It used to be associated with treating "the bends," but breathing pure oxygen can promote healing in other ways as well.
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Hyperbaric oxygen treatment can help heal traumatic injuries.
By Magaly Olivero Oct. 6, 2014 |
At first glance, the room resembles a scene from a science fiction movie: People lying in cylindrical chambers breathing 100 percent oxygen to boost the body’s natural healing process and promote the growth of new blood vessels in areas ravaged by disease.
It’s actually a scene being replicated at hospitals across the country as more Americans turn to hyperbaric oxygen therapy to treat serious conditions, such as chronic wounds, diabetic foot ulcers, radiation injury, bone infections, burns, carbon monoxide poisoning, compromised skin grafts and more.
“Hyperbaric medicine is an incredibly powerful tool. It can be as helpful and therapeutic as a surgical scalpel in the right patient for the right indication. We’re seeing a rise in specialized wound and hyperbaric centers across the United States,” says Dr. Jeffrey Niezgoda, president of the American College of Hyperbaric Medicine.
Nationwide, an estimated 1,800 to 2,000 hospitals offer hyperbaric oxygen therapy and about 500 to 700 non-hospital based programs offer the treatment, said John Peters, executive director of the Undersea and Hyperbaric Medicine Association. Almost all hospital-based programs strictly treat “indications that have been scientifically validated” by the U.S. Food and Drug Administration and UHMS, he says. Non-hospital based hyperbaric oxygen programs are more likely to offer “off-label” treatments.
Boosting oxygen levels
For decades, many people have associated hyperbaric medicine with the treatment of decompression sickness, known as “the bends,” that can strike divers who surface too quickly.
Today, hyperbaric oxygen therapy is a mainstream treatment administered in pressurized mono (single person) or multiplace chambers that can hold a dozen or more people. Patients breathe pure 100 percent oxygen under atmospheric pressure up to three times higher than normal, which significantly boosts the amount of oxygen in the blood stream. The oxygen-rich blood bathes damaged tissue, stimulating the release of chemicals that promote healing, including the formation of new blood vessels, experts say.
“We’re seeing a growing need for hyperbaric oxygen therapy services in the community,” says Peters. “We’re an aging society and with that come significant challenges to healing.”
But not all patients qualify for hyperbaric oxygen therapy and some experts caution consumers to only seek treatment for the 13 FDA-approved conditions: air or gas embolism, carbon monoxide poisoning, gas gangrene, crush injury, decompression sickness, arterial insufficiencies, severe anemia, intracranial abscesses, necrotizing (dying) soft tissue infections, osteomyelitis or chronic bone infections, delayed radiation injury, compromised skin grafts and flaps and acute thermal burn injury.
“Hyperbaric oxygen therapy is not the magic bullet,” says Dr. Timothy Manoni, medical director of the Wound Care and Hyperbaric Center at Stamford Hospital in Connecticut. He sayssome patients mistakenly believe that hyperbaric oxygen therapy can cure cancer, Parkinson’s disease, Alzheimer’s disease and other conditions. “These are non-evidence based uses for hyperbaric oxygen therapy.”
Treating radiation damage
People with chronic bone and soft tissue damage caused by radiation to treat cancer represent a large portion of the patients seeking help at the Hyperbaric Medicine Center at the Beaumont Health System in Michigan, says Dr. Farris Gulli, its medical director. The center’s hyperbaric chamber fits up to a dozen people.
“Radiation therapy does a very good thing – it kills cancer cells. But it also damages the tiny blood vessels that feed the cells,” says Gulli. “About five to 15 percent of cancer patients can experience chronic complications from radiation therapy.”
Breast cancer survivors, for example, can develop severe chest wounds. Patients with head and neck cancers who received high doses of radiation to the jawbone risk bone damage. People treated with radiation to the pelvic area can experience bladder problems.
"In these cases, the lining of the bladder becomes damaged because of the lack of blood flow. The damage can lead to blood in the urine which could require blood transfusions," explains Gulli. “But with hyperbaric oxygen therapy, we grow new capillaries and the bleeding stops in a significant portion of our patients."
For people with diabetes who have advanced foot ulcers, hyperbaric oxygen therapy can “mean the difference between being able to walk and being disabled for the rest of their life,” says Dr. Anna Flattau, medical director of the Hyperbaric Medicine Program at Montefiore Medical Center in New York.
Poor blood circulation and nerve damage put people with diabetes at risk of developing foot ulcers that can become seriously infected and lead to amputation. About 60 percent of non-traumatic lower limb amputations occur in adults with diabetes, according to the U.S. Centers for Disease Control and Prevention.
Montefiore focuses on preventing diabetes and keeping people with diabetes healthy, says Flattau. But if complications such as advanced foot ulcers arise, hyperbaric oxygen therapy administered in conjunction with antibiotics and other interventions may be warranted.
“It makes a huge difference in the lives of patients,” she says. “The goal is to reduce amputations in our community.”
Controversial “off label” uses
The use of hyperbaric oxygen therapy to treat “off label” conditions that haven’t been approved by the FDA – such as traumatic brain injury, autism, stroke, Parkinson’s disease, cerebral palsy, multiple sclerosis, Alzheimer’s disease and more – remains controversial. Many experts say patients should only receive off-label treatments if they are participating in a research study.
But Dr. Carol Henricks, a neurologist at Northstar Hyperbaric in Arizona, calls the FDA’s narrow focus a “terrible shame.” She believes the nation “could dramatically reduce pain and suffering if we used hyperbaric oxygen therapy to its true potential.” The International Hyperbaric Medical Association, for example, recognizes the use of hyperbaric oxygen therapy for neurological conditions. These days, Henricks’ "biggest focus" is treating veterans suffering from “brain blast injury” as a result of being exposed to explosions. These veterans develop brain injuries and post-traumatic stress disorder with symptoms such as sleep difficulties, headaches, short-term memory loss and chronic confusion. "The first thing to happen (after hyperbaric treatment) is that they sleep through the night for the first time since being injured," she says. "Then their headaches go away and over time they get more clear thinking." Henricks began using hyperbaric oxygen therapy 11 years ago after hearing from European doctors about its benefits in minimizing brain damage in stroke victims. She prescribed the treatment for some of her most challenging patients and the “results were tremendous.”
“The genie was out of the bag,” she says. “There was no turning back.”
Although some studies show "very positive outcomes," the use of hyperbaric oxygen therapy to treat traumatic brain injury remains “investigational,” says Niezgoda. Despite its potential, experts said the future of hyperbaric oxygen therapy could be tempered by government concerns about unauthorized uses of the treatment.
The Centers for Medicare and Medicaid Services (CMS) this year implemented a prior authorization program in Illinois, Michigan and New Jersey “to address growing concerns” about patients receiving non-medically necessary hyperbaric oxygen therapy. In 2000, CMS paid $14.2 million to patients who received treatment for non-covered conditions or had inadequate documentation and another $4.9 million on excessive treatments.
“We need to do a better job of policing ourselves,” says Niezgoda.