HYPERBARIC OXYGEN THERAPY ( HBOT )
Hyperbaric oxygen therapy has been available for over a century but our understanding of the medical benefits it can provide in wound healing, bone infections and complications of radiation treatment has evolved considerably over the past 10 to 20 years to include more Off label Indications such as Traumatic Brain Injury and Stroke.
Hyperbaric oxygen therapy is defined by the Undersea and Hyperbaric Medical Society (UHMS) as a treatment in which a patient intermittently breathes 100% oxygen while the treatment chamber is pressurized to a pressure greater than sea level (1 atmosphere absolute, ATA).
Hyperbaric Oxygen Therapy (HBOT) when used as an adjunct treatment of modality can significantly improve morbidity and mortality, reduce length of hospital stay, reduces the need for surgical interventions, lessen the need for surgery or foot amputations, reduces treatments costs, and improves quality of life
Technology of HBOT
HBOT is a medical treatment that delivers 100% oxygen to a person within a pressurized chamber. Each treatment is called a “dive”. During a treatment – oxygen, under pressure, fills the Hyperbaric chamber, increasing the oxygen concentration within a person’s body 15 to 20 times normal at the cellular level. Increased oxygen tension accelerates healing processes and aids in recovery from certain conditions and maladies.
Mechanisms of Action:
Overview: The delivery of 100% oxygen under pressure (1.5 to 3 ATA) within the hyperbaric chamber provides up to 20 times normal oxygen to all tissues within the body. This oxygen supersaturation is in marked contrast to breathing room air (21% oxygen at 1 ATA).
Direct Pressure to Oxygen Molecules: Inside the hyperbaric chamber, oxygen molecules are compressed and become more soluble, obeying the scientific principles of Boyle’s Universal Gas Law. This phenomenon allows oxygen to effortlessly cross cell membranes and enter all of the body’s fluid systems, including plasma, synovial, lymphatic, interstitial (between cells) and cerebrospinal fluids. Normally, only the red blood cells are capable of transporting oxygen throughout the body. Now, all body fluids combine to provide alternate transport routes for extra oxygen and cumulatively can provide up to 20 times normal O2.
Angiogenesis – The Formation of New Blood Vessels: Hyperbaric Oxygen stimulates the body to grow new capillaries (angiogenesis), essentially building a new collateral circulatory system to serve injured and healthy tissues alike. The resulting neovascularization is extremely helpful for reaching tissues and organs that have restricted blood flow (ischemic areas) as well as areas of the body that are lacking or compromised in available oxygen (hypoxic areas).
Increases Fibroblast and Collagen Production: These essential building blocks of connective-tissue, tendon and skin matrix (fibroblasts and collagen) provide the structural framework throughout the body and play a critical role in wound healing. Fibroblast and collagen reproduction and growth are aided by the added availability of increased oxygen provided during hyperbaric conditions.
Decreases Inflammation: Inflammation, one of the most common mechanisms of disease and injury, is caused by biochemical by products that are manufactured by the body’s natural immune response. Hyperbaric oxygen markedly decreases inflammation by stimulating the body’s own anti-inflammatory defences. This may be the single most important function of HBOT.
Indications Treated & Current Mode of Management
HBOT is “approved” in the United States for 14 “accepted” indications which essentially means indications approved by the HBOT Committee of the Undersea and Hyperbaric Medical Society (UHMS), and secondarily, the FDA. Internationally, however, hyperbaric oxygen therapy has a much larger list of applications, some of which are documented by stronger scientific evidence than exists for the accepted indications. The indications not on the “accepted” list are considered off-label uses of hyperbaric oxygen therapy by the FDA. The off-label use of any FDA-approved medical device or drug is allowed by the FDA for a licensed physician.
FDA APPROVED INDICATIONS
- Air or Gas Embolism
- Carbon Monoxide Poisoning
- Clostridial Myositis and Myonecrosis (Gas Gangrene)
- Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischemias
- Decompression Sickness
- Arterial Insufficiencies: Central Retinal Artery Occlusion Enhancement of Healing In Selected Problem Wounds
- Severe Anemia
- Intracranial Abscess
- Necrotizing Soft Tissue Infections
- Osteomyelitis (Refractory)
- Delayed Radiation Injury (Soft Tissue and Bony Necrosis)
- Compromised Grafts and Flaps
- Acute Thermal Burn Injury
- Idiopathic Sudden Sensorineural Hearing Loss
OFF LABEL INDICATIONS
- Traumatic Brain Injury
- Sports Injury Rehabilitation
- Cerebral Palsy
- Anti ageing and Rejuvenation
- Aseptic Necrosis
- Alzheimer’s disease
- Parkinson’s disease
- Vascular dementia
The Off label Indications list gets updated quite often and can be prescribed to most of the patients for wellness and aesthetics purposes also.