When several workers at a downtown hotel were taken to the hospital last February, the treatment of choice for their extended exposure to carbon monoxide was to put them in a room. It was not an ordinary room; it was hyperbaric oxygen therapy that helped them to recover rapidly.
Treating Multiple Medical Conditions
By Mike Haskew
Although many may not be familiar with the process, the medical community recognizes the remarkable properties of hyperbaric oxygen therapy, which has proven effective in treating such diverse conditions as crush injuries, cyanide poisoning, diabetic wounds, thermal burns, radiation tissue damage, necrotizing soft tissue infections (severe type of bacterial infection) and many others.
“We rediscover things in medicine all the time. The original technology for hyperbaric oxygen treatment was developed by a British physician in 1645,” relates Dr. James Creel, chief of staff and program director for emergency medicine residency at Erlanger Medical Center, as well as Erlanger’s director of hyperbaric medicine. “Hyperbaric therapy came to Erlanger in 1995, and the Undersea and Hyperbaric Medical Society has accredited Erlanger’s program. We are the only accredited program in Tennessee and one of only seven in the Southeast.”
Dr. Creel is also one of only a few physicians in the state of Tennessee who has achieved board certification in hyperbaric medicine. “The drug is oxygen,” he says. “It is God’s drug to fight infection and restore the health of a cell. I am excited about the possibilities for the treatment of traumatic brain injuries. Our soldiers in Iraq and Afghanistan, who have suffered injuries from IEDs (improvised explosive devices), are driving this type of treatment.
This is a new frontier for hyperbaric medicine, and it could run the gamut from head trauma to stroke treatment.”
Hyperbaric oxygen therapy is effective in treating conditions due to its multiple mechanisms of action, says Dr. John L. Gwin, director of the Wound Healing Center at Memorial Hospital. “Mechanical action, or pressure, makes it useful for the treatment of air or gas embolism and decompression sickness, known as the bends,” he explains. “The effects of oxygenation allow increased availability of oxygen delivery to tissues. This effect increases blood flow, enhances angiogenesis (growth of new blood vessels from pre-existing vessels) and promotes the healing of wounds. Antibacterial effects include the direct inhibition of bacterial growth and the enhancement of leukocyte (white blood cells that fight infectious disease) function. Its physiologic effects reduce the morbidity of carbon monoxide and cyanide poisoning.”
The Wound Healing Center at Memorial opened in September 2001, and three monoplace, or single-person chambers are utilized. “For treatments, patients are enclosed in the sealed chamber for the length of the treatment, usually two to two and one-half hours,” continues Dr. Gwin. “During the treatment, 100 percent oxygen is breathed and the pressure inside the chamber is increased… . The patients have a see-through plexiglass top in the chamber and are constantly attended to by a nurse or HBO technician, with whom they can communicate.”
Located on the main campus at Memorial, the Wound Healing Center specializes in the management of difficult, non-healing wounds. Patients are evaluated by a team of physicians and nurses, who perform an initial assessment and monitor the patient’s progress until healing occurs.
“There are 13 disease states that are approved indications (FDA-approved condition) for HBO by the Undersea and Hyperbaric Medical Society,” adds Dr. Gwin, “and Medicare recognizes 11 of these indications. Patients treated at the Memorial Wound Healing Center typically have complex wounds often related to diabetes, and HBO has been shown to be a useful adjunct to a comprehensive wound healing program. Additionally, patients who suffer some of the side effects of radiation treatment are commonly treated in an effort to reduce the side effects and symptoms.”
In November 2009, the Hamilton Center for Wound Care and Hyperbaric Medicine opened its doors in Dalton. Dr. Robert Burns, the center’s director, acknowledges that the therapy is not new. However, he appreciates the better understanding of how it works, why it works and the types of patients who can benefit from it.
