* Systemic diseases such as diabetes must be adequately treated
* Nutritional needs must be met
* Nicotine intake must be curbed
* Contraindications and risks must be considered
* Treatment for infection should be instituted
* Major blood vessel flow must be present
* Aggravating factors to the wound such as local pressure or irritation should be minimized
* Wound debridement concurrent with HBO therapy is necessary
* Sufficient HBO treatments must be undertaken before efficacy of treatment is assessed

Features of Our HBO Service
1. Referring physician remains the patient’s physician. He/She also assesses efficiency of treatment by these observations:

* Inflammation should diminish and wounds assume a noninfected appearance. (The antibacterial effect of HBO is not covered in this brochure.)
* Treatments should increase areas of granulation tissue in the wound.
* Wound edges become better defined and wound size begins to decrease.
* During preparation for and salvage of a compromised graft, deterioration of the site should be arrested and appearances occur as above.

2. HBO is used in conjunction with other treatments.

3. Certified HBO physicians and respiratory therapists in attendance during treatment.

4. A series of photographs of lesions are always taken to monitor treatment.

5. The hyperbaric chamber is large enough to accommodate up to six patients comfortably in addition to a therapist, who accompanies patients on all treatments.

6. Our Hyperbaric Medicine Service has experience with more than 8,500 treatments. Results of wound healing have been consistently satisfactory.

In 1983 the New England Journal of Medicine reported a controlled, double-blind study on the effect of hyperbaric oxygenation on the symptoms of multiple sclerosis. It reported scientifically demonstrated benefits but recognised the need for long-term studies.

After a pilot study had confirmed this report, patients and their relatives installed pressure chambers in 56 Centres throughout the UK. Since 1982 over 12,000 UK patients have received HBOT. In most, an initial intensive course has been followed by intermittent maintenance treatment. Well over a million individual sessions have been completed without untoward incident.

It is difficult to assess the effect of any treatment on MS patients because of the unpredictable fluctuation of signs and symptoms. One authority considers that the best experimental design is to observe a large number of patients treated over a period of time. MS National therefore followed the progress of 703 patients who had first received treatment soon after the centres opened.

They were recruited from those attending 28 of the Centres. Details are given in Table 1.

Patients had been told that they had multiple sclerosis by neurologists who had said that there is no effective treatment for their condition. The co-operation of the patient’s family doctor had been obtained before they were accepted for treatment.

During HBO treatments, patients breathed 100% oxygen under pressure in HBO chambers. The initial course of treatment consisted of twenty sessions in 4 weeks. Thereafter, the patients returned for a ‘follow-on’ treatment on a weekly basis, or failing that, as often as they felt the need or found it possible.

The goal is to increase the amount of oxygen delivered to the diseased tissue to help it to heal. Hyperbaric oxygen therapy may be used alone or in conjunction with conventional therapies. The patient is placed in a chamber of suitable size and the pressure surrounding the patient is increased by allowing oxygen to flow into the chamber.

Oxygen should be considered a drug and just as any other drug we might administer, it has various doses, frequencies of administration and duration of therapy. These depend on what disease is being treated. For example, a protocol might call for a patient to receive 2 atmospheres of pressure (like diving to 33 ft. in the ocean) for 1 hr. every other day for 7-10 treatments. Different diseases or problems require different doses, frequencies of treatment, and duration of treatment just like the use any conventional drugs.

There are many indications for this therapy. In most diseases, blood flow to the diseased tissue is compromised which in turn decreases the amount of oxygen available for tissue healing. Hyperbaric therapy is able to increase tissue oxygen levels in diseased tissue which improves and speeds healing, improves the body’s ability to fight infections, and reduces inflammation and swelling. Hyperbaric oxygen therapy is both a primary treatment and a complementary therapy. Consequently, hyperbaric oxygen therapy may be used alone or in conjunction with conventional therapies.

There are many indications for this therapy. In general, any condition or disease in which the circulation to the diseased tissue has been compromised will benefit from this therapy. Hyperbaric therapy is a primary treatment for some diseases including severe smoke inhalation and burns, Clostridial and other anaerobic infections, and compromised wounds. Hyperbaric therapy is potentially beneficial in other diseases:

