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BCMS – TOGETHER
WE STAND

When It’s Better to Be Under

More Pressure

By John J. Feldmeier, DO, Jayesh B. Shah, MD, John S. Peters, FACHE

T he medical discipline of clinical hy- Table 1

perbaric medicine had its origins in
the 1960s with seminal work done
in both Holland and the United States. One
of the early applications employed hyper-
baric oxygen delivered in large chambers
configured as operating theaters. By operat-
ing under pressure and delivering signifi-
cantly increased oxygen doses to the patient,
open-heart surgery was possible because the
enhanced hyperoxemia permitted a toler-
ance to a longer period of asystole than
would be possible for patients operated at
1
normal surface pressures. Once heart and
lung machines became available, there was
no need for surgery under pressure. The very
first application of hyperbaric or recompres-
sion treatment was its application to the
treatment of decompression sickness (com-
monly known as the bends) and other diving
2
injuries. This treatment is still the definitive
intervention for decompression sickness and
injury due to rapid changes in pressure for divers, including traumatic port its application in both these pathologies. One mark of its accept-
air embolism also known as barotrauma. ance is the declaration that hyperbaric oxygen should be considered an
In the intervening years, hyperbaric oxygen has evolved to be a stud- intervention supported by Level 1 evidence published in the article lay-
ied and effective therapy for many disorders, often as an adjunct to the ing out clinical guidelines by the American Society of Colon and Rectal
primary treatment (See Table 1. for the list of accepted indications). Surgeons for the treatment of chronic radiation proctitis. Most third-
These applications are based on a large body of supporting literature party payers including Medicare will reimburse for hyperbaric oxygen
and research, much of it level-1 evidence. Some in other medical disci- treatments for the indications provided in Table 1.
plines still think of hyperbaric oxygen as an “alternative medicine.” It The Undersea and Hyperbaric Medical Society (UHMS) has
is certainly an unusual medical treatment because it does not come as been the premier professional organization for the hyperbaric med-
a pill or capsule nor is it delivered intravenously. Hyperbaric oxygen icine community for over 50 years. This organization seeks to pro-
has been recognized as a medical subspecialty by both the American vide support for education, research and communication, and offers
Board of Preventive Medicine and the American Board of Emergency a forum for continuing education and exchange of the latest updates
Medicine both of whom offer board-certification in this discipline. Hy- at its national and regional meetings. The UHMS has conducted a
perbaric oxygen is most commonly employed now for non-healing practice accreditation program for 20 years that seeks to promote
wounds in the lower extremities of individuals with diabetes and de- high standards of practice within the hyperbaric medicine commu-
layed complications of therapeutic radiation. In both of these applica- nity. Hyperbaric oxygen is a unique treatment that offers unique
tions, hyperbaric oxygen can often permit avoidance of major benefits in certain cases but also introduces unique concerns regard-
disfiguring and disabling surgeries. Randomized controlled trials sup- ing safety in this very specialized environment involving high pres-

18 SAN ANTONIO MEDICINE • January 2023