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Hyperbaric


Medicare, Medicaid, and many insurance companies generally cover hyperbaric oxygen therapy for these conditions, but may not do so in every case. Check with your insurance plan to see if it is covered and if you need pre-authorization before treatment.




hyperbaric



The most common complication after HBOT is trauma to the middle ear. Other possible complications are eye damage, lung collapse, low blood sugar, and sinus problems. In rare, severe cases, a person can get oxygen poisoning. This can lead to seizures, fluid in the lungs, lung failure, or other problems. Considering the possible risks and benefits, the decision to use hyperbaric oxygen therapy must be carefully made after a discussion with your healthcare provider.


Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized environment. Hyperbaric oxygen therapy is a well-established treatment for decompression sickness, a potential risk of scuba diving. Other conditions treated with hyperbaric oxygen therapy include:


In a hyperbaric oxygen therapy chamber, the air pressure is increased 2 to 3 times higher than normal air pressure. Under these conditions, your lungs can gather much more oxygen than would be possible breathing pure oxygen at normal air pressure.


Hyperbaric oxygen therapy is used to treat several medical conditions. And medical institutions use it in different ways. Your health care provider may suggest hyperbaric oxygen therapy if you have one of the following conditions:


For your safety, items such as lighters or battery-powered devices that generate heat are not allowed into the hyperbaric chamber. You also may need to remove hair and skin care products that are petroleum based, as they are a potential fire hazard. Your health care team will provide instruction on preparing you to undergo hyperbaric oxygen therapy.


To benefit from hyperbaric oxygen therapy, you'll likely need more than one session. The number of sessions depends upon your medical condition. Some conditions, such as carbon monoxide poisoning, might be treated in three visits. Others, such as nonhealing wounds, may require 40 treatments or more.


To effectively treat approved medical conditions, hyperbaric oxygen therapy is usually part of a broad treatment plan. This plan may include other therapies and medicines that are designed to fit your unique needs.


Hyperbaric medicine is medical treatment in which an ambient pressure greater than sea level atmospheric pressure is a necessary component. The treatment comprises hyperbaric oxygen therapy (HBOT), the medical use of oxygen at an ambient pressure higher than atmospheric pressure, and therapeutic recompression for decompression illness, intended to reduce the injurious effects of systemic gas bubbles by physically reducing their size and providing improved conditions for elimination of bubbles and excess dissolved gas.


The equipment required for hyperbaric oxygen treatment consists of a pressure chamber, which may be of rigid or flexible construction, and a means of delivering 100% oxygen. Operation is performed to a predetermined schedule by trained personnel who monitor the patient and may adjust the schedule as required. HBOT found early use in the treatment of decompression sickness, and has also shown great effectiveness in treating conditions such as gas gangrene and carbon monoxide poisoning. More recent research has examined the possibility that it may also have value for other conditions such as cerebral palsy and multiple sclerosis, but no significant evidence has been found.


Therapeutic recompression is usually also provided in a hyperbaric chamber. It is the definitive treatment for decompression sickness and may also be used to treat arterial gas embolism caused by pulmonary barotrauma of ascent. In emergencies divers may sometimes be treated by in-water recompression (when a chamber is not available) if suitable diving equipment (to reasonably secure the airway) is available.


Hyperbaric medicine includes hyperbaric oxygen treatment, which is the medical use of oxygen at greater than atmospheric pressure to increase the availability of oxygen in the body; and therapeutic recompression, which involves increasing the ambient pressure on a person, usually a diver, to treat decompression sickness or an air embolism by eliminating bubbles that have formed within the body.[citation needed]


In the United States the Undersea and Hyperbaric Medical Society, known as UHMS, lists approvals for reimbursement for certain diagnoses in hospitals and clinics. The following indications are approved (for reimbursement) uses of hyperbaric oxygen therapy as defined by the UHMS Hyperbaric Oxygen Therapy Committee:[1][2]


There is no reliable evidence to support its use in autism, cancer, diabetes, HIV/AIDS, Alzheimer's disease, asthma, Bell's palsy, cerebral palsy, depression, heart disease, migraines, multiple sclerosis, Parkinson's disease, spinal cord injury, sports injuries, or stroke.[43][44][45] Furthermore, there is evidence that potential side effects of hyperbaric medicine pose an unjustified risk in such cases. A Cochrane review published in 2016 has raised questions about the ethical basis for future clinical trials of hyperbaric oxygen therapy, in view of the increased risk of damage to the eardrum in children with autism spectrum disorders.[46] Despite the lack of evidence, in 2015, the number of people utilizing this therapy has continued to rise.[47]


