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Hyperbaric Oxygen Therapy Safety: What You Need to Know

Hyperbaric oxygen therapy chambers (HBOTC) are categorized in the US by the FDA as CLASS II medical devices. They come in different sizes and shapes as hard-sided chambers and are used predominantly in hospitals and specialist clinics.

A variety of other types of chambers are used in alternative health clinics, and, increasingly, in private residences, but these soft chambers are not recognized by the FDA as a medical device for hyperbaric oxygen treatment and you will not find them in any reputable hospital or medical office.

Given this distinction, you may well ask: Is hyperbaric oxygen therapy safe? And, if you’re considering HBOT, should you buy a hyperbaric oxygen chamber online?

In short, I’d say there are very few circumstances that warrant the purchase or use of a personal hyperbaric chamber at home. Why?

Well, for two key reasons: serious safety concerns and lack of efficacy.

What is Hyperbaric Oxygen Therapy?

The word ‘hyperbaric’ simply means high pressure.

Hyperbaric oxygen therapy, then, is a medical treatment where a person breathes pure oxygen in a pressurized environment. This treatment is well established for decompression sickness (the bends) and altitude sickness, as experienced by divers and mountain climbers.

The first hyperbaric chamber was built in 1662 using bellows and valves. The physician who created this pressurized room believed it could help treat certain respiratory problems, but it wasn’t until the 1940s when HBOT because a well-regarded and soon standard treatment for divers in the US military. The idea was to return a diver who had surfaced too quickly to the depth at which they were diving, and then gradually decompress the atmosphere to allow them to adjust properly and reduce air bubbles in the body.

FDA approval of HBOT is limited

In the past century, hyperbaric oxygen therapy has been approved by the FDA for use in treating a variety of conditions. Indications for hyperbaric oxygen therapy fall into three main categories:

  • lifesaving treatment for air or gas embolisms, decompression sickness, or carbon monoxide poisoning;
  • limb saving treatments, i.e. for crush injuries or non-healing wounds related to diabetes or radiation injury;
  • and tissue saving treatment in the case of serious burns, muscle and skin grafts, severe infections, and more.

What happens in a HBOT chamber?

During a HBOT session, air pressure in the chamber is increased above normal air pressure.

At a level of 1.5 ata and beyond, the pressure allows the blood to carry oxygen in plasma. Under normal circumstances, oxygen is transported around the body attached to the hemoglobin in red blood cells. The result is greater oxygen transportation around the body, including to damaged and infected tissues. This increase in oxygen concentration in the body is beyond that possible from just breathing pure oxygen in a normal pressure environment.

A session in a HBOT chamber usually lasts around 90 minutes, with pressure gradually increasing and then decreasing. As pressure increases, those inside the chamber may experience discomfort and a feeling of fullness in the ears and sinuses. This can usually be mitigated by yawning or swallowing, just like on an airplane.

What is hyperbaric oxygen therapy used for?

Currently, Medicare and private insurance will usually cover the cost of FDA-approved HBOT treatment for the following conditions:

  • Decompression injury
  • Air or gas embolism
  • Gas gangrene
  • Carbon monoxide poisoning
  • Anemia caused by severe blood loss
  • Some infections, such as in sinuses or the brain, and osteomyelitis
  • Burns from heat or fire
  • Radiation injury, from cancer therapy, for example
  • Skin and muscle grafts
  • Necrotizing soft tissue infections
  • Arterial insufficiency
  • Acute traumatic ischemia, after a crush injury, for example.

In cases of carbon monoxide poisoning, hemoglobin cannot attach to oxygen molecules, which is why HBOT is approved for treating this condition. Treatment for carbon monoxide poisoning usually involves one or two sessions. For non-healing wounds, a person may require 40 sessions. The number of sessions varies across conditions and for individual patients.

Oxygen helps the body fight infection and also stimulates the release of growth factors and stem cells to support healing. Tissue that is injured requires a higher level of oxygen to survive and heal.

It’s easy to see, then, why HBOT is promoted as a treatment for all manner of health issues. The reality, though, is that there’s little or no evidence for the safety or efficacy of HBOT for most health concerns, let alone for boosting cognitive sharpness or general energy in healthy individuals.

