A PROVIDER'S REFERENCE FOR CLINICAL HYPERBARIC OXYGEN THERAPY
Hyperbaric oxygen is the intermittent administration of 100% oxygen at pressure greater than that at sea level. At the Davis Hyperbaric Lab, this is accomplished in one of two multiplace or walk-in hyperbaric chambers. These chambers are pressurized with air to reach treatment depth. Once at "depth", the patient breathes 100% oxy-gen through a hood, mask, or endotracheal tube. Under these conditions, the arterial partial pressure of oxygen (P02) will approach 1,700 mm Hg at a pressure equiva-lent to 45 feet of sea water (2.4 ATA).
Hyperbaric oxygen therapy is the primary treatment for decompression sickness (the bends), arterial gas embolism and severe carbon monoxide poisoning. It has been shown to be an important and useful adjunct in the treatment of gas gangrene, chronic refractory osteomyelitis, radiation tissue damage, anaerobic infections, crush injury, compartment syndromes, and other acute traumatic ischemias. Enhancement of healing is common during and following hyperbaric therapy in selected problem wounds, including diabetic ulcers, arterial insufficiency ulcers, and mixed soft tissue infections. It is also utilized as an adjunct in necrotizing soft tissue infections of subcutaneous tissue, muscle and/or fascia (particularly in the compromised host). The use of adjunctive hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis and radiation necrosis of either bone or soft tissue is well accepted. Early adjunctive hyperbaric oxygen therapy has also been found to be beneficial in preservation of compromised skin grafts or flaps, or in preparation of a site for grafting. Additional considerations include thermal burns and excessive blood loss anemia.
During the late 1930's, oxygen at pressure was proposed as a treatment of decompression sickness. In the early 1960's Dutch investigators showed the efficacy of hyperbaric oxygen in the treatment of gas gangrene and anemic states. Later in that decade, hyperbaric oxygen therapy became the standard for naval diving accidents. Subsequent studies have shown the efficacy of oxygen in the treatment of wounds, enhancement of white cell killing ability, preservation of hypoxic tissue, and angiogenesis. The clinical indications for the use of adjunctive hyperbaric oxygen therapy continue to be defined.