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Hyperbaric Oxygen Therapy
If you have a chronic wound, your physician may recommend hyperbaric oxygen therapy to jump-start the healing process. We offer this treatment for all types of non-healing wounds to help promote healing.
Healing compromised tissues
Hyperbaric oxygen therapy can be a powerful treatment for wounds that don't get enough oxygen to heal. These wounds are often caused by radiation treatment for cancer, and by diabetes. Hyperbaric therapy temporarily increases the body's capacity to carry oxygen and helps the body grow new blood vessels. This makes it easier for tissue to repair itself and respond to other medical care.
Our highly skilled wound care staff uses hyperbaric oxygen therapy along with surgery and medication for non-healing wounds. We treat conditions including:
- Radiation tissue injury, is an uncommon, but significant complication of radiation treatment for cancer. Radiation can result in progressive tissue injury in the radiation field (those tissues directly exposed to radiation
- Diabetic foot wounds (see our referral guide for referral criteria)
- Non-healing osteomyelitis (bone infection usually caused by bacteria)
- Threatened / non-healing flaps / grafts
Conditions we treat
In hyperbaric oxygen therapy, you breathe pure oxygen in a pressurized environment. This therapy is used to treat a variety of conditions and diseases, ranging from chronic wounds and chronic bone infections to carbon monoxide poisoning, decompression sickness (typically associated with diving accidents), and many others.
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Certain types of wounds, especially in the lower extremities, often fail to respond to normal medical treatments. Wounds that are caused by the loss of the microvascular bed, such as diabetic foot wounds, do not get adequate oxygen or the other blood factors necessary for healing to occur.
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Low levels of tissue oxygen (tissue hypoxia) limits or impedes immune cell function (white blood cells), that are necessary to kill bacteria. Tissue hypoxia also impedes bone remodeling (normal bone breakdown and build up) activities. In addition, some bone infections come from anerobic bacteria (bacteria that live without oxygen), and these bacteria are impeded or killed within tissues supplied with high oxygen levels. These mechanisms, along with antibiotics (and sometimes surgical removal of non-viable bone), can result in higher healing rates in patients who have persistent bone infection despite prior antibiotic treatment.
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Radiation tissue injury / late effects of radiation / late radiation tissue injury, is a progressive complication or side effect of radiation therapy used to treat cancer. This occurs because radiation can damage normal cells as well as cancer cells. Destruction of nutrient blood vessels in the irradiated area can result in local tissue injury, non-healing wounds (ulceration), destruction of bone (necrosis), and tissue breakdown, which may result in bleeding.
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Osteoradionecrosis is a form of late radiation tissue injury resulting in bone loss, fracture or exposure associated with loss of surrounding tissues. This can occur because radiation inevitably destroys normal cells and blood vessels, as well as cancer cells. Radiation can result in the progressive destruction of the small arteries (capillaries) that supply blood and nutrients to tissues, including bone, resulting in deprivation of oxygen and other necessary nutrients. This process is gradual and may take many months or years to appear. If you require surgery within an irradiated field (tissues exposed to radiation), the wound may not heal post-operatively. Oxygen delivered at hyperbaric pressures has been shown to produce new blood vessels in the irradiated area and stimulate wound healing, reduce tissue fibrosis, and stimulate tissue regeneration.
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Decompression illness includes decompression sickness (a condition that can affect scuba divers, also known as the ‘bends’ who surface after an excess of time breathing compressed gas at depth), and arterial gas embolism (which can occur with scuba divers who breath-hold on ascent resulting in lung overexpansion and alveolar rupture which can lead to air entering into the heart and traveling to the brain and other organs).
A third cause of gas/bubbles within the vascular system can result from accidental infusion of gas into an artery or vein during medical treatments.
These types of injuries often warrant emergent evaluation and treatment in a hyperbaric chamber.
Scientific definition of hyperbaric oxygen (HBO2) therapy
HBO2 therapy is the treatment of a disease or medical condition by the inhalation of near-100% (at least 99%) medical grade oxygen at pressures greater than 1.4 atmosphere absolute (ATA) (101.3 kilopascals (kPa)) in a pressure vessel constructed for human occupancy. All currently approved indications require treatment pressures between 2 ATA and 3 ATA.
