Hyperbaric Oxygen Therapy - Physician Frequently Asked Questions

How does HBO Work?

Answer:
Hyperbaric oxygen therapy works through a combination of increased ambient pressure and oxygen concentration.  Please click below for a more complete discussion of this topic.

Mechanism of Action

What conditions benefit from HBO?

Answer:
The Undersea and Hyperbaric Medicine Society periodically reviews the newest literature and scientific rational for using HBO in various disease states.  They then publish a committee report that lists the indications that they feel are appropriate for hyperbaric oxygen therapy.  Please see click below for a list of these indications and a link where you can find more information.

Indications for HBO

What categories of wounds are appropriate for HBO?

Answer:
Hyperbaric oxygen therapy is an effective adjunct treatment in hypoxic wounds.  These wounds can be caused by a variety of causes, including:
-Diabetes
-Radiation Therapy
-Acute Traumatic Ischemia

However, in wounds where hypoxia is not the primary factor, HBO is not appropriate and these wounds will not heal more quickly or better if HBO is applied.  Some wounds that fall in this category are:
-Venous Stasis Ulcers (edema control is the primary problem)
-Decubitus Ulcers (unrelieved pressure is the primary problem)

Are there any contraindications to HBO?

Answer:
Absolute Contraindications
The only absolute contraindication to receiving hyperbaric oxygen therapy is an untreated pneumothorax, due to the possibility of converting it to a tension pneumothorax as the intra-pleural air expands on decompressing.  All other contraindications are to a more or lesser degree relative.

Relative Contraindications

  • Bleomycin: Cases of fatal interstitial pneumonitis have been reported in patients who were administered elevated oxygen concentrations months to years after receiving bleomycin therapy.  Thus, elective treatment with HBO is contraindicated in patients with even a remote history of bleomycin administration.  However, in emergency, life-threatening situations, the benefits of HBO might outweigh the possibility of bleomycin toxicity.

  • Doxorubicin: In animals, administering HBO concurrently with doxorubicin was associated with cardiac toxicity.  Thus, it is advisable to wait until the drug has been cleared from the body before initiating HBO therapy.

  • Cis-Platinum: In animals, concurrent administration of HBO and cis-platinum was associated with an increase in wound breakdown.  Thus, HBO should be held until cis-platinum therapy is finished if possible.

  • Disulfiram: Disulfram blocks the production of superoxide dismutase, which could lead to decreased free radical scavenging in hyperbaric environments.

  • Mafenide Acetate (Sulfamylin): Increase possibility of oxygen toxicity seizures.

  • Upper respiratory tract infections or chronic sinusitis: These conditions can make it hard to clear the ears and/or can lead to significant sinus squeeze.

  • Seizure disorder: Increased risk of oxygen-induced seizures

  • Emphysema with CO2 retention: Risk of blunting hypoxic respiratory drive and/or rupturing of a bleb during ascent leading to pneumothorax.

What are the possible complications and side-effects of HBO?

Answer:
The possible complications and side-effects of HBO are due to the relatively rapid changes in pressure and hyperoxia.  Please click below for a more through discussion.

Complications and Side Effects

Is HBO safe for pregnant patients?

Answer:
There are at least theoretical concerns with the administration of hyperbaric oxygen treatments during pregnancy. These primarily center around the possible deleterious effects of hyperoxia on the fetus. However, clinical experience has failed to support these concerns and there is no evidence that hyperbaric treatments cause harm to the mother or child. Thus, the use of HBO to treat emergency, life threatening conditions is deemed safe, but elective treatments should probably be held until after delivery if possible. 

Is HBO contraindicated in patients with known malignancies?

Answer:
There is some theoretical concern that HBO might enhance the growth of some tumors, especially those that have out-grown their blood supply.  However, there is no clinical or experimental evidence that this occurs.  Currently, known or active malignancies are not considered a contraindication to HBO, but close monitoring of the lesion is probably indicated.

Can Patients with implanted devices such as pacemakers undergo HBO treatments?

Answer:
Early pacemakers, such as those made in the 1960's, contained air-filled voids that did not tolerate pressurization well and lead to damage to and/or malfunction of the devices.  Most currently produced pacemakers do not suffer from these problems and their manufacturers have certified them as safe in hyperbaric environments.  However, other implanted devices such as medicine pumps and nerve stimulatorx are often not certified for greater than one atmosphere of pressure.  Thus, if there is any question about a device's suitability, the manufacturer is contacted before HBO treatments are initiated.

How do I refer a patient for evaluation?

Answer: 
The Hyperbaric Medicine Service at the University of Iowa can be contacted in a variety of ways.  Please click below for contact information and information for referring physicians.

Contact Information

How much involvement will I have in the ongoing care of my patient?

Answer: 
The Hyperbaric Medicine Service is a purely consultative service.  Thus, primary control over the patient's course of treatment as well as treatment of any co-morbid conditions rests with the referring physician.  Our medical staff works closely with referring physicians to formulate appropriate care plans and to monitor patient progress.  Our involvement in ongoing wound care can be individualized to the referring physician's preferences (i.e. performing all wound care to having the referring physician do all wound care).

What kind of feedback will I recieve?

Answer:
The Hyperbaric Medicine Service works closely with referring physicians and contacts them periodically during the patient's treatment course to update the referring physician and discuss patient progress.  In addition, serial digital photographs are taken of the patient's wound and are provided to the referring physician electronically or on hard copy to document patient progress.  Of course, at any time referring physicians can contact the HMS to discuss any issues or ask questions.

Can I transfer a patient from another facility to the University of Iowa for HBO?

Answer:
The Hyperbaric Medicine Service is a purely consultative service and so, does not have admitting privileges and does not offer an inpatient service.  Therefore, if referring physicians are interested in transferring a patient to the University of Iowa, they must contact a service with admitting privileges to arrange for the transfer.  Once the patient is admitted under this other service, the HMS will be happy to evaluate the patient for hyperbaric oxygen treatments.  We will assist referring physician in this process any way we can, but cannot guarantee the acceptance of a transfer.  Please click below for information on referring a patient to UIHC.

Is the Hyperbaric Medicine Service available for emergencies?

Answer:
Yes, the HMS maintains a call team and is available 24 hours a day, seven days a week for hyperbaric emergencies.  Please click below for contact information. 

Please note that all referrals for carbon monoxide poisoning treatment should be referred to the Emergency and Trauma Center at 319-356-2233.
UI consult

What is a Trans-Cauaneous Oxygen Measurement test and what does it do?

Answer:
The Trans-Cutaneous Oxygen Measurement (TCOM) test assess the level of oxygenation in peri-wound tissues and thus helps determine a wounds likelihood of benefiting from HBO.