Frequently asked questions about hyperbaric oxygen therapy

Essentially, hyperbaric oxygen treatments use a combination of elevated ambient pressure and inspired oxygen concentration to greatly increase the amount of oxygen in the blood. This elevated oxygen concentration allows oxygenation of tissues that are not getting enough oxygen at baseline, encourages new blood vessels to grow into these oxygen deprived tissues, and helps the body eliminate certain kinds of bacteria. Read more about how it works.

There are 14 indications that are approved to be treated by the Hyperbaric Oxygen Therapy Committee:

1. Air or gas embolism – when gas bubbles enter arteries or veins
2. Carbon monoxide poisoning – when carbon monoxide is inhaled and injuries arise from that
3. Clostridial myositis and myonecrosis – a rapidly progressive infection of the soft tissue, known commonly as "gas gangrene"
4. Crush injury, compartment syndrome, and other acute traumatic ischemias – injuries that result from trauma, from minor contusions to limb threatening damage
5. Decompression sickness – referred to as the "bends," is the formation of inert gas bubbles in tissue, usually caused by rapid ascent from a dive.
6. Arterial insufficiencies – wounds that are not healing properly
7. Severe anemia – a loss of red blood cell mass due to hemorrhage, hemolysis, or aplasia
8. Intracranial abscess – an inflammation caused from infected material coming from local or remote infectious sources
9. Necrotizing soft tissue infections – a rare but severe type of bacterial infection that can cause tissue death
10. Osteomyelitis – an infection of bone or bone marrow
11. Delayed radiation injury (soft tissue and bony necrosis) – some radiation treatments leave patients with cell damage to soft tissue (such as mouth, throat, and the gastrointestinal tract).
12. Compromised grafts and flaps – when a skin graft does not heal properly
13. Acute thermal burn injury – severe burns that can be treated with enhanced oxygen
14. Idiopathic sudden sensorineural hearing loss – hearing loss caused by a malfunction in a certain nerve in the brain

Of course, each patient's experience will be somewhat different, but in general, the following events will occur:

• You will be seen by the hyperbaric physician who will perform a history and physical. He or she will determine if hyperbaric treatments are appropriate for you, order any necessary tests, and discuss the treatment options.
• You will speak with a respiratory therapist who will discuss in detail the sequence of events during a dive, discuss the scheduling of treatments, and review applicable risks and safety precautions.
• If you are being seen because of a chronic wound, pictures will be taken to help judge the progress of treatments and a trans-cutaneous oxygen measurement test (TCOM) may be performed.

There are several stages during a typical treatment (or dive).

• The first stage is compression (or diving) in which the chamber is pressurized to the prescribed pressure (or depth), most commonly 2.4 atmospheres absolute (the equivalent of 45 feet below the surface of the ocean, i.e. 45 feet of sea water).
• The chamber is maintained at this pressure (depth) and patients breathe 100 percent oxygen via a hood.
• Patients are given two air breaks during this oxygen-breathing period where they can take off the hood to get a drink of water, etc.
• After the oxygen periods are finished, the chamber is depressurized (or surfaced) and the treatment is finished.

A typical treatment generally lasts a bit over two hours. Of course, treatments can sometimes take longer, especially if patients have difficulty clearing their ears during the pressurization phase.

The number and frequency of treatments needed varies with the specific condition that is being treated. For many conditions, one treatment a day (Monday through Friday) is given for a total of 20 to 30 treatments, usually a total of four to six weeks.

Yes. The Undersea and Hyperbaric Medicine Society has recommended hyperbaric oxygen treatments for several disease states. Medicare and private insurers, to a greater degree, have accepted these recommendations and will pay for HBO treatments for these indications. However, if there are any questions about insurance coverage, our billing staff can look into the matter and confirm coverage prior to starting treatments.

Basically, much of the technology and information that we currently use in clinical hyperbaric oxygen therapy was developed by the world's navies during World War Two as a result of the development of military divers (”frogmen”) and underwater demolitions.

In addition, many of the pioneers of hyperbaric medicine were from a military background, and many current practitioners became interested in hyperbaric medicine through diving-related experiences. Thus, this diving-related terminology continues to be used even though clinical hyperbaric practice has evolved away from it's underwater beginnings.

Yes, chambers are classified into two categories: monoplace and multiplace.

Monoplace chambers

Monoplace chambers are defined as a chamber that is designed to accommodate only one patient at a time. Generally, these consist of an acrylic tube with a door at one end through which the patient is inserted into the chamber. They can be compressed with either air or oxygen. These chambers have the advantage of needing less physical space, and tend to be less expensive to purchase, maintain, and staff. The disadvantages are that they allow only limited access to the patient and tend to restrict patient positioning.

Multiplace chambers

Multiplace chambers are designed to accommodate two or more patients. Some of these chambers are massive and can hold 20 or more people. Thus, they require a large physical space and significant infrastructure to operate, and can be very expensive to acquire, maintain, and staff. The advantages are that they allow for an inside attendant so full access to all patients is possible, which makes caring for very ill patients easier. Also, their size tends to minimize claustrophobia in susceptible patients.

The Dr. Peter J.R. Jebson Hyperbaric Medicine Facility uses a multiplace chamber that can hold six patients and one therapist. It is the largest hyperbaric chamber in the state of Iowa and the only multiplace chamber in the Midwest that admits emergency patients and operates 24 hours a day, seven days a week.