Wound Recovery and Hyperbaric Medicine Center at Kent Hospital offers wound care through an innovative, interdisciplinary approach.
What is hyperbaric oxygen therapy?
A medical treatment administered by delivering 100 percent oxygen at pressures greater than atmospheric (sea level) pressure to a patient in a specially designed acrylic chamber. Hyperbaric oxygen has powerful medicinal properties and has been proven effective as adjunctive therapy for indicated conditions.
How does hyperbaric oxygen therapy work?
Hyperbaric oxygen therapy saturates the patient's circulatory system with oxygen resulting in increased oxygen delivery to tissues. Specifically, hyperbaric oxygen therapy:
- Dissolves increased amounts of oxygen in to the blood plasma.
- Increases oxygen tension in hypoxic tissues.
- Enhances white blood cell activity at the wound site.
- Reduces edema by vasoconstriction.
- Blocks cytotoxic effects of carbon monoxide and hypoxia associated with cyanide poisoning.
- Accelerates formation of blood vessels (angiogenesis) and nerve endings in wounded tissue.
What are accepted indications?
The following is a partial list of conditions that have been approved for hyperbaric oxygen therapy by Medicare, the International Hyperbaric Medical Association (IHMA), the Undersea and Hyperbaric Medical Society (UHMS), and the American College of Hyperbaric Medicine (ACHM). It is very important to note that each organization has its own list of approved indications and the following list is a combination of those lists and not an approved list from any one organization listed here. In most cases, medical insurance carriers (including Medicare and Medicaid) provide coverage for hyperbaric oxygen therapy
- Carbon monoxide poisoning. Cyanide. Cerebral arterial gas embolism. Decompression sickness. Exceptional blood loss anemia. Necrotizing soft tissue infections (necrotizing fasciitis). Gas gangrene. Crush injury; compartment syndrome. Reattachment and suturing of limbs. Acute Peripheral ischemia (including compartment syndrome). Thermal burns.
- Enhancement of healing in selected problem wounds. Compromised skin graft flaps. Radiation necrosis. Refractory osteomyelitis. Refractory mycoses. Diabetic foot ulcers. Complications due to radiation treatment for cancer.
Hyperbaric oxygen therapy should not be a replacement for standard therapeutic measures. Depending on the response of the individual patient and the severity of the condition, treatment may range from less than one week to several months, the average being four to six weeks.
What are the treatment protocols?
The attending physician establishes treatment protocols. Oxygen when breathed under increased atmospheric pressure is a potent medicine with potential side effects. Safe time, dose, and depth limits have been established for hyperbaric oxygen exposure, and these limitations form the basis for today's treatment protocols. With the exception of carbon monoxide and/or cyanide poisoning, decompression sickness and cerebral arterial gas embolism, treatments last approximately two hours. Treatment is usually once a day five days per week. Treatment for the most acute cases is approximately 10 days, while chronic cases may require treatment for 30 days or more, and can be administered on an outpatient or inpatient basis. While receiving therapy, the critically ill patient may be provided with mechanical ventilation, IV therapy and invasive and noninvasive physiologic monitoring.
What is the hyperbaric chamber?
Our hyperbaric chamber is a steel and acrylic cylinder in which air can be compressed to a pressure that is greater than sea level. Most patients are treated at a pressure equivalent to two or two and a half times normal atmospheric pressure. Our 34-inch wide clear acrylic chamber provides a relaxing, non-claustrophobic setting. They are equipped with a comfortable stretcher which can be reclined or placed in a flat position. To further enhance patient comfort, music or movies can be played during treatments. Whenever the chamber is in use, medical personnel trained in hyperbarics are in constant contact via visual or audio communications.
How does a doctor prescribe HBO therapy?
Hyperbaric oxygen therapy is offered as a referral and consultation service. Referrals are telephoned or faxed to the Wound Recovery Center. A consultation appointment will be made for the patient once appropriate case documentation has been received. Referring physicians receive progress reports during treatment. Supportive clinical research is also available to interested health care professionals.
What should I do to prepare for a treatment?
After referral by your doctor and evaluation by a hyperbaric medicine specialist, you will be given detailed instructions. You will be asked not to wear the following materials while in the chamber:
- Hair oils.
- Hair spray.
- Petroleum or Vaseline products.
- Wigs or hair pieces.
- After shave.
- Synthetics (e.g. rayon, nylon, etc.).
Watches are not worn in the chamber because they may break under the increased pressure. Because the therapy involves 100 percent oxygen, any form of smoking material, lighters or matches are STRICTLY prohibited in the chamber and should not be used during therapy. Anything not specifically allowed in the chamber must not be taken in under any circumstances.
How will the treatment feel?
At the beginning of treatment (commonly referred to as a dive) you will feel the change in pressure in your ears (similar to the feeling you have while in an airplane). To equalize the pressure and avoid a feeling of fullness in your ears, you will be instructed how to equalize the pressure in your ears. By holding your nose and attempting to blow through it, or simply swallowing, air can be allowed to enter the middle ear cavity via the Eustachian tube. It is only necessary to do this during the first few minutes of the treatment. The remainder of your treatment should be a time for you to sleep, watch TV, or just relax. Patients of all ages generally tolerate the treatments very well.
Are there any side effects?
The most common side effect is barotrauma to the ears and sinuses caused by pressure changes. To minimize this risk, patients learn techniques to promote adequate clearing of the ears during compression. Other side effects are more rare, but may include oxygen toxicity, claustrophobia, and among diabetic patients, a drop in blood glucose. Occasionally some patients experience minor visual changes after several treatments, which is rare and self-correcting after the treatment ends. Other side effects are extremely rare.
Are there any other conditions where HBO therapy may not be appropriate?
Yes Untreated pneumothorax, congenital spherocytosis, disulfiram (Antabuse), doxorubicin (Adriamycin), cis-platinum, and mafenide acetate (Sulfamylon) may be contraindications. Each patient is evaluated to determine the relative risks and benefits of hyperbaric oxygen therapy.
What if I am a smoker?
To receive the maximum benefit from hyperbaric oxygen therapy, patients are encouraged not to smoke during the course of therapy. Smoking (even one cigarette) causes blood vessels to constrict, which decreases the blood and oxygen supply to tissue, counteracting the benefits of hyperbaric oxygen.
What are treatment schedules like?
It greatly depends on the nature of the illness and the facility. Patients with wound healing problems usually require about 30 treatments, Monday through Friday. Patients with acute diseases such as decompression illness or carbon monoxide poisoning usually need only one to two treatments. Treatments are not usually scheduled on weekends or holidays. Emergency treatments are administered at any time, 365 days per year.
Further information can be obtained by calling the Wound Recovery Center at Kent Hospital at 401-736-4646 or by visiting the Undersea and Hyperbaric Medicine Society website.