Patient Management During HBOT
Guidance on how to manage patients who are undergoing HBOT, including monitoring for side effects, understanding contraindications, and the role of HBOT in combination with other therapies (e.g., antibiotics, surgical interventions). We also provide advice on follow-up care and how to adjust treatment plans based on patient progress.
Patient management
during HBOT
Contraindications and
precautions
Combining HBOT with other therapies
Follow-Up care and adjusting treatment plans
Patient education and psychological support
Approved Indications for Hyperbaric
Oxygen Therapy
Listed here are the approved indications for Hyperbaric Oxygen Therapy (HBOT) by the Undersea & Hyperbaric Medical Society.
Air or Gas Embolism
A dangerous condition where air bubbles block blood flow. HBOT helps by shrinking these bubbles and restoring circulation.
Carbon Monoxide Poisoning
HBOT quickly removes carbon monoxide from the bloodstream, helping to restore oxygen levels in your body.
Clostridial Myonecrosis (Gas Gangrene)
A dangerous condition where air bubbles block blood flow. HBOT helps by shrinking these bubbles and restoring circulation.
Crush Injuries & Compartment Syndrome
HBOT reduces swelling and helps improve oxygen delivery to damaged tissues, speeding up recovery after severe trauma.
Decompression Sickness (The Bends)
Divers experiencing decompression sickness benefit from HBOT, which reduces nitrogen bubbles in the bloodstream.
Delayed Radiation Injury (Soft Tissue and Bone)
HBOT improves blood flow and healing in tissues damaged by radiation therapy.
Diabetic Foot Ulcers and Other Problem Wounds
HBOT enhances oxygenation in poorly healing wounds, significantly improving recovery rates in diabetic patients.
Compromised Skin Grafts & Flaps
HBOT supports the healing of skin grafts and flaps that are at risk of failing by promoting healthy blood flow.
Thermal Burns
For serious burns, HBOT speeds healing and reduces the risk of infection by increasing oxygen delivery to the affected areas.
Necrotizing Infections
Life-threatening infections in soft tissue, such as necrotizing fasciitis, respond well to HBOT as it helps fight infection and heal tissue.
Osteomyelitis (Chronic Bone Infection)
HBOT helps treat persistent bone infections by delivering oxygen to infected areas, boosting the immune response.
Sudden Sensorineural Hearing Loss
When hearing loss occurs suddenly, HBOT may improve oxygen supply to the inner ear, supporting hearing recovery.
Radiation Proctitis, Cystitis, Enteritis
These painful conditions are side effects of radiation therapy, and HBOT can alleviate discomfort and promote healing.
Refractory Anaemia
In cases where blood transfusions aren’t possible or effective, HBOT enhances oxygen delivery in anaemic patients.
Intracranial Abscess
HBOT helps reduce the size of brain abscesses and enhances the effectiveness of antibiotics in severe cases.
Avascular Necrosis (Osteonecrosis)
Avascular necrosis is a condition where bone tissue dies due to lack of blood supply, often leading to joint collapse. HBOT can promote new blood vessel formation and improve oxygen delivery to the affected bone, slowing the progression of the disease and aiding in recovery.
Patient Management
During HBOT
Managing patients who are undergoing Hyperbaric Oxygen Therapy (HBOT) requires careful attention to several clinical factors to ensure effective treatment, minimize risks, and optimize patient outcomes. The role of HBOT is to increase oxygen delivery to damaged tissues, reduce inflammation, promote angiogenesis (the formation of new blood vessels), and support wound healing.
Barotrauma
As patients are exposed to increased atmospheric pressure, barotrauma (injury caused by pressure changes) can occur, particularly affecting the middle ear, sinuses, or lungs.
Patients should be educated on how to equalize pressure in their ears during the session (swallowing or yawning) and be monitored for discomfort.
Oxygen Toxicity
CNS oxygen toxicity includes nausea, confusion, twitching, or seizures.
Monitor patients closely for early signs of oxygen toxicity.
