What is Hyperbaric Oxygen Therapy (HBOT)?

What is Hyperbaric Oxygen Therapy?

Hyperbarics is a medical and scientific field that focuses on the therapeutic use of oxygen under high pressure. This treatment, known as Hyperbaric Oxygen Therapy (HBOT), involves breathing 100% pure oxygen in a pressurized room or chamber at 2.0ATA or greater pressure and has a range of applications, from treating decompression sickness in divers to promoting wound healing in patients with chronic conditions.

Why is Hyperbaric Oxygen Therapy applied?

Your tissues require sufficient oxygen to function properly. When they are injured, the need for oxygen increases significantly. HBOT enhances the oxygen-carrying capacity of your blood. Through repeated sessions, the temporary boost in oxygen levels promotes the restoration of normal tissue oxygenation, even after the completion of the therapy.

How to Prepare for HBOT

For the procedure, you will be given a hospital-approved gown or scrubs to wear instead of your regular clothing. To ensure safety, certain items such as lighters or battery-powered devices that generate heat are prohibited inside the hyperbaric chamber. Additionally, you may need to remove any hair and skin care products that are petroleum-based due to their potential fire hazard. Your healthcare team will provide specific instructions on how to prepare for hyperbaric oxygen therapy.

What to expect

During Hyperbaric Oxygen Therapy:

1. Individual Units (Monoplace Chambers): In these units, you lie on a table that slides into acrylic, aluminum and/or steel chamber.
2. Multiperson Units: These resemble large hospital rooms where several people can sit or lie down during the treatment. Oxygen is administered through a mask or a lightweight, clear hood placed over the head.
3. Mild hyperbaric chambers: Mild units treat under 2.0ATA, usually between 1.3-1.5ATA.  Mild units are only approved for treating acute mountain sickness with AIR (21%oxygen) and are currently considered subtherapeutic of all other conditions.  All FDA and UHMS approved indications require a minimum of 2.0ATA while breathing 100% pure oxygen. The FDA, AMA and UHMS have all issued statements about the lack of safety with these devices.  

During the session, the air pressure inside the chamber is increased to about 2 to 3 times higher than normal atmospheric pressure.

This increased pressure may cause a temporary sensation of fullness in your ears, similar to what you might experience during an airplane flight or at high altitudes. You can relieve this feeling by yawning or swallowing.

Hyperbaric oxygen therapy sessions typically last around two hours. Your healthcare team will monitor you and the therapy unit throughout the treatment.

After Hyperbaric Oxygen Therapy:

Following your session, your therapy team will perform a check-up, which may include examining your ears, taking your blood pressure and pulse, and checking your blood glucose if you have diabetes. Once you are cleared, you can get dressed and leave. You may feel somewhat tired or hungry after the treatment, but that should be the only side effect to deal with.

Results

To achieve the benefits of hyperbaric oxygen therapy, multiple sessions are usually required. The number of sessions depends on your medical condition. Some conditions, like carbon monoxide poisoning, might be treated in three visits, while others, such as nonhealing wounds, may need 40 or more treatments.

Hyperbaric oxygen therapy is often part of a comprehensive treatment plan that includes other therapies and medications tailored to your specific needs.

History of Hyperbarics

The use of high-pressure environments for medical treatment dates back to the 17th century. In 1662, a British physician named Nathaniel Henshaw constructed a sealed chamber called a “domicilium” to treat various conditions. The development of modern hyperbaric medicine, however, began in the early 20th century with the work of Orval Cunningham, who used a steel chamber to treat patients with the Spanish flu. The field expanded significantly during World War II when hyperbaric oxygen therapy was used to treat decompression sickness in divers and pilots. Since then, advances in technology and medical research have broadened the scope of hyperbarics to include a variety of medical conditions.

Mechanisms of Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Therapy increases the amount of oxygen your blood can carry, enhancing the body’s natural healing processes. Under normal atmospheric conditions, oxygen is transported by red blood cells. However, in a hyperbaric chamber, the increased pressure allows more oxygen to dissolve in the plasma, which can diffuse more readily into tissues and cells.

Applications of Hyperbarics

Decompression Sickness

Decompression sickness, or “the bends,” occurs when divers, aviators, astronauts, and compressed air workers ascend too quickly, causing nitrogen bubbles in their blood. HBOT helps dissolve these bubbles and reduces the associated symptoms. Studies show that HBOT is effective in reducing morbidity associated with decompression sickness and has been used for this purpose since WW2.

Chronic Wounds

HBOT can benefit patients with diabetic foot ulcers, radiation injuries, and other chronic wounds. The increased oxygen supply promotes healing in tissues with poor blood flow. A randomized controlled trial published in Diabetes Care showed that HBOT significantly improved healing rates in diabetic foot ulcer patients.

Carbon Monoxide Poisoning

HBOT is an effective treatment for carbon monoxide poisoning, as it quickly replaces carbon monoxide with oxygen in the blood, reducing the risk of long-term damage. A study in the New England Journal of Medicine found that HBOT significantly reduced the incidence of cognitive sequelae after acute carbon monoxide poisoning.

