Patient Label / Name HBO - HYPERBARIC OXYGEN PATIENT EDUCATION - Page | 1 FAQs HBO is a medical treatment which enhances the body’s natural healing process by inhalation of 100% oxygen in a total body chamber, where atmospheric pressure is WHAT IS HBO? increased and controlled. It is used for a wide variety of treatments usually as an adjunctive part of an overall HBO or HBOT stands for: Hyperbaric Oxygen Therapy medical care plan that can be done on an inpatient or WHAT DOES IT DO? outpatient basis. HBO or HBOT, simply, HBOT is a means of providing WAIT! CAN YOU TELL ME MORE ABOUT THE additional oxygen to your body tissues. “ENTIRELY CLOSED PRESSURE CHAMBER”? HOW DOES IT WORK? Your entire body will go in a closely monitored, TRANSPARENT, 100% ACRYLIC topped, sealed chamber. By exposing the Most patients have plenty of room to get comfortable entire body to and can enjoy their 1.5-2 hour treatments while watching oxygen under TV (installed on each chamber with internal speakers) or increased napping. atmospheric A highly qualified Hyperbaric Tech will be in the room pressure. with you at all times during your treatment, and you will be closely monitored before, during and after all HBO The patient is entirely enclosed in a pressure chamber Treatments. breathing 100% oxygen (O2) at greater than one atmosphere HBO Chambers have microphones that allow your HBO (atm) pressure. Tech to hear you without need to push any buttons. SO, HOW DOES THAT HELP? Simply call out and you will be heard. If you should need to cut your treatment short or want to get out at any HBO therapy serves 4 PRIMARY FUNCTIONS: time, your HBO Tech is always right there to safely decompress the chamber and help you out and call for 1. It increases the concentration of dissolved OXYGEN in the transportation. blood, which augments oxygenation to all parts of the body; 2. It replaces inert gas in the bloodstream with OXYGEN, which is then metabolized by the body; 3. It may stimulate the formation of a collagen matrix and angiogenesis; 4. It acts as a bactericide for certain susceptible bacteria. SO, WHY AM I JUST NOW GETTING HOW DO I KNOW IF I QUALIFY FOR HBOT? EVALUATED FOR THIS MIRACLE TREATMENT?? A HBO Specialist (MD/PA) has been consulted to do an evaluation and will help determine if you are a good Hyperbaric oxygen therapy (HBOT) is an ADJUNCTIVE candidate. If you meet Clinical Criteria (& your 3rd (complementary or secondary) treatment that does not Party Payor -CMS/Insurance allow) without significant replace standard medical care you should have already contraindications, then you will be scheduled for HBOT. received. HBOT is usually only indicated when standard treatments have failed, and when patients meet specific criteria. ALEROSA ENT. ® WC & HBO Ed. (V5, 2.0) – Copyright ©2020 Page 1 of 8 HBO - HYPERBARIC OXYGEN PATIENT EDUCATION - Page | 2 IS HBO FOR ME? DO I HAVE ONE OF THE 15 OK – SO, TELL ME MORE ABOUT THE “ALLOWABLE” DIAGNOSES FOR REASONS WHY HBO MAY NOT BE FOR ME? TREATMENT WITH HBOT? ABSOLUTE NO-NO’S / CONTRA- From CMS NCD 20.29: At this facility and others like it, of the 15 total diagnosis, INDICATIONS: that have been primarily designated as “Non-Emergent HBO Therapy” by CMS are considered reasonable & necessary: Untreated Pneumothorax (Lung Collapse) & 1. Spontaneous Pneumothorax - who meet the following 3 criteria: Even with surgical tacking / pleurodesis, this is still considered a contraindication in the monoplace chamber, but a) Patient has Diabetes Type I or Type II and has a lower is “relative” in a multiplace where needle decompression of extremity wound THAT IS DUE TO DIABETES the chest can be performed. 50% of patients with spontaneous pneumothorax have a recurrence. An “absolute b) Patient has a wound classified as ≥Wagner Grade III contraindication” for SCUBA diving. History of “disserved” for ≥30 DAYS. pneumothorax is acceptable for HBO treatment. Absolute contraindication in a monoplace. “Relative” contraindication c) Patient has failed a course of standard wound therapy in a multiplace for ≥30 DAYS. Untreated, On-going Seizures Untreated, Decompensated CHF with an EF <30% 3. unresponsive to conventional medical and surgical Adriamycin (Doxirubicin) management, treated before. 87% mortality when Adriamycin was used with HBO 4. , as an adjunct to exposure in animal model (Upton, 1986) Potentiates oxygen- conventional treatment. free radicals with HBO. Delay HBO for at least 7 days (6 half- lives). 