An Overview: Hyperbaric Oxygen Therapy

My interest about Hyperbaric Oxygen Therapy (HBOT) first piqued when as an operating room nurse; I noticed that some patients were scheduled for a HBOT treatment prior to coming to the operating room for their wound debridements.

My curiosity lead me to talk with Dr. Robert Marx who was at that time one of the attending surgeon on the Oral and Maxillofacial surgical team at Jackson Memorial Hospital in Miami, Florida. He explained that the patients were sent to the HBOT treatment center where they were administered with 100% oxygen by inhalation inside the Hyperbaric Chamber which had a pressure greater than atmospheric pressure. This treatment enhances the healing process for patients with problem wounds that are difficult to heal it is used in conjunction with antibiotics and surgical debridement of the wounds. He also gave me some articles to read about this amazing treatment therapy.

This information sparked my interest more which led me to visit the HBOT center that was on site. After much discussion with Michelle Glowack, RN, in the department of anesthesia, division of hyperbaric and aquatic medicine about the topic, we decided to collaborate and write an article for the Association of Operating Room Nurses (AORN) Journal entitled "Hyperbaric Oxygen Therapy:" A Guide for the Perioperative Nurse." The article was published in June 1988. It was the cover story.

Read on and find out more about this interesting topic: Hyperbaric Oxygen Therapy.

Hyperbaric Oxygen Therapy was developed to treat the "Bends" which is also called Decompression sickness. This is a dangerous and occasionally fatal condition caused by nitrogen bubbles that form in the blood and other tissues of scuba divers when they surface too quickly. The symptoms are severe pain in the joints and chest, skin irritation,nausea, cramps and paralysis.

There are three laws of physics that can explain the basic principles of HBOT.

1. Henry's law:
At a given temperature, the amount of gas that will dissolve in a liquid is directly proportional to the pressure of the gas. Under such great pressure, then, HBOT saturates the blood plasma with oxygen.

2. Dalton's law:
The total pressure of a mixture of gasses is the sum of the partial pressure of each of the gases. Oxygen administered at 3 atmospheres absolute (ATA) would therefore produce a partial pressure of oxygen (PO2) of approximately 2,000 mm Hg.

Boyle's law:
At a constant temperature, the volume of a gas in inversely proportional to its pressure.
The use of HBOT, therefore, will result in a reduction of bubble size, as in the case of decompression sickness.

Simply put: Increase the atmospheric pressure and get a directly proportional increase in available oxygen. A two fold increase in pressure equal twice the available oxygen to breathe. The increased amount of oxygen reaches the blood plasma which increases the amount of oxygen to the tissues and enhances wound healing.

Types of Hyperbaric Chambers
These chambers are made by many different manufactures that make different designs.
They are made with clear, acrylic walls so that the patient can watch television and can see the medical staff. They are able to converse with the medical staff through a two way speaker and microphone system.

The chamber may be:
Monoplace which accommodates one person, these chambers do not allow the medical staff to do hands on treatment for the patient. There is a registered nurse and a respiratory therapist in view of the patient during the treatment. If an emergency situation arises the patient would be decompressed before hands on care is provided.

A Multiple Chamber can accommodate two, three or up to eight people, in this case a nurse, doctor or trained technician remains inside the chamber during the treatment. There is a dual lock system that will allow other medical personnel to enter the chamber if there should be an emergency. The medical staff inside the chamber breathes compressed air and not the 100% oxygen as the patient breathes. Medical staff are screened based on their past medical history and undergo a physical examination.

A Portable Chamber is mostly used for home treatments.

For more than 40 years patients have benefited from this fascinating treatment and more and more HBOT treatment centers are evolving throughout the United States. HBOT is being used in Plastic surgery, General surgery, Otolaryngology (Ears, Nose and Throat) Oral and Maxillofacial surgery and other specialties for the following conditions.

Air or gas embolism

Carbon monoxide intoxication

Cyanide poisoning

Smoke inhalation

Gas gangrene

Crush injuries

Traumatic peripheral ischemia

Delayed radiation injury

Thermal burns

Skin flaps and grafts that are compromised

Enhancement of healing in difficult to heal wounds

Acute blood loss anemia

Decompression sickness (Bends)

Intracranial abscess

Refractory osteomyelitis

Necrotizing soft tissue infections

Preparation before a treatment.
Preparation is a very important aspect of HBOT treatment.
Oxygen, flames or flammable agents make a dangerous combination, therefore, cigarettes, lighters, lotions, nail polish and hairsprays are not allowed in the vicinity.

The patient will change into a cotton gown.

All metal jewelry must be removed.

Special precautions are taken for patients with a nasogastric tube, patients who are intubated or patients with a tracheotomy.

The patient is then made comfortable, the chamber is closed and the treatment is administered.

A treatment averages between 75-150 minutes.

Side effects during a treatment may be pain in the ears, sinus or teeth.

Some patients may become claustrophobic in a Monoplace Chamber, in this case; they would need to have their treatment in a Multiple Chamber.

HBOT is an amazing field that has opened up another specialty for doctors, nurses and technicians, it is becoming more popular as more facilities open and the public become more aware of the benefits this treatment.

Resource: Glowacki, Michelle, Chew, Norma, Hyperbaric Oxygen Therapy: A Guide For The Perioperative Nurse. AORN Journal 1988.
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