Hyperbaric Oxygen Therapy

Overview

Oxygen is an important gas our body needs for proper working and making energy. The oxygen inhaled by the lungs enters the blood and reaches various organs and tissues. Certain medical conditions reduce blood oxygen levels to very low conditions, leading to shortness of breath, tiredness, and confusion, and can also damage the body. Oxygen therapy helps the body get more oxygen.

Hyperbaric oxygen therapy (HBOT) is a treatment procedure of breathing pure oxygen at increased pressure. It is a type of oxygen therapy where oxygen from a pressurized chamber or tube is used to breathe. This causes the lungs to get three times more oxygen than breathing oxygen at normal air pressure. Atmospheric air has about 21% oxygen, while HBOT provides 100% oxygen. 

Mechanism of action of HBOT

Injured body organs need oxygen for repair. The extra oxygen released by HBOT therapy increases the exposure of tissues to oxygen. It increases the oxygen-carrying capacity of blood. With repeated exposure to extra oxygen levels, injured body parts fight against bacteria and release growth factors and stem cells, thus promoting healing. Therefore, HBOT can be used to treat many medical conditions. 

 Description of HBOT technology

HBOT involves breathing 100% oxygen in a hyperbaric chamber pressurized above sea level to enhance its effects on the body. Typically, pressure ranges between 2.0 and 2.5 ATA, equivalent to ~250 kPa/inch2, approximately the pressure at a depth of ~15 m of water. 

Treatment time can vary from 45 to 300 minutes depending upon the condition for which HBOT has been prescribed. Most of the treatment sessions last from 90 to 120 minutes. Generally, therapy for acute indications requires only 1 or 2 treatment sessions, whereas chronic medical conditions may require up to 30 or more treatment sessions. Patients may get up to 3 treatment sessions per day based on their medical indication. 

Uses of HBOT 

HBOT is used as a primary management strategy to treat conditions like embolisms where air bubbles get trapped in blood vessels and block them, infections of bone that are resistant to general treatments, burns, crush injuries, frostbites, certain brain or sinus infections, carbon monoxide gas poisoning, decompression sickness in divers, gas gangrenes, non-healing necrotizing infections due to diabetes (diabetic foot ulcer), radiation injuries, skin grafts, unhealed wounds, sudden deafness and vision loss. 

This is also used for a procedure where the entire lung is cleaned in certain medical conditions like alveolar proteinosis. It is also used as an adjuvant treatment option to treat long-term ailments repeated over days or weeks. 

Advantages of HBOT 

Improved oxygen supply, reduced swelling and edema of tissues, and reduced infections are some of the advantages of HBOT. 

Before HBOT 

Before getting HBOT, an individual should inform the healthcare professional about all the medical conditions, implanted medical devices, and medications that are taken. Factors like age, condition to which HBOT is prescribed, and overall health will be assessed before undergoing HBOT.

During HBOT

Hospital-provided gowns are worn, and the patient enters an oxygen chamber or uses a facemask. Lighters and battery-powered devices are not allowed for safety purposes. Petroleum-based hair care or skin care products have to be removed for potential fire hazards. If one has any medical implants in them, they should be informed before the treatment as they may malfunction after the therapy sometimes. Based on the condition one is treated for, age and overall health conditions, duration of the treatment, and the number of sessions needed are decided. 

During HBOT therapy, individuals are either made to sit or lie down in a special chamber. Some chambers are monoplace chambers where only one person can be treated, while some are multiple chambers where many people can be treated at once. As the oxygen fills the chamber, pressure accumulates, causing the ears to pop. 

After HBOT

At the end of therapy, the pressure is slowly reduced to adjust to the atmospheric pressure. After checking for vitals like blood pressure, blood sugar levels, and pulse, an individual can get back home. 

Side effects of HBOT

Even though it is safe for many purposes, there are certain side effects of HBOT. HBOT chambers can be claustrophobic as the chambers are small and confined, causing anxiety and panic attacks. They can cause middle ear injuries, including bleeding, eardrum rupture, and fluid accumulation. They can also cause sinus congestion and sinus headaches. Temporary vision problems like nearsightedness, central nervous system disorders like seizures, hypoglycemia due to reduced blood glucose levels, and oxygen poisoning from too much oxygen. Sometimes, collapse of the lung occurs due to air pressure alterations. Occasionally, accidental fires may be caught due to high oxygen levels in the chambers. 

Contraindications of HBOT

There are certain conditions with absolute contraindications, like untreated pneumothorax (a lung condition where an abnormal collection of air accumulates outside lung layers) and the use of certain chemotherapy medications. Additionally, certain health conditions are relatively contraindicated or need extreme caution when undergoing therapy. They include seizure disorders, hyperthyroidism, heart failure, and active respiratory tract infections.   

Recovery time after HBOT 

Recovery is immediate, and one can return to daily activities following a session. HBOT generally takes one to two hours, and based on the condition to be treated, one may need to get one to five days a week, up to 30 sessions in total. 

Conclusion 

HBOT is considered as the safest treatment option for many chronic wounds and conditions. It has many advantages for infected diabetic foot ulcers and many life-threatening situations. Despite controversies and side effects, it is a calm and soothing treatment option for many individuals when delivered properly under healthcare provider supervision.