Hyperbaric healing: The power of precise oxygen therapy
November 14, 2024
The hyperbaric chamber at the Institute for Exercise and Environmental Medicine is large enough to treat several people at once.
Hyperbaric chambers are probably best known for their use in treating divers suffering from the bends – aka decompression sickness – but through these sophisticated machines we can provide healing properties for a much wider range of conditions, if the correct treatment protocols are applied.
The key is to use oxygen intermittently at higher ambient pressure. The air we breathe contains nearly 21% oxygen. But in a hyperbaric chamber we can deliver 100% intermittent oxygen in an environment usually two to three times greater than the normal atmospheric pressure. That combination allows for an intermittent increase of the amount of oxygen in the blood, which is an effective stimulus to improve blood flow in areas with poor circulation. That in turn helps with the healing of complicated wounds that do not respond to conventional care, helps the immune system fight infections, and does so much more.
At UT Southwestern, our Hyperbaric Medicine Center at the Institute for Exercise and Environmental Medicine carries a Level 1 Accreditation with Distinction from the nonprofit Undersea and Hyperbaric Medicine Society, and our physicians are board-certified in Undersea and Hyperbaric Medicine. This accreditation is the gold standard and highest honor provided to hyperbaric medicine programs in the U.S. It's achieved by only a select group of outstanding clinical/academic programs with the highest standards of care and patient safety. The coveted “with distinction” status is awarded to only the top 4% of hyperbaric medicine centers that are accredited to offer the full scope of services for the hyperbaric patient, including critically ill and mechanically ventilated patients.
The center, a collaboration between UT Southwestern and Texas Health Presbyterian Hospital Dallas, offers hyperbaric oxygen therapy for a variety of multidisciplinary treatments including Oral and Maxillofacial Surgery, Plastic Surgery, Radiation Oncology, Urology, Wound Care, Podiatry, Orthopaedic Surgery, Ophthalmology, Otolaryngology, and Infectious Diseases.
What are the benefits of hyperbaric oxygen therapy?
With the proper dose, hyperbaric oxygen therapy has the ability to heal wounds and infections by boosting certain cellular processes and pathways within the body – similar to the way a drug activates or suppresses individual genes.
Some benefits of hyperbaric oxygen therapy include:
- Improving circulation, inducing development of new blood vessels
- Increasing the number and activity of stem cells, which are crucial for the body to repair damaged tissues
- Improving the production of collagen, a protein that provides the structure for connective tissues, including skin, tendons, cartilage, and bone
- Controlling inflammation and reducing swelling
- Reducing scarring and hardening in tissues that have been exposed to radiation or multiple surgeries
- Limiting damage that occurs when blood flow returns to areas that lost blood supply (ischemia and reperfusion injury)
- Speeding up the elimination of carbon monoxide
- Enhancing the activity of the immune system (which protects your body from infections), increasing the effectiveness of some antibiotics, inhibiting the growth of certain bacteria, and deactivating their toxins
- Dissolving air or gas bubbles trapped in blood vessels or tissues
Does hyperbaric oxygen therapy have side effects?
The most common side effect with hyperbaric oxygen therapy is trauma to the middle ear, which is caused by the change in ambient pressure. If you’ve ever had your ears “pop” during an airplane’s descent, you can imagine what it feels like inside a hyperbaric chamber. The ears can become pressurized, but this discomfort is minor and preventable with proper instructions and direct supervision by our certified nursing and medical personnel.
There are also some specific medical conditions that may increase a patient’s chance of experiencing more serious side effects. For this reason, patients must be evaluated and treated by physicians specializing in hyperbaric medicine to ensure the treatment will be safe for them.
Related reading: Time is tissue: Tips to manage and prevent chronic wounds and ulcers
Research tool
In addition to treating patients, the hyperbaric chamber is useful in creating simulated environments for research. Here, Renie Guilliod, M.D., left, tests an athlete riding a stationary bike inside the hyperbaric chamber set at an ambient pressure equivalent to the altitude of Mount Everest, the highest mountain in the world with an elevation of just over 29,000 feet.
