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Other
commonname(s): hyperbaric medicine, hyperbarics, HBOT,
HBO2
Scientific/medical
name(s): none
Description
Hyperbaric oxygen therapy (HBOT) involves the breathing of
pure oxygen while in a sealed chamber that has been pressurized at 1
1/2 to 3 times normal atmospheric pressure.
Overview
Research has shown HBOT is effective when used in addition to
conventional treatment for the prevention and treatment of
osteoradionecrosis, a term for delayed bone damage caused by radiation
therapy. There is also some evidence suggesting HBOT may be helpful as
an additional treatment for soft tissue injury caused by radiation.
There is no evidence that HBOT cures cancer. The U.S. Food and Drug
Administration (FDA) has approved HBOT to treat decompression sickness,
gangrene, brain abscess, and injuries in which tissues are not getting
enough oxygen.
How is it promoted for use?
Hyperbaric oxygen therapy is used in conventional treatment
for decompression sickness; severe carbon monoxide poisoning; certain
kinds of wounds, injuries, and skin infections; delayed radiation
injury; and certain bone or brain infections. Decompression sickness,
commonly known as "the bends," is an extremely painful and potentially
dangerous condition that strikes scuba divers who surface too quickly
and, occasionally, miners and tunnel builders who come up too rapidly.
It can also affect fighter pilots who climb very quickly.
Claims about alternative uses of HBOT include that it destroys
disease-causing microorganisms, cures cancer, alleviates chronic
fatigue syndrome, and decreases allergy symptoms. A few supporters also
claim that HBOT helps patients with AIDS, arthritis, sports injuries,
multiple sclerosis, autism, stroke, cerebral palsy, senility,
cirrhosis, Lyme disease, and gastrointestinal ulcers. Available
scientific evidence does not support these claims. Because of that, the
FDA has sent a warning letter to at least one manufacturer about
promoting HBOT for unproven uses. The FDA considers oxygen to be a
drug, meaning it must be prescribed by a physician or licensed health
care provider to treat illnesses or health conditions.
What does it involve?
HBOT can be done in single-person chambers or chambers that
can hold more than a dozen people at a time. A single-person chamber,
or monoplace, consists of a clear plastic tube about seven feet long.
The patient lies on a padded table that slides into the tube. The
chamber is gradually pressurized with pure oxygen. Patients are asked
to relax and breathe normally during treatment. Chamber pressures
typically rise to 2.5 times the normal atmospheric pressure. Patients
may experience ear popping or mild discomfort, which usually disappears
if the pressure is lowered a bit. At the end of the session, which can
last from thirty minutes to two hours, technicians slowly depressurize
the chamber.
After an HBOT session, patients often feel lightheaded and
tired. Monoplace chambers cost less to operate than multiplace chambers
and are relatively portable. Most health insurance policies cover
medically approved uses of HBOT. Recently, Medicare and Medicaid have
begun to cover them as well.
What is the history behind it?
In the early 1900s, Orville Cunningham noticed that people
with some heart diseases did better if they lived closer to sea level
than at high altitudes. He successfully treated a colleague with
influenza who was near death due to lung restriction, and later
developed a hyperbaric chamber. After his attempts to use HBOT to treat
a host of other conditions failed, the method was abandoned and his
chamber was scrapped.
HBOT chambers were developed by the military in the 1940s to
treat deep-sea divers who suffered from decompression sickness. In the
1950s, HBOT was first used during heart and lung surgery. In the 1960s,
HBOT was used for carbon monoxide poisoning, and it has since been
studied and used for a number of health-related applications. It has
been the subject of a great deal of controversy because of the lack of
scientific proof to support many of the other uses for which it is
suggested.
What is the evidence?
There is strong scientific evidence showing HBOT is an
effective treatment for decompression sickness, arterial gas embolism
(bubbles of air in the blood vessels), and severe carbon monoxide
poisoning. It may also be useful as an additional method for the
prevention and treatment of osteoradionecrosis (bone damage caused by
radiation therapy), clostridial myonecrosis (a life-threatening
bacterial infection that invades the muscle), and for helping skin
graft and flap healing. Other evidence suggests HBOT may be helpful for
less severe carbon monoxide poisoning; radiation-induced soft-tissue
injury; anemia due to severe blood loss (when transfusions are not an
option); crushing injuries; poor wound healing; and osteomyelitis
(chronic bone inflammation) that does not respond to standard
treatment. There is conflicting evidence about whether HBOT is helpful
in treating burns and fast-spreading infections of the skin and
underlying tissues.
