HYPERBARIC OXYGEN THERAPY

Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Therapy (HBOT) is the process of exposing a patient to 100% oxygen under pressure. In human medicine this therapy has been utilized to facilitate healing of a variety of conditions including decompression illness, carbon monoxide poisoning, burns, crushing injury, deep infection (tissue/bone), post-radiation recovery, complicated diabetic ulcers and many more complex and difficult to manage cases.

HBOT has been used in veterinary medicine for conditions including recovery of persistent and non-healing wounds, burns, deep tissue infections, bone infections, decubital ulcers (pressure sores), vasculitis, spinal trauma, intervertebral disc disease, and post-surgical recovery. HBOT is used in addition to, rather than in place of, other treatments to speed recovery and improve probability of successful outcomes.

Damaged tissue requires more oxygen to heal, but oxygen concentration in wounds is often lower than that of healthy tissue. Hyperbaric oxygen therapy increases the delivery of oxygen to damaged areas, optimizes cell functions to promote healing, reduce swelling, reduce inflammation, and enhance the patient’s own immune function by maximizing white blood cell’s ability to engulf and destroy bacteria.

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HBOT for animals is non-invasive, non-traumatic, and does not require sedation or anesthesia. Patients are placed inside the HBOT chamber which resembles a large round kennel with portholes. Each treatment lasts about an hour with time at the beginning and end to allow the patient to comfortably adjust to changes in pressure. Patients undergoing HBOT are closely monitored by a doctor and technician during the entire procedure and typically remain calm without the need for sedation during the treatment. The number of treatments is determined based on the condition being treated and your veterinarians’ assessment of response to therapy.

Our dermatologists’ partner with pet owners and their primary veterinarian to determine if HBOT is the right fit for patients with primary dermatologic conditions along with other areas where hyperbaric oxygen therapy can help.

HBOT FAQs

Absolutely! For the last 10+ years, treatment chambers have been designed and built specifically for use in small animal veterinary medicine. These chambers are shaped like a large round kennel to allow even giant breed dogs (over 200lbs) to sit, lay, or stand comfortably. Dogs can look out portals and be observed by attending veterinary health professionals during the entire procedure. Dogs, cats, and even rabbits can receive hyperbaric oxygen therapy as prescribed by a veterinarian. Animals do not require sedation for treatments, and in fact, many dogs relax enough to sleep during therapy sessions once they have become acclimated to the chamber.

There are three primary benefits to hyperbaric oxygen therapy:

  1. Delivering 100% oxygen under pressure to aid in wound healing
  2. Rapid reduction of swelling and pain associated with inflammation, injury, or post-surgical recovery
  3. Treatment of difficult infections that are in hard-to-reach areas such as bone infections.

Hyperbaric oxygen can directly kill bacteria, but also works by enhancing the patient’s own neutrophils (white blood cells) ability to engulf and kill bacteria. Additionally, many antibiotics used in both human and veterinary medicine are “oxygen-dependent” meaning oxygen is an absolute requirement for the antibiotic to effectively kill bacteria. Some antibiotics work synergistically with hyperbaric oxygen therapy to be even more effective than antibiotics at normal oxygen levels.

The room air we all breath under normal conditions is mostly nitrogen and other gases; only about 20% of room air is oxygen. Even when a patient is given 100% oxygen to breath, the delivery of the oxygen to the tissues is entirely dependent on the oxygen carrying capacity of circulating red-blood cells and the red-blood cells ability to reach the organs and tissue. While in the treatment chamber, the patient receives 100% oxygen under pressure equivalent to 1.5 to 2.5 times normal atmospheric pressure at sea level. This causes molecular oxygen to diffuse in the blood plasma (the fluid around the red-blood cells) and directly into tissues. This overcomes many reasons for low oxygen such as anemia (low red blood cell counts), ischemia (blocked blood vessels), vasculitis (inflamed blood vessels), as well as compromised lung or heart function.

