There are currently 13 indications that are reimbursable by Medicare in the U.S. Throughout the rest of the world there are over 65 conditions treated routinely with HBOT.
Clinically Accepted Indications for HBOT
Click UHMS explanation for a specific indication & scroll to topic of interest
|Blood Loss (Anemia)||Approx. hemoglobin
of 6-8 g/dl
|Burns (Thermal)||5-45 treatments|
|Clostridial Myonecrosis (Gas Gangrene)||10 treatments|
|Crush Injury, Compartment Syndrome
and other Acute Traumatic Ischemias
|Decompression Sickness||10 treatments|
|Enhancement of Healing in Selected Problem Wounds||Utilization review after 30 days of treatment and 30 days thereafter. (20 to 40 treatments)
|Gas Embolism or Air||10 treatments|
|Intracranial Abscess||20 treatments|
|Necrotizing Soft Tissue Infections
(Subcutaneous Tissue, Muscle, Fascia)
|Osteomyelitis (Refractory)||40 treatments|
|Radiation Tissue Damage (Bone or Soft Tissue)
|Skin Grafts and Flaps (Compromised)||20 treatments|
|Smoke Inhalation and Carbon Monoxide Poisoning||5 treatments|
Source: Hyperbaric Oxygen Therapy: Committee Report of the Undersea and Hyperbaric Medical Society, 2008.
The following is the list of Conditions treated with HBOT throughout the rest of the world but are currently considered "Off label" in the United States.
The term "cerebral palsy" is not a specific diagnosis, but is now generally applied to children who experience some form of brain trauma either at the time of birth or shortly before. Typically, these children manifest some degree of cognitive impairment as well as physical impairment, often with weakness and spasticity of arms and legs. Typically treatment therapies for children with cerebral palsy have been directed at the physical manifestations of the underlying problem. That is, most efforts are geared to increase range of motion, reduce spasticity, and increase strength, along with specific therapies designed to enhance skills of communication and academic performance.
Evidence from around the globe is now accumulating providing strong support for the use of hyperbaric oxygen therapy (HBO) as an approach to the actual underlying problem in children with cerebral palsy - a technique which actually targets the abnormalities of brain function. The use of hyperbaric oxygen therapy in cerebral palsy offers an exciting new therapeutic approach for the treatment of cerebral palsy. In actuality however, hyperbaric oxygen therapy itself is not a new technique. It has been utilized for decades for the treatment of injuries related to underwater diving, and in addition has found great utility in the treatment of poorly healing wounds, burns, various bone disorders, complications of radiation therapy, circulatory problems, carbon monoxide poisoning, multiple sclerosis, head injury, and stroke.
The effectiveness of hyperbaric oxygen therapy in children with cerebral palsy is likely a manifestation of enhanced function of previously damaged neurons. These neurons have been called "idling neurons" in that while they are still alive, they have been damaged to the extent that their function is compromised.
While it is important to recognize that hyperbaric oxygen therapy clearly represents an important tool in the treatment of children with cerebral palsy, it should be viewed as an adjunctive form of therapy to be used in conjunction with other established treatment protocols including physical therapy, occupational therapy, speech therapy, as well as pharmaceutical therapy designed to reduce spasticity. The use of HBO in children with cerebral palsy is becoming more popular in the United States and there is no doubt that because of its profound effectiveness, its utilization will become much more widespread.
United Cerebral Palsy Association on HBOT and Brain Injury, August 2002
The United Cerebral Palsy Association issues a statement on HBOT, "Sufficient clinical experience does exist to support the need for additional controlled studies exploring these questions in a scientifically acceptable manner."
This study was designed as a randomized, delayed entry trial of the effects of HBOT on children ages 1 to 5 years with moderate to severe CP. Dr. Maurine Packard
Low Pressure Hyperbaric Oxygen Therapy for Pediatric Brain Injury, A Minimal Risk Medical Treatment
HBOT for Developmental Disabilities including RS and CP
Earl M. Williams, Ph.D.
Traumatic Brain Injury
Hyperbaric Oxygen Study Shows Potential Benefit for Patients With
Traumatic Brain Injury (2010)
MINNEAPOLIS, Jan. 4 /PRNewswire-USNewswire/ -- A 5-year study of
patients with severe traumatic brain injury conducted at Hennepin County
Medical Center in Minneapolis shows significant benefit of hyperbaric
oxygen therapy to improve brain metabolism and its ability to recover
from injury. The results were recently published in the Journal of
Every year, more than 1.4 million Americans sustain a traumatic brain
injury (TBI) - the leading cause of death and disability in children and
young adults. Those who survive often face months or even years of
therapy, and sometimes the damage to the brain is irreversible.
Decreased utilization of oxygenated blood to brain tissue immediately
after the injury is often to blame.
Cells need oxygen to fuel metabolism for cellular growth and repair.
Healthy brains produce their own energy to maintain brain tissue and
keep the rest of the body doing what it's supposed to do. That includes
automatic processes like breathing and circulation, as well as voluntary
actions like walking and talking. After a traumatic brain injury, the
brain itself needs care. Barriers to blood flow can be compromised from
the impact of the injury itself, and then when the brain swells inside
the skull, a secondary injury can occur that causes even more brain damage.
