Hyperbarics is expensive but has multiple uses

Medicare payments fall short of cost

Hyperbaric oxygen therapy (HBO2) is not cheap, costing as much as $360 per hour for each patient. The Medicare allowance for HBO2is about $150 per patient per session, which is lower than the cost of hypberbaric operation for many hospitals, saysMichael Capria, DC, director of the Tampa (FL) Hyperbaric Enterprise. As the use of HBO2increases in the United States, Capria predicts that costs will fall. 

The cost of a single-person (monoplace) hyperbaric chamber ranges from $94,000 to $135,000, says Caryn Oldham, marketing manager at Sechrist Industries, a provider of wound healing services in Anaheim, CA. Multiplace chambers can cost as much as $800,000. Monoplace chambers, while small and usually mounted on wheels, are not truly portable because they require a hookup to a steady gas supply. Capria’s company offers a truly portable hyperbaric chamber trailer for $155,000 (plus a delivery charge of $1 per mile from Tampa). The unit is equipped with a television to provide patients with something to do during the two-hour sessions.

Wound care and more

HBO2 is an established therapeutic regimen and has been used for decades to treat decompression sickness among scuba divers. Several hundred systems operate in the United States, and there are an estimated 1,200 hypberbaric chambers in Russia, 800 in China, and hundreds throughout Europe. Modern therapy dates to the early 1960s, when Dutch investigators demonstrated the efficacy of HBO2 for treating gas gangrene and anemic states. 

The Undersea and Hyperbaric Medical Society lists 13 indications for hyperbaric oxygen therapy. Though many of these conditions seem unrelated, they all respond to increased oxygen pressure: 

1. air or gas embolism; 

2. carbon monoxide poisoning and smoke inhalation; 

3. clostridial myonecrosis (gas gangrene); 

4. crush injury, compartment syndrome, and other acute traumatic ischemias; 

5. decompression sickness; 

6. enhancement of healing in selected problem wounds; 

7. exceptional blood loss (anemia); 

8. necrotizing soft tissue infections (subcutaneous tissue, muscle, fascia); 

9. osteomyelitis (refractory); 

10. radiation tissue damage; 

11. skin grafts and flaps (compromised); 

12. thermal burns; 

13. intracranial abscess. 

Exposing the body to pressurized 100% oxygen results in several beneficial physiological processes: 

Hyperoxygenation: A ten- to fifteenfold increase in the level of blood plasma oxygen concentration and resultant heightened perfusion of oxygen ischemic tissue. 

Neovascularization: Multiple HBO2 sessions cause angiogenesis and enhanced fibroblast division and collagen formation. 

Increased antimicrobial activity: The application of hyperbaric oxygen therapy appears to activate phagocytes and "turbocharge" their pathogen-destroying activities. 

Direct pressure: HBO2 reduces the volume of free-floating intravascular gasses. This process is what makes the treatment so effective against decompression sickness and arterial gas embolism. 

Vasoconstriction: Useful for managing intermediate compartment syndrome and other acute ischemias common to injured extremities. Vasoconstriction appears to reduce the fluid resuscitation needs of burn patients. 

Attenuation of reperfusion injury: This is a recently discovered action of hyperbaric oxygen therapy in which the inappropriate activation of leukocytes following ischemia-reperfusion injury is reduced. 

Chronic wounds often heal faster when HBO2 is applied as an adjunctive therapy. A regimen of "standard" wound care usually precedes the use of HBO2. But other conditions, both related and unrelated to chronic wounds, also benefit from HBO2

Gangrene from anaerobic spore-forming clostridia bacteria often turns deadly. These microorganisms can infect wounds and lead to progressive damage. Often, the involved tissue is surgically removed to prevent the progression of the infection. Hyperbaric oxygen can help physicians distinguish healthy tissue from dead unsalvageable tissue, thus allowing more precise limb-sparing surgery. 

Severe, destructive soft-tissue infections in muscle and deep skin layers improve measurably under the high oxygen pressure of the hyperbaric chamber. Among these conditions is purulent skin disease with ulceration. Usually, physicians prescribe a course of antibiotic therapy first and only use hyperbaric therapy as an adjunct to the antibiotics.

An adjunct to other treatments

Tissue damage from radiation therapy often improves faster with HBO2. Impaired circulation often leads to necrosed, dead tissue. Hyperbaric pressure improves oxygen diffusion into the area and buys time for surrounding tissue to survive and recover. 

Compromised skin grafts improve more quickly under hyperbaric oxygenation. These skin grafts are often difficult to heal and have poor prognosis. 

Thermal burns also appear to benefit somewhat from hyperbaric therapy when it is used as an adjunct to proper surgical debridement and medicine. Again, the key here is that hyperbaric oxygenation remains an adjunct to other accepted surgical or medical interventions. The normal course of tissue swelling is reduced by hyperbaric oxygen as it causes the swollen blood vessels to constrict, yet the higher oxygen levels protect the tissue and encourage new tissue regeneration. 

Hyperbaric compresses an air or gas embolism that may damage vital nerve or circulatory tissue to a size at which it can pass through the affected area. Pressures up to six atmospheres (six times greater than air pressure at sea level) may be necessary to relieve the neurological damage of these emboli. 

Decompression sickness, commonly called the bends, is caused by expanding nitrogen gas bubbles in the bloodstream that develop when scuba divers ascend too quickly or stay underwater too long. Excruciating pain, neurological damage, or death can result. Hyperbaric compression at three atmospheres, with long gradual decompression and oxygen inhalation, eliminates the nitrogen bubbles. 

Carbon monoxide poisoning, smoke inhalation, or a combination of either one with cyanide poisoning benefit from HBO2 at three atmospheres (many industrial fires emit cyanide gas). The higher blood plasma oxygen concentrations relieve the oxygen deficit associated with the impairment of red blood cells.
Suggested reading
Davis JC, Hunt TK, eds. Problem Wounds: The Role of Oxygen. New York, NY: Elsevier Science Publishing Company; 1988.
Davis JC, Hunt TK, eds. Hyberbaric Oxygen Therapy. Kensington, MD: Undersea and Hyperbaric Medical Society; 1977.
Kindwall EP, ed. Hyperbaric Medicine Practice. Flaggstaff, AZ: Best Publishing Company; 1995.
Kindwall EP, Goldman RW. Hyperbaric Medicine Procedures, Milwaukee, WI: St. Lukes Medical Center; 1995.