Claustrophobia
Some patients may feel anxious or claustrophobic inside the hyperbaric chamber.
Providing reassurance, creating a calm environment, and, if necessary, mild anxiolytics can help manage these symptoms.
Ocular Changes
Prolonged exposure to high-pressure oxygen may induce myopia (nearsightedness), which typically resolves after HBOT is discontinued.
Regular monitoring of visual changes should be part of patient management.
Contraindications and Precautions
Understanding contraindications and taking precautions for certain patient populations is crucial to avoid complications during HBOT. Contraindications are classified as absolute or relative.
Absolute Contraindications
Untreated pneumothorax: This condition poses a significant risk of lung collapse during HBOT due to pressure changes. It must be ruled out or treated prior to therapy.
Certain Chemotherapy Agents: Some chemotherapy drugs (e.g., doxorubicin, bleomycin) can interact negatively with hyperbaric oxygen and should be avoided in patients undergoing HBOT.
Relative Contraindications
Respiratory infections or conditions (COPD, asthma) may increase the risk of barotrauma or oxygen toxicity.
Pregnancy: HBOT is usually deferred during pregnancy unless for life-threatening conditions (carbon monoxide poisoning) because of limited research on its safety.
Seizure history: Patients with a history of seizures require cautious monitoring due to the risk of oxygen-induced seizures.
Combining HBOT with Other Therapies
Managing patients who are undergoing Hyperbaric Oxygen Therapy (HBOT) requires careful attention to several clinical factors to ensure effective treatment, minimize risks, and optimize patient outcomes. The role of HBOT is to increase oxygen delivery to damaged tissues, reduce inflammation, promote angiogenesis (the formation of new blood vessels), and support wound healing.
Antibiotics
HBOT can enhance the efficacy of antibiotics, particularly in the treatment of chronic infections like osteomyelitis or necrotizing soft tissue infections, by increasing tissue oxygenation, which enhances immune response and antibiotic penetration into infected tissues.
Surgical Interventions
In cases where radionecrosis, diabetic foot ulcers and osteomyelitis has caused tissue or bone damage, surgery may be necessary to remove necrotic tissue or repair the affected area. HBOT plays a supportive role in improving tissue oxygenation pre- and post-surgery, enhancing wound healing and reducing the risk of infection.
Wound Care
For chronic wounds, HBOT can be part of a comprehensive treatment plan involving advanced wound care techniques, including debridement, negative pressure wound therapy, or the application of growth factors. Coordination between wound care specialists and hyperbaric practitioners is essential.
Follow-Up Care and Adjusting Treatment Plans
HBOT treatment plans typically consist of a series of sessions, with the number of treatments tailored to the patient’s condition and progress. Ongoing assessment and follow-up are key.
Regular Assessment
We assess patient progress after every 5–10 treatments, adjusting the number of HBOT sessions based on the healing response and clinical outcomes.
Monitoring for clinical improvements in pain, wound healing, infection control, and overall functional status should guide treatment modifications.
Post-HBOT Care
After the course of HBOT is completed, follow-up care is essential. This may include wound care assessments, monitoring for late side effects, and coordination with other specialists for continued management.
Patient Education and Psychological Support
Managing patients during HBOT also involves providing thorough education on what to expect during treatment and addressing any concerns.
Pre-Treatment Counseling
We explain the purpose of HBOT and its expected benefits in lay terms. Ensure that patients are aware of potential side effects and how they can manage discomfort (equalizing ear pressure).
Psychological Support
For patients undergoing treatment for long-term conditions, the psychological impact of the disease and the treatment process should not be overlooked. Offering mental health support or referring to counseling services can improve patient compliance and overall well-being.
FAQ
Does medical aid cover HBOT?
A: Yes, many medical aids in South Africa cover Hyperbaric Oxygen Therapy (HBOT) for the approved medical indications. We recommend contacting your provider to confirm if your specific treatment will be covered, and our office can assist with providing any necessary documentation.
How long does each session last?
