Hyperbaric Oxygen

The role of hyperbaric oxygen treatment (HBOT) in infectious diseases remains a contentious issue. Advocates typically quote its beneficial physiologic effects in experimental models, effectiveness shown by a growing body of clinical experience, indications recognized by professional organizations and third-party payers, and its safety record. Opponents point to the lack of well-designed randomized controlled trials for the proposed indications as the main weakness of this treatment modality. HBOT can be administered in either monoplace or multiplace chambers. Most sessions are given over 90 to 120 minutes. Acute therapy may require only one or two treatments, whereas chronic medical conditions, such as those addressed by wound-healing protocols, may warrant more than 40 sessions. Nonhealing diabetic foot ulcers have become the most common indication for HBOT in the United States. Other approved indications include necrotizing soft tissue infections, clostridial myonecrosis (gas gangrene), refractory osteomyelitis, bacterial intracranial abscess, and mucormycosis. In general, HBOT has a good safety record, but prolonged treatment may result in serious adverse events, from barotrauma (middle ear, paranasal sinuses, lungs) or oxygen toxicity (affecting central nervous system, eye, lung). Selection of treatment candidates is difficult and mandates a careful risk-benefit analysis. In this chapter we review aspects of HBOT relevant to the infectious disease field, including physiologic effects, methods of administration, recently published clinical evidence supporting currently approved indications, side effects and complications, patient selection, cost, and certification in hyperbaric medicine.