Hyperbaric Medicine - Indications

Indications

In the United States the Undersea and Hyperbaric Medical Society, known as UHMS, lists approvals for reimbursement for certain diagnoses in hospitals and clinics. The following indications are approved (for reimbursement) uses of hyperbaric oxygen therapy as defined by the UHMS Hyperbaric Oxygen Therapy Committee: However, these are reimbursement decisions based on cost of medical treatments vs HBOT at the average U.S. hospital charge of $1,800.00 per 90 minute HBOT treatment. China and Russia treat more than 80 maladies, conditions and trauma with HBOT, since costs are insignificant in those countries.

• Air or gas embolism;
• Carbon monoxide poisoning;
  • Carbon monoxide poisoning complicated by cyanide poisoning;
• Clostridal myositis and myonecrosis (gas gangrene);
• Crush injury, compartment syndrome, and other acute traumatic ischemias;
• Decompression sickness;
• Enhancement of healing in selected problem wounds;
  • Diabetically derived illness, such as diabetic foot, diabetic retinopathy, diabetic nephropathy;
• Exceptional blood loss (anemia);
• Intracranial abscess;
• Necrotizing soft tissue infections (necrotizing fasciitis);
• Osteomyelitis (refractory);
• Delayed radiation injury (soft tissue and bony necrosis);
• Skin grafts and flaps (compromised);
• Thermal burns.

HBOT is recognized by Medicare in the United States as a reimbursable treatment for 14 UHMS "approved" conditions. A 1-hour HBOT session may cost between $108 and $250 in private clinics, and over $1,000 in hospitals. U.S. physicians (either M.D. or D.O.) may lawfully prescribe HBOT for "off-label" conditions such as Lyme Disease, stroke, and migraines. Such patients are treated in outpatient clinics. In the United Kingdom most chambers are financed by the National Health Service, although some, such as those run by Multiple Sclerosis Therapy Centres, are non-profit. In Australia, HBOT is not covered by Medicare as a treatment for multiple sclerosis.

Other reported applications include:

• Autism. A small 2009 double-blind study of autistic children found that 40 hourly treatments of 24% oxygen at 1.3 atm provided significant improvement in the children's behavior immediately after treatment sessions. The study's effect has not been independently confirmed. Research conducted by the Center for Autism and Related Disorders (CARD) found that hyperbaric oxygen therapy does not have a significant effect on symptoms of autism.
• Cerebral Palsy;
• Epidural abscesses;
• Certain kind of hearing loss;
• multiple sclerosis
• Radiation-induced hemorrhagic cystitis;
• Inflammatory bowel disease.
• Psoriasis.

The toxicology of the treatment has recently been reviewed by Ustundag et al. and its risk management is discussed by Christian R. Mortensen, in light of the fact that most hyperbaric facilities are managed by departments of anaesthesiology and some of their patients are critically ill.