The Ultimate Guide to Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric chambers at a wound care center in Idaho are used to speed healing times

Introduction

Hyperbaric chambers are vessels in which patients breathe oxygen at pressures up to three times greater than normal atmospheric pressure. They are used to treat divers suffering from decompression illness or to administer hyperbaric oxygen therapy, also known as HBOT.

Although oxygen therapy might be a novelty for most of us, the concept is certainly not new. Documentation shows that breathing hyperbaric oxygen as therapy has been around for nearly 350 years. It wasn’t until the mid-1800s that clinical use of hyperbaric oxygen therapy started. Decades later, the military developed and tested hyperbaric chambers for purposes related to deep sea diving and aeronautics.

But in a complex and sometimes crowded marketplace, it can be difficult to research and choose the right hyperbaric chamber for your needs, whether you're a medical professional looking to add to your facility or an individual looking for the right home hyperbaric chamber. 

Whether you're in the market for a new hyperbaric chamber, or you're just beginning your research journey to determine whether HBOT is right for you, browse our guide and click through the pages listed below to learn everything you need to know about this remarkable and versatile therapy.

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Hyperbaric Therapy 101
Hyperbaric Chambers and What to Look For
What to Know about Oxygen and Air Pressure in Hyperbaric Chambers
Benefits of Hyperbaric Oxygen Therapy
Hyperbaric Oxygen Therapy Glossary of Terms
What to Expect Your First Time in a Hyperbaric Chamber
Is Hyperbaric Therapy Right for You? 
Safety, Side Effects and Risks of Hyperbaric Oxygen Therapy
For Health Care Providers

More Resources

What does the FDA say about Hyperbaric Oxygen Therapy?
8 Ways to Prepare for your First Hyperbaric Oxygen Therapy (HBOT) Session
What is a Hyperbaric Chamber and What Does it Do?
Hyperbaric Chambers on Rehabmart.com


Hyperbaric Oxygen Therapy (HBOT) 101

What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy is a medical treatment that entails the use of oxygen at increased pressures for therapeutic purposes. The treatment is administered in hyperbaric chambers and sometimes involves the circulation of pure oxygen.

What’s the difference between hyperbaric oxygen therapy and mild hyperbaric oxygen therapy?
The difference is simple and boils down to the level of oxygen in the pressurized environment: Mild hyperbaric oxygen therapy (mHBOT) generally involves a pressure protocol up to 1.3 ATA or 4 psi, or, a mildly greater pressure than what’s experienced at sea level. High pressure hyperbaric oxygen therapy involves pressure above 1.5 ATA, a substantially greater percentage of oxygen than you normally breathe. You can achieve different levels of pressure depending on the type of hyperbaric chamber you use, including monoplace, multiplace and portable chambers. Read more about air pressure and oxygen density here.

How does hyperbaric therapy work?
Hyperbaric technology involves increasing the air pressure in the environment (a hyperbaric chamber) to enable the body to absorb more oxygen per volume of compressed air. Normally, your body transports the oxygen you breathe via hemoglobin in your red blood cells, but if you inhale pressurized air with a higher concentration of oxygen, that oxygen is driven into the body’s fluids to more intensely saturate the bodily tissues and organs. This increased pressure can even impact injuries involving damaged circulation (such as a blood clot in the brain that leads to a stroke) by infusing the body with oxygen.

How often do most people receive HBOT treatment?
Frequency varies, but most people see the best results after completing a treatment plan of two sessions a day, five days a week. At the least, those seeking effective hyperbaric oxygen therapy should commit to three sessions per week. After 40 sessions, it’s often wise to review progress and adjust session frequency as needed.

Read more about navigating hyperbaric therapy with your healthcare provider here.

How is HBOT effective?
From Virginia Mason Medical Center: “Normally, most of the oxygen circulating in the body is carried by the red blood cells called hemoglobin. Hyperbaric oxygen dissolves any extra oxygen into the plasma (Henry’s law). The total oxygen carried to the tissues is about 10 times more than breathing air at sea level. The increase in the oxygen concentration in the bloodstream promotes the healing of certain wounds.”

