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Hyperbaric Oxygen (HBO) Therapy

For Referring Physicians

The HBO therapy program operates under the auspices of the William Randolph Hearst Burn Center at NewYork-Presbyterian Hospital. Consultations are available 24 hours a day, seven days a week.

HBO therapy is administered in conjunction with the referring physician's plan of care. The standard of care has been established in accordance with the current guidelines of the Undersea and Hyperbaric Medical Society.

Hyperbaric oxygen is a valuable treatment for patients with chronic wounds, damaged soft tissues, and certain life-threatening conditions. Clinical indications for referral to the HBO program include:

Acute conditions:

  • Acute carbon monoxide poisoning (carboxyhemoglobin > 25% or >15% in pregnant women)*
  • Cerebral artery gas embolism
  • Gas gangrene (clostridial myonecrosis)
  • Crush injury, compartment syndrome
  • Decompression sickness**
  • Exceptional blood loss anemia
  • Necrotizing soft tissue infections
  • Hemorrhagic radiation cystitis

*Patients with carbon monoxide poisoning may require up to three treatments immediately following exposure. The first treatment must occur within 24 hours of exposure.

**A specific plan for patients with decompressions sickness will be arranged in collaboration with Divers Alert Network (DAN) to determine the proper dive table.

Chronic conditions***

  • Osteoradionecrosis
  • Chronic diabetic foot ulcers
  • Radiation tissue injury
  • Chronic osteomyelitis (refractory to antibiotics and debridement)

***Long-standing infections or other chronic conditions such as osteoradionecrosis may require up to 50 treatments or more over a period of several weeks. Most patients receive one treatment per day.

Treatment duration lasts approximately two hours. The patient may sit or recline comfortably and rest, or watch television and movies on our plasma televisions. The number of treatments is determined by the patient's diagnosis and response to therapy. Continuous supervision and monitoring are provided by the experienced registered nurses and respiratory therapists.

Inpatient Treatment

Patients requiring hospitalization, particularly those with critical illness, will be admitted to the Burn Center at NewYork-Presbyterian Hospital. Depending on the diagnosis, patients generally receive one to three treatments per day. For patients requiring critical care, a staff member will accompany them into the chamber and monitor the treatment. Staff members are on call 24 hours per day, seven days a week to treate any emergencies.

Outpatient Treatment

Treatment will be coordinated by staff in close collaboration with the referring physician. We provide outpatient services Monday through Friday. Daily treatments begin at 7:00 am, with the last treatment of the day at 5:30 pm. Treatment sessions lasts approximately 2 hours.

Benefits of HBO Therapy

Patients breathe 100% oxygen in the chamber pressurized to two-to-three times of normal atmospheric pressure. The physiological effects of treatment, which may be of significant benefit to patients include:

Hyperoxygenation: The plasma carries as much oxygen as saturated hemoglobin with an arterial oxygen pressure of 1,500 to 2,000 mmHg. This high concentration facilitates increased diffusion into surrounding tissues from perfused capillaries. This effect will last for several hours and can help in both acute and chronic disease.

Resolution of postinjury edema: Vasoconstriction is an immediate reflex response to the hyperoxygenation. Because the hyperoxia is so extreme, the decreased arterial inflow is not associated with hypoxia. There is however, an increase in net venous outflow from congested capillary beds. This change in flow facilitates the resolution of postinjury edema, which can often obviate the need for fasciotomy in moderate compartment syndrome and facilitate wound healing.

Neovascularization: Enrichment of ischemic chronic wounds facilitates macrophage and fibroblast function, with improved angiogenesis and fibroplasia, which promotes healing in cases of diabetic ulcers, radiation-damaged tissue, and refractory osteomyelitis.

Enhanced immune function: High concentrations of oxygen enhance white blood cell phagocytosis and oxidative cells kill Clostridium perfingens bacteria as well as inhibit toxin synthesis.

Mitigation of reperfusion injury: This effect has been documented in clinical laboratory studies. While the interruption of flow leads to accumulation of ischemic metabolites, the substances are not damaging until flow is re-established and a cascade of inflammatory events s triggered. Treatment with HBO prior to or just after reestablishment of flow helps to rid the ischemic tissues of these metabolites and decrease the effect of ischemia and reperfusion. As a result, replanted and transplanted tissues, as well as injured tissues with compromised capillary flow, have decreased inflammation and increased survival.

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