How hyperbaric oxygen therapy heals the body - Part 2

Hello, I'm Rob Hoell, and welcome back to 20-Minute Health Talk. This is part two of our deep dive into the fascinating world of hyperbaric medicine. Our guests are two world-renowned experts in the field and in part one of this interview — which listeners can find in our feed and show notes — they shared insights into hyperbaric oxygen therapy's many benefits, how it works, and what it's like to receive treatment in the largest hyperbaric chamber in the northeastern United States located, at

Phelps Hospital. In part 2, we discussed the research driving hyperbaric medicine forward, the training required to conduct this brand of medicine, and what patients should look for if they want to pursue hyperbaric oxygen therapy. Here is part two of our interview with Dr. Owen O'Neill, founding and current Medical director of the Department of undersea and hyperbaric medicine at Phelps Hospital, and John Peters, Executive director of the undersea and hyperbaric Medical Society.

John, are there studies showing how effective this can be? Yes, absolutely. On the magnitude of thousands of studies, hyperbaric medicine has come along and evolved from diving really in the 50s, including wound car, aggressive bacterial infections, life without blood, Ite Boerema out of Amsterdam. A lot of that research now too is real-world research and is where we're actually looking at patients that have multiple comorbidities. They're coming to us, and they're pretty sick.

Unless it's something that is an acute injury — carbon monoxide, Navy or decompression sickness — but most of the patients that we're treating are ill with multiple conditions, and they are going to come for, you know, somewhere in the neighborhood of 20 to 60 treatments depending. Well, you know, we talked about different conditions that hyperbaric

oxygen therapy can help treat, it's also being studied for covid-19 and Dr. O'Neill, during the pandemic, you began using hyperbaric oxygen hoods to help improve covid-19 patient's oxygen saturation levels. Tell us about that. Okay, well, first just to differentiate the hyperbaric oxygen treatments for covid-19 patients were proving to be very successful.

So at Phelps Hospital, you had to be part of an IRB (Institutional Review Board) study research project in order to use hyperbaric oxygen on patients for that condition because it's an experimental condition. So we were not part of an IRB so we looked at the patients at the time who were very sick from the lung standpoint.

They had a very hard time breathing, they were not able to maintain tissue oxygen oxygenation, and they were put on various modes of breathing oxygen, high flow oxygen and in some patients it worked and in some patients it didn't. The majority of the patients were it did not work, they had to be intubated. So that means they had a breathing tube and had to be put on a breathing machine. So once that happened, they had about a 98 percent mortality rate.

So if you were put on a breathing machine, that was almost like the the end of your life, you were not going to come off of that breathing machine. The other part of that is that there were not enough machines to give patients because everybody was on them, there were none to be had. There were also some other drugs coming up at the time that seem to be helping the patient.

So, We came up with the idea of putting an oxygen hood from the hyperbaric chamber on the patient because those hoods are completely enclosed. So, while wearing that hood and breathing 100% oxygen, we knew the patients could be delivered that oxygen. We could also put valves on that hood, that would help them keep their oxygen levels

even a little bit higher. We call those a peep valve, and when we did that, we put them on the patients and we found that the number of the patients we first put the hood on, those were patients that needed to be on the breathing machine, but there wasn't a breathing machine available, so we put them on the hood, and we found that a number of them, maintained an oxygen level high enough that they didn't need to be put on the machine.

So, in a sense, that also decreased their chances of dying; for those patients who were on it for maybe two, three, or four days before they required the breathing machine, that gave them another three or four days of medication treatment to help them along. When they finally got put on the breathing machine, they had a better chance of getting off of it.

So, all in all we probably prevented about 57 percent of the patients we put the hood on from requiring the breathing machine, and hence we decrease their mortality of either chance of being alive, we increased that. Based on that work and the decades of diligence and

excellence in the practice of hyperbaric medicine, the undersea and hyperbaric medicine society awarded Dr. O'Neill, the 2022 excellence in hyperbaric medicine award, tell us more about this award. Yes, really we were pleased to have Dr. O'Neill picked for this excellence in hyperbaric medicine award.

The award is presented at our annual scientific meeting to an individual UHS member in recognition of continued diligence and excellence in the practice of hyperbaric medicine, particularly in the areas of basic, and clinical research, as it might impact patient care. So, Owen is a perfect recipient for this award.

He has been Been working diligently for over 30 years in the specialty and has really raised raises the bar for all of our practitioners, and he's expanded his practice into commercial diving and tunneling and he continues to grow. So even at 30 years as a 30-year veteran, he continues to grow his practice and improve his knowledge base and he's helping to mentor others. And this is demonstrated in his award this past year.

