Clinical indication for
the use of HBO
HBO has become an indicated therapy in a large and increasing number of recognised conditions.
The uses of HBO in critical care conditions include acute anoxia
(eg; carbon monoxide poisoning), acute gasembolism,
decompression sickness, gas gangrene, crush injuries and certain neurosurgical conditions.
One of the more widespread clinical applications for HBO is that of wound healing. Hypoxic and ischaemic wounds such as stasis ulcers, diabetic wounds, failing graphs and necrotizing soft tissue infections all respond well to HBO. Of critical importance, HBO used
pre-surgically, is effective in promoting neovascularization, and therefore maximising limb salvage in prospective amputees. In the clinical setting, HBO has been utilised as a primary and adjunctive therapy.
Current research and clinical evidence
suggest that HBO has valid implications in the treatment of meningitis, sickle cell crisis/retinopathy, intraabdominal abscess, intracranial abscess, pseudomembranous colitis, multiple scleroses and head and spinal cord injury. Until recently, HBO therapy as been reserved for conditions which have failed to respond to normal management techniques owing to the high cost: benefit ratio, and unavailability. Previously, HBO has been available for patient care in selected major hospital settings. Obviously this has excluded private patients, outpatients and non-critical care excluded private patients, outpatients and non-critical care patients from receiving the benefits of HBO.
14 Townsend St, Portland, Victoria 3305
Contact: Jamie Zeigler
Email jamiezeigler@profdivers.com
Contact Phone 03 55 236392
Oxygen is the essential ingredient in aerobic life. Biologically, if respirations were to cease, cellular death would result within 4-6 minutes. Thus oxygen is vital. It becomes increasingly important to the sick and injured whose capacity for oxygen absorption and distribution is impaired.
Utilisation of a hyperbaric chamber allows administration of high concentrations of oxygen under pressure. The HTA1-1000 Hyperbaric Medicine Chamber is designed to enable a single patient to be subjected to a maximum pressure of 2ATA whilst breathing air or 100% oxygen. The patient breathes 100% oxygen whilst in the chamber, to assist in the treatment of certain difficult, persistent, costly or otherwise hopeless clinical problems.
What is the justification for using HBO?
The physiological and therapeutic effects of HBO may be explained by several mechanisms.
These effects can be divided into primary and secondary mechanisms.
A process known as hyper- oxygenation, it is a
direct effect of increasing the concentration of
oxygen and the pressure. A normal level of oxygen in arterial blood does not ensure that tissue oxygen
levels are correct. The very fact that many diseases
are associated with ischaemia highlights the
importance of normal tissue oxygen levels.
HBO acts to restore this imbalance.
HBO causes a reduction of the size of peripheral as well as cerebral blood vessels, thereby decreasing capillary blood flow. Subsequently blood flow and oedema are reduced, whilst oxygen delivery to the tissues is increased (owing to increased oxygen tension within the capillaries). This is useful in treating cerebral oedema, spinal cord injuries, compartment syndrome and thermal burns
ii. Neovascularization
HBO stimulates the development of new blood vessels at the microcirculatory level via fibroblast activation. Collagen is deposited, and subsequent capillary bud formation occurs. This mechanism is useful in treating radiation necroses, or compromised wound healing problems.
iii. Antibacterial
It has been clinically demonstrated that HBO has a specific role in fighting certain infections (eg: gas gangrene) by acting directly against anaerobic bacteria. The sensitivity of these organisms to oxygen is due, in part, to the absence of protective enzymes such as superoxide dismutase and catalase.
HBO also acts to enhance the killing power of leukocytes. In addition, HBO can deactivate or inhibit the formation of certain toxins produced by clostridial organisms.
acute indications
i. Carbon monoxide poisoning
ii. Crush injury
iii. Acute smoke inhalation
iv. Cyanide poisoning
v. Decompression sickness
vi. Gas embolism
vii. Gas gangrene
viii. Radiation necrosis
ix. Refractory osteomyelitis
x. Exceptional blood loss anaemia
xi. Ileus
xii. Actinomycosis
for adjunctive therapy
i. Thermal burns
ii. Cerebral oedema
iii. Fracture healing
iv. Peripheral vascular disease
v. Musculoskeletal injury (pre and post surgical conditions)
vi. Necrotizing soft tissue infections
vii. Anaerobic infections
viii. Skin grafts or flaps
ix. Wound healing
but also for other primary care physicians who have previously been unable to provide the best possible
care for their patients.
Monoplace hyperbaric oxygen therapy is now a cost effective means of dealing
with difficult and persistent clinical problems by effectively:
i. Reducing direct hospitalisation costs
ii. Increasing patient accessibility to HBO
iii. Permitting utilisation of outpatient and private clinic facilities
iv. Minimising the degree of disfigurement
v. Improving patient care and disability/recovery time
What care does the patient require when undergoing Hyperbaric Therapy?
One of the most important areas in hyperbaric training is the understanding of possible hazards and
complications of the HBO therapy and their prevention. With proper application, HBO is one of the safest
adjuncts in medical management.
All procedures in the application of HBO therapy are administered under the guidance of the hyperbaric nurse.
Doctors, trained in hyperbaric medicine, will also be in attendance at all times.