What is hyperbaric medicine?
The US Food and Drug Administration (FDA) and the Undersea and Hyperbaric Medical Society (UHMS) approved indications are treated on 100 percent oxygen at a minimum of 2 ATA’s (33 FSW), up to a maximum of 3 ATA’s (66 FSW).
Breathing oxygen under pressure significantly enhances oxygen supply to hypoxic (low oxygen levels) tissue. Our chamber at Virginia Mason Medical Center (VMMC), Center for Hyperbaric Medicine (CHM) is capable of providing treatments as deep as 6 ATA’s (165 FSW) for approved US Navy Treatment Table protocols.
The most common VMMC CHM patients are those undergoing treatment for the delayed effects of radiation therapy. Radiation establishes a progressive destruction of small blood vessels and creates abnormal tissue architecture, fibrosis, and scarring. We also treat people with diabetic foot ulcers and chronic refractory osteomyelitis. Patients in these categories undergo approximately 40 treatments provided once daily.
The VMMC CHM is the only hyperbaric facility available to treat emergencies, critically ill patients requiring a higher level of care (e.g.: Intensive/Critical Care needing respiratory or cardiac support) and provide after hours care in the Northwest region of the country (AK, WA, OR, ID, MT). The closest hospital that provides 24/7 hyperbaric care is in Salt Lake City, Utah. Our facility is one of only two UHMS accredited hyperbaric chambers in the state of Washington. VMMC CHM is the only multiplace chamber in this state, and the only chamber capable of treating urgent and emergent patients 24/7, while running routine hyperbaric treatments during business hours.
How hyperbaric oxygen therapy works
Hyperbaric oxygen therapy provides near-100 percent oxygen in a pressurized chamber. This therapy dramatically increases the amount of oxygen in the blood which enables healing by, collagen formation, stem cell migration, and growth of functional blood vessels to form and supply nutrients to tissues. Hyperbaric oxygen also reduces tissue inflammation and edema, and expedites the removal of inert gas in cases of decompression injury, and removal of carbon monoxide in cases of acute exposure.
Most indications are treated daily for about two hours per treatment, and often require as many as 30 or 40 total treatments. Hyperbaric oxygen therapy can help heal some types of wounds and infections in the following ways:
- Diabetes and radiation therapy destroy blood vessels (capillaries). Increasing oxygen to the body helps new blood vessels grow, which provides more oxygen rich blood reaching injured areas. Certain types of chronic wounds can also benefit in this way.
- Increased oxygen levels decrease the swelling (edema) around a wound site. Decreasing the swelling allows blood and oxygen to flow more effectively injured tissues.
- High oxygen levels increase the ability of the “infection fighting” cells (white blood cells), which gives injured tissues a better chance of healing.
Hyperbaric treatments should be absolutely painless. However, some patients experience fullness or pain in their ears. This can usually be prevented with equalization techniques. Some people require pressure-equalization tubes that can be placed (quick outpatient procedure) by our ear-nose-and-throat surgeons. Negative side effects are rare, and your physician will discuss them with you in detail before your treatment.
What to expect during hyperbaric oxygen therapy
Your hyperbaric oxygen therapy session has three phases:
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During the compression phase (approximately 10-minutes) you can hear the compression gas entering the chamber, and you will feel the chamber temperature increase. This phase of the treatment is the only active portion, where patients will need to ‘equalize’ or pop their ears repeatedly during compression until we reach our treatment pressure. This is similar to what you experience when you drive in the mountains or fly in an airplane, and is the same process divers perform when descending underwater.
The reverse occurs on decompression, where you will feel the chamber cool. This phase of the treatment rarely requires active ear equalization other than swallowing, yawning, or chewing.
A certified hyperbaric technician or nurse will be in the chamber with you at all times and they are in communication with the chamber operator and medical team. Wireless headsets enable real-time communication between department team members, which enables real-time ability to stop compression, or change compression speed to ensure patient comfort and safety.
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When the pressure reaches the prescribed level, your treatment begins. During this time, you may rest, sleep, listen to music or watch television (television is an option at some facilities).
Learn more
Talk to your primary care physician or provider if you believe you have a condition that may be improved through hyperbaric oxygen therapy. For appointments at VMMC, please reivew parking information for the Seattle location.