It seems to me that hyperbaric treatment is so complex and yet, so simple, in a way, what's the training like to be able to

use hyperbaric medicine? Well, the Platinum standard now for being trained in undersea and hyperbaric medicine, which is the specialty name is a fellowship program. So physicians who come out of residency training they've completed residency training in internal medicine, family Medicine, emergency medicine, anesthesia. If they desire to become board certified in undersea and hyperbaric medicine they would be required to take a one year undersea ann hyperbaric medicine fellowship.

That's one way. The second way is there are 40 hour programs. So a physician, a nurse, or a technologist who wants to learn more on undersea and hyperbaric medicine, they can sit in one of these 40 hour programs, take the examination when they're all done, if they pass the examination, they can then go back to their hospital with this introductory course in hyperbaric medicine, and start to actually learn the specialty.

Once a physician, nurse, or technologist, has done that, for the physicians who can't take that one year off to go back and do a fellowship training program in undersea hyperbaric medicine, the undersea and hyperbaric medical society now has what we call the path program, which is basically an online program that will last approximately six to nine months, where you have a tailored study program and then a test to qualify you at the end for the

knowledge and then also a technical piece that the physicians know how to actually function with their hands, controls, Etc.,

when necessary. There's also an accrediting process that hospitals must go through to be able to use hyperbaric oxygen therapy, John, can you tell us about that and what people seeking this treatment should know? The UHMS had established a hyperbaric facility accreditation program in 2000 and we've surveyed approximately 350 hospitals in the United States.

This accreditation program was established to set the standard really for how programs operate, and how patients are managed, and for a safe outcome. Hopefully, at some point we'll actually get some of our large payers or even CMS actually mandate accreditation. We do see variation and that's because we see variation in practice.

And so by closing those gaps rapidly, we're really elevating their practice and really helping those individuals, those professionals, and those facilities to actually to do a better job and deliver better patient care. So it's a win for the patient. It's a win for the caregivers. Dr.

O'Neill, in addition to the program you run at Phelps Hospital, there are several other Northwell facilities that offer hyperbaric medicine. Do you ever work with other programs in the health system? And what does that collaboration look like? Here at Northwell, I started the hyperbaric collaborative. So basically it's a collaboration among all of the medical directors for all of the hyperbaric facilities in the system.

And we've gotten together to look at exactly how we should do things, make sure we're all on the same page, how we get the message out to individuals, and how we do things according to the undersea and hyperbaric medicine rules and regulations and those that CMS or Medicare put in our way, Awesome. We always like to end on a positive note here on 20-Minute Health Talk. Dr. O'Neill we'll start with you. What gives you hope? What gives you optimism going forward?

Well, as John explained, we have accreditation process now, we have hospitals becoming more aware of undersea and hyperbaric medicine, I have patients that self-refer now because they're becoming interested in it. So we really would like the patients to know what it is that we do and how we can help them. Especially patients that have chronic wounds that are not getting better.

As with radiation damage, they may have bleeding from their bladder, from radiation cystitis, or bleeding from their bottoms, from radiation proctitis. These are all patients and especially our breast patients now are cancer breast patients that require radiation. They require extensive reconstruction after the cancer is removed, they tend to have a fair number of problems as well that hyperbaric oxygen is able to alleviate. So there are, again, a number of conditions out there.

We just want patients to know that they feel as they have a condition that oxygen is required to make it better. Regular Oxygen by face mask is not going to help you, climbing into a zip-up chamber is not going to help you, you need to contact a hospital facility that has an undersea and hyperbaric medicine program and speak to the proper specialist. And John, what gives you hope? What gives you optimism moving forward?

Well yeah, I'm very hopeful actually for the field. I think some the items that Owen has mentioned, I think, are really key. I think that our focus on dose-response is really critical for our future and that is looking at the indication studying the indications that are already approved and new indications and actually zeroing in on exactly the right pressure that is needed for determining the length of treatment based on those responses.

And so, I think that we're gaining more data around that topic, and I think that's going to help ultimately benefit the patient. I believe that they open the door for additional educations out there. And then again, I think as I mentioned Hyperbaric facility, accreditation standardization, I think it's key.

We need to look at practice and make sure that we are determining and we have determined what the best practices are for our patients so that both the patient and our physicians and the caregivers are having or have a great experience. I think that's key especially in today and we need to really bring down the cost of the treatment, and we can do that through this mechanism

through evaluation oversight and engagement. Dr. O'Neill, John Peters, thank you so much for joining us today, and best of luck in your new role as President elect of the undersea and hyperbaric medical society. And for you, the listener. thank you so much for tuning in and listening. I'm Rob Hoell and stay safe and have a great week. Thanks Rob. Get more expert insight from the leading voices in healthcare today. You can subscribe to 20-minute Health talk wherever podcasts are available.