ED: Hyperbaric Oxygen Treatment (HBOT) exposes an individual to near 100% oxygen while inside a treatment chamber at a pressure higher than sea level pressure. What is its role?

Dr Neil Banham, Medical Director, FSH Hyperbaric Medicine Unit

For clinical purposes, the pressure must equal or exceed 1.4 atmospheres absolute (ATA). Most HBOT in Australasia is performed at 2.4 ATA.

Fiona Stanley Hospital Hyperbaric Medicine Unit (HMU) is the state referral service for Diving and Hyperbaric Medicine providing a 24/7 on-call service. It is the only facility able to provide HBOT at pressure equal or greater than 1.4 ATA in Western Australia. FSH HMU has a new three compartment ‘multiplace’ chamber with the capability of treating intubated patients and two single occupant ‘monoplace’ chambers.

The Medicare Benefit Schedule has specific item numbers for HBOT. Accepted indications include decompression sickness and gas embolism, radiation tissue damage (including radiation cystitis and proctitis), problem wounds (especially diabetic foot wounds where the major vascular supply is present), necrotising infections (necrotising fasciitis and gas gangrene), acute ischaemia (retinal artery occlusion, failing flaps) and carbon monoxide poisoning.

These indications have a good evidence base. Often, HBOT is an adjunct to other therapies (good wound care for diabetic foot wounds, surgical debridement and antibiotics for necrotising fasciitis).

HBOT for radiation cystitis has shown to be effective in over 80% of cases – both in our experience and in the published literature. The usual course of HBOT for this is 30 sessions (2.5 hours per day, five days per week for six weeks) – not an insignificant time commitment.

Newer emerging indications with a developing evidence base include refractory fistulating Crohn’s disease and idiopathic sudden sensorineural hearing loss.

A quick internet search will reveal a multitude of other purported conditions which ‘hyperbaric therapy’ will cure including autism, cerebral palsy, Lyme disease, chronic fatigue syndrome and Alzheimer’s. Such providers administer ‘mild’ hyperbaric therapy (air compressed to 1.3 ATA) in inflatable chambers, for which there is no published evidence of benefit.

FSH HMU does not treat such referrals.

There are few contraindications to HBOT—the main being inability to equalise middle ear or sinus pressures and severe claustrophobia.

Significant complications are unusual. Mild middle ear barotrauma is not uncommon but easily managed. Transient worsening of myopia may occur during a course of treatment and is usually reversible over 6-8 weeks. Oxygen toxicity seizures are rare and self-limiting, being more common in patients on medications which may lower the seizure threshold.

Refer patients via phone (6152 5222), fax (6152 4943) or email (FSH.Hyperbaric@health.wa.gov.au). A list of accepted indications is on the FSH website.

Discussion or referral of difficult ‘fitness to dive’ cases is welcomed.

Key messages:

  • HBOT has an evidence base in certain conditions.
  • It is generally well tolerated.
  • FSH HMU is contactable 24/7.

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References available on request

Author competing interests, nil relevant disclosures. Questions? Contact the author at FSH.Hyperbaric@health.wa.gov.au

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