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Hyperbaric Chambers and What to Look For

What’s the difference between hard hyperbaric chambers and soft hyperbaric chambers? 
Hard chambers are typically made of steel and most commonly found in a hospital or clinical environment, while mild (or soft) chambers are purchased most often by private individuals for their portability, compact size, and ease of use. Hard (or steel) chambers in a hospital environment are often connected to an oxygen tank outside the building that supplies the chamber with 100% pure oxygen, while mild chambers will never reach 100% oxygen density and saturation.

What pieces or parts are sold with hyperbaric chambers?
All of Rehabmart’s mild HBOT chambers are shipped with the internal wire frame, air compressors and an internal mattress. Essentially, the chamber arrives with all the required components necessary for full chamber operation. Oxygen concentrators are sold separately and require a prescription.

Is there a chamber available that would accommodate larger adults?
It depends on the individual’s size, and comfort preferences. The hyperbaric chambers available on Rehabmart.com come in a variety of internal diameters, so it’s important to reference the size of the chamber you’re considering.

How do I clean my mild hyperbaric chamber?
Consult the manufacturer’s recommendations, but most chambers can be wiped down inside and out with a damp cloth and cleaned with mild hypoallergenic soap and water. Do not use bleach or harsh chemicals on the chamber bladder. Dry after cleaning. Any chamber covers may be laundered according to the manufacturer’s instructions.

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What to Know about Oxygen and Air Pressure in Hyperbaric Chambers

Will a hyperbaric chamber always be filled with 100% pure oxygen? 
No. Mild hyperbaric chambers are inflated to their standard operating pressure using standard ambient air. Conversely, only medical-grade hyperbaric oxygen chambers are pressurized with 100% pure oxygen. Medical grade HBOT chambers may only be operated by specially trained technicians who work under the supervision of a physician.

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Benefits of Hyperbaric Oxygen Therapy

How can a hyperbaric chamber help a diabetic person? 
Check out this video to see how hyperbaric oxygen therapy can help diabetes patients.

What conditions are hyperbaric therapy used to treat?
Many people seek hyperbaric oxygen therapy for FDA-approved uses:

Air embolism
Gas embolism
Acute traumatic ischemia
Burns
Carbon monoxide poisoning
Smoke inhalation
Diabetic foot ulcers
Exceptional blood loss
Decompression sickness
Gas gangrene
Necrotizing infections
Severe anemia
Skin grafts and flaps
Wound healing

Hyperbaric therapy can also be used for the following off-label uses, which have not been cleared by the FDA:

AIDS/HIV
Alzheimer's Disease
Asthma
Bell's Palsy
Brain Injury
Cerebral Palsy
Depression
Heart Disease
Hepatitis
Migraine
Multiple Sclerosis
Parkinson's Disease
Spinal Cord Injury
Sports Injury
Stroke

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Hyperbaric Oxygen Therapy Glossary of Terms

What does mHBOT stand for? 
mHBOT means “mild hyperbaric oxygen therapy,” which is different from high-pressure hyperbaric oxygen therapy because of the level of oxygen delivered to the bloodstream in a pressurized environment.

What is a “dive”?
Hyperbaric oxygen therapy began as a treatment for the bends, the condition most often seen in deep-sea divers. A hyperbaric treatment session is called a dive as a reference to that early use.

What’s an oxygen concentrator?
An oxygen concentrator is a medical device that supplies an oxygen-enriched gas stream by concentrating the oxygen in a gas supply (typically ambient air).

Monoplace Hyperbaric Chambers
Monoplace hyperbaric chambers were first introduced in the 1960s. Made of clear acrylic material and shaped as a cylinder, they were designed to accommodate only one patient.
During the treatment, the monoplace chamber is filled with 100% pure oxygen and the atmospheric pressure is increased to up to three times higher than normal. Transparent walls allow the clinical staff to monitor the patient closely.
Because the time and access in a monoplace chamber is limited, they are used for less severe cases of injuries or decompression illness.
One of the primary disadvantages of monoplace chambers is that the patient is isolated and confined in a relatively small place. It might be a bit difficult to endure a two-hour treatment, especially if you’re claustrophobic.