As each year goes by, the body of scientific evidence to support the use of hyperbaric oxygen therapy builds…
Pressurization of a gas to treat medical disorders was first utilized in 1662 by a British clergyman named Henshaw. At that time, air was compressed in a sealed chamber he called a “Domicillium.” Without evidence, Henshaw theorized that acute disorders of all kinds would benefit from increased pressure. Compression of oxygen was introduced in 1879 by a French surgeon. Fontaine constructed a mobile operating room which could be pressurized. He observed that pressurized patients were not as cyanotic after the use of nitrous oxide during surgery as compared to patients who had been treated in the traditional fashion. In addition, he noted that hernias were much easier to reduce. Around that same time, the work of Paul Bert and J. Lorrain-Smith showed that oxygen under pressure had potentially deleterious consequences on the human body with side effects that included central nervous system and pulmonary toxicity.
The field of hyperbaric medicine evolved from the early years of observation and anecdote to one of scientific trials and evidence-based medicine. The work of pioneers such as Behnke and Cousteau gave us the foundation on which undersea medicine and research has flourished. The efforts of Churchill-Davidson and Boerema spurred the modern scientific use of clinical hyperbaric medicine.
In 1967, The Undersea Medical Society was formed to support and further the scientific field of diving and undersea medicine. As the applications and use in the clinical arena grew, the society expanded to include clinical hyperbaric medicine. This evolution prompted the society to formally change its name to the Undersea and Hyperbaric Medical Society in 1986.
In 1972, an Ad Hoc Medicare committee was formed to evaluate the efficacy of hyperbaric oxygen therapy for specified medical conditions. The focus was to determine if this treatment modality showed therapeutic benefit and merited insurance coverage. The growth of the body of scientific evidence that had developed over the preceding years supported this endeavor and recognition for the field.
The Undersea and Hyperbaric Medical Society established the Hyperbaric Oxygen Therapy Committee in 1976. The first report was published the following year and served as guidance for practitioners. Additionally, the document continues to be used by the Centers for Medicare and Medicaid Services and other third party carriers in determining reimbursement. The report, currently in its twelfth edition, has grown in size and depth to reflect the evolution of the literature. To date, the Committee recognizes thirteen indications. It is believed that the scientific evidence supports the use of hyperbaric oxygen therapy for treatment of these medical conditions from both a clinical practice standpoint and insurance coverage perspective.
The Undersea and Hyperbaric Medical Society has grown in strength and reputation over the years. It continues to be known for its expertise on compression therapy. The authors of the chapters in this book are some of the leading experts in the field. The goal of this publication is to provide guidance and support for scientists and practitioners of hyperbaric oxygen therapy.

1. Non-healing infected deep ulcerations (reaching tendons or bone) of the lower extremity in diabetic adults unresponsive to at least 1 month of meticulous wound care (including aggressive debridement, maximal antibiotic therapy, tight glycemic control, and appropriate treatment of arterial insufficiency, including revascularization if necessary). HBOT is not considered medically necessary for superficial lesions.
2. Acute carbon monoxide poisoning
3. Decompression illness (“the bends”)
4. Acute air or gas embolism
5. Gas gangrene (Clostridial myositis and myonecrosis)
6. Cyanide poisoning (with co-existing carbon monoxide poisoning)
7. Acute traumatic peripheral ischemia (including crush injuries and suturing of severed limbs) when loss of function, limb, or life is threatened and HBOT is used in combination with standard therapy
8. Acute peripheral arterial insufficiency (i.e., compartment syndrome)
9. Progressive necrotizing soft tissue infections, including mixed aerobic and anaerobic infections (necrotizing fasciitis, Meleney’s ulcer)
10. Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management
11. Compromised skin grafts and flaps
12. Radiation necrosis (osteoradionecrosis, myoradionecrosis, brain radionecrosis, and other soft tissue radiation necrosis)
13. Radiation proctitis
14. Exceptional blood loss anemia only when there is overwhelming blood loss and transfusion is impossible because there is no suitable blood available, or religion does not permit transfusions
15. Pneumatosis cystoides intestinalis
16. Prophylactic pre- and post-treatment for members undergoing dental surgery of a radiated jaw
17. Acute cerebral edema
18. Idiopathic sudden deafness, acoustic trauma or noise-induced hearing loss, when HBOT is initiated within 3 months after onset.

A. Hyperbaric Oxygen Therapy (HBO) is defined as a treatment mode in which the patient is entirely enclosed in a pressure chamber breathing oxygen at a pressure greater than one atmosphere. Breathing 100 percent oxygen at one atmosphere or applying oxygen outside a pressurized chamber are not considered hyperbaric oxygenation.

Q. What is a monoplace hyperbaric chamber?

A. A monoplace chamber is one in which only one patient is placed, and pressurized oxygen is introduced into the entire chamber. Access to the patient is made from the outside via ports and pass-throughs.

Q. How does Hyperbaric Oxygen Therapy work?

A. Significant physiological mechanisms, which are activated as a result of hyperbaric oxygenation, explain the many therapeutic results of HBO:

1. Hyperoxygenation:

HBO physically dissolves extra oxygen into the blood plasma. The breathing of pure oxygen at three times normal pressure (3 A.T.A.) delivers 15 times as much physically dissolved oxygen to tissues as breathing room air. This promotes formation of new capillaries into wound areas, and sufficient oxygen tensions to meet the needs of ischemic tissues. Hyperoxygenation effects are useful in the treatment of anemias, ischemias and some poisonings.

2. Mechanical effect of increased pressure:

Any free gas trapped in the body will decrease in volume as the pressure on it increases. With a threefold increase in pressure, a bubble trapped in the body is reduced by two-thirds. This reduction in gas volume has been successfully applied to air embolism and decompression sickness.