Traumatic Brain Injury

Growing evidence shows that HBOT can improve cognitive function and reduce symptoms in patients with traumatic brain injuries by enhancing oxygen delivery to the brain involving the TrkB signal pathway. Various studies reported improved mental and functional outcomes in chronic traumatic brain injury patients treated with HBOT, and it was concluded that HBOT can improve cognitive functions in patients with vascular dementia.

Air or Gas Embolism

Air or gas embolism occurs when air bubbles enter the bloodstream and block blood vessels. This can happen due to trauma, surgical procedures, or as a complication of certain medical treatments. HBOT effectively treats air or gas embolism by reducing the size of the air bubbles and improving oxygen delivery to affected tissues. Studies highlight the efficacy of HBOT in managing cerebral air embolism, showing significant neurological recovery in patients treated promptly.

Infections

Hyperbaric oxygen therapy can enhance the body’s ability to fight certain infections, particularly those caused by anaerobic bacteria that thrive in low-oxygen environments. For example, studies show that HBOT enhances the repair processes by modulating various cellular activities, including transcription, signaling, stress responses, apoptosis, and inflammation. It upregulates repair processes and downregulates mechanisms that perpetuate tissue damage. Specifically, HBOT influences pathways involving oxidative stress, inflammation, cell growth, and stem cell mobilization, thereby aiding in the regeneration of neural, bone, cartilage, muscle, cardiac tissue, and the intestinal barrier.

Stroke and Neurodegenerative Diseases

Research is ongoing, but some studies suggest that HBOT may improve outcomes in patients with strokes or neurodegenerative diseases by promoting neuroplasticity and reducing inflammation. Studies suggest HBOT improved neurological function and quality of life in post-stroke patients. Furthermore, another study demonstrates that HBOT significantly enhances spatial learning and memory in rats with amnestic mild cognitive impairment (aMCI). HBOT reduced neuronal apoptosis in the hippocampus and decreased the expression of pro-apoptotic proteins Fas and FasL, suggesting that HBOT can mitigate cognitive decline associated with aMCI by protecting neuronal health.

Severe Anaemia

Studies highlight the use of HBOT in treating severe anemia, especially in patients who refuse blood transfusions, such as Jehovah’s Witnesses. HBOT can enhance oxygen delivery to tissues by increasing the amount of dissolved oxygen in plasma, providing a temporary solution to sustain oxygenation and support vital organ function until the patient’s red blood cell count can recover. This approach can be life-saving in critical situations where traditional transfusions are not an option.

Benefits of Hyperbaric Oxygen Therapy

Accelerated Healing

Hyperbaric oxygen therapy (HBOT) significantly accelerates the healing process by increasing oxygen concentration in the blood, which enhances tissue repair and reduces inflammation. This is particularly beneficial for chronic wounds, diabetic foot ulcers, and radiation injuries where conventional treatments have failed. Studies have shown that HBOT can improve wound healing rates and reduce recovery times.

Improved Quality of Life

For patients suffering from chronic pain, non-healing wounds, or traumatic injuries, HBOT can lead to substantial improvements in quality of life. By reducing pain and inflammation, enhancing mobility, and speeding up the overall recovery process, patients can experience a return to daily activities and an overall sense of well-being. For instance, patients with fibromyalgia have reported reduced pain levels and increased function after undergoing HBOT.

Non-Invasive Treatment

HBOT is a noninvasive treatment that can be seamlessly integrated with other therapies, such as physical therapy, medications, and surgical interventions. Its noninvasive nature makes it a preferred option for patients who are unable to undergo surgical procedures or who have not responded well to other treatments. Generally well-tolerated, HBOT poses a low risk of serious side effects, making it suitable for a wide range of patients, including those with compromised health conditions.

Enhanced Immunity and Infection Control

Hyperbaric oxygen therapy has antimicrobial effects that can inhibit certain bacteria’s growth and enhance antibiotics’ effectiveness. This makes HBOT an effective adjunct therapy for treating infections such as osteomyelitis and necrotizing fasciitis. By boosting the body’s immune response and promoting better blood flow to infected tissues, HBOT helps in faster recovery from infections.

Neuroprotection and Cognitive Benefits

Research suggests that HBOT can provide neuroprotective benefits, potentially aiding in the recovery of patients with traumatic brain injuries, strokes, and neurodegenerative diseases. By enhancing oxygen delivery to the brain, HBOT promotes neuroplasticity, reduces cerebral edema, and supports cognitive function recovery. Some studies have shown improvements in memory, attention, and executive functions in patients undergoing HBOT for brain injuries.

Anti-Inflammatory Effects

HBOT reduces systemic inflammation, which is a common underlying factor in many chronic conditions. By decreasing inflammatory cytokines and oxidative stress, HBOT helps manage conditions such as rheumatoid arthritis, Crohn’s disease, and other inflammatory disorders. This reduction in inflammation can lead to decreased pain and improved overall health.

Cosmetic and Dermatological Benefits

HBOT is increasingly being used in cosmetic and dermatological practices to enhance skin health. It promotes collagen production, reduces scarring, and improves the skin’s overall appearance. Patients with acne, rosacea, and psoriasis conditions may find relief and cosmetic improvement through HBOT treatments.

