Search

Overutilization of hyperbaric oxygen therapy (HBOT) is commonplace and primarily associated with outpatient wound care. While the number of hospitals providing HBOT is at an all-time high, the number of those willing to treat patients in immediate need is at an all-time low. Huge areas of the country, including major population areas, are now completely devoid of 24/7 HBOT availability and inpatient access. Purchasers of healthcare, including the Centers for Medicare and Medicaid Services, have become increasingly concerned to the point that several strategies have been introduced to constructively deal with this issue. This commentary serves as a counterpoint to concerns that one such approach, prior authorization of elective indications, adversely delays medically necessary care. The historical evolution of HBOT practice will be described to underscore how this problem has become so widespread and, to date, largely unchecked. It will also address the paradoxical national crisis of access for emergencies.

Hyperbaric oxygen therapy has a rich and diverse history, both in the United States and around the world. From its early uses in war to the building of bridges, and through many introductions to innovations in the medical community, it has been debated and modified until its ultimate acceptance in multiple areas of patient care. Numerous areas of patient care use hyperbaric therapy, from wound care to military applications, in both single monoplace chambers and multipatient settings in larger chambers. This article provides an overview on the history, trial and error, and modern development of hyperbaric oxygen in clinical care therapies in 21st century medicine and nursing.

Hyperbaric medicine, which was called compressed air therapy prior to 1956, began in the 1830s in England and France. After initial enthusiasm for this treatment, interest began to wane because of a lack of documentation of benefit. The medical community became skeptical, and use of the modality diminished. In the 1900s there was a resurgence of interest, but again, due to a lack of data and because conferences on the therapy were devoted more to the research aspects of complications than to clinical uses, less and less attention was given to potential applications. During the past 15 to 20 years, interest in hyperbaric medicine has reemerged. However, despite the facts that its uses are now well documented and that eminent professionals are involved in hyperbaric research and application, the field has never quite recovered from the equivocal role it once played.