5. as an adjunct to conventional treatment. Bleomycin “Antibiotic” w/ antineoplastic activity. Used for head & neck 6. only as an adjunct to conventional tumors, lymphomas, and testicular tumors. Case reports therapy when the disease process is refractory to suggest that even modest increases in FIO2 to 32% or 45% antibiotics and surgical treatment. during surgery months or yrs following Bleomycin produce severe interstitial pneumonitis. Any history of exposure to 7. ACUTE CARBON MONOXIDE INTOXICATION this drug should be considered a contraindication Scuba Diving also contraindicated if prior exposure to bleomycin 8. DECOMPRESSION ILLNESS Cisplatin / Carboplatin 9. GAS EMBOLISM In animal models, the breaking strength of wounds is diminished in the setting of HBO + Cisplatin Nemiroff P. UBR 10. GAS GANGRENE 1988) Elapsed time from last drug use to HBO exposure 6 half lives ~ 99% elimination. 11. ACUTE TRAUMATIC PERIPHERAL ISCHEMIA. 12. CRUSH INJURIES AND SUTURING OF SEVERED LIMBS. Disulfiram (Antabuse) Blocks production of Superoxide Dismutase, which protects 13. PROGRESSIVE (ACUTE) NECROTIZING INFECTIONS against oxygen toxicity. HBO is contraindicated if multiple (NECROTIZING FASCIITIS) sessions required (Seizure risk). Single exposure for CO tx probably acceptable 14. ACUTE PERIPHERAL ARTERIAL INSUFFICIENCY Mefanide (Sulfamylon) 15. CYANIDE POISONING Carbonic anhydrase inhibitor. Increased risk of Seizure ALEROSA ENT. ® WC & HBO Ed. (V5, R2.0) – Copyright ©2020 Page 2 of 8 HBO - HYPERBARIC OXYGEN PATIENT EDUCATION - Page | 3 RELATIVE NO-Nos / CONTRA-INDICATIONS: These complications are incredibly rare but can be quite serious, particularly if not recognized. CHF, Congestive Heart Failure Pneumothorax History, Risk & CPR Patients with any history of CHF should have a baseline echocardiogram before HBOT Tension pneumothorax for pts who were comatose & Caution should be taken in patients with a low ejection intubated post CPR is associated with HBO therapy. In those fraction (EF) (i.e., <40-45%). cases, the incidence of Tension PTX rose to 12%. It is unlikely Patients with very low EF will likely need a CARDIOLOGY that the benefits of HBOT will outweigh the risks in an LTAC CLEARANCE prior to HBO. setting, but each case will be looked at individually. Untreated, Decompensated CHF with an EF <30% cannot go in History Of Thoracic Surgery the chamber. Patients should be careful to avoid fluid overload before Air trapping lesions w/ thoracic surgery, such as: HBOT and report it to their HBO Team before treatment pneumonectomy or thoracoplasties are a concern. should it develop. Mild cases of air trapping can be treated successfully with HTN, Uncontrolled HIGH Blood Pressure slow depressurization (ascent rates 1 psi/min). However, more significant air trapping in the lungs or Blood Pressure should be well controlled. anything that leads to pulmonary over-pressurization – as Blood pressure effects of HBOT can cause a temporary already discussed, can lead to alveolar rupture. increase in both systolic (SBP) & diastolic blood pressure (DBP). This holds true for both hypertensive (HTN) & non- Obstructive Lung Disease (COPD, hypertensive patients, but more so in HTN. EMPHYSEMA, OSA) HTN Rxs: Calcium channel blockers & beta-blockers are known to exacerbate HBOT effect on blood pressure. The risk for PULMONARY BAROTRAUMA (PBT) is Confinement Anxiety & other factors, like wound related pain, essentially zero for patients with normal lungs and an open can add to this phenomenon. glottis. Acute upper respiratory infection However, the risk does exist for PULMONARY Before HBO, if possible, mild symptoms should be BAROTRAUMA (PBT) for patients with asthma or chronic controlled with a regimen of decongestant nasal spray, obstructive pulmonary disease [COPD] with active antihistamines, and/or steroid nasal spray just before bronchospasm, mucous plugging, and bullous lung disease. These diseases can lead to PULMONARY OVER- compression. PRESSURIZATION aka lung over-inflation from air PULMONARY BAROTRAUMA (PBT), [which just means trapping during decompression. DAMAGE = trauma TO THE LUNGS = pulmo RELATED TO PRESSURE = baro]; risk in patients with moderate – severe URI CXR (Chest X-Ray) +/- Chest CT Scan will be needed to screen symptoms are likely too high for the possible benefit. for PULMONARY LESIONS. …During depressurization (Ascent at end of treatment), an . IF any significant PULMONARY LESIONS such as acutely ill patient with Moderate to Severe URI or any of the blebs are noted on CXR or CT scan or positive evidence following: for air trapping- it MIGHT be possible to treat with . Severe bronchospasm slow ascent rates of 1 psi/min. A closed glottis from coughing fit . A closed glottis from seizure Asthma May be helped by bronchodilator prophylaxis . Holding their breath …Can cause PULMONARY OVER-PRESSURIZATION Implanted Medical Devices which can then lead to alveolar rupture. In layman’s Special consideration needs to be given to any implanted terms: Doing these things at the end of HBO Treatments