Each HBOT session typically lasts between 60 and 120 minutes. The exact duration depends on the condition being treated and your individualized treatment plan.
How many sessions will I need?
The number of sessions required depends on the condition being treated and how your body responds to the therapy. For most conditions, patients typically undergo between 10 and 40 sessions. Severe conditions, such as chronic non-healing wounds or radiation injuries, may require additional treatments.
What should I wear during treatment?
You will need to wear 100% cotton clothing during your session, as synthetic fabrics may pose a safety risk in the hyperbaric environment. We will provide you with comfortable, suitable clothing.
Can I bring personal items into the chamber?
For safety reasons, certain items are not allowed inside the chamber, including electronics, jewelery, and flammable objects. You may bring reading material such as a book to keep yourself entertained during the session.
What are the common side effects of HBOT?
HBOT is generally safe, but some patients may experience temporary side effects such as ear discomfort, sinus pressure, or fatigue after treatment. These effects are usually mild and resolve quickly. We monitor all patients closely to ensure their comfort and safety.
What happens if I feel uncomfortable during the session?
Safety is our top priority. During the session, you are constantly monitored by our trained medical team. If you feel uncomfortable or need assistance, you can communicate with us immediately, and we will take appropriate action to ensure your comfort.
Is hyperbaric oxygen therapy painful?
No, HBOT is not painful. However, you may experience some pressure in your ears, similar to what you feel during an airplane take-off or landing. This can usually be alleviated by swallowing or yawning.
Can HBOT help with sports injuries?
While HBOT is not typically the first line of treatment for sports injuries, it may help in cases where healing is delayed or if there is severe tissue damage. It enhances oxygen supply to injured tissues, which can speed up recovery.
How safe is HBOT for children?
A: HBOT is safe for children and is often used to treat conditions like carbon monoxide poisoning and certain infections. Our chambers and staff are fully equipped to handle paediatric patients.
What conditions can be treated with HBOT?
There are 15 approved medical conditions for HBOT, ranging from diabetic foot ulcers and radiation injuries to decompression sickness and carbon monoxide poisoning. Visit our page on approved conditions to learn more about what can be treated with hyperbaric oxygen therapy.
How should I prepare for my first HBOT session?
Before your first session, make sure to eat a light meal and stay hydrated. Avoid smoking, as it reduces oxygen levels in your blood. Also, remove any lotions, perfumes, and synthetic clothing before treatment.
Can I continue my regular medications during HBOT?
In most cases, you can continue your regular medications during HBOT. However, it’s important to inform our medical team of all medications you’re taking so that we can ensure your safety throughout the treatment process.
Are there any risks associated with HBOT?
While HBOT is considered very safe, there are rare risks such as barotrauma (pressure-related injury to the ears or lungs) and oxygen toxicity. Our medical team will thoroughly assess you before treatment and monitor you closely to minimize any potential risks.
What is the success rate of HBOT?
The success of HBOT depends on the condition being treated and individual patient factors. For many conditions, such as diabetic foot ulcers and radiation injuries, HBOT has been shown to significantly improve healing and reduce the risk of complications.
Is there a difference between hyperbaric oxygen therapy and oxygen therapy?
Yes, hyperbaric oxygen therapy involves breathing 100% oxygen at a higher pressure than normal atmospheric levels, which allows for increased oxygen delivery to tissues. Standard oxygen therapy delivers oxygen at normal atmospheric pressure, which doesn’t achieve the same therapeutic benefits for conditions requiring enhanced oxygenation.
How do I know if I’m a candidate for HBOT?
If you have a condition that is among the UHMS-approved indications for HBOT, you may be a candidate. Our team will perform a thorough assessment of your medical history and condition to determine if HBOT is appropriate for you.
Will I need to take time off work for my treatment?
The need to take time off depends on your condition and treatment plan. HBOT sessions are typically outpatient procedures, meaning you can return to your daily activities after your treatment unless your condition requires rest. Some patients experience mild fatigue after sessions, which may warrant some rest.