Multiplace Hyperbaric Chambers
Though more expensive than monoplace chambers, and they require more hands to operate, multiplace chambers are a popular option in hospitals and medical centers. They can hold up to 18 patients and are used to treat various conditions, from injuries and hypoxia to decompression illness and burns. Patients may sit in a chair or recline.

In multiplace chambers, patients breathe oxygen through a face mask, hood, or endotracheal tube. The pressurized atmosphere is normal air in a multiplace hyperbaric chamber. Medical personnel monitor each patient’s signs and symptoms and provide drugs and fluids if necessary. They can enter or exit the chamber during the treatment through doorways that can be independently pressurized to allow the transfer of patients and medical staff. One of the main advantages of multiplace chambers is that they allow for extended treatment times. As a result, they are best suited for patients who are in convalescence and need time to heal.

Portable Chambers
Portable hyperbaric chambers were first designed for emergency treatments and patient transportation after decompression illness (the bends). They are lightweight, inflatable, and operate on air from a compressor. A major disadvantage of small portable chambers is that they are pressurized to only 3 ATAs, limiting their use.

Manufacturers also developed large transport hyperbaric chambers. Made of steel, they are heavier and sturdier than small, inflatable version. More than that, they can be pressurized to up to 6 ATAs, enabling them to treat a number of injuries and medical conditions.

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What to Expect Your First Time in a Hyperbaric Chamber

How long does an mHBOT session last? 
You can expect the entire session to last around 90 minutes, though the first session may take longer. Pressurizing and depressurizing the chamber takes about 15 minutes while the chamber is pressurized for about an hour.

How does the air in the hyperbaric chamber stay fresh?
Normal air is filtered and ventilated continuously through the chamber, to minimize any “stuffiness” during your session.

Are hyperbaric chambers comfortable?
Quite. Hyperbaric chambers are well ventilated, and you can use a blanket if you feel cold. Most treatment centers will request that you avoid wearing scented perfumes or deodorants, and abstain from smoking before going in for your session out of consideration for fellow clients.

What can I do to prepare for my first hyperbaric therapy session?
Keep in mind that you may experience mild discomfort in your ears (as you would during the ascending part of a commercial flight). You may also feel fatigued after your first few sessions. This is normal and temporary. It’s advisable to wear comfortable, loose clothing, as tight garments may contribute to a claustrophobic feeling. You might also want to bring some form of entertainment, like a book, a movie or a portable game, as the sessions typically last about 60 minutes.

Related: 8 Ways to Prepare for your First Hyperbaric Therapy Session

Are hyperbaric chambers soundproof?
Most are not, however, the sound of air compressors may help mask outside noise, much like soothing white noise.

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Is Hyperbaric Therapy Right for You? 

What is hyperbaric oxygen therapy used for? 
Individuals find HBOT helpful for a variety of therapeutic uses, including anemia; brain abscess; bubbles of air in your blood vessels (arterial gas embolism); burns; decompression sickness; carbon monoxide poisoning; crushing injuries; sudden deafness; gangrene; infection of skin or bone that causes tissue death; non-healing wounds, such as a diabetic foot ulcer; radiation injury; skin graft or skin flap at risk of tissue death and vision loss.

Does my child need a prescription for mHBOT?
While you should inform your doctor if you’re considering mHBOT as a treatment option for your child, many doctors are not familiar with the therapy and can express resistance to the program. However, this trend is falling by the wayside as positive results are reported.

Can mHBOT cure autism, cerebral palsy or other conditions?
While the answer depends greatly on the individual case, in most instances, a child has developed skills and abilities previously considered beyond the scope of possibility. We see frequent cases in which the child’s and his or her caregiver’s lives are improved after undergoing mHBOT.

Do I need an oxygen concentrator for my hyperbaric chamber to work?
Your hyperbaric chamber will function properly without an accompanying oxygen concentrator, but the decision to enrich your oxygen intake while receiving hyperbaric oxygen therapy is one that should be made between you and your doctor.

If your doctor prescribes an oxygen concentrator, you can increase the oxygen density inside your home hyperbaric chamber.

