Hyperbaric Oxygen Treatment
OVERVIEW
- Carried out in a pressurised chamber (single or multiple patients)
- Treatments typically between 2 and 3 ATA (200-300 kPa or 10-20 metres of sea water equivalent pressure)
- 100% Oxygen provided via hoods/masks/ETT
- PaO2 around 2280 mmHg at 3 ATA (tissue levels up to 500 mmHg)
- Typical treatments between 2-2.5 hours, can be >5 hours in severe cases of decompression illness
- Number of treatment varies depending on indication can be up to 60 sessions
EMERGENCY INDICATIONS
- Decompression Sickness (Caisson Disease)
- Arterial Gas Embolism (Iatrogenic/Diving Related)
- Necrotising Soft Tissue Infections / Clostridial Myonecrosis
- Acute Spinal Cord Infarction
- Central Retinal Artery Occlusion
- Carbon Monoxide Poisoning *controversial*
URGENT INDICATIONS (aim to start next day)
- Trauma (open fractures – Gustilo 3b, subacute compartment syndrome, burns)
- Idiopathic Sudden Sensorineural Hearing loss
- Compromised flaps and grafts
ELECTIVE INDICATIONS
- Late radiation tissue injury (non-neural tissues only)
- Hypoxic wounds (diabetic foot ulcers, arterial ulcers)
- Inflammatory bowel disease (Fistulating Crohn’s, flares of Ulcerative Colitis)
- Chronic refractory osteomyelitis
- Avascular necrosis (Aseptic Osteonecrosis)
- Severe anaemia where transfusion is contraindicated *controversial*
MECHANISM OF ACTION
Pressure related
- Reduction in gas bubble volume (Boyle’s Law)
Hyperoxygenation related
- Restoration of tissue normoxia
- Gas washout e.g., Nitrogen and Carbon Monoxide
- Hyperoxic vasoconstriction
- Reduces ischaemia-reperfusion injury
- Bacteriostatic/Bactericidal effects
- Inhibits Clostridium perfringens toxin synthesis
- Improves neutrophil migration and oxidative killing
- Stimulates angiogenesis and stem cell mobilisation
- Oedema reduction
- Anti-inflammatory effect
ADVERSE EFFECTS
Short-Term
Pressure related – Barotrauma
- Middle ear (may require grommets)
- Sinus squeeze
- Dental/gastrointestinal (rare)
- Pulmonary Barotrauma – Pneumothorax/Pneumomediastinum (rare)
Hyperoxygenation related
- Pulmonary Oxygen Toxicity (Lorrain-Smith Effect)
- Cerebral Oxygen Toxicity (Paul Bert Effect)- seizures
- Hypoglycaemia
- Middle ear effusion
Medium to Long Term
- Reversible myopia (Lenticular aetiology – more so in natural (phakic) lenses)
- Worsening of pre-existing cataracts
References:
- Bennett MH, Hui CF, See HG, Au-Yeung KL, Tan C, Watson S. The myopic shift associated with hyperbaric oxygen administration is reduced when using a mask delivery system compared to a hood–a randomised controlled trial. Diving and hyperbaric medicine. 2019 Dec;49(4):245.
- Buckley NA, Juurlink DN, Isbister G, Bennett MH, Lavonas EJ. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane database of systematic reviews. 2011(4).
- Celebi AR. Hyperbaric oxygen therapy for central retinal artery occlusion: patient selection and perspectives. Clinical Ophthalmology. 2021 Aug 13:3443-57.
- Devaney B, Frawley G, Frawley L, Pilcher DV. Necrotising soft tissue infections: the effect of hyperbaric oxygen on mortality. Anaesthesia and Intensive Care. 2015 Nov;43(6):685-92.
- Dulai PS, Buckey Jr JC, Raffals LE, Swoger JM, Claus PL, O’Toole K, Ptak JA, Gleeson MW, Widjaja CE, Chang JT, Adler JM. Hyperbaric oxygen therapy is well tolerated and effective for ulcerative colitis patients hospitalized for moderate-severe flares: a phase 2A pilot multi-center, randomized, double-blind, sham-controlled trial. Official journal of the American College of Gastroenterology| ACG. 2018 Oct 1;113(10):1516-23.
- Huang E, editor. UHMS Hyperbaric Medicine Indications Manual. Best Publishing; 2024.
- Joshua TG, Ayub A, Wijesinghe P, Nunez DA. Hyperbaric oxygen therapy for patients with sudden sensorineural hearing loss: a systematic review and meta-analysis. JAMA Otolaryngology–Head & Neck Surgery. 2022 Jan 1;148(1):5-11.
- Kranke P, Bennett MH, Martyn‐St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews. 2015(6).
- Lin ZC, Bennett MH, Hawkins GC, Azzopardi CP, Feldmeier J, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database of Systematic Reviews. 2023(8).
- Millar IL, Lind FG, Jansson KÅ, Hájek M, Smart DR, Fernandes TD, McGinnes RA, Williamson OD, Miller RK, Martin CA, Gabbe BJ. Hyperbaric Oxygen for Lower Limb Trauma (HOLLT): an international multi-centre randomised clinical trial. Diving and Hyperbaric Medicine. 2022 Sep;52(3):164.
- Mitchell SJ, Bennett MH, Moon RE. Decompression sickness and arterial gas embolism. New England Journal of Medicine. 2022 Mar 31;386(13):1254-64.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
MBBS (Hons), MPH, DipDHM, PGDipClinUS, CCPU
Diving & Hyperbaric Medicine Fellow
Fiona Stanley Hospital, Perth.
Dual trainee in Hyperbaric and Emergency Medicine.
Graduated with honours from Monash University. Commenced teaching at Monash University as a bedside tutor then clinical skills tutor whilst training in Emergency. Keen interest in ultrasound to help improve diagnostic efficiency and patient outcomes in the emergency setting. Strong advocate for pre-vocational medical trainees as part of the PMCV accreditation team.