Top Ten Things You Need to Know About HBOT #10: Oxygen's Long History of Wound Healing

Hyperbaric oxygen therapy (HBOT) is an accepted therapeutic modality for use in several medical conditions including problem wounds. HBOT enhances oxygen supply to hypoxic tissues and increases wound healing and tissue remodeling capacity. Currently, HBOT therapy is applied in a wide range of clinical conditions.
 
In the first in a series of articles, these authors count down the top ten things you need to know about HBOT. 

10

Did you know that HBO therapy has been around for over 150 years in the USA?

Contrary to popular belief, hyperbaric oxygen therapy (HBOT) has been utilized in the USA for over 150 years. This is longer than penicillin has been around. Although the use of HBOT in the North American continent dates back over a century, its history goes back even further than that.
 
The first report of a hyperbaric chamber dates to over 300 years ago, when Nathaniel Henshaw, MD, developed the first hyperbaric chamber, which he called the “domicilium.”¹ Technically, the domicilium was not an HBOT chamber, as oxygen had not yet been “discovered” and it is thought that these chambers were pressurized with compressed air rather than oxygen. Oxygen was “discovered” in 1774 by Joseph Priestley.
 
In 1860, the first hyperbaric chamber in North America was constructed in Ontario, Canada. In 1861, Dr. James Corning, who was a neurologist, built the first hyperbaric chamber in the US in New York.² The field kept advancing, and eventually, the largest hyperbaric chamber was built by Dr. Orval J. Cunningham in Cleveland, Ohio. This chamber was five stories high and 64 feet in diameter. It was known as the “Hyperbaric Hotel.”³
 
The Undersea and Hyperbaric Medical Society (UHMS) was formed in 1967 to further address additional clinical indications of hyperbaric medicine, besides diving diseases. The UHMS was originally named the “Undersea Medical Society” and was formed before HBOT had achieved any broad recognition in treating non-diving diseases. All (but one) of the Society founders were associates with the US Navy, and most of the members in the early years drew their experience with HBOT exclusively from diving.⁴ Their efforts yielded important results and the use of HBOT started to spread, with a small number of centers in the US providing HBOT and some of these centers starting to treat diseases other than air emboli and “bends” in 1972.
 
At present, it is estimated that there are more than 1,250 HBOT centers in the USA according to Medicare Billing Data in 2021 (Table 1), with some of them utilizing multiplace chambers, where multiple patients can be treated at the same time, and others being monoplace chambers where one patient is treated at one time.
 
Recently, there has been a growth in office-based hyperbaric medicine and a decrease in hospital-based programs, as evidenced by Medicare billing records. There were 1,060 hospitals providing HBOT services in 2021 comprising of 76% under Medicare records, which has decreased compared with almost 1,400 hospital-based program in 2014. Office based hyperbaric centers are 9% of these, which shows an increase from previous years’ Medicare billing records.⁵ (Table 2)

Why Is Office Based HBOT Use Growing?

We rationalize that the recent growth we have seen within hyperbaric medicine has three main causes. The first pertains to the increased availability of monoplace chambers, with associated costs of space requirements and installation being more affordable. The second reason is that the list of indications for HBO therapy that is approved by insurance is expanding. The third reason is that Medicare is allowing payment under a G code for office-based facilities to charge for HBOT services.
 
Denise Nemeth is a first-year medical student at the University of the Incarnate Word School of Osteopathic Medicine in San Antonio, TX. Formerly a general and vascular surgery PA in a rural community, Ms. Nemeth aspires to become a general surgeon. She is certified wound specialist with the American Board of Wound Management. Her interests include rural health, wound healing, colorectal surgery, and minimally invasive surgery.

Jayesh B. Shah is Immediate Past president of the American College of Hyperbaric Medicine and serves as medical director for two wound centers based in San Antonio, TX. In addition, he is president of South Texas Wound Associates, San Antonio. He is also the past president of both the American Association of Physicians of Indian Origin and the Bexar County Medical Society and Current of Board of Trustees of Texas Medical Association. 

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References
 
1. Hyperbaric medicine history: From theory to practice. Biobarica. Published Oct. 15, 2020.
2. History of hyperbaric oxygen therapy (HBOT). Oxygen Oasis.
3. Whelan HT, Kindwall EP. Hyperbaric Medicine Practice. 4th ed. Best Publishing; 2017.
4. Undersea and Hyperbaric Medicine Society, 1967–2007. A history of 40 years. 
5. American Hospital Directory.