Health Topics for Respiratory Problems

Department of Respiratory Care

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Interstitial Lung Disease -- Department of Internal Medicine

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Hyperbaric Oxygen Therapy

Hyperbaric oxygen is a means of providing additional oxygen to your body tissues. This is done by placing the patient’s entire body under increased atmospheric pressure in a closely monitored air-tight chamber. During HBO therapy, the patient breathes 100% oxygen for a restricted time.

Medical treatments of this type have been proven effective for a number of medical and surgical conditions, either as primary treatment, or as a supplement to other forms of treatment such as surgery or antibiotics. The University of Iowa has been using HBO therapy since 1988.

• How Does It Work?

  The result of the increased pressure and oxygen concentration is greatly increased oxygen-carrying capacity of blood -- and in turn is a greatly improved supply of life giving oxygen to the tissue.

  HBO is also the treatment of choice for any form of air embolism, or air bubble, which gets into the system and blocks the flow of blood. In this application, the increased atmospheric pressure reduces the size of the bubbles so that over time they can be circulated to the lung and expelled. Circulation and oxygenation of the tissues is thereby restored.

  To understand HBO therapy, one must first realize that under normal atmospheric conditions, (one atmosphere absolute or ATA), we are subjected to approximately 14.7 pounds per square inch of pressure and the air we breathe is composed of 21% oxygen and 79% nitrogen.

  During HBO therapy, those conditions are altered. The barometric pressure can be increased up to three times normal atmospheric pressure, while 100% oxygen is circulated for the patient to breathe.

• What Is A Chamber?

  Picture a tube that is 23 feet in length and 7 feet in diameter. It will accommodate 6 sitting patients or 2 stretcher patients plus the attendant. The chamber is comfortable for the patient, designed to allow a limited range of movement and activity.

  An attendant is always present in the chamber. There is also a medical lock that will allows medications, juices or snacks to be passed in.

• Is HBO Treatment Painful?

  Hyperbaric treatment is painless, but patients may have the sensation of a fullness in the ears, similar to what is experienced driving up or down a mountain road, changing altitudes in an airplane, or changing depths in underwater diving. The feeling of fullness occurs as the eardrums respond to the changes in atmospheric pressure.

  The eardrum is normally flat while at ground level. The eardrum tends to bow inward during compression and unless positive action is taken, fullness or pain will be felt. In order to avoid this, patients are taught how to force air into the middle ear during the 5 to 7 minutes the chamber is being pressurized. This can be done by swallowing, moving the lower jaw or blowing with the nose pinched. What is actually happening is that air is being forced behind the eardrum, via the Eustachian tubes, which connects the middle ear with the throat for passage of air. This prevents the eardrum from collapsing and causing pain. These procedures are taught to patients by the staff and is practiced thoroughly prior to the patient's first dive.

  At any time during compression the pressurization of the chamber can be stopped if the patient feels any type of discomfort. The patient and attending therapist will be communicating with the chamber operator at all times.

• What Will The Patient Feel During The Treatment?

  Once inside the chamber, the patient will hear the air beginning to circulate. Patients are able to see and talk with the chamber staff member, who will tell them when the gradual increase in pressure is begun. This is called compression.

  When the prescribed pressure (usually 2.4-3.0 ATA) is reached, patients are asked to place a hood or mask over their heads in order to receive 100% oxygen while in the chamber. The attendant will assist with this. The hood is clear plastic which will allow unobstructive vision.

  The reoccurring fullness in the ears will stop and then patients may rest or sleep during the remainder of the treatment. Patients also may read or do small handwork during the treatment which will last approximately 90 minutes. Also at any time, bedpans and urinals are available for prolonged treatments.

  Near the end of the treatment, the staff will gradually decrease the chamber pressure. This is the decompression phase, which usually lasts for about 7 minutes. During decompression, patients will experience an automatic "popping" sensation in the ears as a result of the decreasing pressure. This may be similar to what is felt in an airplane.

• Are There Any After Effects?

  Generally, patients will experience no after effects from HBO. However, some patients report a popping or cracking sensation in their ears between treatments. This sensation should be relieved in the same manner used to clear the ears while in the chamber.

  Additionally, some patients report feeling light-headed for a few minutes immediately following a treatment but should be able to continue with their normal daily activities.

• How Many Treatments Are Needed?

  Your physician, will recommend an individual treatment program. The amount of pressure used and the duration and frequency of the HBO treatments depend upon the specific disorder and its severity.

• What Must A Patient Do To Prepare For Treatment?

  Medications: Some medications are not compatible with Hyperbaric Oxygen Therapy. The staff will obtain a complete drug history. Each drug a patient is taking will be considered individually in relation to HBO therapy and if changes in either medication or schedule are necessary, the patient's physician will be advised.

  Colds and Symptoms: It is important to notify the HMS staff of a cold or the flu including fever, cough, sore throat, runny nose, fever blisters, cold sores, nausea, vomiting, diarrhea or general body aches. It may be difficult for a patient to clear the ears when these symptoms are present. The HBO treatments may be postponed until the patient's symptoms have subsided and have been cleared by their doctor to resume treatment.

  Smoking: Nicotine is another substance that is incompatible with HBO therapy. Once HBO therapy has been prescribed, the patient will have to stop smoking until the therapy is complete. This "No Smoking" rule applies to all forms of tobacco use.

  Cosmetics: Any make-up, hair spray, perfume, or shaving lotion containing a petroleum or alcohol base is not allowed during the treatment session.

  Clothing: Patients are provided with a 100% cotton scrub suit to wear during treatment. No articles containing nylon or polyester are to be worn in the chamber. Watches and prosthetic devices must be removed before treatment. Personal cleanliness is also very important to the effectiveness of the treatment.

Last Reviewed 2005

Source: J. Eric Greensmith, M.D., Ph.D.
Division of Respiratory Care
University of Iowa Hospitals and Clinics

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.