Hyperbaric Oxygen Treatments Reviews

Formally “The Hyperbaric Oxygen Therapy Committee Report: Indications and Results.”

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.

# Aetna considers systemic hyperbaric oxygen therapy (HBOT) medically necessary for any of the following conditions:

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.

Q. What is Hyperbaric Oxygen Therapy?

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