We all live in a yellow....come on now - you know the words...

Who? Where? Why? What?
Hyperbaric Oxygen Therapy is defined by the Undersea and Hyperbaric Medical Society (UHMS) as a treatment in which a patient intermittently breathes 100% oxygen while the treatment chamber is pressurized to a pressure greater than sea level. The pressure increase must be systematic and be applied in a monoplace (single person) or multiplace chambers. I am in a multiplace chamber with my pressure posse. Multiplace chambers are pressurised with air, with oxygen given via a face mask, hood tent or endotracheal tube, whilst monoplace chambers are pressurised with oxygen.


Where did it all start?
Use of hyperbaric therapy was first documented in 1662, when English Clergyman, Henshaw, built the first hyperbaric chamber. Henshaw, who apparently had no real scientific or medical background (loving that!), sure made history with his "domicilium" which was really nothing more than a sealed room with an enormous pair of bellows attached. Since then, reports of the beneficial effects from increased pressure have increased, and by 1877, chambers were widely used for many conditions, though there was little scientific rationale or evidence.
Early chambers used compressed air rather than oxygen due to early reports of oxygen toxicity. A dude called Drager was the first to explore the use of pressurised oxygen in decompression sickness and his protocols were put into practice by Behnke and Shaw in the late 1930's.
The US military conducted research after the Second World War (yep, them and everyone else - there's nothing like a war to get a bit of research going) and this brought greater knowledge about survivable pressures. As a result of this research, the use of HBO increased, and throughout the late 1950s and early 60s, HBO was used to potentiate radiotherapy effects, prolong circulatory arrest during surgery, and to treat anaerobic infections and carbon monoxide poisoning.
Due to the excitement about the potential of HBO, it has been used for a variety of conditions including dementia, emphysema and arthritis without solid evidence base. Concerns about the lack of scientific progress and regulation led to the UHMS to form a Committee on Hyperbaric Oxygen Therapy in the late 70s, which is now the international authority on HBO.



So who are the lucky ones?
In hypoxic conditions, HBO reduces infection and cell death and maintains tissue viability while healing occurs. HBO is widely accepted as the only treatment for decompression sickness and arterial gas embolism and the UHMS lists thirteen conditions for which it feels that research data and extensive positive clinical experience has become 'convincing'.
The European Committe for Hyperbaric Medicine (ECHM) advocates HBO for the following conditions;
Air or gas embolism
Decompression sickness
Gas gangrene
Necrotising fascilitis
Post-radiotherapy tissue damage
Preparation for surgery in previously irradiated tissue
In addition, the UHMS also supports the use of HBO for the following additional conditions;
Crush injury
Severe bloody loss anaemia
Selected problem wounds
Compromised skin flap and grafts
Refractory osteomyelitis
Thermal burns
 However, other conditions are still being treated such as Autism Multiple Sclerosis and some would argue that beneficial and significant results are being achieved. The ECHM held a workshop in Istanbul in September 2010 to discuss "controversial issues in HBO" to review evidence on treatment for Aseptic bone necrosis, Autism and Global brain ischemia. I've yet to find the outcome of these discussions.

For more on HBOT and my tap dance through it - stay tuned!