Bends

Chamber for the bends. Hyperbaric Oxygen Therapy: Treating Decompression Sickness and Beyond

How does hyperbaric oxygen therapy work. What conditions can it treat. What are the risks and side effects of hyperbaric oxygen therapy. How is a hyperbaric oxygen therapy session conducted. What precautions should patients take before and after treatment.

Understanding Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) is a medical treatment that involves breathing pure oxygen in a pressurized environment. This innovative therapy has gained recognition for its effectiveness in treating various conditions, with decompression sickness being one of its primary applications.

During HBOT, patients breathe 100% oxygen while inside a clear plastic tube or chamber. The air pressure inside the chamber is increased to two or three times higher than normal atmospheric pressure. This increased pressure allows the lungs to gather more oxygen than they would under normal conditions, leading to a range of therapeutic benefits.

How does hyperbaric oxygen therapy work?

The principle behind HBOT is simple yet powerful. By increasing the air pressure and oxygen concentration, the body’s tissues can absorb significantly more oxygen. This super-oxygenated state promotes healing and helps combat various medical conditions in several ways:

  • Enhances oxygen delivery to damaged tissues
  • Stimulates the formation of new blood vessels
  • Reduces swelling and inflammation
  • Enhances the body’s ability to fight infections
  • Accelerates wound healing

Treating Decompression Sickness: The Primary Application

While hyperbaric oxygen therapy has numerous applications, its use in treating decompression sickness, commonly known as “the bends,” remains one of its most critical functions.

What causes decompression sickness?

Decompression sickness occurs when scuba divers ascend too quickly from deep waters. During a dive, the body absorbs nitrogen under high pressure. If a diver surfaces too rapidly, this dissolved nitrogen can form bubbles in various parts of the body, including joints, muscles, and the skin.

How does HBOT treat decompression sickness?

HBOT effectively treats decompression sickness by:

  1. Reducing the size of nitrogen bubbles in the body
  2. Helping the body eliminate excess nitrogen
  3. Providing extra oxygen to oxygen-starved tissues
  4. Reducing inflammation and swelling caused by bubble formation

The number of treatments required depends on the severity of the condition. Some cases may resolve with a single session, while more serious instances might require multiple treatments.

Beyond the Bends: Other Applications of Hyperbaric Oxygen Therapy

While decompression sickness treatment remains a crucial application, hyperbaric oxygen therapy has proven effective in treating a wide range of other conditions. The Diving Diseases Research Centre in Plymouth, for instance, has expanded its services to address various medical issues.

What other conditions can HBOT treat?

Hyperbaric oxygen therapy has shown promise in treating:

  • Carbon monoxide poisoning
  • Chronic wounds and diabetic foot ulcers
  • Radiation injuries from cancer treatments
  • Certain types of infections
  • Burns
  • Traumatic brain injuries
  • Sudden hearing loss

The versatility of HBOT has made it an invaluable tool in modern medicine, extending far beyond its original application in diving-related injuries.

The HBOT Treatment Process: What to Expect

Understanding the HBOT treatment process can help patients feel more comfortable and prepared for their sessions.

How is a hyperbaric oxygen therapy session conducted?

A typical HBOT session involves the following steps:

  1. The patient lies on a table that slides into a clear plastic tube or enters a room-sized chamber.
  2. The chamber is sealed and filled with pressurized oxygen.
  3. Patients may experience ear popping or fullness, similar to taking off in an airplane.
  4. The treatment lasts between 30 minutes to 2 hours, depending on the condition being treated.
  5. During the session, patients can relax, breathe normally, and communicate with the staff if needed.

Most patients receive treatment at specialized outpatient clinics. The frequency and duration of treatments vary based on the individual’s condition and response to therapy.

Safety Considerations and Potential Risks

While hyperbaric oxygen therapy is generally considered safe, it’s important to be aware of potential risks and follow necessary precautions.

What are the risks and side effects of hyperbaric oxygen therapy?

Some potential risks and side effects include:

  • Ruptured eardrum
  • Collapsed lung (in rare cases)
  • Temporary nearsightedness
  • Seizures due to oxygen toxicity (extremely rare)

These risks are generally minimal when the therapy is administered by trained professionals in a controlled setting.

What precautions should patients take before and after treatment?

