Hyperbaric Oxygen Therapy – What It Is…and Isn’t
By Dr. Leonardo Profenna, MD, MPH
Advanced Wound Care Clinic
Connally Memorial Medical Center
Dr. Profenna recently retired from the USAF after 22 years of service. He is board certified in both Internal Medicine and Hyperbaric and Undersea Medicine
Hyperbaric Oxygen Therapy (HBOT) is a relatively new treatment modality that utilizes oxygen at high atmospheric pressures to treat certain medical conditions. The field has steadily grown since the early 70’s, with accelerated growth over the last 10 years as more physicians have completed research clarifying its effectiveness. The therapy is usually performed by trained physicians in wound care centers that are associated with hospitals, as we have at CMMC in Floresville. Hyperbaric oxygen is a powerful tool for physicians to use in many cases, but HBOT is not a cure-all, and should be reserved for proven indications.
The practice of Hyperbaric Medicine is overseen by the Undersea and Hyperbaric Medicine Society (UHMS), which is a group of medical professionals that develops guidelines for safe and effective use. Every five years, UHMS reviews the completed worldwide research, and makes recommendations as to the appropriate use of HBOT. UHMS now lists 14 proven indications (figure 1) for hyperbaric medicine, and many insurance companies and Medicare/Medicaid follow these guidelines to determine if the treatment is effective. The most common use of HBOT in the US is for chronic or non-healing wounds, and the second most common is radiation-damaged tissue (after cancer treatment).
Chronic wounds are a severe problem, especially here in South Texas, where we have an epidemic of diabetes. People with diabetes develop thickness of their artery walls over time that decreases how well they can supply their body with nutrients and oxygen. This leads to nerve damage and fragile skin of the feet. If a diabetic does not examine their feet on a regular basis, they can develop deep wounds that they cannot feel, due to the nerve damage. The wounds can then become infected and lead to complications, including amputation. Good quality wound care and hyperbaric oxygen can help to heal these difficult wounds, thus preserving the patients’ ability to work and take care of themselves.
Normally, our body delivers oxygen to our cells exclusively through hemoglobin. Hemoglobin is a molecule in red blood cells that acts like a boxcar, picking up oxygen at the lungs and offloading it to the cells after circulating in the body. The hemoglobin in the body is limited by the number of red blood cells, so giving extra oxygen at sea level is sometimes not helpful to increase delivery of oxygen to cells, as all the boxcars are already full. This is where hyperbaric oxygen can be helpful. HBO centers have specially built pressure chambers that safely increase the pressure of oxygen to the point where extra oxygen gets dissolved in the patient’s blood serum, and then is delivered to cells that need it. The increased pressure opens up a second delivery method for oxygen, saturating the wounds during treatment, and for hours thereafter. This oxygen primes the cells that cleanse and rebuild the damaged tissue, hastening the wound healing process.
Several centers in the United States treat multiple indications not endorsed by UHMS or the FDA. Treatment is popular for autism, cerebral palsy, traumatic brain injury and rapid healing of athletic injuries, to name a few, and while several centers report excellent results, research has not proven that HBOT is beneficial in these conditions. Most of these centers provide therapy to patients on a pay as you go basis, and insurance does not reimburse patients for this. Our Advanced Wound Care Clinic at CMMC does not provide treatments for these conditions, but if you have questions concerning hyperbaric medicine or wound care, please give us a call at (830) 393-1730 and we will be glad to discuss the pros and cons of HBOT for your condition. The clinic is located in the Medical Office Building on the campus of CMMC, at 497 Tenth Street, Floresville, TX 78114. Please join Dr. Profenna for CMMC’s monthly Lunch & Learn on Friday, November 22nd from 12:00 p.m. – 1:00 p.m. Call 830-393-1311 for more information.
UHMS Approved Indications for Hyperbaric Oxygen Use
1. Air or Gas Embolism
2. Carbon Monoxide Poisoning
Carbon Monoxide Poisoning Complicated By Cyanide Poisoning
3. Clostridial Myositis and Myonecrosis (Gas Gangrene)
4. Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischemias
5. Decompression Sickness
6. Arterial Insufficiencies:
Central Retinal Artery Occlusion
Enhancement of Healing In Selected Problem Wounds
7. Severe Anemia
8. Intracranial Abscess
9. Necrotizing Soft Tissue Infections
10. Osteomyelitis (Refractory)
11. Delayed Radiation Injury (Soft Tissue and Bony Necrosis)
12. Compromised Grafts and Flaps
13. Acute Thermal Burn Injury
14. Idiopathic Sudden Sensorineural Hearing Loss