in about 24 hours. However, to be prudent, it would be wise to wait at least two to three days after the last dose of doxorubicin before initiating hyperbaric oxygen treatment. HBO has been used safely to aid in healing tissue necrosis secondary to doxorubicin extravasation, but chamber treatment was given after treatment with the drug had been halted.

Mafenide Acetate (Sulfamylon®) – This antibacterial drug was first synthesized in Germany, but later developed into a useful topical agent by Pruitt and his colleagues at the Brook Army Burn Center in San Antonio, Texas. It was found to be effective in suppressing bacterial infection in burn wounds and superseded silver nitrate therapy. Mafenide, however, is a carbonic anhydrase inhibitor which tends to promote a CO2 buildup, causing a peripheral vasodilatation. When this is coupled with the central vasoconstriction caused by HBO, the results are worse than when using either agent alone. If a burn patient is referred for hyperbaric therapy, all the mafenide cream must be carefully removed by showering or tubbing before putting the patient in the chamber. Silver sulfadiazine (Silvadene®) may be substituted quite effectively and it is safe for concomitant use with HBO.

Untreated Pneumothorax – Untreated pneumothorax is considered an absolute contraindication to hyperbaric treatment, as there is always a concern that if it becomes a tension pneumothorax while the patient is in the chamber, it will render decompression hazardous or potentially life threatening. Since there is no guaranteeing that a pneumothorax will not continue to enlarge at pressure or be transformed into a tension pneumothorax, a chest tube should always be inserted for control, before the patient is placed in the chamber. It is highly advisable to obtain a chest roentgenogram after placement, or attempted placement, of a subclavian line, before the patient is submitted to HBO. If the patient does not develop a pneumothorax at pressure, any preexisting pneumothorax will be made smaller when the patient breathes oxygen at treatment depth. The pneumothorax diminishes in size as the nitrogen present is rapidly eliminated secondary to oxygen breathing. Under such circumstances, the pneumothorax will be smaller when the patient is removed from the chamber. A one-liter pneumothorax, present just before decompression, however, will assume a 2.5 liter volume on reading the surface from 2.5 atmospheres absolute.

Rationale of Hyperbarics for the following Medicare Approved Conditions:

Air or Gas Embolism
Anemia
Burns
Carbon Monoxide Poisoning
Compartment Syndromes (skeletal muscle)
Crush Injuries
Decompression Sickness
Intracranial Abscess
       Cerebral Abscess
       Subdural Empyema
       Epidual Empyema
Ischemic Injury
Flaps
Gangrene
       Clostridial Myositis
       Clostridial Myonecrosis (gas gangrene)
       Clostridial Cellulitis
Grafts
Necrotizing Soft Tissue Infections
Osteomyelitis
Radiation Injuries (soft tissue and bony necrosis)
Ulcers
       Venous Stasis Ulcers
       Pressure Ulcers
       Arterial Insufficiency Ulcers
Wounds
       Non-Healing Wounds
       Diabetic Non-Healing Wounds

More Information for Physicians

Carcinogenesis—Concerns Related to Potential Cancer Growth Enhancement

The following are excerpts from Hyperbaric Oxygen 2003: Indications and Results, The Hyperbaric Oxygen Therapy Committee Report by John J. Feldmeier, D.O., Chairman and Editor. Copyright 2003, Undersea and Hyperbaric Medical Society, Inc. Visit: www.uhms.org.

Hyperbaric Oxygen: Definition back to top

Hyperbaric oxygen (HB2O) is a treatment, in which a patient breathes 100% pure oxygen intermittently while inside a treatment chamber at a pressure higher than sea level pressure (i.e., >1 atmosphere absolute; atm abs). It can be viewed as the new application of an old, established technology to help resolve certain recalcitrant, expensive, or otherwise hopeless medical problems. In certain circumstances, it represents the primary treatment modality while in others it is an adjunct to surgical or pharmacologic interventions.

Treatment can be carried out in either a mono- or multiplace chamber. The former accommodates a single patient; the entire chamber is pressurized with 100% pure oxygen, and the patient breathes the ambient chamber oxygen directly (or the patient breathes 100% pure oxygen via a mask or hood while in the chamber). The latter holds two or more people (patient, observers, and/or support personnel); the chamber is pressurized with compressed air while the patients breathe 100% oxygen via masks, head hoods, or endotracheal tubes. According to the UHMS (Undersea and Hyperbaric Medical Society) definition and the determination of Medicare and other third party carriers, breathing 100% oxygen at 1 atmosphere of pressure or exposing isolated parts of the body to 100% oxygen does not constitute HBO2 therapy. The patient must receive the oxygen by inhalation within a pressurized chamber. Current information indicates that pressurization should be to 1.4 atm abs or higher.1

Acceptance (Addition) of New Indications for Hyperbaric Oxygen Therapy back to top

New indications for HBO2 therapy are considered for acceptance at the meeting of the Hyperbaric Oxygen Committee during the annual meeting of the Undersea and Hyperbaric Medical Society. This consideration can be initiated from within the Committee itself or may result in response to a written report by a non-committee member. When a new indication is considered for acceptance, a position paper is written. The information must summarize the in vitro, in vivo, and clinical aspects of the new indication for HBO2 therapy. Two members of the Hyperbaric Oxygen Committee review the position paper and each writes a critique. The position paper and critiques are presented to the Hyperbaric Oxygen Committee. A consensus of the Hyperbaric Oxygen Committee is required for recommending the indication be moved into the approved category. If the Committee determines that a new condition merits approval, it makes this recommendation to the Executive Committee of the Society which ultimately votes to approve or disapprove the new indication.1

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