Back in 2012, a robust report was put together by the University of Birmingham, UK, to help guide the UK’s National Health Service in the use of HBOT. Their report clearly states that, “The primary research studies investigating the efficacy of HBOT are remarkable for the consistent poor quality of the published clinical trials as well as the lack of evidence demonstrating significant health benefits. There is a lack of adequate clinical evidence to support the view that HBOT therapy is efficacious for any of the indications for which it is being used”.

Furthermore, the few studies that were carried out used pressures far higher than those possible with a soft-sided chamber. And we can’t simply take any benefits seen at higher pressures and extend those to lower pressures in a mild hyperbaric oxygen therapy (mHOBT) chamber.

Proper use of HBOT

All that said, there is a time and a place for HBOT, and a chance that additional benefits of HBOT may yet be established by clinical trials and result in FDA-approved treatments. So, how can you stay safe with hyperbaric oxygen therapy and where can you buy the best hyperbaric oxygen therapy chambers online?

The Undersea and Hyperbaric Medical Society issues guidance on how HBOT should be used and when. These guidelines require that a patient breathe near 100% oxygen while inside a chamber pressurized to at least 1.5 atmospheres absolute (ata). Soft-sided chambers cannot provide this combination of oxygen and pressure, but may be used by qualified personnel in emergency situations while en route to a hard chamber.

If you’re considering HBOT at a private clinic, be sure that the clinic strictly regulates the use of the chamber and that the chamber was properly installed by professionals and is regularly serviced. Electronics and other items that might cause a spark should be kept out of the chamber, and a qualified staff member should supervise the chamber during use.

A traditional HBOT chamber requires installation permits and other paperwork, offering some reassurance that a chamber is properly installed and serviced. Low-pressure chambers do not have this level of regulation, can be delivered via FedEx and set up in half an hour, meaning there’s little to prevent improper installation and use.

In general, choosing to work with an operator who follows the National Fire Protection Agency (NFPA) code 99 is your best bet for staying safe as there have been no reported fire-related deaths in facilities operating to this standard. 1

Learning from hospitals

In a hospital setting, for example, a HBOT chamber must be installed so that the exhaust from the chamber is piped to the exterior of the building. Soft-sided chambers typically vent into the room in which they’re placed. Add in the oxygen concentrator I mentioned earlier and the oxygen level in the chamber can increase to more than 23.5%, the limit at which the NFPA 99 code requires both the chamber and the patient to be electrically grounded. This rarely happens in at-home situations or in alternative health and sports clinics, which puts both patients and staff at risk of serious injury and death.

Tablets, cell phones, e-readers, laptops, lighters, battery-powered gadgets, and other devices, as well as synthetic fibers from clothing, mattress covers, cushions and other items can all cause sparks that lead to a fire. If clinic personnel do not operate under strict conditions where such items are kept out of the chamber, be wary. If a clinic encourages the use of these items during a session, I would avoid that clinic.

Reputable clinics may also recommend that you do not use (and that you remove) any hair and skin care products that are petroleum-based, so as to further minimize fire hazards.

The problems with mild hyperbaric oxygen therapy chambers

So called ‘mild personal hyperbaric chambers’ are usually soft-sided and cannot be pressurized to the same extent as a hard-sided chamber. This means that the chambers don’t provide anywhere near the level of oxygen saturation used in clinics and supported by medical science. mHOBT chambers also run the risk of recirculating contaminated air, while a hard-sided chamber does not pose such a risk as it uses a closed system of oxygen piped in directly from a liquid oxygen tank.

This last point is particularly troublesome when you consider that oxygen only becomes bacteriostatic at 1.5 ata. This means that bacteria are prevented from reproducing at this pressure. A soft-sided chamber can only achieve pressure of 1.3 ata, which isn’t bacteriostatic. In fact, at this pressure and with recirculated air, the growth of some aerobic bacteria, molds, and fungus may be promoted.

At home HBOT is risky

In short, the type of chamber most commonly sold for at-home use is both more likely to pose serious safety risks and least likely to confer health benefits. Unfortunately, this situation can lead some people to supplement a personal soft-sided hyperbaric chamber with an oxygen concentrator, which can further increase the risk of serious injury or death.

