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Hyperbaric Oxygen Therapy

For Referring Physicians

The Hyperbaric Oxygen Program operates under the auspices of NewYork-Presbyterian's Burn Center. Consultations are available 24 hours per day, seven days per week.

Hyperbaric oxygen therapy is administered in conjunction with the referring physicians 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 potentially life-threatening disorders. Clinical indications for referral to the Hyperbaric Program include:

Acute conditions:

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

Chronic conditions:

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

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

Inpatient Treatment

Patients requiring hospitalization, particularly those with critical illness, will generally be admitted to the William Randolph Heart Burn Center here at NewYork-Presbyterian Hospital. Depending on the acuity and diagnosis, inpatients will generally receive one-to-three treatments per day. For patients requiring critical care, a staff member will accompany them into the chamber and monitor them throughout the treatment. Our staff members are on call and available 24 hours per day, seven days per week to treat these acute emergencies.

Outpatient Treatment

Treatment will be coordinated by our staff in close collaboration with the referring physician. We treat outpatients Monday - Friday. Our first treatment starts at 7AM and the final treatment of the day begins at 5:30 PM to accommodate the busy schedules of our patients. Treatment sessions are approximately 2 hours.

Course for Acute Conditions

Carbon monoxide poisoning

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

Decompression illness

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

Course for Chronic Conditions

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 generally receive one treatment per day, Monday through Friday.

Benefits of Hyperbaric Oxygen Therapy

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

Hyperoxygenation

The plasma carries as much oxygen as saturated hemoglobin with an arterial oxygen pressure of 1,500 to 2,000 mm Hg. 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 post-injury 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 post injury 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. This effect is the basis of treatment of diabetic ulcers, radiation damaged tissue and refractory osteomyelitis.

Enhanced Immune function

High concentrations of oxygen enhances white blood cell phagocytosis and oxidative cell kill, as well as inhibiting and inactivating C. perfringens toxins.

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, when they trigger a cascade of inflammatory events. Treatment with hyperbaric oxygen prior to or just after re-establishment of flow helps to rid the ischemic tissues of these metabolites and decreases the effect of ischemia and reperfusion. As a result, replanted and transplanted tissues, as well as injured tissues that have suffered compromised to capillary flow, all have increased survival and decreased inflammation when hyperbaric oxygen is applied in the acute phase.

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