Risks and Contraindications

While hyperbaric oxygen therapy is generally safe, it is not without risks. Potential side effects and contraindications include:

Barotrauma

The high-pressure environment can cause damage to the ears, sinuses, and lungs, particularly if pressure changes are not managed carefully.

Oxygen Toxicity

Breathing pure oxygen at high pressures can lead to oxygen toxicity, which can cause seizures and other serious complications. Studies outline the mechanisms and prevention measures for oxygen toxicity.

Claustrophobia

Some patients may experience claustrophobia in the confined space of a hyperbaric chamber.

Specific Contraindications

Certain conditions, such as untreated pneumothorax (collapsed lung) and some types of chemotherapy, are contraindications for HBOT.

Future of Hyperbarics

The future of hyperbaric medicine looks promising, with ongoing research exploring new applications and refining existing treatments. Advances in technology, such as portable hyperbaric chambers and improved monitoring systems, are making HBOT more accessible and safer for patients.

Emerging Applications

Researchers are investigating the potential of HBOT in treating a variety of conditions, including:

• Autism Spectrum Disorders. Preliminary studies suggest that HBOT may improve cognitive and behavioral outcomes in children with autism. A study published in BMC Pediatrics showed significant improvements in social skills and cognitive function in autistic children undergoing HBOT. Furthermore, a more recent study found significant improvements in verbal communication skills among the children who underwent HBOT, suggesting that this therapy may enhance verbal abilities in ASD patients.
• Sports Injuries. Athletes increasingly use HBOT to speed up recovery from injuries and improve performance. Studies demonstrated significant reductions in pain and muscle injury markers (creatine phosphokinase, glutamic oxaloacetate transaminase, myoglobin) in the HBOT group compared to the control group, with improvements sustained for two weeks post-treatment.
• Anti-Aging. Some researchers believe HBOT could have anti-aging effects by promoting cellular repair and reducing inflammation. Studies showcase a positive impact on cognition, skin rejuvenation, metabolic regulation, musculoskeletal restoration, and cardiopulmonary function improvement.

Integration with Other Therapies

Physical Therapy

Combining HBOT with physical therapy can significantly accelerate recovery from musculoskeletal injuries. HBOT promotes angiogenesis and reduces inflammation, which complements physical therapy by improving tissue oxygenation and reducing pain, leading to more effective rehabilitation. This integrated approach is particularly beneficial for patients with chronic conditions like stroke, peripheral vascular disease, and spinal cord injuries, enhancing their mobility and recovery rate.

Pharmacological Treatments

HBOT can enhance the efficacy of certain medications. For instance, it increases the effectiveness of antibiotics and anti-inflammatory drugs by improving tissue oxygenation and reducing inflammation. This synergy is particularly useful in treating infections and chronic inflammatory conditions. Additionally, combining HBOT with neuroprotective drugs can offer added benefits in managing neurodegenerative diseases like Alzheimer’s and Parkinson’s by improving oxygen supply to the brain and reducing oxidative stress.

Surgical Interventions

HBOT is beneficial when used pre-and post-operatively. Pre-operative HBOT enhances tissue oxygen saturation, potentially reducing surgical complications. Post-operative HBOT accelerates wound healing, reduces infection risks, and minimizes recovery time. In reconstructive and plastic surgeries, HBOT supports tissue regeneration and improves the viability of grafts and flaps, leading to better surgical outcomes.

Stem Cell Therapy

HBOT can significantly enhance stem cell efficacy, mobilizing and improving the function of stem cells and increasing their survival and differentiation. This makes HBOT a valuable adjunct in stem cell therapies, improving outcomes in regenerative medicine by promoting angiogenesis and reducing inflammation, thereby supporting the therapeutic effects of stem cell treatments.

Oncology

In cancer treatment, HBOT can increase the efficacy of radiotherapy and chemotherapy by improving oxygen levels in tumors, making cancer cells more susceptible to these treatments. It also helps mitigate some adverse effects of cancer treatments, such as radiation-induced tissue damage, by promoting healing and reducing inflammation. Furthermore, studies suggest that HBOT may reduce growth in some cancer types, such as breast cancer.

Chronic Conditions Management

For chronic conditions like diabetes and cardiovascular diseases, HBOT can be integrated with conventional treatments to improve outcomes. In diabetic patients, especially those with non-healing wounds, HBOT significantly enhances wound healing and reduces severe complications. Combining HBOT with standard therapies improves myocardial oxygenation, reduces ischemia, and enhances overall cardiac function in cardiovascular diseases.

Conclusion

As scientific research and technological innovations progress, the scope and efficacy of HBOT are anticipated to expand. Future studies will likely refine treatment protocols, optimizing oxygen pressures, session durations, and frequencies tailored to specific conditions and patient populations. These advancements will undoubtedly enhance the therapeutic arsenal available to healthcare professionals, solidifying HBOT’s status as a cornerstone of contemporary medical practice. Integrating HBOT with other therapeutic modalities promises to amplify its benefits further, fostering holistic and improved patient outcomes across a broad spectrum of medical disciplines.