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."
Salvaging
limbs
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.
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