In a recent issue of Forbes Health, they ask the question, “What Is Hyperbaric Oxygen Therapy (HBOT)?”, and then they dive into the nitty gritty of the therapy including the pros, cons, and if it could be right for you.
Hyperbaric oxygen therapy (HBOT) is a medical treatment that involves sitting in a pressurized chamber filled with pure oxygen to increase blood oxygen levels. This treatment has multiple uses, including being the “standard of care” for carbon monoxide poisoning, decompression sickness from scuba diving, wound healing, as well as gangrene and other infections. More uses are continuously being researched and span from skin health to brain injury repair.
This article explains what hyperbaric oxygen therapy is, how it works, its benefits and side effects and who to speak to if you think you are a candidate for this type of therapy.
What is Hyperbaric Oxygen Therapy?
The use of hyperbaric medical therapy can be traced back to the late 1600s in Britain, but HBOT was not used widely until after World War II, when it was utilized to treat decompression sickness in divers. Since that time, scientific research into the methods and uses of HBOT has been ongoing, with hundreds of facilities providing this therapy since the early 2000s.
“Fundamentally, HBOT [delivers] oxygen at greater concentrations than those naturally available in the atmosphere,” explains Ahmet Ergin, M.D., an endocrinologist at Heart & Family Health Institute in Florida. Increasing the atmospheric pressure during an HBOT treatment session allows more oxygen to dissolve into the bloodstream, enabling the healing and regeneration of damaged or injured tissues, according to Ergin.
Through this process, HBOT not only increases oxygen concentration, but also reduces inflammation, speeds recovery time and lessens pain, according to Dr. Ergin.
How Does Hyperbaric Oxygen Therapy Work?
“During hyperbaric oxygen therapy, a patient breathes 100% oxygen intermittently while the whole body is pressurized within a hyperbaric chamber to at least 1.4 atmospheres absolute (ATA),” explains Dr. Renie Guilliod, a rehabilitation specialist at UT Southwestern Medical Center in Texas and director of the Hyperbaric Medicine Program at the Institute for Exercise and Environmental Medicine. ATA is a unit of measurement used to describe the sum of barometric (air) and hydrostatic (fluid) pressures used in hyperbaric oxygen therapy.
“With HBOT, we deliver higher amounts of oxygen to the body by increasing the driving pressure of O2 from the lungs through the blood to the tissues,” says Dr. Guilliod.
This oxygen delivery results in intermittent hyperoxygenation, which means one’s oxygen levels in the blood are higher for a short period. The increase in blood oxygen levels has been demonstrated to promote the healing of injured tissues and can be used for several conditions.
HBOT is part of the Undersea and Hyperbaric Medicine Society (UHMS). The American Board of Medical Specialties recognizes it under the umbrella of the American Board of Preventive Medicine (ABPM) and the American Board of Emergency Medicine (ABEM).
Hyperbaric Oxygen Therapy Benefits
With the proper dose, HBOT can have powerful healing properties, according to Dr. Guilloid. He explains that by inducing a controlled amount of oxidative stress through the production of free radicals (reactive oxygen and nitrogen species) in the blood and tissues, several beneficial cellular processes and pathways are activated.
The beneficial effects of HBOT depend on how the treatment is performed and will ultimately be based on the needs of an individual.
According to Dr. Guilloid and an overview of HBOT published in the journal Medicina, some of its beneficial effects include:
- Aiding the development of new blood vessels, thus improving microcirculation
- Increasing the number and activity of stem cells
- Improving collagen production
- Modulating inflammation and reducing swelling
- Reducing fibrosis in irradiated tissues and areas with multiple surgeries
- Mitigating ischemia and reperfusion injury
- Promoting the healing of infections through several mechanisms, such as accelerating the elimination of carbon monoxide)
- Dissolving air or gas bubbles trapped in blood vessels or tissues
Side Effects and Risks of Hyperbaric Oxygen Therapy
There are a few side effects of HBOT to be aware of, the most common being middle ear barotrauma. “The pressure inside a hyperbaric chamber can feel like the pressure changes that occur during the descent of an airplane. The ears can become pressurized, and patients need to balance this differential pressure,” explains Dr. Guilloid.
Fortunately, this discomfort is minor and preventable with proper training and direct supervision by certified nursing and medical personnel. Without control and supervision, however, a perforated eardrum or hearing loss can occur, according to Dr. Guilloid.
While rare, other possible severe side effects include sinus barotrauma (tissue injury), reversible nearsightedness, pulmonary barotrauma (lung tissue injury), oxygen toxicity, seizures and decompression sickness.
Certain medical conditions can increase one’s risk for more severe side effects. “Patients must be initially evaluated and authorized by physicians specialized in hyperbaric medicine to ensure that the treatment will be safe and subsequently prescribe the therapeutic plan for each case,” explains Dr. Guilloid. Likewise, constant medical supervision is essential during each session.
In addition to the previously noted treatment of decompression sickness from diving and carbon monoxide poisoning, HBOT may also “yield promising results in the treatment of anemia, brain abscesses, acute crush injuries, radiation therapy, wound infections with nonhealing ulcers and sensorineural hearing loss” explains Dr. Ergin.
Approved indications for HBOT, according to the UHMS, include:
- Severe anemia
- Brain abscess
- Traumatic brain injury
- Crushing injury
- Air bubbles in your blood vessels (arterial gas embolism)
- Carbon monoxide poisoning
- Burns
- Sudden deafness
- Sudden loss of vision without pain
- Decompression sickness
- Gangrene infection
- Infection of skin or bone leading to tissue death (oxygen-starved tissues)
- Diabetic foot ulcers or other wounds that will not heal
- Tissues at risk of death from a skin graft or flap procedure
- Injury from radiation
Some studies have demonstrated its potential benefits for additional conditions, such as stroke and treatment-resistant post-traumatic stress disorder. Researchers are also exploring its use in the field of cosmetic medicine to treat signs of aging and other skin concerns.
“Perhaps most exciting is the possibility that HBOT could be used to enhance recovery from infection or injury when traditional methods fail,” says Dr. Ergin.
As the scientific community continues to explore this alternate form of medical therapy, there will no doubt emerge more potential off-label uses in the years ahead. For now, more research is necessary to determine whether many of these uses are suitable options for most people.
Do You Need a Prescription for Hyperbaric Oxygen Therapy?
Most hyperbaric centers are specialized referral centers, meaning you need to have a doctor’s referral in order to access treatment. “Patients must be referred to a hyperbaric medicine doctor so that the doctor, through a hyperbaric medicine consultation, establishes whether the patient is a suitable candidate for this treatment. If so, this specialist is the one who should prescribe the HBOT treatment protocol to follow,” explains Dr. Guilloid.
According to Dr. Guilloid, Medicare, Medicaid, and most health insurances cover the treatments if they are duly justified and overseen by a doctor certified in hyperbaric medicine.
People interested in HBOT can speak with a UHMS-accredited facility. A list of those facilities can be found on the UHMS website. Dr. Ergin recommends speaking with a health care provider to learn more details about how individuals may benefit from HBOT and establish a plan of care.
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