Should I get Hyperbaric Oxgen Therapy?

Should I get Hyperbaric Oxgen Therapy?

The answer to this question, sadly, may depend on who you ask. Since, hyperbaric oxygen therapy came up in a real life consultation recently. I think it is worth raising consumer and patient awareness around this.

So, what is it? Hyperbaric Oxygen Therapy (HBOT) is a treatment in which 100 percent medical grade oxygen is administered while the patient rests comfortably in a sealed chamber pressurized to 2.4 – 4.0 times the normal atmospheric pressure. 

We do have a national hyperbaric oxygen therapy unit through the HSE, and it is located in Galway. It is managed by an expert team of highly trained medical professionals.  After that, however, there is shockingly little regulation of the other facilities that may advertise or promote use of HBOT. The regulations state that HBOT chambers should comply with EU regulations. But there are non-medical grade HBOT chambers in Ireland connected to wellness centres, staffed by those with little-to-no necessary training.  Often the chambers are not equipped with medical grade oxygen, nor do they reach pressures of 2.4atm.

  Let’s do 10 fast-facts on HBOT:

1. HBOT can be a single chamber or a chamber that can sit multiple people. Single chamber treatments should only be used for patients who are very well as they usually won’t be able to receive care without interrupting the treatment and de-pressurising.
2. International guidelines recommend HBOT for decompression sickness from diving (“the bends”), gas emboli, and significant carbon monoxide poisoning. There is good clinical evidence that HBOT treatment is safe and effective for these patients, and patients in Ireland have good access 24/7 to care through the HSE national unit in Galway for this.
3. There is good clinical evidence for a few other uses: various types of complex wound healing, specific types of severe infections, or for certain complications from radiation therapy. In all of these cases, a team of expert consultants will be involved with the patient throughout the decision-making process, and refer on to a properly validated and safe facility staffed by appropriately trained staff.
4. Is HBOT safe? When done by properly skilled and trained healthcare professionals in a facility that meets international standards, HBOT is very safe. Experts know they should be cautious, for example,  about using HBOT in patients with fevers, or those with ear or sinus infectious, recent ear or sinus surgery, or certain types of lung disease.
5. What can happen? In an expert-run facilities that meet international standards, complications are rare. Complications include barotrauma (injury from changes in pressure) to inner ear, less commonly, sometimes the lung.  Some patients experience short term change in vision.
6. What about everything else? Current international guidelines are that for many other conditions, the evidence is still lacking to justify the cost and risk of routine use against the potential benefit.
7. But the advertisements and social media posts say that it works for my condition? Like all marketing of for-profit treatments, check the source.  Does the person recommending the treatment profit from the treatment?  Specifically, does the person recommending HBOT for you either own an HBOT facility or have any kind of investment relationship with the non-HSE HBOT facility they are recommending?  It doesn’t mean they are wrong, but you might consider an unbiased second opinion.  If the person recommending HBOT is not actually a IMC-registered physician, definitely get a second opinion. **
8. Is HBOT right for me and how do I find a facility that I know is safe and I can trust? Talk to your specialist doctor.  They can help you look at evidence, decide if it’s right for you, and refer you to a safe facility with properly trained staff.
9. I heard it works for fibromyalgia, multiple sclerosis, or can even improve my appearance? The studies done so far have not yet validated the use of HBOT in those conditions.  HBOT research is a busy area.  Other ongoing studies are looking at stroke and heart disease.
10. I heard it’s good for Long Covid? That one is interesting and I have a special interest in this area of research.   There were some pilot (small studies) done that were inconclusive (one study said it worked, but another didn’t).  There are number of reason that this can happen, including how they defined “long covid”, what symptoms were assessed, how they measured the change in symptoms.  The study results that many of us are waiting for is from a study going on right now nick-named “HOT – LoCO” which is a randomised, double-blind, placebo-controlled study on the Use of HBOT in long covid.  It is being done by the amazing Karolinska Institute in an academic hospital facility with experts.  A few weeks ago, they published an interim safety report – highlighting that more participants than they had expected (60%!) were experiencing negative side effects. The reason isn’t clear, and the study is ongoing with caution.  But reinforces need for caution when recommending treatment for a disease that is still incompletely understood.  If we still don’t understand the disease (despite that there are many, many theories!), how can we target treatments? The trial is excellent, and worth doing, but an element of extra caution is needed when we can’t really explain, at a molecular level, how we expect HBOT to help long covid patients.

Wait, I need to know a lot more about something called HOT-LoCO. https://bmjopen.bmj.com/content/12/11/e061870.abstract

If you’re really into this, you can check out the EU regulations, whereever you download your standards.  Look for:  Pressure Vessels for Human Occupancy (PVHO). Multiplace Pressure Chamber Systems for Hyperbaric Therapy – Performance, Safety Requirements and Testing. EN 14931:2006

Or, the NHS Specifications:   https://www.england.nhs.uk/wp-content/uploads/2018/11/1766-HBOT-Service-Specification.pdf

**Did you know? Ireland does not have the equivalent of US Stark or “anti-kickback” Laws.  Anti-kickback laws basically prohibit a healthcare professional from referring you to a healthcare facility from which they directly benefit financially.