Hyperbaric Oxygen Therapy Basics
Hyperbaric oxygen therapy (HBOT) is a common medical treatment for a wide range of traumatic, acute, and chronic diseases and conditions.
HBOT is perhaps best known as a treatment for divers suffering decompression sickness, or “the bends.” Today HBOT is becoming better known
and respected as an advanced therapy for diabetic foot ulcers and other wounds, as an emergency treatment for serious infectons and acute
carbon monoxide poisoning, and as an alternative or adjunctive treatment for a growing number of ailments, including a dozen other indications
approved by the US Food and Drug Administration (FDA).
Safe, proper hyperbaric oxygen therapy delivers a carefully managed dosage of pressure and pure oxygen over a prescribed period
Pressure. The word hyperbaric means above-normal pressure. Hyperbaric oxygen therapy is delivered in a chamber pressurized at 1.4
to 3.5 times the normal sea-level atmospheric pressure of 14.696 pounds per square inch.
Oxygen. Patients breathe 100% oxygen during hyperbaric oxygen therapy, sometimes with short “air breaks” of normal air. Normal air contains
21% oxygen, 78% nitrogen, trace amounts of other gases, and water vapor. Air breaks ensure patients will avoid oxygen toxicity.
Time. Most HBOT treatments, often called “dives,” last between 50 and 90 minutes. Patients may expect to spend extra time at the treatment center
consulting with the clinical staff and changing clothes before entering and after exiting the chamber. Some conditions, such as acute carbon monoxide
poisoning and decompression sickness, may be treated successfully in just 1 to 3 dives. Patients with diabetic foot ulcers and other chronic wounds
may undergo 40 or more daily treatments, 5 to 6 days per week, for a number of weeks.
Hyperbaric oxygen is serious medicine that should always be prescribed by a physician. Treatments should always be
supervised by a qualified hyperbaric specialist (MD or DO) assisted by a certified hyperbaric technician (CHT). Whenever possible, clinicians should follow
a standard treatment protocol firmly supported by the published, peer-reviewed medical literature.
Hyperbaric Oxygen Physiology: What Happens in the Body
The hyperbaric oxygen environment changes the relative pressures of oxygen, nitrogen, and other gases in the blood, organs, and tissues. Normally oxygen
is carried by hemoglobin on red blood cells. Under higher pressures, oxygen dissolves in the blood plasma, as well. So breathing pure oxygen in a
hyperbaric chamber increases the oxygen-carrying capacity of blood.
The idea is to push oxygen into parts of the body that lack oxygen and push harmful gases out.
Oxygen is a potent antibacterial agent. It is especially toxic to certain kinds of bacteria (anaerobes) that cause life-threatening infections. Increasing
the supply of oxygen to the infected tissue helps kill the bacteria.
In some conditions, such as crush injuries, skin grafts, and chronic wounds, healing is inhibited by a restriction of blood flow to the injured part of the
body. Healing is promoted by maximizing the amount of oxygen in the blood that can reach the injured area.
No effective medical treatment comes without the risk of some adverse reactions. The rates of complication for hyperbaric oxygen therapy are very low.
Potentially serious side effects include trauma to the middle ear, the eye (progressive myopia or cataracts), the lungs (pulmonary edema), and the brain
(seizure), as well as claustrophobia.
Learn more about side effects from the UHMS
Cost and Reimbursement for Hyperbaric Oxygen Therapy
Fees for hyperbaric oxygen therapy can range from $150 to $1,000 or more per treatment, depending on the type of treatment center, physician consultation
fees, and other factors. Medicare, Medicaid, and private insurers generally reimburse for the treatment of FDA-cleared indications and occasionally reimburse
for the treatment of off-label or alternative indications. Reimbursement rates and criteria may vary widely by insurance carrier and by state or region.
Mild Hyperbaric Oxygen Therapy
So-called mild HBOT, or mHBOT, is administered in inflatable bags that operate with room air (21% oxygen) at slightly
increased pressure (< 1.5 ATA). Some mild hyperbaric devices are FDA-cleared for the treatment of
Acute Mountain Sickness
(AMS). None is FDA-cleared to treat any other disease or condition.
In our opinion a mild hyperbaric device cannot safely deliver a therapeutic dosage of pressure. Using medical gases or
oxygen concentrators with mild hyperbaric devices may also create a safety hazard. UHMS warns that hyperbaric treatment
should not be self-administered or administered by nonprofessionals in the home. Also, we run across too many quacks and
fraudsters in the mild HBOT and personal hyperbarics community. Their claims are as wild as their HBOT is mild. Still,
many people with many diseases and conditions have reported real health benefits with mHBOT, and we eagerly await the
publication of new clinical evidence.
We’ve pulled together answers to many of the frequently asked questions about HBOT.
Access the FAQ »
Our directory of diseases and conditions provides a description of each condition and its causes, treatment with HBOT, approval status, and links to clinical
Access the directory of diseases and conditions »
Our directory of treatment centers lists the diseases and conditions treated by the facility for those that have reported it.
Access the treatment center directory »
Our directory identifies the type of treatment center, diseases and conditions, clinical staff, treatment center certifications,
hyperbaric chamber types, and provides complete contact information.
Access the treatment center directory »
Hundreds of hospitals and other facilities in the US and around the world offer hyperbaric oxygen therapy. The capabilities of a treatment center depend on
its type and other factors. Every profile in our directory of treatment centers includes this important information.
Learn more about treatment center types »
Hyperbaric medicine is a specialized treatment for which physicians, nurses, and technicians may receive specialized training and certification. Many also
hold credentials in preventive medicine, wound care, podiatry, pulmonary care, and other specialties.
Our directory of physicians and clinicians lists those specializing in the practice of hyperbaric medicine and relevant professional credentials for those
who have reported them.
Access the directory of physicians and clinicians »
Our directory of medical organizations provides information on the professional groups that educate and certify healthcare professionals for hyperbaric
oxygen therapy and accredit hyperbaric treatment centers.
Access the directory of medical organizations »
There are two basic types of hyperbaric chambers. Monoplace chambers are filled with 100% oxygen during treatment and hold one patient. Multiplace chambers
hold multiple patients and caregivers. In multiplace chambers the pressurized atmosphere is a standard mix of gases, and patients receive 100% oxygen through
a mask or hood.
Learn more about chamber types »
A growing body of clinical evidence and improvements in treatment management are reshaping the practice of hyperbaric medicine today.
O2.0 — the HyperbaricLink blog — reports on
new developments in hyperbaric medicine, related conditions, and hyperbaric treatment centers.
Our resources for healthcare professionals provide links to more information on indications, dosage, reimbursement, and other considerations for primary care
physicians and other clinicians considering referring a patient for hyperbaric oxygen therapy.
Access information for healthcare professionals »
The Undersea and Hyperbaric Medical Society provides
information on indications for hyperbaric medicine, approved conditions, and treatment protocols.