To ensure safety and maximize the benefits of HBOT, patients should:

  • Avoid alcohol for at least 8 hours before treatment
  • Remove all battery-powered devices before entering the chamber
  • Avoid petroleum-based skin care products before treatment
  • Get plenty of rest for 24 hours after treatment
  • Stay hydrated but avoid caffeinated drinks
  • Avoid hot showers or baths for 24 hours post-treatment
  • Refrain from strenuous activities for 48 hours
  • Avoid flying for at least 24 hours after treatment

The Future of Hyperbaric Oxygen Therapy

As research continues to uncover new applications for HBOT, its role in modern medicine is likely to expand further.

What new applications are being explored for HBOT?

Researchers are investigating the potential benefits of hyperbaric oxygen therapy in treating:

  • Alzheimer’s disease and other forms of dementia
  • Autism spectrum disorders
  • Chronic fatigue syndrome
  • Fibromyalgia
  • Stroke rehabilitation
  • Certain types of cancer

While more studies are needed to confirm the efficacy of HBOT in these areas, initial results are promising and suggest a bright future for this versatile treatment.

Hyperbaric Oxygen Therapy Centers: More Than Just Diving Clinics

Facilities like the Diving Diseases Research Centre in Plymouth exemplify the evolution of hyperbaric medicine. What started as a specialized treatment for diving-related injuries has grown into a comprehensive medical service addressing a wide range of conditions.

How have hyperbaric centers evolved?

Modern hyperbaric centers have expanded their services to include:

  • Treatment for a diverse range of medical conditions
  • Research into new applications of HBOT
  • Education and training for medical professionals
  • Collaboration with other medical specialties
  • Development of advanced hyperbaric technology

This evolution reflects the growing recognition of HBOT’s potential in various medical fields, far beyond its original diving-related applications.

The Science Behind Hyperbaric Oxygen Therapy

Understanding the scientific principles underlying HBOT can help appreciate its wide-ranging benefits and potential applications.

How does increased oxygen affect the body at a cellular level?

The increased oxygen levels during HBOT lead to several beneficial effects:

  • Stimulation of growth factors and stem cells, promoting tissue repair
  • Enhanced white blood cell function, improving the body’s ability to fight infections
  • Reduction of inflammation through various biochemical mechanisms
  • Improved mitochondrial function, enhancing cellular energy production
  • Activation of genes involved in cell growth and survival

These cellular-level changes contribute to the systemic benefits observed in patients undergoing HBOT for various conditions.

What role does pressure play in the effectiveness of HBOT?

The increased pressure in the hyperbaric chamber is crucial for several reasons:

  1. It allows more oxygen to dissolve in the blood plasma, reaching areas with poor circulation
  2. It helps reduce the size of gas bubbles in the body, critical for treating decompression sickness
  3. It can enhance the penetration of certain antibiotics, improving their effectiveness
  4. It may stimulate the production of growth factors and stem cells more effectively than oxygen alone

The combination of high oxygen concentration and increased pressure creates a unique therapeutic environment that cannot be replicated by other means.

Patient Experiences and Success Stories

Real-life accounts of patients who have undergone hyperbaric oxygen therapy can provide valuable insights into its effectiveness and impact on quality of life.

How has HBOT changed patients’ lives?

Patients have reported various positive outcomes, including:

  • Faster recovery from diving accidents and decompression sickness
  • Improved wound healing, particularly for diabetic patients with chronic ulcers
  • Reduced symptoms in patients with carbon monoxide poisoning
  • Improved cognitive function in some patients with traumatic brain injuries
  • Enhanced quality of life for patients with radiation injuries from cancer treatments

While individual experiences may vary, these success stories highlight the potential of HBOT to make a significant difference in patients’ lives across a range of conditions.

Integrating HBOT into Comprehensive Treatment Plans

Hyperbaric oxygen therapy is often most effective when incorporated into a broader treatment strategy. Understanding how HBOT complements other medical interventions can help optimize patient outcomes.

How does HBOT work alongside other treatments?

HBOT can enhance the effectiveness of various treatments:

  • In wound care, it can be combined with advanced dressings and surgical interventions
  • For cancer patients, it may help mitigate the side effects of radiation therapy
  • In cases of traumatic brain injury, it can be part of a multidisciplinary rehabilitation program
  • For diabetic patients, it complements proper glucose management and foot care

Healthcare providers often develop personalized treatment plans that integrate HBOT with other appropriate therapies to achieve the best possible outcomes for each patient.