There is limited evidence that hyperbaric oxygen therapy improves hearing in patients with sudden sensorineural hearing loss who present within two weeks of hearing loss. There is some indication that HBOT might improve tinnitus presenting in the same time frame.[49]


As of 2012, there was no sufficient evidence to support using hyperbaric oxygen therapy to treat people who have traumatic brain injuries.[52] In acute stroke, HBOT does not show benefit.[53][45] Small clinical trials, however, have shown benefits from HBOT for stroke patients between 6 months to 3 years after the acute phase.[54][55]


In alternative medicine, hyperbaric medicine has been promoted as a treatment for cancer. However, a 2011 study by the American Cancer Society reported no evidence it is effective for this purpose.[59] A 2012 review article in the journal, Targeted Oncology, reports that "there is no evidence indicating that HBO neither acts as a stimulator of tumor growth nor as an enhancer of recurrence. On the other hand, there is evidence that implies that HBO might have tumor-inhibitory effects in certain cancer subtypes, and we thus strongly believe that we need to expand our knowledge on the effect and the mechanisms behind tumor oxygenation."[60]


Low-quality evidence suggests that hyperbaric oxygen therapy may reduce the pain associated with an acute migraine headache in some cases.[61] It is not known which people would benefit from this treatment, and there is no evidence that hyperbaric medicine can prevent future migraines.[61] More research is necessary to confirm the effectiveness of hyperbaric oxygen therapy for treating migraines.[61]


The toxicology of the treatment has been reviewed by Ustundag et al.[64] and its risk management is discussed by Christian R. Mortensen, in light of the fact that most hyperbaric facilities are managed by departments of anaesthesiology and some of their patients are critically ill.[65]


An absolute contraindication to hyperbaric oxygen therapy is untreated pneumothorax.[66] The reason is concern that it can progress to tension pneumothorax, especially during the decompression phase of therapy, although treatment on oxygen-based tables may avoid that progression.[67] The COPD patient with a large bleb represents a relative contraindication for similar reasons.[68][page needed] Also, the treatment may raise the issue of Occupational health and safety (OHS), which has been encountered by the therapist.[69][clarification needed]


The traditional type of hyperbaric chamber used for therapeutic recompression and HBOT is a rigid shelled pressure vessel. Such chambers can be run at absolute pressures typically about 6 bars (87 psi), 600,000 Pa or more in special cases.[81] Navies, professional diving organizations, hospitals, and dedicated recompression facilities typically operate these. They range in size from semi-portable, one-patient units to room-sized units that can treat eight or more patients. The larger units may be rated for lower pressures if they are not primarily intended for treatment of diving injuries.[citation needed]


There are several sizes of portable chambers, which are used for home treatment. These are usually referred to as "mild personal hyperbaric chambers", which is a reference to the lower pressure (compared to hard chambers) of soft-sided chambers.


Oxygen is never fed directly into soft chambers but is rather introduced via a line and mask directly to the patient. FDA approved oxygen concentrators for human consumption in confined areas used for HBOT are regularly monitored for purity (+/- 1%) and flow (10 to 15 liters per minute outflow pressure). An audible alarm will sound if the purity ever drops below 80%. Personal hyperbaric chambers use 120 volt or 220 volt outlets.


There are reports that cataracts may progress following HBOT'[94] and rarely, may develop de novo, but this may be unrecognised and under reported. The cause is not fully explained, but evidence suggests that lifetime exposure of the lens to high partial pressure oxygen may be a major factor. Oxidative damage to lens proteins is thought to be responsible. This may be an end-stage of the relatively well documented myopic shift detected in most hyperbaric patients after a course of multiple treatments.


Orval J Cunningham, a professor of anaesthesia at the University of Kansas in the early 1900s observed that people with circulatory disorders did better at sea level than at altitude and this formed the basis for his use of hyperbaric air. In 1918, he successfully treated patients with the Spanish flu with hyperbaric air. In 1930 the American Medical Association forced him to stop hyperbaric treatment, since he did not provide acceptable evidence that the treatments were effective.[113][62]


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