What’s more, soft-sided, low-pressure, fabric chambers are not built to a variety of important safety standards. These include the American Society of Mechanical Engineers, Pressure Vessels for Human Occupancy -1 (ASME PVHO-1) hyperbaric chamber design and fabrication code (as required by NFPA 99). NFPA 99 is a standard laid out by the National Fire Protection Agency. Such chambers are also routinely operated outside of FDA approval.

So, why do soft-sided chambers exist at all? Their original purpose was as a portable, temporary treatment for acute mountain sickness (altitude sickness). Indeed, the FDA only recognizes soft chambers as a medical device for use in treating altitude sickness during transport to a proper medical facility and otherwise warns against the improper use of mHOBT chambers.

Why is the FDA concerned about this type of chamber and off-label use of HBOT?

Health risks of HBOT

In the proper setting, i.e. in a hospital or approved clinic, HBOT can be a generally safe procedure. However, even under optimal conditions, some side effects and risks are possible. These include middle ear injuries and hearing loss, temporary nearsightedness caused by pressure changes to the lens of the eye, seizures from oxygen toxicity, and fire.

Barotrauma is another serious complication of HBOT. This most commonly affects delicate tissues of the body, such as the lungs, eardrum, and paranasal sinuses, but can also be caused due to air trapped under dental fillings. There have been documented cases of death from HBOT caused by massive trauma to the lungs, leading to lung collapse and suffocation.

Other risks include progression of cataracts, and serious, life-threatening burns. Again, there are documented cases of fatalities resulting from fire sparked inside a hyperbaric oxygen therapy chamber.

Simple static build-up inside a chamber can cause a spark that ignites the concentrated oxygen, leading to horrific burns and death. This is why hospitals and reputable clinics using these chambers are extremely careful about everything that goes into the chamber, requiring patients to wear cotton clothing rather than synthetic fibers, for instance.

A 1997 report from the Undersea and Hyperbaric Medical Society looked at the use of hyperbaric and hypobaric chambers from 1923 to 1996. They found evidence of 77 deaths resulting from 35 fires in clinical hyperbaric chambers. These fires and explosions in HBOT chambers were due to static electricity, electrical devices, chemical handwarmers, and other sources. 1

A power failure can also pose serious problems for HBOT. While most hard-sided chambers are designed to pressurize and decompress without electrical power, a soft-sided chamber can deflate rapidly in a power outage, creating the risk of suffocation and entrapment. There has also been at least one documented death from suffocation in a soft-sided HBOT chamber that deflated because of a loose valve.

The future promise of HBOT and final thoughts

It should be clear by now that I come down strongly on the side of sticking with the approved use of HBOT. I also appreciate, however, that HBOT shows considerable potential in treating other health issues. Indeed, promising research has been published in recent years looking at the effects of HBOT in vascular dementia and traumatic brain injury (TBI).2 3

Interestingly, a study using a mouse model of TBI found that HBOT may help reverse damaging changes in brain cells associated with such injuries. Specifically, HBOT may help restore normal levels of proteins pAkt/Akt, pGSK3β/ GSK3β, and β-catenin induced by acute TBI. This helps to reverse the TBI-induced increase in the number of apoptotic neurons and mRNA expression and activated caspase 3 protein. 4

All in all, HBOT is expensive, somewhat inconvenient and uncomfortable and, frankly, rife with safety concerns. As such, you have to wonder why some folks are such ardent fans.

Over the years, various celebrities have espoused the benefits of hyperbaric oxygen chambers, including Michael Jackson, Dave Asprey (of BulletProof fame), and others. It’s possible that these folks were/are using a properly installed hard-sided hyperbaric oxygen chamber in their home with qualified medical supervision, but for us ordinary folk, these things aren’t typically within reach.

With a single HBOT session at a private clinic easily costing $300 an hour or more, typically in a low-pressure chamber with no proven health benefits, my advice is to choose other ways to boost brain health, enhance energy, and otherwise support good health.

Leigh Matthews, BA Hons, H.Dip. NT

Leigh Matthews, BA Hons, H.Dip. NT, is a health and wellness writer for Gene Food specializing in plant-based nutrition. Read her full bio here.

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