Definition and Description of Clinical Hyperbaric Oxygen Therapy (HBOT):

In the United States, hyperbaric oxygen therapy is recognized as a subspecialty by the American Board of Emergency Medicine (ABEM) and the American Board of Preventive Medicine (ABPM). The discipline is defined based on scientific principles, but understanding its appropriate practice also requires knowledge of its clinical implications and the risks associated with unproven practices.

Scientific Definition of Hyperbaric Oxygen (HBO2) Therapy:

Hyperbaric oxygen therapy is a medically supervised procedure. It involves placing the patient in a hard-sided hyperbaric chamber that complies with the American Society of Mechanical Engineers and Pressure Vessels for Human Occupancy (ASME-PVHO-1) code, and the National Fire Protection Agency (NFPA 99) code for hyperbaric chambers. The treatment requires exposure to medical grade oxygen (>99.0% purity) at pressures not less than 2.0 ATA (202.65 KPa) for a typical duration of 90-120 minutes.

Safe Delivery and Proven Applications of HBO2:

Proven applications of HBO2 are usually delivered at pressures between 1.9 to 3.0 ATA. These include treatments for conditions like decompression sickness, carbon monoxide poisoning, diabetic wounds, delayed radiation injury, necrotizing fasciitis, gas gangrene, refractory osteomyelitis, among others. Facilities must adhere to NFPA and ASME PVHO-1 standards or equivalent, with treatments prescribed and supervised by trained physicians. Most conditions require a series of daily treatments over several weeks.

Alternative Hyperbaric Treatment (Often Termed “Mild Hyperbaric Oxygen”):

Mild hyperbaric oxygen therapy, defined as treatment at pressures lower than 1.5 ATA, is considered unproven and often uses gas mixes with less than 95% O2. Such treatments are widely available in non-medical settings like wellness centers and health spas.

Indications for HBO2 Therapy:

  1. Air or Gas Embolism
  2. Carbon Monoxide Poisoning
  3. Carbon Monoxide Poisoning Complicated By Cyanide Poisoning
  4. Clostridial Myositis and Myonecrosis (Gas Gangrene)
  5. Crush Injury, Compartment Syndrome, and Other Acute Traumatic Ischemias
  6. Decompression Sickness
  7. Arterial Inefficiencies: Central Retinal Artery Occlusion
  8. Arterial Inefficiencies: Enhancement of Healing in Selected Problem Wounds
  9. Severe Anemia
  10. Intracranial Abscess
  11. Necrotizing Soft Tissue Infections
  12. Osteomyelitis (Refractory)
  13. Delayed Radiation Injury (Soft Tissue and Bony Necrosis)
  14. Compromised Grafts and Flaps
  15. Acute Thermal Burn Injury
  16. Idiopathic Sudden Sensorineural Hearing Loss (Approved in 2011)