Hyperbaric Oxygen Therapy

New markets and opportunities for this medical gas

Monoplace chamber

Most HBOT patients are treated in a monoplace chamber. The patient lies down on a stretcher that slides into the chamber.

Quite a bit of discussion over the last couple of years has centered on hyperbaric opportunities and how gas distributors can capitalize on this growth industry. Understanding more about what hyperbaric therapy is and how it works will provide distributors with a better chance to obtain a piece of this business.

Hyperbaric oxygen therapy (HBOT) is the medical use of 100 percent oxygen at increased atmospheric pressures. Literally, hyper means “increased” and baric relates to pressure. As early as the 1950s, hyperbaric applications have been used to oxygenate the brain while the heart was stopped during open-heart surgery. In the 1960s, HBOT was determined to have positive results related to slow-healing wounds. Some people may be more familiar with hyperbarics as treatment for carbon monoxide poisoning or the bends, a condition related to scuba diving.

HBOT has increased in treatments for chronic degenerative health problems related to atherosclerosis, stroke, peripheral vascular disease, diabetic ulcers, wound healing, cerebral palsy, brain injury, multiple sclerosis, macular degeneration and many other disorders. There are many recent studies on the effect of using HBOT to aid children with autism. Gangrene, carbon monoxide poisoning, radiation therapy, bone infections, traumatic “crush” injuries, cyanide poisoning, smoke inhalation, spinal injuries and gunshot wounds have seen treatment advantages with HBOT. Also, HBOT has shown positive results for trauma faced by many combat soldiers, as it may activate stunned parts of the brain and restore function.

manifold

A manifold for a hospital hyperbaric application

There is some debate over the measurable effectiveness of HBOT. It is being evaluated continuously in order to determine what treatments should be covered by insurance and make this business more feasible for the facilities making the investment in personnel and equipment to support this technology.

Growth of an Industry
The hyperbaric industry has seen much growth over the past three to five years, primarily due to wound care healing, with a substantial growth trend forecast with autism and other related traumatic brain injuries and complications. Medicare approves the treatment of approximately 15 conditions, and the list of new applications is being evaluated. There is an ongoing focus to seek additional approvals.

Most hyperbaric facilities are located at hospitals that have extended their capabilities to offer this treatment. Many chambers also are being installed in doctors’ offices and smaller outpatient facilities catering to wound care. Nursing homes are one of the fastest-growing market segments.

More recently, many professional athletic teams, including those in hockey, football, basketball and soccer, have utilized and relied on HBOT as enhanced treatment for sports-related injuries. Some NFL players bring portable sleeping bag/tent-like units with small oxygen generators with them when they travel to obtain a healing edge prior to game day.

Multiplace chamber

Multiplace chambers, typically located in hospital settings, can treat several patients at one time.

Another area that has seen increased usage of HBOT is equine therapy centers that cater to a population of high-dollar horses. Many have dramatically improved results by using HBOT along with intensive antibiotics to treat infections and wounds, saving the lives of many horses. Many in this field believe they are just scratching the surface of the potential for other treatments.

Types of Chambers
There are two basic types of hyperbaric chambers. A monoplace chamber is a system designed to tend to one individual at a time. The patient lies down on a stretcher that slides into the chamber. Typically, the chamber is pressurized with 100 percent oxygen. Most hyperbaric patients are treated in a monoplace chamber. A monoplace chamber is usually found at a doctor’s office or wound care facility.

A multiplace chamber is a unit that can accommodate multiple patients and most likely would be located in a hospital environment. Usually there is an assistant in the chamber with the patients. Hooded assemblies or masks are typically used to deliver the oxygen.

GAWDA Distributor Takes Advantage of Growing Market
Roberts Oxygen Company in Rockville, Maryland, sells oxygen for use in hyperbaric chambers. The company got into this market three years ago when approached by a potential customer who needed help evaluating sites and supply system requirements prior to renting a facility where hyperbaric chambers would be installed and used for the treatment of acute ischemia stroke, cerebral edema, infections, peripheral artery disease and wounds.Mike Kitzinger, vice president of sales at Roberts Oxygen, says the process of setting up a supply system for the first time can take anywhere from 6 to 18 months for the customer, due mostly to the difficult task of locating the right site. The oxygen supply must be installed close enough to the facility space in order to minimize installation costs and provide the necessary volume to the chambers. In addition, the local jurisdiction must approve the permits for the oxygen supply.

The oxygen supplier should have the capability to supply medical oxygen in dewars, microbulk and bulk. Roberts Oxygen can exchange the oxygen dewars, provide the on-site microbulk tank, and install a bulk tank that is filled from the company’s tractor-trailer.