The lack of randomized clinical studies makes it hard to judge
the value of HBOT for many of its claims. Available scientific evidence
does not support claims that HBOT stops the growth of cancer cells,
destroys germs, improves allergy symptoms, or helps patients who have
chronic fatigue syndrome, arthritis, multiple sclerosis, autism,
stroke, cerebral palsy, senility, cirrhosis, or gastrointestinal
ulcers.
Carefully controlled scientific studies are going on to find
out whether HBOT may be helpful for lymphedema (swelling in arms or
legs after surgery, which can happen after modified radical mastectomy
or other treatments in which lymph nodes are removed or irradiated),
diabetic ulcers, cluster headaches, heart attacks, and other
conditions.
Are there any possible problems or
complications?
HBOT is a relatively safe method for approved medical
treatments. Complications can be reduced if pressures within the
hyperbaric chamber remain below three times the normal atmospheric
pressure and sessions last no longer than 2 hours.
Milder problems associated with HBOT include claustrophobia,
fatigue, and headache. More serious complications include myopia
(short-sightedness) that can last for weeks or months, sinus damage,
ruptured middle ear, and lung damage. A complication called oxygen
toxicity can result in seizures, fluid in the lungs, and even
respiratory failure. Patients at high risk of oxygen toxicity may be
given "air breaks" during which they breathe
ordinary air rather than pure oxygen for short periods during
treatment. People with severe congestive heart failure may have their
symptoms worsened by HBOT. Patients with certain types of lung disease
may be at higher risk of collapsed lung during HBOT. Pregnant women
should be treated with HBOT only in serious situations where there are
no other options. Hyperbaric oxygen chambers can also be a fire hazard:
fires or explosions in hyperbaric chambers have caused about 80
deaths worldwide.
Relying on this treatment alone and delaying or avoiding
conventional medical care for cancer may have serious health
consequences.
Additional Resources
More information from your American Cancer
Society
The following information on complementary and alternative
therapies may also be helpful to you. These materials may be found on
our Web site (www.cancer.org)
or ordered from our toll-free number (1-800-ACS-2345).
References
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Hyperbaric oxygen and malignancies: a potential role in radiotherapy,
chemotherapy, tumor surgery and phototherapy. Med Sci Monit.
2005;11:RA279-RA289.
Bennett MH, Feldmeier J, Hampson N. Smee R, Milross C.
Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane
Database Syst Rev. 2005;(3):CD005005.
Bennett M, Feldmeier J, Smee R, Milross C. Hyperbaric
oxygenation for tumour sensitisation to radiotherapy. Cochrane Database
Syst Rev. 2005;(4):CD005007.
Brizel DM, Hage WD, Dodge RK, Munley MT, Piantadosi CA,
Dewhirst MW. Hyperbaric oxygen improves tumor radiation response
significantly more than carbogen/nicotinamide. Radiat Res.
1997;147:715-720.
Carl UM, Hartmann KA. Hyperbaric oxygen treatment for
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Coles C, Williams M, Burnet N. Hyperbaric oxygen therapy.
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Gill AL, Bell CN. Hyperbaric oxygen: its uses, mechanisms of
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2004 Jul;97(7):385-395.
Heys SD, Smith IC, Ross JA, Gilbert FJ, Brooks J, Semple S,
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Kalns J, Krock L, Piepmeier E Jr. The effect of hyperbaric
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Kohshi K, Kinoshita Y, Imada H, et al. Effects of radiotherapy
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Landesberg R, Wilson T, Grbic JT. Bisphosphonate-associated
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Morrison DS, Kirkby RD. Hyperbaric medicine: what works and
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July 5, 2001. Accessed May 30, 2008.
Neheman A, Nativ O, Moskovitz B, Melamed Y, Stein A.
Hyperbaric oxygen therapy for radiation-induced haemorrhagic cystitis. BJU Int.
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Neumeister M. Hyperbaric oxygen therapy. E-Medicine Web site.
Accessed at www.emedicine.com/plastic/topic526.htm on May 30, 2008.
Niezgoda JA, Cianci P, Folden BW, Ortega RL, Slade JB, Storrow
AB. The effect of hyperbaric oxygen therapy on a burn wound model in
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Sheffield PJ, Desautels DA. Hyperbaric and hypobaric chamber
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17, 2005. Content no longer available.
Woo TC, Joseph D, Oxer H. Hyperbaric oxygen treatment for
radiation proctitis. Int
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Note:
This
information may not cover all possible claims, uses, actions,
precautions, side effects or interactions. It is not intended as
medical advice, and should not be relied upon as a substitute for
consultation with your doctor, who is familiar with your medical
situation.
Last Medical Review: 11/01/2008
Last Revised: 05/06/2009
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