Hyperbaric chamber therapy is gaining usage in Memphis, as in other cities, and its applications are expanding. Its latest approved use is for a type of sudden aural disability called idiopathic sudden sensorineural hearing loss (ISSHL).
Though off-label uses for hyperbaric therapy such as post traumatic stress disorder have been reported nationally, and fervent oxygen enthusiasts can build their own chambers by tutorial on YouTube, the Memphis medical community sticks to the basics. Memphis offers a spectrum of Undersea and Hyperbaric Medical Society (UHMS)-approved treatments, Medicare-approved applications and current technologies.
Stephen King, MD, associate professor in the department of plastic surgery, University of Tennessee Health Science Center, and chief medical information officer at Regional One Health, explained that scientists are looking at hyperbaric chamber oxygen (HBO) for uses in stroke patients, multiple sclerosis and acute traumatic brain injury – but those uses are not yet approved.
For now, uses include idiopathic hearing loss, air embolism, carbon monoxide poisoning, gas gangrene, necrotizing soft tissue infections (flesh-eating bacteria), decompression sickness (also known as “the bends”), delayed radiation injury, compromised grafts and flaps, problem wound care and acute traumatic ischemia. They also accept referrals from Divers Alert Network for treating sport and commercial diving accident victims in the Mid-South.
Regional One Health has the only multi-place chamber in the area with the capacity to hold 12 patients at a time, King said. It has had a multi-place chamber since 1992, but the technology has been updated to remain current over the years. King describes today’s unit as “more patient friendly,” with places to sit/recline and watch TV or movies with a “head tent” on to optimize oxygen usage.
Since the whole chamber is not pressurized, fire risks decrease. This arrangement also provides the ability to treat critically ill patients such as those with carbon monoxide poisoning, necrotizing soft tissue infections and air embolisms. A critical care nurse can accompany the patient and monitor him or her while in the chamber. Last year, Regional One rendered 654 hyperbaric treatments.
The most prevalent diagnosis for Regional One hyperbaric patients is delayed radiation injury, according to King. Some of these referrals come from places such as St. Jude Children’s Research Hospital and some come years down the road from radiation treatment. Reduced blood flow to certain areas can kill tissue or bone. In osteoradionecrosis, the mandible is compromised and begins to die. Some radiation can cause brain tissue to die. HBO therapy stops the necrosis and promotes healing. It even causes new small blood vessels to grow into the area, increasing blood flow.
“HBO is an expanding form of therapy,” King said. “We provide a valuable service and treat a lot of different patients with a lot of good medical outcomes. In some conditions, hyperbaric oxygen therapy increases the effectiveness of standard therapy. For many of the conditions we treat with hyperbaric oxygen therapy, there is no alternative treatment.”
Both Delta Medical Center and Methodist North have two monoplace chambers. At Delta, hyperbaric therapy is included in its wound center, and both chambers are 36-inch, the largest constructed. Although patients are seen with conditions ranging from diabetic foot ulcers to osteomyelitis, arterial insufficiency, skin grafts, thermal/chemical burns, plastic surgery scars, carbon monoxide poisoning, cyanide poisoning, smoke inhalation, air and gas embolisms and osteoradionecrosis, HBO serves 15 percent of wound care patients, according to Delta's Sandy Eckhoff, LPN, CHT, safety director, hyperbaric unit. Sessions there are 90 minutes long Monday through Friday. Depending on the diagnosis, infectious disease specialists might get involved and all wound care hyperbaric treatment is done in conjunction with regular protocols.
“We’ve had multiple patients avoid amputation, either from osteo, arterio or diabetic,” Eckhoff said. “It is an amazing treatment. You have patients come in with large wounds that are extremely difficult and patients do treatments, go home and the wounds are totally closed.”
At Methodist North, the monoplace hyperbaric chambers are part of the Comprehensive Wound Healing Center. The patient can listen to music, watch TV or a DVD and talk to the technician via a two-way phone. They are also able to drink water from a sports bottle, or just go to sleep. Based on the diagnosis, conditions might require 20 to 40 treatments, since HBO therapy is cumulative. One to two treatments a day for 60 to 90 minutes a day, five days a week, is the usual treatment period.
Primary conditions seen at Methodist North for hyperbaric oxygen include chronic refractory osteomyelitis, diabetic wounds of the lower extremities, osteoradionecrosis, soft tissue radionecrosis and preservation of compromised skin grafts and flaps, according to Sandy Deimund, BSN, clinical director.
People excluded from therapy at Methodist North due to contraindications are those taking certain medicines or chemotherapies, those with poor lung function and those with decreased lung capacity (i.e., emphysema).