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By Martye L. Marshall, MD, Wound Care
The Chester County Hospital and Health System
Published: May 9, 2011
Hyperbaric oxygen therapy (HBOT) is a medical treatment during which a patient breathes a higher concentration of oxygen at a higher-than-usual atmospheric pressure. Usually, the air we breathe is about 20% oxygen (most of the other 80% is nitrogen), and the pressure is equal to the usual atmospheric pressure (also known as the barometric pressure, the familiar weather forecast measurement). HBOT uses 100% oxygen at increased barometric pressure while the patient is in a clear acrylic treatment chamber. When pressurized this way, oxygen behaves as a drug; for this reason, hyperbaric chambers are FDA-cleared medical devices for the treatment of specific conditions. HBOT can be helpful in treating selected medical conditions, such as diabetic foot ulcers, and wounds caused by the effects of the radiation therapy used for managing cancer.
Approximately 800,000 people will undergo radiation therapy this year as part of their cancer treatment. Many of these patients will be long-term survivors and may develop a side effect months or years after they are treated. The exact mechanism of delayed radiation injury is not entirely known, but it is felt that the inflammation of the blood vessels causes eventual damage to these vessels and scars the tissues. Since the blood vessels transport oxygen to all the tissues in the body, a reduction in their number leads to inadequate levels of oxygen in the affected area of the body. Such areas may include the skin that was in the field of radiation, or it may be any vulnerable deeper tissues including the inside of the throat, mouth and cheeks, voice box, bladder or bowel.
When there is insufficient blood and oxygen delivered to any part of the body, the affected tissue begins to die. This may present itself as a non-healing wound -- as in the case of the skin--or as pain or bleeding because of damage to other tissues such as the bladder (radiation cystitis) or rectum (radiation proctitis). If these side effects don';t self-heal, they may become chronic or progressive. HBOT can be a beneficial treatment for these types of wounds because hyperbaric oxygen can induce blood vessel growth (angiogenesis) after two weeks of treatment (the process can occur on its own, but commonly takes longer).
When HBOT is appropriate for the treatment of diabetic foot ulcers, the oxygen has a two-fold effect. In addition to blood vessel re-growth, it also controls infection. Many infections thrive in the absence of oxygen. By introducing high concentrations of oxygen to the wound, the increased blood flow and infection control help heal the skin ulcer. Often times, HBOT helps in situations where amputations might otherwise be considered and necessary. While the lifetime cost of care for an individual post-amputation could exceed $500,000, a course of HBOT can cost less than $20,000.
Patients are generally treated for 90-minutes sessions, five-days-a-week for 30 total treatments. Extended regimes may be required if symptoms have been present for a long time. Hyperbaric oxygen therapy is becoming increasingly available for these complications, and is safe with proper patient selection. Serious lung disease or an inability to follow the therapy plan could exclude a patient from treatment. Although some patients are anxious about being in the HBOT treatment unit, they are often surprised by how open and roomy the clear acrylic chamber actually feels. There are strict safety guidelines about what can be worn or brought into the chamber, but a TV is easily viewed for entertainment purposes. A registered nurse is in constant attendance and a physician is available at all time. Patients have felt their commitment to these sessions was well worth the benefit.
This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.
Last Updated: 5/10/2011