3. Mass action of gases (gas wash out):

The flooding of the body with any one gas tends to “wash out” all others. This action occurs more rapidly under pressure than under ordinary conditions, and makes HBO an indicated treatment for carbon monoxide intoxication and acute cyanide poisoning.

4. Vasoconstriction:

High pressure oxygen causes constriction of the blood vessels (without creating hypoxia) which decreases edema in injured tissues and secondarily decreases intracranial pressure. This effect is useful in burns, crush injuries and interstitial bleeding. It may also be effective in acute brain and spinal cord injuries.

5. Bacteriostasis:

HBO inhibits the growth of a number of anaerobic as well as aerobic organisms. This effect also complements the improved action of host disease-fighting factors. It is useful in conditions where resistance factors are compromised such as dysvascular conditions and disorders involving immunosuppression

Because OxyHealth has taken the “work” or “burden” out of operating a hyperbaric oxygen chamber, its user-friendly designs continue to entice doctors and patients alike.  In fact, the mass appeal of OxyHealth’s portable hyperbaric chambers has made hyperbaric therapy the hot button modality in the medical field today.

And, it’s no wonder.  Hyperbaric Oxygen Chamber installation requires little to no down time (even for its higher pressure steel chambers!); the cost consideration is fair and manageable; chamber safety records are flawless; and customer care has become an ‘art’ in the service of clients.

With over 7000 chambers in service today (that’s more than all other manufacturers combined!), OxyHealth is the global leader in quality and safety. So many chambers, so many options, so much ease.  More than at any other time, hyperbaric therapy is possibly the most possible now because of the bold moves this company decided were worth the price.  OxyHealth designs have provided an in-road into the medical profession in ways that have reached out to many people who may otherwise not have been able to attain hyperbaric therapy. Practitioners too have been given new, accessible tools—modalities within reach—for the benefit of patients in an immediate way… not as a last resort option rarely available at an expensive hospital chamber—as has been common practice in the healthcare industry for years..

By focusing on the unmet needs in the hyperbaric community, OxyHealth has developed an armory of products that have transported the field to new heights—forever changing how doctors and researchers provide care to the patients they treat.  At the forefront of the OxyHealth business platform is its commitment to keep a firm hand on the pulse of the field and to keep raising the level of technology, while keeping products within public reach.

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*
What Is Hyperbaric Oxygen Treatment (HBOT)?

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HBOT’s General Uses

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HBOT’s Indications

What Is HBOT?

During hyperbaric oxygen treatment (HBOT), the amount of oxygen you breathe is increased to 100% oxygen. At the same time, the pressure surrounding your body is slowly increased.

HBOT allows the blood to carry more oxygen to the tissues, promoting new tissue and blood vessel growth, and assisting in the healing process by permitting skin grafting or spontaneous healing.

A hight level of oxygen in the blood helps to fight infections caused by a variety of bacteria, some that only live in the absence of oxygen. It also enables white blood cells to destroy many kinds of bacteria more efficiently.
General Uses

Increased Oxygen Helps Promote Healing

Traditionally used to treat diving complications, hyperbaric oxygen therapy now has new indications from the specialties of:

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Orthopedics
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Surgery
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Plastic Surgery
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Maxillofacial & Oral Surgery
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Infectious Disease
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Radiation Oncology
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Emergency Medicine.

HOBT is not designed to replace other proven methods of treatment but to supplement other forms of treatment such as surgery, antibiotics and wound care.
Indications

Utilizing knowledge gained from clinical experience and basic sciences research, the Undersea and Hyperbaric Medical Society’s Committee on Hyperbaric Oxygen has approved the use of HBOT as adjunctive or primary treatment for the following diseases and conditions:

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Air or Gas Embolism
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Carbon Monoxide Poisoning Complicated by Cyanide Poisoning
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Clostridial Myositis and Myonecrosis (Gas Gangrene)
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Crush Injury, Compartment Syndrome, and other Acute Traumatic Ischemias
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Decompression Sickness
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Enhancement of Healing in Selected Problem Wounds
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Exceptional Blood Loss (Anemia)
*
Intracranial Abscess
*
Necrotizing Soft Tissue Infections

The air pressure inside a hyperbaric oxygen chamber is about two and a half times greater than the normal pressure in the atmosphere. This helps your blood carry more oxygen to organs and tissues in your body.

Hyperbaric therapy can help wounds, especially infected wounds, heal more quickly. The therapy may be used to treat:

* Air or gas embolism
* Bone infections (osteomyelitis) that have not improved with other treatments
* Burns
* Carbon monoxide poisoning
* Certain types of brain or sinus infections
* Decompression sickness (for example, a diving injury)
* Gas gangrene
* Necrotizing soft tissue infections
* Radiation injury (for example, damage from radiation therapy for cancer)
* Skin grafts
* Wounds that have not healed with other treatments (for example, it may be used to treat a foot ulcer in someone with diabetes or very bad circulation)

Treatments for chronic conditions may be repeated over days or weeks. A treatment session for more acute conditions such as decompression sickness may be longer but not necessarily repeated.