Content area
Full Text
ABSTRACT
The indications for the use of hyperbaric oxygen therapy have expanded greatly in the last 200 years. This article provides a brief history of hyperbaric oxygen, reviews the indications and contraindications for its use, and presents an overview of the hyperbaric oxygen program at a tertiary care facility. We describe three common indications for hyperbaric oxygen therapy: osteomyelitis, delayed radiation injury, and graft or flap compromise. We also discuss therapeutic protocols for treatment with hyperbaric oxygen at our facility. Patients with a wide range of diagnoses have access to hyperbaric oxygen therapy 24 hours per day and seven days per week at our facility, in addition to a well-qualified team of health care providers who strive to deliver optimal patient care.
Key words: hyperbaric oxygen therapy, chronic wound, chronic osteomyelitis, diabetic foot ulcer, transcutaneous oxygen measurement.
Hyperbaric oxygen therapy (HBOT) is a treatment technique in which a patient breathes 100% oxygen in an enclosed chamber at pressures two to three times greater than ambient atmospheric pressure. This technique offers multiple positive physiologic effects, including increasing the arterial partial pressure of oxygen to more than 1,000 mm Hg and facilitating oxygen delivery to hypoxic tissue.1 Clinicians have used HBOT as a therapeutic modality for more than 200 years, and the first US hyperbaric chamber was built in New York in 1861.2 Historically, clinicians most commonly used HBOT to cure patients with decompression sickness (ie, the bends). Its uses have expanded to include treatment of foot ulcers in patients with diabetes, ischemic ulcers, chronic osteomyelitis, radiation injury, failed grafts or flaps, carbon monoxide poisoning, necrotizing soft tissue infections, and central retinal artery occlusion.1,3 Certain risks are associated with HBOT, including otic barotrauma, oxygen toxicity, transient myopia, and fire hazards. However, the reported severity of these risks is mild and the incidence of these complications is low.2 The only absolute contraindication for HBOT is an untreated pneumothorax, although there are many relative contraindications that enter into the decision of whether or not to use HBOT. These relative contraindications include poorly controlled seizure disorder, congestive heart failure, pulmonary disease, and severe claustrophobia.4
HBOT CHAMBERS
There are two types of hyperbaric chambers: the monoplace chamber and the multiplace chamber. As the name suggests, a monoplace chamber is equipped...