Hyperbaric Oxygen Therapy (HBOT) is a medical treatment that significantly enhances and accelerates the process of healing, and in some cases, is among the only known treatments for certain medical conditions. About 20 percent of chronic wound care patients would benefit from hyperbaric treatments.

This therapy is administered to patients inside a comfortable, pressurized chamber (see photo above) where they breathe 100 percent oxygen at levels as much as three times the normal atmospheric, sea level pressure. This rich environment allows oxygen to enter the bloodstream more quickly, thereby enabling the body’s natural healing mechanism to function more efficiently.

HBOT has been proven effective as direct or adjunctive therapy for a growing variety of medical conditions. Studies show that patients with diabetes and others who suffer from slow-healing wounds can benefit from the increased oxygen supply in a hyperbaric chamber. High-oxygen therapy can also help people preparing for skin grafts, cancer patients suffering radiation side effects, and victims of carbon monoxide and cyanide poisoning. HBOT was originally conceived of as a means of treating decompression sickness or "the bends" in divers and others who worked in pressurized environments.

In the last 40 years, the United States scientific and medical communities have increasingly applied HBOT to a growing number of medical conditions. In 1996, medical reimbursements for HBOT in the U.S. alone were approximately $350 million. InnovoMed believes that the potential market for such treatments in the U.S. is approximately $3.5 billion, creating ample future demand for treatment centers with hyperbaric chambers.

HBOT is presently recommended and reimbursable by public and private medical insurers for several diagnosed conditions, the most prominent of which is the treatment of chronic wounds due to diabetes. Such therapy often provides the only alternative to the amputation of a limb. As a result, wound care centers are being opened in hospitals and as freestanding centers around the country. There is also a growing trend in sports medicine to treat soft tissue injuries with HBOT.

Outside the United States, governments and medical societies have mandated HBOT for treatment in a number of additional conditions, including heart attack and stroke. InnovoMed believes that the present increase in growth of HBOT may be further accelerated in the U.S. due to domestic adoption of such applications, as well as the already growing use of HBOT with cosmetic surgery, where pre-operative and post-operative application has been shown to reduce scarring and shorten healing time.

Other applications such as the treatment of smoke inhalation and healing tissues damaged from radiation treatments in cancer patients are also reimbursable and have garnered the support of patient advocacy groups.

InnovoMed’s comprehensive wound care centers specialize in providing wound care services and HBOT to underserved communities. Our company is also dedicated to educating the medical and lay communities about the synergistic relationship of aggressive wound care and the remarkable benefits of HBOT, while further expanding research in the rapidly growing field of hyperbaric medicine.

1. What is Hyperbaric Oxygen Therapy (HBOT)?
2. What is the protocol for hyperbaric treatment?
3. How much experience is there with HBOT?
4. How does HBOT aid in wound healing?
5. How long do treatments last?
6. Does medical insurance cover HBOT? What are the approved indications?
7. How much does HBOT cost?
8. Are there any side effects with HBOT?
9. Would you tell me more about the chambers used for hyperbaric treatments?
10. Who supplies InnovoMed’s hyperbaric chambers?
11. What is Topical Oxygen Therapy?

The term "Hyperbaric Oxygen Therapy" is derived from Greek language: "hyper" means high and "baric" means pressure. It is defined as breathing 100 percent oxygen while the entire body is under increased pressure (that is, higher than at sea level). More simply, patients rest inside a small room or chamber and breathe oxygen for one to several hours. These chambers may be round or square, built for individuals or small groups, and made out of clear acrylic or thick steel. All are designed to ensure patient safety and all help to heal wounds in the same way. HBOT is safe, painless and cost-effective.

• Assess each patient’s condition, as well as his or her general health
• Recommend a specific treatment plan including frequency, duration and number of treatments
• Describe the expected course of improvement and how that will be monitored
• Explain possible side effects and statistical probability of success
• Discuss this treatment plan with the patient and his or her family at length

HBOT was used as far back in history as Alexander the Great. It became important early in the twentieth century to treat workers building bridges and tunnels across deep rivers when they developed "caissons disease," what we now call "the bends." After Jacques Cousteau and others developed scuba diving, the use of HBOT increased. In the 1950s, physicians and surgeons began applying HBOT to assist in the treatment of other medical conditions. By 2005, there have been approximately 40,000 scientific articles published in numerous journals including: The New England Journal of Medicine, The Journal of the American Medical Association (JAMA), The Lancet, Circulation, The Journal of Bone & Joint Surgery (JBJS), and many others.

