Other Conditions Considered for Hyperbaric Oxygen Therapy

Indications that HBO can help with but we don't routinely treat at DDRC

Acute Thermal Burn Injury

Burn injuries have low oxygen levels and can take a long time to heal. Use of hyperbaric oxygen in patients with burn wounds has been shown to:

  • Improve healing
  • Reduce oedema (swelling)
  • Prevent extension of the burn
  • Reduce hospital stay
  • Reduce need for surgery
  • Reduce wound infection

HBO is considered for patients with complex or serious burns therefore each case is assessed on a case by case basis.

Cases that are accepted are often serious but survivable:

  • Greater than 20% total body surface area and/or with involvement of the hands, face, feet or perineum.
  • Deep partial or full thickness injury.

Further information regarding the Referral and Funding process can be found here.

 

References

Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. doi: 10.28920/dhm47.2.131-132. PMID: 28357821; PMCID: PMC6147240.

Niezgoda JA, Cianci P, Folden BW, Ortega RL, Slade JB, Storrow AB. The effect of hyperbaric oxygen therapy on a burn wound model in human volunteers. Plast Reconstr Surg. 1997 May;99(6):1620-5. PMID: 9145132.

Carbon Monoxide Poisoning

Carbon monoxide (CO) is a colourless, odourless gas that occurs as a result of incomplete combustion of carbon containing substance. It is less common as safety has improved but can still occur as a result of poorly maintained gas appliances, burning solid fuel inside (log burners) or using barbecues or camping stoves in confined spaces.

The symptoms of carbon monoxide poisoning include:

  • Headache - 90%
  • Nausea and vomiting - 50%
  • Vertigo - 50%
  • Alteration in consciousness - 30%
  • Weakness  - 20%

CO poisoning can also cause longer term nervous system damage and result in problems with dementia, memory and concentration, as well as causing symptoms similar to Parkinson's Disease. Possible longer term effects include mental health problems such as depression.

If you think you have been exposed to carbon monoxide open windows and doors to increase ventilation and attend your nearest Emergency Department. A blood test can be taken to determine if you have carbon monoxide poisoning.

There are very specific circumstances in which HBO may help someone who has carbon monoxide poisoning. HBO can help improve oxygenation of tissues and speed up the elimination of carbon monoxide from the body.

A doctor can refer a patient to a hyperbaric chamber if they fit the following criteria:

  • new neurological deficit or mental status change
  • carboxyhaemoglobin of greater than 25% at any time
  • pregnancy
  • ECG evidence of myocardial involvement (evidence of damage to the heart)
  • loss of consciousness, even if subsequently recovered

Further information about the Referral & Funding process can be found here.

 

References

Hampson NB, Little CE. Hyperbaric treatment of patients with carbon monoxide poisoning in the United States. Undersea Hyperb Med. 2005 Jan-Feb;32(1):21-6. PMID: 15796311.

Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. doi: 10.28920/dhm47.2.131-132. PMID: 28357821; PMCID: PMC6147240.

Central Retinal Artery Occlusion

Central Retinal Artery Occlusion is a rare cause of sudden loss of vision. The degree of visual loss is dependent on the exact location and degree of occlusion (blockage of blood supply to the eye).

Hyperbaric oxygen therapy (HBO) can help restore blood supply to the eye however studies have shown that it is only effective if treatment is started within 24 hours of symptom onset.

In practical terms this means that very few patients meet the criteria for HBO and therefore it is a condition that we very rarely treat in the UK.

Further information regarding the Referral and Funding process can be found here.

 

References

Beiran I, Goldenberg I, Adir Y, Tamir A, Shupak A, Miller B. Early hyperbaric oxygen therapy for retinal artery occlusion. Eur J Ophthalmol. 2001 Oct-Dec;11(4):345-50. doi: 10.1177/112067210101100405. PMID: 11820305.

Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. doi: 10.28920/dhm47.2.131-132. PMID: 28357821; PMCID: PMC6147240.

Intracranial Abscess

An intracranial abscess is a closed collection of pus and infection somewhere within the skull.

Hyperbaric Oyxgen Therapy (HBOT) is recognised to be a useful alongside the treatment provided in the hospital, i.e. antibiotics, neurosurgery and possibly intensive care involvement. However this only applies to some patients; it is not offered as standard and each case is carefully reviewed to decide if worthwhile.