“If you do an internet search, you will discover that hyperbaric oxygen therapy is touted as a treatment for all kinds of conditions, despite the lack of any clinical evidence to support most of those claims,” he advises. “At our center, we limit treatment to those conditions that have been shown to benefit from hyperbaric oxygen therapy, based on scientific study and clinical evidence. We adhere to the list which the Undersea and Hyperbaric Medical Society has developed for the therapy.”
Wound treatment is, in fact, one of the most common uses of hyperbaric oxygen therapy. According to Dr. Burns, for wounds to heal, they must receive an adequate supply of oxygenated blood. At the tissue level, blood is delivered to the wound by small blood vessels. If these vessels are diseased or damaged, the wound may be slow to heal – or it might not heal at all. Hyperbaric oxygen therapy stimulates the formation of new blood vessels and subsequently promotes healing.
“Diabetes is associated with disease of the small blood vessels,” Dr. Burns notes. “This obstructs blood flow to the tissues and results in problems with wound healing. Most diabetic wounds will heal with good local wound care. But if the wound is deep and it does not respond to conventional wound care, then hyperbaric oxygen may assist wound healing by providing new blood flow to the wound bed.”
Damage to small blood vessels may also be an unintentional side effect of radiation therapy, and the condition may potentially worsen over a period of years. Wounds forming in tissue that has undergone radiation treatment may not heal well on their own. Surgery or even the extraction of teeth from tissue that has been treated with radiation may result in a wound which is slow to heal. Hyperbaric oxygen therapy can promote the formation of new blood vessels in such tissue as well.
Dr. Burns comments, “Radiation can also result in damage to the small blood vessels of the bladder and bowel, resulting in damage to the lining of these organs. The resulting conditions are known as radiation cystitis, radiation proctitis, radiation colitis or radiation enteritis. Currently, hyperbaric oxygen therapy is the only treatment option that has the potential to cure these patients.”
The course of treatment may vary on an individual basis; however, patients often undergo five treatments per week through a total course of 20 to 40 treatments. As patients undergo a treatment, they may experience mild discomfort, such as ear popping. Following a treatment, patients often feel tired or lightheaded, but these symptoms generally subside in a short period of time. Side effects are usually mild; however, as with any treatment, there are risks. These may include sinus or lung damage, ruptured middle ear, oxygen toxicity, fluid in the lungs or possible respiratory failure. For some, particularly patients with certain lung disorders, congestive heart failure or other conditions, hyperbaric oxygen therapy may not be appropriate. Generally, pregnant women should not be treated.
The Food and Drug Administration has identified at least 15 conditions that are approved for hyperbaric therapy treatment, which are usually covered by health insurance policies. Medicare and Medicaid also provide coverage for such treatments.
Recently, the leadership of Hutcheson Medical Center authorized the development of hyperbaric oxygen therapy facilities at the center’s Fort Oglethorpe campus. The total project investment topped $460,000, and the new equipment is scheduled to become operational in the spring.
“Several months ago, as part of our strategic planning, we looked at meeting the needs of our community,” comments Hutcheson Vice President of Operations Gerald Faircloth. “One of those needs was a wound care center, and a hyperbaric chamber is part of that. We looked at an aging population which is prone to diabetes and obesity. These are concerns nationally, and the three major factors that are creating wound care issues.”
Following approval by state regulatory authorities, the decision was made to install two treatment chambers. “This will be a focused effort for us to provide more advanced wound care in a central location,” says Faircloth. “We will have wound care and hyperbarics together and consolidate our existing services into the wound care center. Everything will be located on the main campus.”
Although hyperbaric oxygen therapy in itself is not a recent discovery, the healing properties of the treatment continue to impress medical professionals. New possibilities are being considered and research into its potential is ongoing. In the Chattanooga area, hyperbaric oxygen therapy is gaining a higher profile, offering physicians and patients another option in managing and successfully dealing with numerous health related conditions.
Mike Haskew is a graduate of the University of Tennessee at Chattanooga and holds a degree in history. He is a native Chattanoogan and is currently an executive with First Citizens Bank.