If you receive hyperbaric oxygen therapy at a hospital or clinical environment, it’s likely that the hyperbaric chamber will be pumped with air from an oxygen tank stored outside the building, using 100% pure oxygen to pressurize the chamber to the prescribed psi.

Mild hyperbaric chambers for home use pressurize and inflate with ambient air, which contains 21% oxygen at sea level. While the amount of oxygen in your mild hyperbaric chamber will never reach 100%, you can use a prescribed oxygen concentrator to increase the oxygen percentage, density and saturation used in your treatment.

The FDA has approved mild hyperbaric chambers for certain uses under the condition that they’re pressurized with ambient air, as described above.

Why would a doctor prescribe an oxygen concentrator?
Research has shown positive results using mHBOT for many conditions when the individual is treated with additional oxygen delivered via an oxygen concentrator. However, evidence suggests different protocols are needed depending on the PSI and the oxygen concentrator.

I’m healthy. Can hyperbaric help me with my fitness and wellness goals?
Mild hyperbaric oxygen therapy is used by people from all walks of life - including professional athletes and mountain climbers, who find hyperbaric oxygenation helps with sports recovery and prevents muscle fatigue and the buildup of lactic acid that causes soreness.

What are the most common uses for mild hyperbaric chambers?
Many people seek hyperbaric oxygen therapy for off-label uses (that is, uses that are not cleared by the FDA) in both adults and children.

Children: Developmental disorders such as cerebral palsy, anoxic brain injury, traumatic brain injury, autism spectrum disorder and general autoimmune disorders.

Adults: Oxidative stress, sports injuries & sports recovery (fatigue and soreness), autoimmune disorders, stroke, nonhealing diabetic wounds and peripheral vascular disease.

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Safety, Side Effects, and Risks of Hyperbaric Oxygen Therapy

Is hyperbaric oxygen therapy safe? 
Yes! Very few safety complications have ever been reported, and many visitors to hyperbaric centers report only mild discomfort, similar to the ear pressure you feel in an ascending or descending airplane. This kind of discomfort can be minimized by altering the pressure inside the chamber at a slower rate. Discuss any concerns you might have with your treating physician or a hyperbaric technician.

Is hyperbaric therapy safe for the elderly?
Yes. Hyperbaric therapy can be very beneficial in your golden years, even contributing to reducing the signs of aging. New research indicates hyperbaric oxygenation slows Apoptosis, or cell death, that ages us.

Is mHBOT painful?
No, mHBOT is painless and noninvasive. As long as you can handle the air pressure change normally experienced on a commercial aircraft, you can tolerate mHBOT. Severely claustrophobic people may have some difficulty, but your hyperbaric technician can teach you techniques to relieve pressure and alleviate any discomfort.

What are the side effects of HBOT?
Some clients report vision changes after long-term treatments, but visual acuity returns to normal within three to four months after ending treatment. However, there is a chance that HBOT could contribute to the worsening of cataracts.

Is there any reason someone should not use a hyperbaric chamber?
Do not enter a hyperbaric chamber if you’re under the influence of intoxicants, if you have ear canal problems or an ear infection, or if you’re experiencing symptoms of a cold or influenza. It’s also a good idea to refrain from wearing strongly scented perfumes or other products out of consideration for the next user.

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For Health Care Providers

Can I legally use an oxygen concentrator with a mild hyperbaric chamber? 
Since oxygen is considered a drug by the FDA, oxygen must be prescribed by an MD, DO or DDS in the United States. Therefore, an oxygen concentrator should only be used when it’s prescribed by your physician. It’s the patient’s responsibility to obtain a prescription and seek consultation for their mild HBOT treatment protocol.

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Mike Price, OT, CTO Rehabmart.com

Author:

Mike Price, OT, CTO Rehabmart.com

Co-Founder of Rehabmart and an Occupational Therapist since 1993. Mike has spent his professional career working in multiple areas of Occupational Therapy, including pediatrics, geriatrics, hand therapy, ergonomics and inpatient / outpatient rehabilitation. Mike enjoys writing articles that help people solve complex therapeutic problems and make better product choices.

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