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Deep Dive into Hyperbaric Oxygen Therapy

A number one rule of scuba diving is always to ascend slowly. Coming up too fast from a dive can cause "the bends" (also called decompression sickness). Risk increases when diving for extended periods and at greater depth. 

Symptoms of “the bends” may include joint pain, fatigue, low back pain, paralysis of the legs, weakness or numbness of the arms, dizziness, confusion, vomiting, ringing in the ears, and loss of consciousness. 

The bends happen when air bubbles form and expand in the body and can become life-threatening if left untreated. 

Hyperbaric Oxygen Therapy (HBOT) has been used to treat "the bends" in deep-sea U.S. Navy divers since the 1940s. HBOT involves breathing oxygen in a pressurized chamber that will gradually reduce the volume of the bubbles in the body.

Today, HBOT is used as the primary treatment for scuba diver’s decompression sickness, people (including firefighters and miners) suffering from carbon monoxide poisoning, and arterial gas embolism. 

HBOT is also used for adjunctive (i.e., add-on) treatment in multiple conditions. 

13 conditions have been FDA approved for treatment through the use of HOBT: 

  • Air or gas embolism (blockage of blood supply by air or gas bubbles) 
  • Arterial insufficiencies—enhancement of health in selected problem wounds: diabetic foot, diabetic retinopathy, diabetic nephropathy 
  • Carbon monoxide poisoning 
  • Clostridial myonecrosis (gas gangrene) 
  • Compromised skin grafts and flaps 
  • Crush injuries and skeletal muscle compartment syndromes
  • Decompression sickness 
  • Delayed radiation injures (soft tissue and bony necrosis)
  • Intracranial abscess 
  • Necrotizing soft tissue infections (necrotizing fasciitis) 
  • Refractory osteomyelitis 
  • Severe anemia 
  • Thermal burns 

Types of Hyperbaric Oxygen Therapy Chambers 

Individual chamber: built for one person. It is a long, plastic tube (similar to an MRI machine), where the patient lays on a table inside the chamber. The chamber slowly pressurizes to 100% oxygen. 

Multi-person chamber: a large chamber or room that can fit more than one person at a time. The difference is that patients will breathe pressurized oxygen through masks or hoods. 

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What to Expect with Hyperbaric Oxygen Therapy

You will enter a special chamber to breathe in pure oxygen in air pressure 1.5 to 3 times higher than average. The goal is to fill the blood with enough oxygen to repair tissues and restore normal body function. 

Depending on the condition, a doctor will recommend a certain number of sessions. 

A session will typically consist of the following: 

  • Wearing a 100% cotton medical gown 
  • Sitting or lying in a sealed chamber 
  • Receiving pressurized oxygen through a mask or hood 
  • Breathe normally during the procedure; typically, while listening to music or watching tv 
  • Option to talk with a therapist during treatment 
  • As the pressure rises, patients may experience ear popping and mild discomfort 
    • To minimize problems with ears and sinuses, yawning or swallowing techniques can be used to clear the ears
    • After the session, the chamber will slowly depressurize 

Some patients feel lightheaded or tired after a session, but these symptoms will usually go away after a short time. 

Things to Know Before Starting Hyperbaric Oxygen Therapy

    • Don't arrive sick 
      • a. Having a cold makes it hard to clear your ears 
      • b. It may feel like you are on an airplane at first (pressure build-up) 
    • Plan to be there for a few hours 
      • a. The length of the session depends on the condition being treated: chronic illnesses may last 2 hours, decompression sickness sessions can last up to 5 hours 
    • Topical administration should be avoided beforehand 
      • a. Avoid all perfumes, lotions, hairspray, and deodorants  
      • b. Petroleum hair and skin products may be a fire hazard 

Hyperbaric Oxygen Therapy Risks 

Some patients may feel claustrophobic, and experience increased anxiety while in the chamber. Mild side effects may also include fatigue and headaches. 

Rare side effects to HOBT may include pressure-injury to ears or nose, oxygen poisoning, seizures, collapsed lung, or changes in vision, causing nearsightedness.

In general, you should not receive HOBT if you: 

    • Have had recent ear surgery or injury 
    • Have a collapsed lung 
    • Have certain types of lung disease 

The FDA is concerned about unwarranted claims made by treatment centers using HBOT that may give patients the wrong impression. The FDA warns patients not to be misled. HBOT has NOT been established for the following diseases and conditions: 

    • AIDS/HIV 
    • Alzheimer's Disease 
    • Asthma 
    • Autism 
    • Bell's Palsy 
    • Brain Injury 
    • Cancer
    • Cerebral Palsy 
    • Chronic fatigue syndrome 
    • Depression
    • Diabetes  
    • Heart disease 
    • Hepatitis 
    • Migraine 
    • Multiple sclerosis 
    • Parkinson's Disease 
    • Spinal cord injury 
    • Sport's injury 
    • Stroke 

HBOT should not be utilized in conditions that are not FDA approved indications because of safety concerns and lack of scientific evidence. 

Bottom Line 

HBOT is an effective therapy option for various health conditions. Patients must be aware of misleading claims and always check with a certified HOBT professional before undergoing treatment. 

References: 

Leach RM, Rees PJ, Wilmshurst P. Hyperbaric oxygen therapy. BMJ. 1998;317(7166):1140-1143. doi:10.1136/bmj.317.7166.1140

Johns Hopkins Medicine. Hyperbaric Oxygen Therapy for Wound Healing. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hyperbaric-oxygen-therapy-for-wound-healing. Published 2020. Accessed 20 August 2020.

The Hyperbaric Oxygen Therapy Committee. Hyperbaric Oxygen Therapy Indications.https://www.uhms.org/images/indications/UHMS_HBO2_Indications_13th_Ed._Front_Matter__References.pdf. Published 2014. Accessed 20 August 2020.

Food and Drug Administration. Hyperbaric Oxygen Therapy: Don't Be Misled. https://www.fda.gov/consumers/consumer-updates/hyperbaric-oxygen-therapy-dont-be-misled. Published 2013. Accessed 21 August 2020.

Mayo Clinic. Hyperbaric Oxygen Therapy. https://www.mayoclinic.org/tests-procedures/hyperbaric-oxygen-therapy/about/pac-20394380. Published 2018. Accessed 21 August 2020.

Published August 27th, 2020 by Dr. Miriam Opara, PharmD
Fact Checked by Chris Riley

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