"There's a direct correlation between clinical outcome and the degree to
which the brain's metabolism is restored," explains one of the study's
authors, neurosurgeon Gaylan Rockswold, MD. "In previous research we
learned that the brain's energy production is improved and maintained
with hyperbaric oxygen treatment, but this study confirms that
hyperbaric oxygen treatment has a major impact in terms of /increased
Within 24 hours after injury, eligible patients for the study were
randomized into three groups: One group received "normobaric" treatment:
oxygen delivered at the patient's bedside; another group received
hyperbaric treatment in Hennepin County Medical Center's hyperbaric
oxygen chamber; and a third (control) group did not receive additional
oxygen therapy. All groups received the intensive standard of care for
brain injury consistent with good clinical practice. The patients who
received higher levels of oxygen (hyperoxia) via the hyperbaric oxygen
chamber were found to have a marked increase in positive_ _brain
metabolism when compared to the normobaric and control group.
"Our goal was to evaluate the brain's metabolism and intracranial
pressure, and whether or not too much oxygen posed a concern with
hyperbaric oxygen treatment in these patients," said Dr. Rockswold. "The
results indicate that hyperbaric oxygen treatment was found to
significantly enhance the brain's energy production and reduce
intracranial pressure without any toxic effects on the brain or lungs
from too much oxygen."
This research provides important preliminary data for a National
Institutes of Health (NIH) supported multicenter trial. NIH trials
directly assess the ability to improve clinical outcomes, which is the
final step needed to change standard clinical processes. Currently
standard clinical practice does not include hyperbaric oxygen for
traumatic brain injury/. /
"TBI is not only devastating for the patient, it's also heart wrenching
for his or her family. We couldn't be more pleased about the impact this
study will have for patients with traumatic brain injury."
The Traumatic Brain Injury Center at Hennepin County Medical Center
offers comprehensive, multidisciplinary patient care education and
research to serve people who have sustained a traumatic brain injury.
Providing a full range of state-of-the-art medical and rehabilitative
services, HCMC's expertise spans the entire continuum of care for adult
and pediatric TBI patients, from prevention to emergency care,
neurosurgery, critical care, rehabilitation and the Mild to Moderate
Traumatic Brain Injury Clinic.
It has been estimated that at the present time there are about 1.7 million stroke survivors in this country. Regrettably, a commonly held belief is that once an area of the brain has been damaged by a stroke, nothing can be done to restore the function of that area. Recent scientific research has revealed that while the more central areas of stroke involve brain tissue may be irreversibly damaged, there exists an area surrounding this tissue which may be functionally salvaged with the use of hyperbaric oxygen. Since the early 1970’s, scientific journals have reported over 1,000 cases demonstrating a 40-100% rate of improvement for stroke patients treated with HBO. In the journal Stroke, Dr. Richard Neubauer, a pioneer in the use of hyperbaric oxygen and various neurological diseases, reported outstanding results in a group of 122 stoke patients treated with HBO. In one case, significant functional improvement was noted when HBO therapy was given 14 years after the initial stroke event.
The benefit of hyperbaric oxygen in stroke patients likely results from its ability to enhance the metabolism of so-called "idling nerve cells" as well as increasing oxygen supply surrounding the area of maximal damage.
West Germany has long recognized the effectiveness of HBO in stroke rehabilitation to the extent that now virtually all stroke patients in West Germany receive a three week intensive course of hyperbaric oxygen paid for by insurance companies.
The Lion Magazine, November 2002
Hyperbaric Oxygen Offers New Hope for Stroke Victims
"Autism" is not a diagnosis but rather a description of one symptom of a brain-injured child who is usually injured in the cortical and midbrain areas of the brain. This is opposed to a child with Cerebral Palsy, who's brain injury is in a different area of the brain, the subcortical areas. This helps explain why Autistic children are improving with HBOT.
Hyperbaric treatment shows promise for autism - Fri, Mar 20, 2009 (Reuters Health) — Kids with autism may benefit from a series of treatments in a pressurized chamber with boosted oxygen levels. http://www.babycenter.com/204_hyperbaric-treatment-shows-promise-for-autism_10310687.bc
Over the past two decades, extensive international medical research has demonstrated that HBO can play an extremely important role in the treatment of multiple sclerosis (MS). In many European countries, HBO is now considered an integral part of the MS treatment program - in England alone, over 10,000 MS patients are currently receiving hyperbaric oxygen treatment.
In a recent publication in the prestigious New England Journal of Medicine entitled, "Hyperbaric Oxygen Treatment of Multiple Sclerosis, a Randomized, Placebo Controlled, Double-blind Study," researchers demonstrated significant objective improvements in a variety of MS symptoms in 70% of patients treated. At one year after treatment, deterioration was noted in 55% of MS patients not treated as compared to only 12% of patients who underwent hyperbaric oxygen treatment.
