HBOT as a Standard of Care


Doctors should always consider the established standard of care when prescribing treatment to a patient.

In Western Medicine, the “standard of care” is a term used by clinicians to describe the established medical protocol for the treatment or management of a disease or affliction, whether it be chronic (recurring) or acute (“random” occurrence in the patient).

When it was first introduced and practiced in the United States (circa 1970), hyperbaric medicine was an unregulated medical practice. Thankfully, because of the efforts of medical societies such as the Undersea and Hyperbaric Medical Society (UHMS), the American College of Hyperbaric Medicine (ACHM), and the efforts of hyperbaric pioneers such as Dr. Eric Kindwall, Dr. George Hart, Dr. Robert Borer, Dr. Harry Whelan, Dr. James Clark, Dick Clark, Jefferson C. Davis, Dr. Paul Sheffield, and many others during the infancy of HBOT, it has grown into a de facto sub-specialty, complete with a growing community of reputable and responsible clinicians, scientists, technicians, engineers, and champions who distinguish themselves as both self-governing of the existing practice of HBO, and ambitious in their efforts to grow the specialty, either through research or outreach.

Through their tireless efforts, the UHMS have successfully petitioned the U.S. Food and Drug Administration (FDA) for “label use” of hyperbaric oxygen for the following conditions, which are widely reimbursed by third-party insurers in the clinical practice of HBOT if they are appropriately documented because of the extensive reputable medical research surrounding them, and because of the significant improvement that HBO represents, either as a shorter length of treatment, or by a significantly improved clinical outcome compared to “conservative” or “traditional” care.

The following list of the 14 indications for treatment with hyperbaric oxygen is available through the UHMS, and should be considered by clinicians and physicians alike as the standard of care for patients presenting with these afflictions at facilities where hyperbaric oxygen therapy is an option.

  1. Air or Gas Embolism
  2. Carbon Monoxide (CO) Poisoning
  3. Gas Gangrene
  4. Crush (Pressure Related) Injury / Acute Traumatic Ischemia
  5. Decompression Sickness (DCI), “The Bends”
  6. Arterial Insufficiency (“Problem” Wounds, Central Artery Occulsion)
  7. Severe Anemia
  8. Intracranial Absess
  9. Necrotizing (“Flesh Eating”) Soft Tissue Infections
  10. Osteomyletis (Refractory)
  11. Radiation Injury (Osteo Radio-Necrosis / Soft Tissue Radio-Necrosis)
  12. Compromised Skin Grafts/Flaps
  13. Acute Thermal Burns
  14. Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) [Approved; UHMS , Oct. 2011)

NOTE: In the absence of availability of a hyperbaric facility, conventional treatment for these conditions is acceptable until the patient can be safely treated with hyperbaric oxygen.  

Despite the UHMS’ appropriately labeling “problem” wounds as an indication for HBO, most third-party insurers, including CMS, will only reimburse treatment of GRADE (III) WAGNER (or higher) DIABETIC FOOT ULCERS. This is chiefly due to the “non-specific” language used in studies demonstrating hypoxic wound improvement presented to third party payers.

CONSIDERATION: ADJUNCTIVE WOUND CARE THERAPY

Although hyperbaric oxygen is considered part of the standard of care for many conditions treated within the specialty of wound care, it is important to note that in most cases, hyperbaric oxygen is used alongside to other techniques for treatment and healing of a patient’s wound-related problem. Patients receiving HBO should also be treated with traditional measures.

CONSIDERATION: TRANSCUTANEOUS OXYGEN MONITORING

T.C.O.M.s are a measurement of capillary oxygen perfusion. Leads can be placed at specific points on the patient’s body, including an area where a physician may suspect hypoxia. T.C.O.M. studies are useful tools in the selection of prime candidates for HBO, as well as for amputation site selection, and to aid in the ruling out of certain vascular disorders. Further, T.C.O.M.s given periodically during the course of a prescribed treatment regiment, or during a specific treatment may provide a clinician with valuable information on the progress or stagnation of a patient’s healing response based on their oxygen tensions at a wound site. However, because of the length of time needed to conduct a T.C.O.M. study (most take between 45-60 minutes, at least), the costs associated with T.C.O.M. machines and maintenance, and because they are not required for reimbursement by third-party payers, T.C.O.M. studies are losing favor with the wound healing community in favor of faster measurements of similar factors, though none predict HBO results as well.

CONSIDERATION: HBO SURGERY

When it was first practiced, hyperbaric oxygen chambers were converted into surgical environments, where physicians operating on patients in cardiac distress could virtually guarantee myocardial tissue oxygenation and increase the potency of anesthesia. However, due to advanced in medical technology — specifically the heart/lung machine — hyperbaric surgery was quickly replaced as a standard of care for cardiac surgery. Nevertheless, because of its effectiveness, HBO Sx. might be an option to physicians who find themselves needing to perform emergency surgery in the middle of the ocean. (A possibility, since most diving operation ships do possess hyperbaric chambers, but do not possess heart/lung machines.)

CONSIDERATION: NEURONS AND HBO

Although some studies have been conducted and conclude that partial recovery of damaged/ischemic nerve cells is possible with immediate hyperbaric oxygen, it is important to remember that once a nerve cell is damaged (eg. the nerve cell has “died,” been rendered useless, or has prolonged hypoxia), it cannot be re-generated or re-animated due to the special properties of nerve cells.  Therefore, reputable physicians and scientists have unanimously concluded that treatment of neurological disorders, including autism, multiple sclerosis, cerebral palsay, T.B.I. (unless IMMEDIATELY treated),  PTSD, and Chronic Depression will have no improving or curing effect on the compromised neurological cell. HOWEVER, because HBO has been proven to oxygenate hypoxic brain tissue, future medical advancements such as stem cells may, when presented as adjunctive therapy to HBO, produce different results. Please always remember that any clinician offering to treat a patient with a neurological disorder in a non-research-based environment is administering off-label hyperbaric oxygen. Off-label therapy is most often paid for by the patient in cash, and has no real scientific basis.

CONSIDERATION: MYOCARDIAL INFARCTION AND HBO

Like neurons, once dead (due to hypoxia), cardiac cells cannot be re-produced or re-invigorated. Therefore, after an acute cardiac event, such as myocardial infarction, HBO would be ineffective. HOWEVER, studies have shown drastic improvement in patients receive hyperbaric oxygen at the time of an M.I. as compared to patients who did not.  Moreover, because of the increased partial pressure of oxygen in the plasma during HBOT, it is extremely unlikely that a patient receiving HBO would incur a spontaneous M.I. during treatment, or in the hours immediately thereafter.