• The New England Journal of Medicine, http://content.nejm.org/
• The Journal of the American Association of Medicine,
  http://jama.ama-assn.org/
• The Lancet, http://www.thelancet.com/
• Circulation, http://circ.ahajournals.org/
• The Journal of Bone & Joint Surgery, http://www.ejbjs.org/

Breathing oxygen under increased pressure causes oxygen to dissolve in the liquid part of the blood (known as plasma) and reach tissues that suffer from a lack of oxygen. This lack of oxygen is one of the major reasons that wounds and infections don’t heal. Breathing oxygen under pressure can increase the oxygen in the blood 10 to 20 times as much as breathing oxygen under normal atmospheric pressure. It can also increase the oxygen in ischemic tissues 100 to 200 times or more. As a result, normal physiologic functions in the body may be restored, stimulating healing, fighting infection, promoting growth of new capillaries, and more.

HBOT can also help to rid the blood of certain toxic gases (like carbon monoxide and cyanide) that bind to hemoglobin in the red blood cells and to the energy-producing mechanisms inside cells, which can lead to brain and heart damage … or even death.

The specific physiologic mechanisms of action are complex and require an advanced understanding of biochemistry and cell biology. If you would like to learn more, please ask to speak with our expert staff.

Most patients undergo daily treatments that last about two hours, four to five times per week. Some conditions, like decompression illness or acute carbon monoxide poisoning, require fewer but more frequent treatments. The total number of treatments can be as little as one or as many as 60; most wounds require from 10 to 40 treatments.

InnovoMed informs patients and their insurance company (if requested) of how many treatments we anticipate they will need and how we will assess their progress along the way.

• Non-healing diabetic foot ulcers (Wagner grade II or higher)
• Enhanced healing in selected problem wounds
• Air or gas embolism
• Clostridal myositis and myonecrosis (gas gangrene)
• Crush injuries, compartment syndrome, and other acute traumatic ischemias
• Necrotizing soft tissue infections
• Osteomyelitis (refractory)
• Delayed radiation injury (soft tissue and bony necrosis)
• Skin grafts and flaps (compromised)
• Decompression sickness
• Carbon monoxide poisoning/carbon monoxide poisoning complicated by cyanide poisoning

Insurance carriers contract reimbursement rates. Our centers follow the cost of care for each patient and their conditions, and we are committed to providing the highest quality care at the most affordable price. Many studies have looked at the cost of adding HBOT to standard care for the various approved diagnoses. In most studies, the financial effect of adding HBOT has actually decreased the average cost of treatment by tens of thousands of dollars. The cost of HBOT is reasonable and is usually far outweighed by the savings realized from preventing side effects and amputation, healing infections, and reducing the number of surgeries required for our patients.

We would be happy to provide more information on the above research and quote specific financial data for our individual patients.

HBOT is one of the safest medical therapies available. The most common side effect is pressure sensation in the ears, like one might experience as an airplane descends before landing. Staff monitor patients constantly during treatment and will stop the pressure before the ears start to hurt. Pressure can also build up in the sinuses or dental cavities. Some people with lung disease (for example, severe asthma and emphysema) may be at risk of lung damage due to pressure effects. People with congestive heart failure need to be monitored for acute failure. It is important to monitor blood sugar closely for diabetes patients on medicine, since the oxygen can precipitate a drop in the serum glucose.

In high doses, oxygen can have side effects too. After many treatments, visual acuity may get better or worse. However, these effects are temporary and revert to normal after the treatments end. Oxygen can also cause a seizure in a few patients. (Studies have reported seizures in 1 per 4,000 patient treatments or as rare as 1 in 20,000.) Oxygen seizures do not lead to epilepsy or seizure disorders; they are treated by turning off the oxygen for a few minutes and then reducing the amount of time spent breathing oxygen during each treatment.

Patients of all ages generally tolerate the treatments very well and use the time to read, sleep, watch TV, or just relax. All patients are thoroughly educated by staff members before beginning HBOT and instructions are reviewed frequently. Questions are encouraged, and family members are invited to attend.

Chambers can be equipped with comfortable reclining chairs or stretch out to a completely flat position. To enhance patient comfort, music or movies may be played during treatments. Whenever the chamber is in use, medical personnel trained in hyperbarics are in constant contact via visual and audio communications.

InnovoMed selects the best chamber available for the intended application to maximize results. Therefore, we purchase chambers from various internationally recognized suppliers, including Gulf Coast, Perry Baromedical, and Seachrist.

We actively follow advances in hyperbaric medicine and wound care so that we can provide the best possible innovations to our patients.

While some companies market a bag-like device in which pressure is slightly increased with oxygen, Medicare and most insurance companies do not recognize such devices as Hyperbaric Oxygen Therapy (HBOT). More correctly, they are referred to as Topical Oxygen Therapy, or TopOx. Touted as being cheaper and safer than HBOT, they don’t provide the same benefits as HBOT. Although topical oxygen may have some useful applications, there is not enough evidence for Medicare or most major insurers to pay for such treatments at this time.

Sources:
Hyperbaric Medicine Today, www.hbomedtoday.com
National Baromedical Services, Inc., www.baromedical.com
Perry Baromedical Corporation, www.perrybaromedical.com