Hyperbaric-oxygen treatment of multiple sclerosis. A randomized, placebo-controlled, double-blind study
BH Fischer, M Marks, and T Reich, New England Journal of Medicine
Bell's palsy is a common affliction characterized by the fairly sudden onset of weakness of one side of the face. Typically, patients are offered steroids early in the course of their illness in hopes of reducing swelling of the nerve involved in facial movement. Exciting new research demonstrates that hyperbaric oxygen therapy is significantly more effective than steroids in the treatment of Bell's palsy - both shortening the length of illness as well as increasing the likelihood of full recovery.
Patients diagnosed with Meniere's disease typically suffer from recurrent attacks of disabling vertigo with progressive hearing loss. Until recently, therapeutic options were limited to either aggressive surgical or medical approaches.
Recent research confirms usefulness of HBO in Meniere's disease. HBO treated patients experienced significant improvement in attacks of vertigo as well as hearing. These improvements continued when these patients were re-evaluated two years after the hyperbaric oxygen treatment program.
Lyme disease, first discovered in 1975, is an infectious illness transmitted by ticks. In the past decade, Lyme disease has spread across the nation and has increased in incidence some ten fold. Lyme infection may produce muscle and joint pain, immune system dysfunction, nervous system abnormalities, cardiac problems, and fever.
Typically, if aggressive antibiotic therapy is initiated early in the course of the illness, successful treatment is achieved. Unfortunately, many patients do not adequately respond to antibiotic therapy and essentially become incapacitated by this illness.
New and exciting research showing the efficacy of hyperbaric oxygen therapy now offers hope to patients crippled by chronic Lyme disease. Dr. William Fife at Texas A & M University has published extensive research demonstrating profound improvements in chronic Lyme disease patients treated with HBO. These improvements include pain reduction, return of clarity of mentation, reduction of depression, and frequently the ability to discontinue antibiotics.
REFLEX SYMPATHETIC DYSTROPHY
Although uncommon, reflex sympathetic dystrophy can be a crippling disease characterized by swelling and severe pain of an extremity, at times following what would otherwise have been trivial trauma. Treatment options including injection techniques and medication have met with only limited success. Having demonstrated its usefulness in clinical studies, HBO offers an effective treatment option in treating reflex sympathetic dystrophy.
Without question, one of the most widely recognized applications of hyperbaric oxygen has been in the area of wound healing. These conditions include decubitous ulcers, venous stasis ulcers, arterial insufficiency ulcers, burns, crush injuries, severed limbs, non-healing bone fractures, diabetic foot ulcers, brown recluse spider bites, poorly healing skin grafts, and osteoradionecrosis (bone damage as a result of excessive radiation exposure). The mechanisms by which HBO enhances healing include:
Hyperoxygenation - increase tissue levels of oxygen
Neovascularization - enhance growth of new blood vessels
Antimicrobial effect - destroys harmful bacteria
Leukocyte activation - enhances ability of white blood cell to remove bacteria and debris
Fibrolastic proliferation - increases growth of cells which form reparative tissue.
Hyperbaric oxygen therapy can be an important adjunct in a comprehensive wound healing program utilized in conjunction with other modalities including surgical, medical, and physiotherapeutic techniques.
Spinal Cord Injury
Spinal Rehab in Australia has done a fantastic job of documenting the importance of HBOT and Physical Rehabilitation.
Other Neurological Disorders:
Peripheral nerve injury
Epilepsy due to hypoxia
Hypoxic birth disorders
Candidas and fungal infections
Chemical Poisoning/ Pesticide
Spinal Cord injury
Fracture repair, delayed and non-union
Post surgical instability
Aid to prosthesis rehabilitative care
Degenerative Joint disease
Auto Immune Related Disorders:
Chronic Fatigue Syndrome
Silicone induced disorders
Soft tissue musculoskeletal injuries
Closed head injury
Pre and Post Surgery healing, reconstruction and cosmetic surgery
Delayed wounds, recurrent ulcers an infections
Acute and Chronic arterial insufficiency
Acute and Chronic Anemia
Gastric and Duodenal Ulcers
Medicare Reimbursed Indications
1.Air or gas embolism
2.Carbon monoxide poisoning and CO poisoning complicated by cyanide poisoning.
3.Clostridal myositis and myonecrosis, (gas gangrene)
4.Crush injury, compartment syndrome, and other acute traumatic ischemias.
6.Enhancement of healing in selected problem wounds
7.Exceptional blood loss (anemia)
8.Intracranial abscess, actinomycosis
9.Necrotizing soft tissue infections
10.Refractory osteomyelitis (Infected bone)
11.Delayed radiation injury (soft tissue and bony necrosis)
12.Skin grafts and flaps (compromised)
HOT 4R CP Kids Foundation The foundation’s goal is to fund education and research into Hyperbaric Oxygen Therapy for the treatment of children living with Cerebral Palsy. Our hope is that one day all children living with CP can benefit from this therapy.
The Healing Center Online Good site for Autism and CP research.
Spinal Rehabilitation Group: Molecular Hyperbaric Medicine
"The Spinal Rehabilitation Group is a day care facility in Australia utilizing the benefits of Hyperbaric Medicine as part of a multi disciplinary treatment program specializing in chronic degenerative spinal related, neurological and vascular disorders."