At Regenerative & Hyperbaric Medicine, we have been at the forefront of utilizing hyperbaric oxygen therapy (HBO₂) since 1993, delivering expert care to patients in Metro Atlanta. We've refined our approach for more than three decades to harness the powerful healing properties of HBO₂, a treatment that promotes rapid recovery and enhances the body's natural ability to heal.
HBO₂ is effective in treating a wide range of conditions, including chronic wounds, infections, neurological conditions, and more. The therapy works by significantly increasing oxygen concentration in the blood and tissues, triggering a cascade of biophysical responses that accelerate tissue repair, reduce inflammation, and stimulate cellular regeneration.
This helps in reducing pain, improving circulation, and optimizing the body’s healing processes. Whether used as a stand-alone treatment or in conjunction with other medical interventions, our experienced team ensures that HBO₂ is applied with precision, maximizing its potential benefits for each patient’s unique condition. With nearly three decades of expertise, we are proud to offer some of the best hyperbaric oxygen therapy in Metro Atlanta, improving patient outcomes and helping individuals recover faster and more effectively.
For referring physicians, Hyperbaric oxygen therapy (HBO₂) is an exciting and effective in treating a range of diseases, with many of its benefits derived from the following biophysical responses and mechanisms of action:
At 3 ATA of pressure, arterial pO₂ levels can reach around 2000 mmHg, with 6.6 vol% of oxygen dissolved in solution sustaining life.
This hyperoxygenation is why HBO₂ is useful for treating acute blood loss or severe anemia, particularly when blood transfusion is not possible or allowed. Although arterial pO₂ levels return to pre-treatment levels within minutes after HBO₂ ends, increased tissue oxygen levels can last an additional three to four hours.
Since oxygen transport is no longer dependent on hemoglobin, HBO₂ addresses cellular hypoxia in conditions where hemoglobin is tightly bound to a toxic substance, such as in carbon monoxide poisoning. The enhanced oxygen gradient allows oxygen to diffuse 2 to 3 times farther than normal, ensuring sufficient dissolved oxygen reaches the tissues. Additionally, high tissue oxygen levels promote the dissociation of carbon monoxide and cyanide from peripheral binding sites.
In a person without any blood dyscrasia, hemoglobin is almost fully saturated by breathing air (FiO₂ = 0.21) at the surface, with about 0.3 ml of oxygen dissolved in every 100 ml of plasma. When breathing 100% O₂ in a hyperbaric environment, Pao₂ progressively increases since hemoglobin is already saturated at the surface. According to Henry's law (solumetric effect), oxygen gradually dissolves in plasma in direct proportion to the increase in absolute pressure. At 3 ATA, Pao₂ exceeds 2000 mmHg, and the amount of oxygen dissolved in plasma reaches approximately 6.8 ml per 100 ml of plasma. By dividing 6.8 ml of O₂/100 ml achieved at 3 ATA by 0.3 ml of O₂/100 ml at the surface, we can see that the oxygen concentration in plasma increases by 23 times, a phenomenon known as hyperoxygenation.
2. Reduction in Bubble Size (Volumetric Effect/Boyle’s Law)
Gas bubbles shrink when subjected to progressively increasing pressure (Boyle's Law).
Both decompression sickness and arterial gas embolism involve gas bubbles within the bloodstream or tissues. Recompression in a hyperbaric chamber is the fastest way to reduce the size of these bubbles, providing rapid relief from the mechanical pressure they cause. Additionally, if the patient is breathing 100% oxygen, nitrogen exits the tissues even more quickly. After equilibrium, the bubble still contains about 80% nitrogen, while the surrounding blood has none, creating a steep diffusion gradient that allows nitrogen to leave the tissues faster than if only compressed air were being inhaled. This process is known as counter-diffusion. Increasing the ambient pressure from 3 to 6 ATA results in less dramatic bubble size reductions but may increase the risk of oxygen toxicity.
