Hyperbaric oxygen therapy
definition
Oxygen is essential for the human body to function properly. It is absorbed through the lungs and released into the blood. Through this the oxygen is distributed throughout the body.
The hyperbaric oxygen therapy, too hyperbaric oxygenation (HBO), has the function of increasing the concentration of oxygen in the blood. This is intended to enable tissues with poor blood circulation to receive sufficient oxygen or to remedy an oxygen deficiency. This increase in concentration is achieved through ventilation with pure oxygen in a chamber in which there is an increased ambient pressure of 1.5 to 3 bar absolute.
indication
The goal of hyperbaric oxygen therapy is always to improve the oxygen supply. This can have various positive effects that can help cure the following disease states. However, the HBO is only to be seen as an addition to standard therapy or if previous therapies have failed.
For example, the gas fire-causing bacterium can only grow if there is no oxygen. For this reason, hyperbaric oxygen therapy is used to treat this bacterial infection. The bacteria die due to the high oxygen pressure. Read more about this under: Gas fire
Tinitus and sudden hearing loss
With tinnitus it is assumed that a lack of oxygen in the inner ear can be the cause. Therefore, attempts can be made to treat tinnitus with hyperbaric oxygen therapy to improve the oxygen supply to the inner ear and to strengthen the immune system.
This goal is also pursued in the treatment of sudden hearing loss with HBO.
However, there is still no clear evidence for the effectiveness of hyperbaric oxygen therapy in either case.
Read more about this under
- Treatment of tinnitus
- Therapy for sudden hearing loss
Osteomyelitis
The refractory bone marrow inflammation (Osteomyelitis) is an indication for HBO with a high level of evidence, as it can not only improve blood circulation, but also increase bone formation, collagen synthesis and the formation of new blood vessels.
Read more about this under Osteomyleitis
Ahlbäck's disease
In addition, HBO can be used in the early stages of Ahlbäck's disease, aseptic osteonecrosis of the knee joint, or bone marrow edema. In this case, the HBO supports the formation of new blood vessels, which leads to better blood circulation, has an anti-edematous effect and supports natural healing.
Read more about this under
- Ahlbäck's disease
- Bone marrow edema
Chronic wounds
Chronic wounds can also be stimulated to heal with the support of hyperbaric oxygen therapy. This also includes wounds in the context of a diabetic foot syndrome.
preparation
Before therapy can be started, various tests must be carried out to determine suitability for pressure. Each patient is examined physically, with particular focus on the heart and lungs. In addition, a resting ECG and a lung function test are initiated. The middle ear is assessed to ensure that pressure equalization can be carried out successfully. A sound pressure measurement and an ear mirror may also be performed. You must also have a chest x-ray, which must not be older than two years.
The presence of contraindications must also be excluded. These include, for example, bronchial asthma, hyperinflation of the lungs or a recent heart attack.
No flammable objects, e.g. Tobacco or electronics are brought along. Removable aids, such as Contact lenses and hearing aids must be removed before entering the chamber.
Course of hyperbaric oxygen therapy
Hyperbaric oxygen therapy can either take place in a single chamber or in a multi-person chamber. In any case, the patient has the opportunity to contact the staff via an intercom during the entire treatment.
As soon as the patients are seated in the pressure chamber, the air pressure in the chamber is slowly increased. During this time, the patient regularly equalizes the pressure by swallowing or Valsalva maneuver (Try to exhale with your mouth closed and your nose covered). Chewing gum can also help to equalize the pressure.
As soon as the target pressure is reached, the patient puts on an oxygen mask and breathes in 100% oxygen through it. Depending on the duration of the treatment, breaks can be made during which air of the usual composition is inhaled. To ensure the success of the treatment and for the safety of the patient, the patient's oxygen partial pressure is continuously monitored. During the treatment phase, the patient can read something or listen to music.
After completing the treatment, the pressure is slowly reduced to normal air pressure values.
Depending on the indication and therapy scheme, several sessions are carried out, all of which follow the same procedure.
Risks
Various complications can arise with hyperbaric oxygen therapy. Since HBO is ventilation with a high dose of oxygen under positive pressure, acute damage to the lungs can occur, just like mechanical ventilation with positive pressure (Acute Lung Injury or Acute Respiratory Distress Syndrome). However, if the therapy is carried out properly, no lasting damage is to be expected.
Myopia can occur as a result of the increased oxygen concentration. This is only temporarily available and completely regresses. A seizure is a very rare complication of the increased oxygen content in the air we breathe. On the other hand, it is relatively common to damage the eardrum caused by the increased pressure. However, this generally heals within a few days without further therapy. In addition, the treatment may lead to nausea and vomiting.
In addition to the physical risks, there is an increased risk of fires and explosions, especially in a single-person pressure chamber with 100% oxygen.
Duration of hyperbaric oxygen therapy
Both the duration of treatment and the number of sessions performed daily vary depending on the clinical picture. For most clinical pictures, one session is carried out five to six days a week. These daily units usually last 60-135 minutes. Several sessions per day are required in emergencies.
In the case of acute inner ear diseases, the number of sessions is usually between 15 and 20. In the case of more severe diseases, such as Bone infections, a total of 30 to 60 sessions may be required.
Cost of hyperbaric oxygen therapy
Hyperbaric oxygen therapy performed on an outpatient basis is generally not covered by statutory health insurance. In extremely rare individual cases, a medical report and a cost estimate may be covered.
The only indication in which the statutory health insurance covers the costs for an outpatient HBO is diabetic foot syndrome.
Private health insurance companies, on the other hand, usually cover the costs of the HBO if at least one high-quality study is available on the benefits of HBO in the present clinical picture. It is advisable to inquire about the assumption of costs using a cost estimate before starting the treatment.
For civil servants, a number of indications are also eligible for outpatient support, including peripheral ischemia, severe burns, carbon monoxide poisoning or gas embolism.
If, on the other hand, hyperbaric oxygen therapy is carried out as part of an inpatient stay due to carbon monoxide poisoning, decompression sickness, arterial gas embolism or clostridial myonecrosis, the entire treatment is also paid for by the statutory health insurance.
Since the costs of an outpatient HBO therapy vary greatly depending on the duration and number of sessions, it is advisable for self-payers to apply for a cost estimate based on the individual diagnosis.
What are the chances of success?
In the absence of many studies on the effectiveness of hyperbaric oxygen therapy, HBO is a controversial practice. This fact also forms the basis for the fact that the statutory health insurance companies largely do not pay the HBO.
For the treatment of tinnitus, for example, there is no evidence of the success of HBO. However, it is assumed that positive effects mainly can be achieved in acute situations and the psychologically expected success plays a major role.
On the other hand, positive studies are available for the use of hyperbaric oxygen therapy in chronic osteomyelitis, which has previously been unsuccessfully treated with standard therapies (both surgical and antibiotic), which consider therapeutic success to be likely. The same applies to the treatment of diabetic foot wounds. Here, too, there are studies that show that the chronic wounds heal better through treatment with HBO.
Overall, the likelihood of success of treatment with HBO has not yet been reliably proven by studies. However, it is a potentially effective alternative if the standard procedures fail.