What conditions can be treated with hyperbaric oxygen therapy?
Conditions approved by the U.S. Food and Drug Administration (FDA) and the Undersea and Hyperbaric Medicine Society (UHMS) for hyperbaric oxygen therapy include:
- Urinary or rectal bleeding as well as non-healing wounds arising from radiation therapy following cancer treatment
- Chronic diabetic foot ulcers
- Chronic bone infections
- Aseptic osteonecrosis, which is the death of bone tissue due to a lack of blood supply
- Skin grafts or flaps that aren’t properly healing
- Acute ischemia, which involves any condition that stops blood flow, such as traumatic wound injuries, crush injuries, and compromised surgical incisions
- Sudden blindness or partial loss of vision due to central retinal artery occlusion
- Sudden hearing loss
- Gas gangrene
- Necrotizing soft-tissue infection, often from flesh-eating bacteria
- Intracranial abscess, in situations where surgery is contraindicated.
- Carbon monoxide poisoning
- Gas embolisms, where air gets trapped in blood vessels and tissues, such as when scuba divers surface too quickly from deep water
The staff at the Hyperbaric Medicine Center includes, from left, Adam Mottley, CHT; James Berry, M.D.; Randy Gillmore, R.N.; Amber Goodwin, MSHA; Jacob Moore, CHT; Birgitta VanDooren, R.N.; and Renie Guilliod, M.D.
What should you expect during hyperbaric oxygen therapy?
The treatment compartments in our hyperbaric chamber are spacious and offer multiple seating options. There is also recumbent bedding for patients with limited movement. Some patients watch TV or a movie or read during the session. Others might nap.
Patients receive an individual therapy plan based on their medical needs.
Hyperbaric oxygen therapies generally last two hours at a time and may be administered over multiple days, which will vary depending on the patient's specific medical condition. We provide constant medical supervision during each session, so a patient is never alone.
The best way to ensure that hyperbaric treatments are effective and safe is to use facilities accredited by the UHMS and be under the care of physicians who are board-certified in Undersea and Hyperbaric Medicine.
Unfortunately, dozens of medical conditions are being treated in free-standing centers that are not certified or affiliated with hospitals and that do not have FDA or UHMS approval. These centers do not follow national operating and safety standards and are often operated by staff who do not have specialized medical and technical training.
Even more concerning is that some centers offer hyperbaric oxygen therapy for medical conditions without proven scientific evidence, using a lower pressure and either portable hyperbaric chambers or inflatable hyperbaric bags. These low-pressure chambers and bags are not FDA-approved to treat hyperbaric oxygen therapy patients. The FDA has authorized the use of some of these inflatable portable bags, like the Gamow bag, but only for the treatment of altitude sickness. The use of 100% oxygen in those instances is not authorized. These chambers operate at less than the minimum necessary treatment pressure, usually less than 1.4 atmosphere absolute (ATA). One atmosphere (1 ATA) is the estimated pressure at sea level. The optimal range of treatment pressure for currently accepted indications is between 2 and 2.8 ATA. Patients should ensure a facility is properly certified before getting any treatment.
Dr. Guilliod is a board-certified Undersea and Hyperbaric Medicine specialist with recognized expertise in the fields of wound care, lymphedema, and deep-sea diving. He leads the Hyperbaric, Diving, Altitude, and Aerospace Medicine team within the Institute for Exercise and Environmental Medicine. Dr. Guilliod is a Clinical Associate Professor with Physical Medicine & Rehabilitation as well as Anesthesiology & Pain Management at UT Southwestern.
Hyperbaric oxygen therapy at UTSW is offered to patients referred by a physician. For referrals, call 214-345-4651 or email IEEMOxygen@texashealth.org.