3. Increased Resistance to Anaerobic Bacteria
High pO₂ levels are effective in combating infections caused by certain anaerobic bacteria.
Strict anaerobes lack enzymatic defenses like superoxide dismutase or peroxidases, which protect aerobic bacteria from toxic oxygen radicals. Elevated oxygen levels are particularly beneficial in treating conditions like clostridial gas gangrene or other infections caused by anaerobic bacteria. Generally, HBO₂ has a bacteriostatic effect against many organisms and may even be bactericidal in some cases.
4. Increased Phagocytosis
The "killing function" of white blood cells can be divided into oxygen-dependent and oxygen-independent activities.
Oxygen-independent processes, which rely on pH alterations and enzymatic reactions, are less efficient than oxygen-dependent ones, which involve the production of specific microbicidal agents that degrade cell membranes. Ischemia hampers a polymorphonuclear leukocyte's ability to migrate or respond effectively to chemotactic stimuli.
In hypoxic tissues, such as those affected by chronic ulcers or osteomyelitis, increasing tissue oxygen levels to near-normal enhances the ability of white blood cells to phagocytize bacteria. For example, Mader reported that local tissue pO₂ levels in osteomyelitis are about 23 mmHg compared to control levels of 45 mmHg, and HBO₂ can raise these levels to 109 mmHg. By enhancing the "killing function" of white blood cells, HBO₂ improves their efficiency in fighting infections, particularly in areas with marginal perfusion.
5. Toxin Inactivation and Inhibition
HBO₂ not only inactivates circulating toxins produced by certain bacteria, but the increased O₂ tensions also seem to reduce many organisms' ability to secrete potentially lethal toxins in the first place.
For instance, the ability of Clostridia perfringens to secrete alpha toxin diminishes with higher pO₂ levels, which explains HBO₂'s clinical effectiveness in treating this infection.
6. Increased Wound Healing
When local tissue oxygen tensions drop below 10–15 mmHg, fibroblasts lose their ability to synthesize collagen, migrate, or divide, preventing new bone formation after injury in hypoxic bone.
HBO₂ administration reverses this condition. Higher oxygen tensions enable fibroblasts to synthesize collagen and osteoclasts to deposit bone and promote new blood vessel formation. These factors accelerate wound healing and have proven beneficial in treating osteomyelitis, osteoradionecrosis, and bony nonunion.
Howe demonstrated that ischemia impairs the healing of contaminated wounds. By inoculating bacteria into sharply incised or ischemic wounds, he found no infection in the sharp wounds, but all ischemic wounds became infected. Local ischemia creates an environment conducive to bacterial growth. Unless oxygen tensions are restored to normal physiological levels, ischemic wounds will fail to generate the adequate inflammatory response needed for wound repair.
7. Vasoconstriction
High O₂ levels cause blood vessels to constrict, likely due to a central alpha-adrenergic-like effect.
Although this can lead to a 15% to 20% reduction in regional blood flow, the substantial increase in total oxygen content—10 to 15 times normal—compensates for the hypoxic effects typically associated with reduced blood flow, preventing tissue hypoxia. This vasoconstrictive action is beneficial in treating crush injuries, acute thermal burns, and cerebral and peripheral edema. Since oxygen diffusion through plasma is proportional to the square root of the distance from the capillary to the cell, even minor reductions in edema can result in significantly more oxygen reaching the cell.
HBO₂ has been shown to reduce fluid replacement needs in burn patients and promote faster healing of burned tissue. In cases of peripheral crush injuries or compartment syndromes, HBO₂ may reduce blood flow and edema by 15%. In cerebral edema, 2 ATA of HBO₂ can lead to a 30% reduction in cerebral blood flow. Under normal conditions, a dynamic equilibrium maintains fluid balance in the interstitial space, preventing edema. In the blood vessels, fluid outflow (filtration) occurs at the arterioles (arterial end), while fluid reabsorption takes place in the smaller veins (venous end). Additionally, continuous drainage into the lymphatic system helps prevent fluid accumulation.
