St. Joseph Hospital of Orange
1100 West Stewart Dr, Orange, CA 92868714.633.9111
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Wound Management
Hyperbaric Medicine

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History
The first pressure-tight chamber was called the “Domicilliun” in 1662; the first use of a hyperbaric chamber was in 1834 for lung disease. Hyperbaric chambers were first used in Europe until James C. Corning (1861) brought hyperbaric air therapy to the United States. Developments in hyperbaric oxygen as a treatment began in 1937 for the treatment of decompression sickness. Treatment for radiation began in 1955 and the first wound was treated in 1960.

Hyperbaric Oxygen Therapy

Setup
An individual will prepare for treatment by changing into 100% cotton clothing and removing of all objects that are unsafe during hyperbaric treatment. Hyperbaric oxygen treatments are done by placing an individual on a rolling bed that is on top of a gurney. The individual has a pillow for his or her head and a pillow that is located under the knees to take pressure off the lower back. Two blankets are given during the first treatment. if the individual becomes warm, he or she can remove one or both of the blankets; if the individual is still cold, then during the next treatment the individual is given a third blanket.

Compression
After the bed is rolled into the chamber and the large door is closed and sealed, the technician turns on the oxygen and adjusts the pressure to the required depth. The rate of descent is adjusted to the experience of the individual; during the first treatment the rate is slow at one pound of pressure per minute. During the compression the individual will yawn, swallow, or hold the nose and swallow to clear the pressure from the ears. If the individual has difficulty clearing the ears or feels slight pain then he or she should tell the technician so that the problem can be resolved. The feeling of fullness in the ears is like the feeling an individual will have when traveling into the mountains.

Treatment
Once the individual reaches the prescribed pressure, he or she can watch television or movies (VHS or DVD), listen to music or sleep. Individuals breathe normal breaths during the treatment. Treatments are a total of 110 minutes: 10 minutes to compress, 90 minutes for treatment, and 10 minutes to decompress. Treatments are prescribed by a hyperbaric trained physician and the normal treatment protocol is 40 treatments for 90 minutes at 2 Absolute Total Atmospheres (ATA) or 66 feet of sea water (fsw). More or less treatments are determined by the hyperbaric physician and the individual’s wound physician.

Decompression
At the end of the treatment, the technician will decrease the amount of pressure in the chamber. During the decompression the individual will notice less pressure on the ears. After the pressure is released to a safe limit the technician will unseal the door and open the chamber. The gurney will be re-attached to the rolling bed and the bed will be rolled out of the chamber. The individual will have his or her vitals retaken by the technician and recorded. Either the technician or physician will observe the ears for possible Barotrauma. Barotrauma is a condition that can happen if the ears are not properly open and pressure increases to the point of trauma.


Hyperbaric Staff
All of the staff of the hyperbaric department are trained in the proper use of hyperbaric medicine and in the operation of the chamber. The technician is a certified hyperbaric technician by the national board of Diving and Hyperbaric Medical Technology (DHMT), one registered nurse and five physicians are trained in hyperbaric medicine, one physician is board certified by the Undersea and Hyperbaric Medicine Society (UHMS).

Frequently Asked Questions

1. What can I wear in the chamber?

Individuals can only wear cotton clothing or outside garments that are checked and passed by the hyperbaric department.

2. How long are the treatments?

Each treatment is scheduled for two hours. This allows 15 minutes for garment change before and after treatment, 10 minute compression time, 90 minute treatment time, and 10 minute decompression.

3. How much pressure is a treatment?

The depth of the treatment depends on the type of wound; most treatments are 2 Absolute Total Atmosphere (ATA) or 66 feet of sea water (fsw).

4. Do I stay on my regular schedule with my medications?

Individuals should remain on their current schedule. Tell the technician if medications have been added or discontinued.

5. Why do I need to wait for the physician to start my treatment?

Medical Insurance requires the presence of the physician for safety reasons.

6. Will my Insurance reimburse the hyperbaric treatments?

Hyperbaric treatments are reimbursed by Medicare and most other insurance carriers. Prior authorization is needed before treatments can begin.

7. How many hyperbaric treatments will I need?

The amount of treatments depend on the individual and his or her wound. Sometimes a change in the wound can be seen after 10 treatments. The hyperbaric physician and wound physician will schedule an initial 40 treatments.

8. What will I feel during my hyperbaric treatments?

During compression an individual will feel pressure building in the ears, which needs to be cleared by yawning or swallowing. At this time the individual will feel warmer. During the treatment the individual may feel warm or cold, during decompression the individual may become cold.

9. How does the hyperbaric treatment heal my wound?

Hyperbaric uses 100% oxygen to pressurize the chamber. The individual breathes regular breathes and the oxygen is absorbed into the blood stream via the lungs. Pressure forces compression of the arteries and veins, which forces oxygenated blood to the wound site. Oxygen is also carried to the wound site by way of the lymphatic system.

  • Greatly increasing the oxygen concentration in all body tissues, even with reduced blood flow

  • Improving the healing time of stubborn wounds

  • Stimulating the growth of new blood vessels in areas of reduced circulation

  • Increasing the efficiency of white blood cells to kill bacteria and aiding in infection control

  • Assisting in the treatment of chronic bone infections (osteomyelitis)

  • Preserving skin grafts, flaps and other tissues where the circulation is suddenly reduced

  • Reducing swelling (edema)

  • Reversing damage to tissues exposed to radiation therapy

  • Reducing effects from toxic exposure from carbon monoxide

10. Will hyperbaric treatments help all health conditions?

St. Joseph Hospital follows the Medicare guidelines for hyperbaric treatments. Any other reasons are considered off-label and not an accepted practice of the facility. These are the accepted Medicare conditions:

  • Non-healing diabetic leg and foot wounds and other selected problem wounds
  • Delayed radiation injury to soft tissues (soft tissue radiation necrosis)
  • Delayed radiation injury to bone (Osteoradionecrosis)
  • Compromised skin grafts or flaps
  • Chronic bone infections (Chronic refractory osteomyelitis)
  • Crush injuries, compartment syndromes, and other acute traumatic injuries
  • Necrotizing soft tissue infections.