UNDERSEA AND HYPERBARIC MEDICAL SOCIETY Hyperbaric Oxygen Therapy INDICATIONS 14TH EDITION Richard E. Moon MD Chair and Editor Undersea and Hyperbaric Medical Society 631 US Highway 1, Suite 307 North Palm Beach, FL 33408 USA No responsibility is assumed by the publisher or editor for any injury and or damage to persons or property as a matter of product liability, negligence or otherwise, or from any use or operation of any methods, product, instructions, or ideas contained in the material herein. No suggested test or procedure should be carried out unless, in the reader’s judgment, its risk is justified. Because of rapid advances in the medical sciences, we recommend that the independent verification of diagnoses and drug dosages be made. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Copyright © 2019 Undersea and Hyperbaric Medical Society ISBN: 978-1-947239-16-6 Library of Congress Catalog Number: 2019940027 Published by: Best Publishing Company 631 U.S. Highway 1, Suite 307 North Palm Beach, Florida 33408 Printed and bound in the United States of America Table of Contents Preface . v Members of the Hyperbaric Oxygen Therapy Committee. vii I. Background . ix II. Hyperbaric Oxygen: Definition . x III. Utilization Review For Hyperbaric Oxygen Therapy . xii IV. Acceptance (Addition) of New Indications for Hyperbaric Oxygen Therapy . xii V. List of Abbreviations . xiii VI. Author Biographies . xvi PART I. Indications 1. Hyperbaric Treatment of Air or Gas Embolism: Current Recommendations . 1 2. Arterial Insufficiencies A. Central Retinal Artery Occlusion . 15 B. Hyperbaric Oxygen Therapy for Selected Problem Wounds . 31 3. Carbon Monoxide Poisoning . 81 4. Clostridial Myonecrosis (Gas Gangrene) . .105 5. The Effect ofyperbaric H Oxygen on Compromised Grafts and Flaps. 117 6. The oleR of Hyperbaric Oxygen for Acute Traumatic Ischemias. 135 7. Decompression Sickness. 153 8. Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) and Potential for Future Research . 163 9. Sudden Sensorineural Hearing Loss . .203 10. Intracranial Abscess . .231 11. Necrotizing Soft Tissue Infections . 239 12. Refractory Osteomyelitis . .263 13. Severe Anemia . .293 14. Adjunctive Hyperbaric Oxygen Therapy in the Treatment of Thermal Burns . 301 PART II. Additional Considerations 15. Mechanisms of Action of Hyperbaric Oxygen Therapy . 325 16. Side Effects of Hyperbaric Oxygen Therapy . .335 17. Oxygen Pretreatment and Preconditioning. 343 18. Randomized Controlled Trials in Diving and Hyperbaric Medicine . 351 19. Hyperbaric Oxygen for Symptoms Following Mild Traumatic Brain Injury . 379 Appendix A. Approved Indications for HBO2 Therapy. 393 Index . .399 Preface The application of air under pressure (hyperbaric air) dates back to 1667, when Nathaniel Henshaw proposed a hypo-hyperbaric room pressurized and depressurized with an organ bellows.1 In the nineteenth century, Simpson wrote a treatise on the use of compressed air for certain respiratory diseases.2 The medicinal uses of oxygen were first reported by Beddoes in 1794,3 while the first article describing adjunctive uses of hyperbaric oxygen therapy 4 (HBO2) was written by Fontaine in 1879, who constructed a mobile operating room which could be pressur- ized. He observed that pressurized patients were not as cyanotic after the use of nitrous oxide during induction of anesthesia as compared to patients anesthetized at atmospheric pressure. In addition, he noted that hernias were much easier to reduce. Also around that time, the work of Paul Bert5 and J. Lorrain-Smith6 showed that oxy- gen under pressure had potentially deleterious consequences on the human body with side effects that included central nervous system and pulmonary toxicity. The efforts of Churchill-Davidson and Boerema in the 1950s and 1960s spurred the modern scientific use of clinical hyperbaric medicine. In 1967, the Undersea Medical Society was founded by six United States Naval diving and submarine medical officers with the explicit goal of promoting diving and undersea medicine. In short order, this society expanded to include those interested in clinical hyperbaric medicine. In recognition of the dual interest by members in both diving and clinical applications of compression therapy, the society was renamed The Undersea and Hyperbaric Medical Society in 1986. It remains the leading not for profit organization dedicated to reporting scientifically and medically efficacious and relevant information pertaining to hyperbaric and undersea medicine. In 1972, an ad hoc Medicare committee was formed to evaluate the efficacy of hyperbaric oxygen therapy for specified medical