Indications for the use of Hyperbaric Oxygen Therapy (HBOT)

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by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

The use of Hyperbaric Oxygen Therapy (HBOT), according to Medicare, is a modality in which the entire body is exposed to oxygen under increased atmospheric pressure. HBOT is a CMS covered adjunctive therapy and should be used in conjunction with standard care, which include modalities like surgery, debridement, medications, topical wound care and offloading the wound. It is also important to have plans of care that include monitoring nutritional status and glucose control to help ensure a positive outcome for the patient.

HBOT can consist of a patient being in either a monoplace or multiplace chamber. Most facilities have monoplace chambers which is a single patient chamber where the patient breathes under pressurized conditions with 100% oxygen.

The following indications are approved uses of HBOT:

  • Air or gas embolism
  • Carbon monoxide poisoning
  • Carbon monoxide poisoning complicated by cyanide poisoning
  • Clostridial myositis and myonecrosis (gas gangrene)
  • Crush injury, Compartment Syndrome and other acute traumatic ischemias
  • Decompression sickness
  • Arterial insufficiencies
  • Central retinal artery occlusion
  • Enhancement of healing In selected problem wounds
  • Severe anemia
  • Intracranial abscess
  • Necrotizing soft tissue infections
  • Osteomyelitis (refractory)
  • Delayed radiation injury (soft tissue and bony necrosis)
  • Compromised grafts and Flaps
  • Acute thermal burn injury
  • Idiopathic sudden sensorineural hearing loss (Approved on October 8, 2011 by the Undersea and Hyperbaric Medical Society Board of Directors)

The conditions listed above are approved and CMS recognized. There are studies being published about HBOT assisting with other conditions, however CMS is not currently reimbursing for these indications. Some private centers or private insurances have made exceptions and are performing trials on conditions such as:

  • Cutaneous, decubitus, and stasis ulcers
  • Chronic peripheral vascular insufficiency
  • Anaerobic septicemia and infection other than clostridial
  • Skin burns (thermal)
  • Senility
  • Myocardial infarction
  • Cardiogenic shock
  • Sickle cell anemia
  • Acute thermal and chemical pulmonary damage, i.e., smoke inhalation with pulmonary insufficiency
  • Acute or chronic cerebral vascular insufficiency
  • Hepatic necrosis
  • Aerobic septicemia
  • Nonvascular causes of chronic brain syndrome (Pick’s disease, Alzheimer’s disease, Korsakoff’s disease)
  • Tetanus
  • Systemic aerobic infection
  • Organ transplantation
  • Organ storage
  • Pulmonary emphysema
  • Exceptional blood loss anemia
  • Multiple sclerosis
  • Arthritic diseases
  • Acute cerebral edema

References:
American Hyperbaric Center. Approved Indications for Hyperbaric Oxygen Therapy. Available at: http://www.americanhyperbariccenter.com/approved_indications.htm. Accessed April 14, 2014.

Undersea and Hyperbaric Medical Society. Indications for Hyperbaric Oxygen Therapy: Available at: http://membership.uhms.org/?page=indications. Accessed April 14, 2014.

About the Author
Lindsay (Prussman) Andronaco is board certified in wound care by the Wound Ostomy Continence Nursing Certification Board. She also is a Diplomate for the American Professional Wound Care Association. Her clinical focus is working with Diabetic Limb Salvage/Surgical/Plastic Reconstruction patients, though her interests and experience are varied and include surgical, urological and burn care, biotherapeutics and Kennedy Terminal Ulcer research. Lindsay is the 2011 recipient of the Dorland Health People's Award in the category of 'Wound Ostomy Continence nurse' and has been recognized in Case In Point Magazine as being one of the "Top People in Healthcare" for her "passionate leadership and an overall holistic approach to medicine."

Lindsay is board certified in wound care by the Wound Ostomy Continence Nursing Certification Board. She also is a Diplomate for the American Professional Wound Care Association. In 2011, Lindsay was honored with the Dorland Health People's Award in the category of 'Wound Ostomy Continence nurse.'

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Comments

My 81yo mother had outpatient surgery to remove squamous cells on her right calf about 12 weeks ago. Not only is her surgical wound not healing as expected, she has developed several new, post-op ulcers, which have caused her to regress from being fully ambulatory pre-op to falling because she was being unable to bear her own weight due to excrutiating pain. Since her hospitalization to address debilitating pain and underlying causes, doctors have diagnosed her with cellulitis which they've treated with antibiotics (labs say she's clear of infection and fungi), and performed an angioplasty to open blood flow into her lower extremity, plus varying types of wound care, etc. She is now in a skilled nursing facility getting daily wound care and physical + occupational therapies. My concern is that her condition has barely stabilized let alone improved. I am wondering if you're aware of hyperbaric treatments being used to help aid/accelerate healing in these types of cases. Thank you.

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