Studies have shown better survival rates in those with multiple abscesses, in a deep location in immunocompromised patients and where surgery is contraindicated or there has been failure of standard treatments.

Further information regarding the Referral and Funding process can be found here.

 

References

Bartek J Jr, Jakola AS, Skyrman S, Förander P, Alpkvist P, Schechtmann G, Glimåker M, Larsson A, Lind F, Mathiesen T. Hyperbaric oxygen therapy in spontaneous brain abscess patients: a population-based comparative cohort study. Acta Neurochir (Wien). 2016 Jul;158(7):1259-67. doi: 10.1007/s00701-016-2809-1. Epub 2016 Apr 25. PMID: 27113742.

Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. doi: 10.28920/dhm47.2.131-132. PMID: 28357821; PMCID: PMC6147240.

Severe Anaemia

Oxygen is carried around the body by red blood cells, if you lose blood due to trauma or surgery and that blood is not replaced immediately with a blood transfusion you have a reduced supply of oxygen to your heart and brain which can quickly lead to death.

Hyperbaric oxygen can provide oxygen to depleted tissues without the need for a good blood supply and several animal studies have shown strong evidence of this. If a patient is unable to receive blood transfusions for blood loss due to medical or religious reasons then HBO has be used to sustain oxygenation and increase the chance of survival.

However, as these patients are critically unwell and the hyperbaric centres in the UK are not on hospital sites it is very complex to arrange treatment of these patients. HBO also only provides a bridge therapy until the patient is stabilised (i.e. it is not a definitive solution in itself).

Individual referrals are assessed on a case-by-case basis.

Further information regarding the Referral and Funding process can be found here.

 

References

Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. doi: 10.28920/dhm47.2.131-132. PMID: 28357821; PMCID: PMC6147240.

McLoughlin PL, Cope TM, Harrison JC. Hyperbaric oxygen therapy in the management of severe acute anaemia in a Jehovah's witness. Anaesthesia. 1999 Sep;54(9):891-5. doi: 10.1046/j.1365-2044.1999.01004.x. PMID: 10460565.

Crush Injuries and Compartment Syndrome

Crush Injuries

Crush injuries can cause soft tissue trauma but may also feature open wounds, broken bones, nerve injury, and vascular damage. Surgery can be employed to stabilise fractures and to repair nerves and vessels, but there are no surgical interventions that address tissue damage at the microvascular level. The trauma from the crush injury causes swelling (oedema), reducing the amount of oxygen able to get to the damaged tissues and causing further injury.

HBO has been used to counteract this phenomenon and increase oxygenation to the damaged tissues thus increasing the chance of healing.

 

Compartment syndrome

Compartment syndrome is a complication of a crush injury where bleeding occurs in the muscle compartment. This compartment is a fixed space and does not expand therefore, if the bleeding continues, the pressure can cause damage to the muscles and nerves. Surgery is used to relieve this pressure before the muscles and nerves die.

In some studies, HBO has been used when compartment pressures were elevated but before surgery was indicated, allowing for recovery before surgery was required.  Therefore, in patients where compartment syndrome is a risk but not yet established, the early addition of HBO may be considered.

 

In both crush injuries and compartment syndrome HBO treatment is decided on a case by case basis.

Information on Referral & Funding can be found here.

 

References

Buettner MF, Wolkenhauer D. Hyperbaric oxygen therapy in the treatment of open fractures and crush injuries. Emerg Med Clin North Am. 2007 Feb;25(1):177-88. doi: 10.1016/j.emc.2007.01.008. PMID: 17400080.

Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. doi: 10.28920/dhm47.2.131-132. PMID: 28357821; PMCID: PMC6147240.

Van Poucke S, Leenders T, Saldien V, Verstreken J, Beaucourt L, Adriaensen H. Hyperbaric oxygen (HBO) as useful, adjunctive therapeutic modality in compartment syndrome. Acta Chir Belg. 2001 Mar-Apr;101(2):73-4. PMID: 11396055.

While DDRC Healthcare is commissioned by the NHS to provide emergency treatment for decompression illness and arterial gas embolism, we also support patients with a range of other recognised hyperbaric indications as part of our charitable aims. These referrals are reviewed individually and treatment is subject to clinical assessment, supporting evidence, funding arrangements and operational capacity.

  • Anaerobic and Mixed Bacterial Infections
  • Chronic Osteomyelitis
  • Compromised Grafts and Flaps
  • Problem Wounds
Emergency
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