What factors determine the success of HBOT treatment?

The effectiveness of hyperbaric oxygen therapy can depend on several factors:

  1. The specific condition being treated
  2. The severity and duration of the condition
  3. The patient’s overall health and medical history
  4. The timing of HBOT initiation relative to the onset of the condition
  5. Adherence to the prescribed treatment regimen
  6. Integration with other appropriate medical interventions

Healthcare providers carefully consider these factors when recommending HBOT and designing treatment plans to maximize the chances of success.

Decompression Sickness | Wound Care


Hyperbaric oxygen therapy is used to treat decompression sickness in scuba divers. During these treatments, you breathe pressurized oxygen while you lie inside a clear plastic tube. This helps your body remove the nitrogen that can build up during a dive and make you sick. Side effects from the treatment are rare.


Hyperbaric [hahy-per-bar-ik] oxygen therapy is a treatment for many kinds of illnesses and injuries. During this treatment, you breathe pure oxygen in a special chamber where the air pressure is two or three times higher than normal. This lets your lungs take in more oxygen than they normally can and helps your body remove extra nitrogen.

Hyperbaric oxygen therapy is usually considered safe and side effects are rare. However, there are some risks associated with the high air pressure used. These risks include:

  • Ruptured eardrum
  • Collapsed lung
  • Temporary nearsightedness (not being able to clearly see things that are far away). This usually goes away in a few days or weeks.

Another risk of hyperbaric oxygen therapy is seizure caused by having too much oxygen in your body.


During scuba diving, nitrogen builds up inside your body. When you come up, the nitrogen can form bubbles in your joints, muscles, skin, and other parts of your body. This causes decompression sickness or “the bends.” Decompression sickness has many symptoms, including pain, numbness, weakness, nausea, and vomiting. Hyperbaric oxygen therapy can treat decompression sickness and help your symptoms.

You should not drink alcohol within 8 hours of hyperbaric oxygen therapy.

Because oxygen can cause a fire if there is a spark, you should not bring a lighter or any device with a battery in it into the hyperbaric oxygen therapy treatment area.

Avoid skin care products with petroleum jelly before treatment. They are also a fire hazard around oxygen.

Hyperbaric oxygen therapy usually is given at a special outpatient clinic. You will lie on a table inside a long clear plastic tube. The tube will be sealed and filled with pressurized oxygen. You might feel popping or fullness in your ears, similar to the way you feel taking off in an airplane. If this happens, it can help to swallow or yawn.

The clinic staff will be able to see and hear you during your treatment and you can talk to them. You should try to relax and breathe normally. Your treatment will take between 30 minutes and 2 hours. You might feel tired or lightheaded afterwards. This should go away soon.


Depending on how serious your decompression sickness is, you might need only one hyperbaric oxygen treatment or several treatments.


If your decompression sickness was not serious, you will probably be able to scuba dive again. However, some people with serious decompression sickness should not continue scuba diving. A doctor will evaluate you to decide if you can scuba dive again and how long you need to wait before diving.

After a hyperbaric oxygen treatment, you should:

  • Get plenty of rest for the next 24 hours.
  • Drink lots of fluids; avoid alcohol and caffeinated drinks such as coffee, tea, and colas.
  • Avoid taking hot showers or tub baths for 24 hours.
  • Do not participate in any strenuous activities for 48 hours.
  • Do not fly in any private or commercial aircraft for at least 24 hours

© 2018 Intermountain Healthcare. All rights reserved. The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns. 

Hyperbaric chambers: Not just for the bends

  • Published

Image caption,

The centre’s main chamber is used to treat up to nine people at time

By Andrew Segal

BBC News, Devon and Cornwall

The Diving Diseases Research Centre in Plymouth has had its work highlighted recently, after members of a family in Cornwall with carbon monoxide poisoning were treated in its hyperbaric chambers.

The chambers are most associated with treating divers with decompression sickness – the bends – if they surface too quickly, resulting in nitrogen bubbles forming in blood.