conditions. The focus was to determine if this treatment modality showed therapeutic benefit and merited insurance coverage. The growth of the body of scientific evidence that had developed over the pre- ceding years supported this endeavor and recognition for the field. In 1976, the Hyperbaric Oxygen Therapy Committee became a standing committee of what was then the UMS. The first Hyperbaric Oxygen Committee Report was published in 1977 and served as guidance for practitioners and scientists interested in HBO2. The report is usually published every three to five years and was last published in 2014. Additionally, this document continues to be used by the Centers for Medicare and Medicaid Services and other third party insurance carriers in determining payment. The report, currently in its 14th edition, has grown in size and depth to reflect the evolution of the literature. To date, the committee recognizes 14 indications for which scientific and clinical evidence supports the use of HBO2. The Undersea and Hyperbaric Medical Society continues to maintain its reputation for its expertise on hyper- baric therapy. With leading experts authoring chapters in their respective fields, this publication continues to provide the most current and up to date guidance and support for scientists and practitioners of hyperbaric oxygen therapy. Richard E. Moon MD Editor, UHMS Committee Chair v Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc. References 1. Henshaw N. Aero-Chalinos or a register for the air for the better preservation of health and cure of diseases, after a new method. London. 1677. 2. Simpson A. Compressed Air as a Therapeutic Agent in the Treatment of Consumption, Asthma, Chronic Bronchitis and Other Diseases. Edinburgh: Sutherland and Knox; 1857. 3. Beddoes T, Watt J. Considerations of the Medicinal Use of Factitious Airs, and on the Manner of Obtaining Them in Large Quantities, First Edition, part II. Bristol: Bulgin and Rossier; 1794. 4. Fontaine JA. Emploi chirurgical de l’air comprime. Union Med. 1879;28:445. 5. Bert P. Barometric Pressure [Hitchcock MS, Hitchcock FA, translation]. Bethesda, MD: Undersea Medical Society; 1978. P. 579. 6. Lorrain-Smith J. The pathological effects due to increase of oxygen tension in the air breathed. J Physiol. 1899; 24:19-35. vi ~ Hyperbaric Oxygen Therapy Indications Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc. Members of the Hyperbaric Oxygen Therapy Committee Richard Moon MD (Chair) Dirk Bakker MD Robert Barnes MD Michael Bennett MD Enrico Camporesi MD Paul Cianci MD James Clark MD William Dodson, MD John Feldmeier DO Laurie Gesell MD Neil B. Hampson MD Brett Hart MD Enoch Huang MD Irving Jacoby MD Robert Marx DDS Heather Murphy-Lavoie MD Richard Roller MD Ben Slade MD Michael Strauss MD Stephen Thom MD, PhD Keith Van Meter MD Lindell Weaver MD Wilbur T. Workman MS vii Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc. I. Background The Undersea and Hyperbaric Medical Society (UHMS) is an international scientific organization which was founded in 1967 to foster exchange of data on the physiology and medicine of commercial and military diving. Over the intervening years, the interests of the Society have enlarged to include clinical hyperbaric oxygen therapy. The society has grown to over 2,000 members and has established the largest repository of diving and hyperbaric research collected in one place. Clinical information, an extensive bibliographic database of thousands of scientific papers, as well as books, and technical reports which represent the results of over 100 years of research by military and university laboratories around the world are contained in the UHMS Schilling Library, holdings are now part of the Duke University Library, Durham, NC. The results of ongoing research and clinical aspects of undersea and hyperbaric medicine are reported annually at scientific meetings and inUndersea and Hyperbaric Medicine published bi-monthly. Previously the society supported two journals, Undersea Biomedical Research and the Journal of Hyper- baric Medicine. These two journals were merged in 1993 into Undersea and Hyperbaric Medicine. UHMS headquarters is located at: 631 US Highway 1, Suite 307 North Palm Beach, FL 33408 Phone: 561-776-6110 / 1-877-533-UHMS (8467) FAX: 919-490-5149 Email: [email protected] Internet: www.uhms.org I. Background ~ ix Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc. II. Hyperbaric Oxygen: Defi nition Th e UHMS defi nes hyperbaric oxygen (HBO2) as an intervention in which an individual breathes near 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure (1 atmosphere absolute