INDEX

    Hyperbaric Oxygen Therapy

    Critical Care / Resuscitation, Environmental Injuries / Exposures, Infections, Other

    Last Updated Aug 30, 2017
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    Context

    Hyperbaric Oxygen Therapy (HBOT) is a treatment modality in which patients breathe 100% oxygen within a pressurized vessel. Hyperbaric chambers are regulated as a medical device by Health Canada.

    The combination of high ambient pressure and high inspired oxygen levels produces extremely high blood and tissue oxygen levels. These high levels of oxygen are effective in treating a limited number of disorders.

    Indications

    Health Canada approves the use of HBOT for 15 indications.

    1. Acute decompression sickness.
    2. Arterial gas embolism.
    3. Acute carbon monoxide poisoning.
    4. Clostridial myonecrosis (gas gangrene).
    5. Acutely compromised flaps and grafts.
    6. Sudden idiopathic sensorineural hearing loss within 2 weeks of onset.
    7. Necrotizing fasciitis.
    8. Acute central retinal artery occlusion.
    9. Exceptional blood loss anemia.
    10. Acute peripheral ischemia, including crush injury, compartment syndrome and ischemia from sudden arterial occlusion.
    11. Selected ischemic wounds, including diabetic foot ulcers.
    12. Chronic osteomyelitis.
    13. Delayed effects of radiotherapy, including osteoradionecrosis, soft tissues such as skin, larynx and neural tissues, radiation cystitis, radiation proctitis.
    14. Intracranial abscess.
    15. Thermal burns.

     

    HBOT is also promoted for treating a wide variety of other conditions by proponents of “alternative therapies” in private, unregulated facilities throughout British Columbia. Practitioners are cautioned against recommending HBOT for unapproved conditions at these facilities.

    VGH Hyperbaric Unit

    The Hyperbaric Unit (HBU) at Vancouver General Hospital treats only those conditions approved by Health Canada. The VGH HBU is ICU capable with the ability to provide ventilatory support, inotropic support, external pacing, and physiological monitoring. It is capable of treating 8 patients simultaneously. Patients are accompanied by one or more inside attendants, who may be an RT, RN, or MD. Patients are usually seated while in the chamber, but can be accommodated on a stretcher.

    Patient Selection

    • All ages can be treated.
    • Children less than 10 years will usually require myringotomies prior to treatment. These may be performed at the referring institution prior to transfer, or arrangements can be made for them to be done a BC Children’s Hospital prior to arrival at VGH.
    • Adult patients must be either intubated and sedated or fully alert and cooperative with therapy.
    • In many cases HBOT is one of several therapeutic options in a complex treatment plan. Treatment requires consultation with the Hyperbaric Unit physician, and the Patient Transfer Network.

    Making the Referral

    • Non urgent cases (radiation injury, chronic wounds, chronic osteomyelitis, and intracranial abscess) – call the VGH Hyperbaric Unit at (604) 875-4033 during regular business hours or fax a consultation request to (604) 875-5294.
    • Emergency cases during regular business hours – call the HBU at (604) 875-4033. If you reach voicemail, page the hyperbaric medicine physician at (604) 875-5000. These cases are on a 24/7 basis.
    • Emergency cases outside of regular business hours – page the hyperbaric physician on call (604) 875-5000.
    • Sudden Sensorineural Hearing Loss is urgent in nature. These cases are not treated on nights or weekends, but are ideally started with our elective patients within 48 to 72 hours of referral. Call the HBU at (604) 875 4033 during regular business hours or paging the hyperbaric physician at (604) 875-5000 between 8 am and midnight seven days a week.

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