With HBO₂, vasoconstriction occurs only at the arterial end, affecting fluid outflow but not reabsorption. Consequently, fluid accumulation in the interstitial space is reduced due to preserved absorption at the venous end and lymphatic drainage. Thus, hyperoxic vasoconstriction results in decreased edema.
8. Neovascularization
HBO₂ speeds up the formation of new blood vessels.
This angiogenesis is beneficial for treating osteomyelitis, osteoradionecrosis, ulcers, and marginally surviving skin grafts. It also aids in preparing a site for skin graft acceptance. Once the vascular supply is reestablished, the other positive effects of HBO₂ become more effective.
9. Effect on Carbon Monoxide and Cyanide Poisoning
It is well established that hemoglobin has a higher affinity for carbon monoxide than for oxygen.
Since oxygen transport is no longer dependent on hemoglobin during HBO₂ treatment, it addresses hypoxia at the cellular level in cases where hemoglobin is bound to toxic substances like carbon monoxide. Additionally, the increased oxygen gradient allows for a diffusion distance 2 to 3 times greater than normal, ensuring sufficient dissolved oxygen reaches the tissues. High tissue oxygen levels also facilitate the dissociation of carbon monoxide and cyanide from their peripheral binding sites.
What Conditions Hyperbaric Oxygen Therapy Can Help Your Patients With?
There are several relative contraindications for HBO₂ therapy, with the most significant being patients who are prone to spontaneous pneumothorax or oxygen toxicity seizures during treatment. Other relative contraindications involve pressure-related "squeeze" syndromes. Although these issues are not absolute contraindications, they should be factored into the overall risk-benefit analysis for each patient.
1Obstructive Lung Diseases
Patients with a history of spontaneous pneumothorax or significant chronic obstructive pulmonary disease (COPD) are particularly at risk. Bronchiolar obstruction and distal air trapping can create stress areas where a pneumothorax may occur. Blebs and bullae, which are often visible on chest X-rays, may also rupture. A history of thoracic surgery can indicate potential air trapping within lung segments. Other obstructive pulmonary conditions, such as asthma, pulmonary cysts, or abscesses, can lead to similar outcomes. If air enters the vasculature, it can cause systemic air embolism. COPD with elevated pCO₂ increases the risk of oxygen toxicity seizures and raises concerns about apnea due to the loss of the patient's "hypoxic drive."
2Seizure Disorder
Patients with existing seizure disorders should receive prophylactic anticonvulsant medication before starting HBO₂ treatments. Those already on such medications should have their serum levels monitored to ensure adequate protection. Some researchers suggest that Phenobarbital may be more effective than Phenytoin in preventing and treating oxygen toxicity seizures.
3Fever
Hyperthermia increases the risk of oxygen toxicity seizures, while hypothermia can prolong the time before a seizure occurs. If possible, treatment should be postponed until the patient's temperature normalizes. This can be achieved through methods such as tepid water sponging, ice packs in the groin and axillae, or antipyretic agents like acetaminophen. If treatment cannot be delayed, such as in cases of gas gangrene, the patient should be closely monitored due to the higher risk of seizures.
4Pregnancy
Treating pregnant patients with HBO₂ therapy remains controversial. While some clinical research suggests there may be no harmful effects, Russian literature indicates minimal risk, whereas Bolton reports an increased risk of fetal abnormalities. There are also theoretical concerns that high fetal pO₂ levels could cause retinal issues or premature closure of the ductus arteriosus. Until further research provides more clarity, HBO₂ should be reserved for pregnant patients with life-threatening conditions and avoided for those with chronic conditions where treatment can be deferred.