There are very few risks with Hyperbaric Oxygen Therapy. The most common in both humans and veterinary patients is “barotrauma” or pressure-related pain in the ears and sinuses. Much like a scuba diver who goes up or down slowly to avoid sudden changes in pressure, the pressure inside the chamber is raised or lowered gradually while observing the patient for any signs of discomfort (head-shaking, pawing at ears). If this happens, the pressure is lowered slightly or held steady until the patient is able to continue. Dogs and cats clear their ears/sinuses by yawning - the same as people. Another risk, “confinement anxiety”, can occur in some patients but is rarely severe enough to prevent treatment. Dogs that are kennel or crate trained treat the chamber like a big round kennel and have no difficulty adjusting. Dogs that are extremely nervous in crates, cages, or kennels may require some desensitization training prior to treatment. All patients are assessed prior to treatment and monitored continually while in the chamber for any signs of stress. Patients typically do not require any form of medication or sedation; however if necessary, this would be provided in consultation with the owner and the veterinarian in charge. In rare circumstances, patients must be removed from the chamber due to anxiety or stress. Less frequent risks are “oxygen seizures” which occur in approximately 1 in 10,000 patients. This condition is fully reversible when therapy is discontinued. Finally, patients with advanced heart disease must be treated with caution and guidance, as worsening of congestive heart failure has been reported. The only absolute contraindications to hyperbaric oxygen therapy are pneumothorax (air trapped between the lungs and rib cage), certain chemotherapy agents, and severe congestive heart failure as mentioned above. Any questions or concerns regarding medications and risks should be discussed prior to treatment.

Hyperbaric oxygen therapy in animals is most useful for treatment of non-healing wounds, complicated or infected wounds, burns, decubital ulcers (bed sores), deep tissue infections, osteomyelitis (bone infections), and post-surgical recovery. Other indications in human and veterinary medicine include:

  • Carbon monoxide poisoning
  • Gas gangrene
  • Crush injury
  • Skin graft
  • Radiation injury during cancer treatment
  • Traumatic brain injury
  • Concussion
  • Stroke
  • Spinal trauma
  • Sports injury
  • Snake bite
  • Sudden blindness
  • Sudden deafness
  • Severe dental disease/infection

Most conditions with swelling, inflammation, hypoxia (low oxygen), and infection can benefit from adding hyperbaric oxygen therapy to already established protocols. However, hyperbaric oxygen is not a replacement for other treatments. But it may improve the speed and outcome of those treatments.

 

Yes. Hyperbaric Oxygen is not a new therapy and is backed with a large body of knowledge, research, and case outcomes. There are medical journals and research societies dedicated to the study and advancement of HBOT. The earliest consistently successful uses of hyperbaric oxygen was for decompression illness in Navy divers. As early as 1960’s, hyperbaric oxygen became standard of care for carbon monoxide poisoning, followed by burns, complicated wounds, and bone infections. The strongest evidence in veterinary medicine is for improved wound healing, overcoming difficult to manage infections, vascular compromise, and soft tissue injury. Neurologic injury is also being studied extensively in human and veterinary medicine with evidence provided primarily by case outcome reports.

Every patient is different. The most common observation is deep sleep after treatment, either from relief of pain or deep relaxation. Some older dogs act like their younger selves and want to bound and play. This is seen most often in dogs with significant osteoarthritis and joint disease, presumably due to the anti-inflammatory benefit. Duration of affect is variable. Additionally, many dogs are thirstier immediately after treatment but not much longer.

Owners should be provided with a checklist of do’s and don’t’s prior to treatment. This list is reviewed each visit no matter how many treatments the patient has received. The most important consideration is to avoid anything that could cause static or spark. Remove all external metal (collars, harness, e-collars with snaps, etc.). Internal metal implants such as orthopedic plates or pins are not a problem. No blankets or toys are allowed in the chamber. Synthetic bandage materials such as VetWrap should be avoided. If a patient has a catheter or other bandage material it should be made of natural, inert material such as cotton. Patients should not have any oily ointments on their skin or ears. These can be rinsed prior to treatment and then re-applied afterwards. No nail polish on their pedicure. Verify all medications to be given prior to treatment day, as some medications, such as opioid analgesic pain relievers or patches, must be discontinued for a short time period prior to treatment. Your veterinary team will perform a physical examination and review their own checklists prior to treatment to ensure every patient is safe, well-protected, and cared for before and after therapy.

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