Hyperbaric Oxygen Therapy (HBOT) is a medical treatment that allows patients to breathe pure oxygen inside a pressurized chamber. During typical treatments, the hyperbairc chamber is pressurized to 2.5 times normal atmospheric pressure. When a patient breathes 100 percent oxygen in a pressurized chamber, the elevated air pressure leads to a 10 to 15 fold increase in tissue oxygen content. Prolonged exposure to the pure oxygen environment within the chamber allows many conditions to heal significantly faster including:  burns, diabetic ulcers, pressure sores and arterial or venous ulcers.

Rapid Healing for Specific Wounds
At the Wound Healing Center, Hyperbaric Oxygen Therapy is used to treat a wide range of wounds, including:

• Diabetes: Despite the best efforts of doctors and patients, many diabetic patients de-velop skin ulcers. When the skin breaks down on the feet, a diabetic can face difficult challenges. Diabetic patients often require hospitalization when they develop lesions on their feet. Early, aggressive wound care strategies that include the use of hyperbaric therapy can prevent amputations, and often vastly improve the quality of life for patients.

• Osteomyelitis: Osteomyelitis arises from an inflammatory process involving a bacterial infection of bone. Although physicians use aggressive surgical and antibiotic therapies, the healing process can slow dangerously. In studies done with animals, HBOT was proven to be an effective extra or adjunct therapy for certain infections of the bone. Those infections arose from the infective organisms Staphylococcus aureus and Pseudo-monas aeruginosa. The oxygen tension in infected bone is low. Studies show that elevating the oxygen tensions in affected bones and the surrounding tissues helps speed healing. To be even more precise, at pressures of 1500 mm Hg, HBOT increases the phagocyte killing of anaerobic and some microaerophilic aerobic pathogens. Oxygen radicals tend to concentrate, which proves lethal to some infective organisms. The effectiveness of some antibiotics may be enhanced, and collagen synthesis accelerates.

• Necrotizing Soft Tissue Infections: Necrotizing infections cause hypoxia in surrounding tissues. This condition promotes an environment where anaerobic bacteria can proliferate. The infection also triggers a condition called occlusive endarteritis. Antibiotics aren’t always useful against the infection because of insufficient oxygen. Aminoglycosides, the antibiotics used against such infections, need oxygen to be transported across the bacterial cell wall. The hypoxia accompanying infection makes these medications less efficacious. The principal treatments for necrotizing soft tissue infections are surgical debridement and systemic antibiotics. Death rates are lower among patients with necrotizing infection who receive HBOT treatments plus standard therapy, and they require fewer debridements.

• Soft Tissue Radionecrosis: Some patients undergoing radiation therapy experience complications that emerge long after the treatment. One such delayed complication is radionecrosis caused by damage to small blood vessels, which can lead to a condition known as a progressive obliterative endarteritis with fibrosis. Scientific studies show that HBOT is a therapy that heals areas affected by soft tissue radionecrosis by promoting angiogenesis in compromised areas.

• Osteoradionecrosis: Osteoradionecrosis (ORN) can be another side effect from cancer treatment, when bone sustains damage to its cells and the blood cells supplying it. Four areas of the body most likely to be damaged are the lower jaw, or mandible; the chest wall; the pelvis and vertebral column; and the skull. Damage is most common in the mandible. Wounds to affected bone fail to heal because of hypoxia. Fortunately the damaged bone responds to HBOT.

Giving HBOT
The Wound Healing Center at Bryn Mawr Hospital uses monoplace chambers to deliver HBOT treatments. These chambers are used by a single occupant and are commonly compressed with oxygen and do not require use of a breathing mask or hood. To communicate with the patient, therapists use an intercom system. During the treatment, patients are able to listen to the radio, watch television, or even sleep. Commonly, a patient is treated for two hours once a day. The Wound Healing Center’s unit is staffed by technicians and nurses specially trained in the administration of HBOT. When the patient is being treated, a physician is always in the Center.

How to Prepare for HBOT?
After referral by your doctor for HBOT and an evaluation by a hyperbaric medicine specialist you will be given detailed instructions about preparing for hyperbaric oxygen therapy. HBOT involves 100 percent oxygen and the following materials are NOT ALLOWED to be worn or brought in while in the HBOT chamber:

• hair oils
• hair sprays
• deodorant
• perfumes
• make-up
• nylons (panty hose)
• ointments
• liniments
• petroleum or Vaseline products
• wigs or hair pieces
• aftershave
• synthetic fibers (i.e. rayon, nylon, etc.)
• salves
• smoking materials (matches/lighters)

It is important to mention again that any form of smoking material, lighters or matches are STRICTLY prohibited in the chamber and should not be used for at least an hour after treatment.

How Will HBOT Feel?

The first few minutes of HBOT (commonly referred to as a dive) can be quite noisy. It may get warm at first, and then the temperature will be adjusted to a comfortable setting. A change in pressure may cause ear discomfort (similar to the feeling one has while in an airplane); otherwise it should be unnoticeable. To equalize the pressure in ears, simply hold your nose and attempt to blow air through it, or try swallowing. Both will allow air to enter the middle ear cavity via the eustachian tube. It is only necessary to do this during the first few minutes of the treatment. The remaining time in HBOT can be spent sleeping, watching TV, or just relaxing. Patients of all ages generally tolerate HBOT very well.

Any Side Effects with HBOT?

The most common side effect is barotrauma to the ears and sinuses caused by pressure changes. To minimize this risk, patients learn techniques to promote adequate clearing of the ears during compression. Other side effects are more rare, but may include oxygen toxicity, claustrophobia, and accelerated maturation of cataracts. Occasionally some patients experience visual changes after several HBOT treatments that cause then to have changes in their visual activity. This is usually only temporary and should disappear three to four months after HBOT treatments. Any feeling out of the ordinary should be reported to the treating technicians immediately.

What if I am a Smoker?

Patients are encourages not to smoke during the course of therapy. Smoking (even one cigarette) can cause blood vessels to constrict, which decreases the blood and oxygen supply to tissue, counteracting the benefits of HBOT.

How Does HBOT Work?

HBOT saturates the patient's plasma with oxygen resulting in increased oxygen delivery to tissues. Specifically, hyperbaric oxygen therapy:

• Dissolves oxygen into the plasma
• Increased oxygen tension in hypoxic areas
• Enhances white blood cell activity at the wound site
• Reduces edema by vasoconstriction
• Blocks cytotoxic effects of carbon monoxide and hypoxia associated with cyanide poisoning. Starts the formation of new peripheral vascular vessels and nerve endings (Angiogenesis) in damaged area of the body.

Before Receiving HBOT

We need to know when:

• You experience a cold, flu symptoms, sinus or nasal congestion, or chest congestion
• There is a possibility of pregnancy
• Your medications have changed
• You have skipped a meal prior to HBOT treatment
• You are a diabetic and did not take your insulin prior to treatment
• You have any concerns or anxiety.

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