5Acute Viral Infections
In patients with existing viral infections, there have been anecdotal reports of severe illness and death following HBO₂ treatment. For instance, Hart reported the death of a 4-year-old due to herpes simplex. Schmidt and Ball found that HBO₂ treatment significantly increases mortality in animals with viral diseases. Therefore, many centers recommend postponing treatment until the patient has fully recovered from viral infections. Additionally, upper respiratory infections can make it more difficult for patients to equalize pressures in their ears and sinuses during HBO₂ treatments.
6Malignant Disease
There is concern that HBO₂ might promote tumor growth, making this another area of debate. Controlled animal studies do not support this concern, but until more evidence is available, HBO₂ should be avoided if active metastatic disease is present. Additionally, since increased oxygen levels may exacerbate endarteritis, patients who have undergone radiation therapy should wait about six weeks before receiving HBO₂.
7HEENT (Head, Eyes, Ears, Nose, and Throat) Problems
When referring patients to Regenerative & Hyperbaric Medicine for hyperbaric oxygen therapy (HBO₂), it is essential to assess and address any potential HEENT (head, ear, eye, nose, and throat) concerns, as these areas can sometimes complicate treatment. Here are key considerations for your patients:
Eye Problems
For patients with a history of optic neuritis, be aware that there have been reports of severe recurrences, including blindness, in those with previously inactive cases. Before starting therapy, evaluate the patient's history to ensure no risks are present. Additionally, patients wearing non-fenestrated contact lenses should remove them prior to treatment to avoid squeeze-related injuries caused by trapped air.
Sinusitis
Patients with a history of sinus issues may experience pain during compression or decompression, particularly from mucus plugging, which can result in a sinus squeeze. To minimize discomfort, we recommend decongestants or nasal sprays before treatment. A thorough evaluation of the patient's sinus health prior to referral will help ensure a smooth HBO₂ experience.
Dental Disease
Poorly fitting dental work can lead to a painful dental squeeze. We advise that patients with any dental issues, especially those with dentures, be evaluated and treated by a dentist prior to starting therapy. This is particularly important for patients with dentures, as they can obstruct the airway in the event of a seizure, so removal is necessary. Eating or chewing gum during HBO₂ sessions is also prohibited, particularly in a monoplace chamber, to prevent complications.
Ear Problems
Given the dynamics of the Eustachian tube, the ear is especially sensitive to pressure changes and can be vulnerable to barotrauma. Some patients may experience a painful squeeze requiring medical intervention. Most individuals can equalize pressure using Valsalva or Toynbee maneuvers, especially with slow compression. To alleviate discomfort, decongestants or antihistamines can be administered prior to treatment. If the patient has a history of ear surgery or implants, it is crucial to assess the potential for displacement or damage. Regular ear examination is important to prevent issues during HBO₂ sessions.
By considering these factors, you can help ensure that your patients are well-prepared for HBO₂ therapy at Regenerative & Hyperbaric Medicine, minimizing risks and optimizing treatment benefits. If you have questions or need assistance with specific cases, our team of wound care and hyperbaric oxygen therapy specialists is here to collaborate with you for the best possible outcomes.
8Claustrophobia
Many individuals experience severe anxiety about entering a hyperbaric chamber, particularly small monoplace chambers. While this fear can sometimes prevent treatment, it is often manageable with reassurance or anti-anxiety medications like intravenous diazepam. Demonstrating an actual treatment to the patient can help set expectations and reduce anxiety. Patients should also be informed that their voices may sound slightly different during treatment to avoid surprise or fear later.
The Evidenced-Based Solution for Faster Healing in Your Patients
At Regenerative & Hyperbaric Medicine, we are committed to providing exceptional care through hyperbaric oxygen therapy and advanced wound care treatments. Our expertise in addressing complex medical conditions, combined with nearly thirty years of experience, makes us a trusted partner in improving patient outcomes. We welcome the opportunity to collaborate with you to provide the best care for your patients.
If you believe your patients could benefit from hyperbaric oxygen therapy or advanced wound care, we invite you to send them to our clinic. Contact us today to discuss how we can support their recovery.