Although it was founded in 1980 “with divers in mind”, staff at the charity, which treats people with 100% oxygen in pressurised chambers, are not just standing around waiting for divers to get in trouble.

The charity has six chambers – four in Plymouth and two at a sister facility in Newport in Gwent – and Plymouth’s chambers can treat up to 10 patients on a weekday with a variety of conditions.

‘Bump starts’

The treatment involves patients spending two hours in a 100% oxygen atmosphere in a sealed chamber usually pressurised to the equivalent of 14m (45ft) under water, or 2.4 atmospheres, centre medical director Dr Christine Cridge said.

It could be pressurised to the equivalent of 30m (100ft), she added.

Patients breathe in pure oxygen instead of the 21% found in normal air and the pressure increases the amount of oxygen that dissolves into the bloodstream and the body’s tissues.

Image caption,

Patients are given oxygen through helmets in the main chamber, the Krug

In the case of the bends, this results in nitrogen bubbles which form in blood being squeezed into a solution blood can absorb.

In carbon monoxide poisoning cases, the oxygen-rich environment “bumps” the poisonous gas, which prevents blood from absorbing oxygen, off the oxygen-carrying red blood cells.

In other cases, the pure oxygen may not be a cure in itself for what is being treated but could often be a “piece of the jigsaw puzzle”, Dr Cridge said.

Such cases included helping patients with skin, bone or tissue conditions after their body’s own healing process had “stalled”, she said.

Conditions treated include chronic non-healing wounds, such as ulcers as a result of diabetes, through to radiotherapy-damaged tissue or bone in cancer patients, or even flesh-eating bugs which do not like an oxygen atmosphere.

In the case of flesh-eating necrotising fasciitis, Dr Cridge said: “We can’t resurrect dead tissue, but we can prop up what remains and bump-start its healing.

“Bumping” or “bump-starting” are phrases used a noticeable number of times by Dr Cridge, who first got interested in the field after time with a diving club at university.

Such bump-starting can see pure oxygen providing extra fuel for the immune system’s white blood cells and the body’s building blocks for new cells.

“In certain patients, it can encourage growth”, she said.

Another use of the oxygen treatment has been assisting radiotherapy by “feeding” tumours, which are often faster growing than other cells, making them making them easier to target, she added.

The Krug

As to the actual treatment, if anyone has the idea such chambers are little bigger than a medieval iron maiden, the centre’s largest, the Krug, easily defeats preconceptions.

Built in 1990, the chamber, named after the company that designed it, is 6m (20ft) long with a 2.4m (8ft) diameter.

It can hold up to 12 people, though it is only used to treat a maximum of nine, with two staff also inside to monitor the process.

Emergency cases can be wheeled straight in, as it can cope with intensive care cases and offers “more room to work in”, Dr Cridge said.

Image caption,

Staff can pressurise the chambers to the equivalent of 30m under water

“One older patient commented it was bigger than a World War II tank. We’ve also been told it’s the size of a small bus.

“They are best known for treating the bends and people have turned up with swimming costumes before, not realising they’ll be dry.”

However, you do not just fill a 25 cubic metre chamber with 100% oxygen.

While the entire chamber is filled with compressed air, the oxygen is actually ingested via transparent plastic helmets which are sealed around the neck.

“It means people can read or watch a DVD,” Dr Cridge said.

Dealing with boredom is a serious consideration. While a diver might have just two or three sessions, other patients may be in for two hours a day, five days a week, for up to eight weeks.

The centre also has two smaller 3m (10ft) by 1. 8m (6ft) diameter chambers, which employ helmets.

Its smallest chamber resembles a 2m (6ft 6in) long transparent plastic tube which is about 1m (3ft 3in) in diameter.

Unlike the other chambers, this is filled completely with oxygen, allowing treatment for anyone who cannot use the helmets because of wounds or other considerations.

The centre also has wound treatment rooms with specialist staff, as well as facilities for training in hyperbaric medicine.

It also works with universities on research projects.

As to divers who have been treated at the centre for what can be a fatal condition, Dr Cridge said: “It rarely puts them off.

“At least 90% of divers will go into the water again, with many of them asking as they’re being wheeled in or out: ‘When can I go back?’.”

The BBC is not responsible for the content of external sites.

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February 7, 2020, Friday
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Blogs

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