The type of application and number of patients determines what size oxygen supply source is needed. Many newly installed standalone systems require a dedicated main oxygen tank, reserve tank (cryogenic tank or high-pressure cylinders) and pressure control medical manifold with switches and local alarm to supply the hyperbaric facility.

Other systems can be tied into a hospital’s existing bulk supply if it operates at the same pressure as the current system. In most cases, the hyperbaric chamber will operate at a higher pressure and require, at minimum, a dedicated control manifold. The main and reserve systems must be evaluated to ensure that they are properly sized to supply the additional potential volume to the existing facility. All systems must comply with NFPA 99, NFPA 50, NFPA 55, NFPA 101, as well as guidelines published in CGA M-1.

Market Potential
As more treatments become candidates for HBOT, it is important for gas suppliers to stay close to these facilities so that you are the one who gets the phone call to provide the appropriate gas supply systems needed to operate these chambers. Ask your local hospitals or wound care centers if they plan to incorporate HBOT and if they have evaluated the business, as it is an area that could certainly open up some opportunities.

Getting more involved with the numerous hyperbaric- related medical associations and companies that manufacture the chambers also may help you uncover opportunities for business. Contact your local sports teams to see if they have invested in HBOT. Search the Internet for hyperbaric therapy and products, and you will find quite a bit of information that will help you determine how you can be of service. No doubt that numerous applications, some of which will require oxygen supply systems from the distributor, may prove to be effective sales opportunities.

Home Health Market

Jim Byington has a hyperbaric oxygen chamber in his house. The former owner of Mountain Aire Medical Equipment in Colorado Springs, Byington has been selling medical oxygen and respiratory equipment since 1976 while working for Lincare, CAIRE, and 1993 NWSA President Jack Dammann’s company, Industrial Gas Products. Since selling his company to Puritan Bennett, Byington has been involved with the market development of new products and has become known industry-wide as a hyperbaric chamber specialist.

When Byington’s wife was diagnosed with breast cancer in late 2009, treatment involved the removal of the stage one tumor, along with  reconstructive surgery. Byington knew that hyperbaric oxygen therapy (HBOT) was being used worldwide to treat a variety of currently accepted conditions, including decompression illness, carbon monoxide poisoning, compromised skin grafts, diabetic wounds, brain injury and cerebral palsy, with approximately 150 other health conditions that are off-label applications.

In fact, the week before the Super Bowl, Indianapolis Colts defensive end Dwight Freeney used HBOT to help heal an ankle injury. Freeney ended up playing in all four quarters of the game. In a study currently underway with America’s Armed Forces, HBOT is in use to treat injuries sustained from explosives attacks in Iraq and Afghanistan.

Byington purchased a “mild hyperbaric chamber” (mHBOT), a soft-shell made of urethane material and weighing 240 pounds. Considered portable, it differs from a standard chamber, called a hard-shell monoplace chamber, which is made with a combination of steel and acrylic shell. Hospital-based hyperbaric oxygen departments usually have equipment that weighs upwards of 650 pounds for a monoplace chamber.

Protocols for home use are different from those in a hospital environment. Hospital protocols typically start at a minimum of 2 atmospheres (referred to as ATAs), equivalent to a 35-foot underwater dive and lasting 90-120 minutes, for a limited number of treatments. At-home access provides a patient control of the frequency, and reduces the cost of the treatments by thousands of dollars. A single hospital-based hyperbaric oxygen treatment can be as much as $2,500. Portable mHBOT chambers can be rented for home use from $800 to $2,400 a month.

Before and after surgery, Byington’s wife used the chamber to increase the oxygen saturation in her plasma, the carrier of the body’s red and white blood cells, and to establish a vascular granulation base for grafting tissue. Three weeks after surgery, swelling, pain and bruising as a result of the surgical trauma had progressed well beyond expected healing times, characteristic of outcomes seen at 6-8 weeks in patients not using HBOT. Mild HBOT in a home can source high flows of oxygen (15 liters per minute) from either a high-pressure cylinder oxygen bank or a special oxygen concentrator. Byington’s chamber has an upgraded portable, home liquid cryogenic container that holds 45 liters. Oxygen is delivered by a non-breather facemask while the chamber is continuously being vented to prevent unsafe oxygen concentration. A handheld oxygen analyzer is used to monitor the oxygen levels within the chamber; a handheld liter meter is used to assure adequate oxygen flows. The chamber is pressurized to 4 psig, or 1.3 ATA, with filtered ambient air from an oil-less air compressor.

This modality of care has not been actively embraced by the medical community. Consequently, patients and the families of loved ones are taking on grassroots responsibility of educating the attending physicians. Byington points out that since oxygen is not a patentable drug, no large pharmaceutical company is promoting what he terms “this life-enhancing method of delivering the healing power of oxygen.”

(Disclaimer: The information provided in this article is for informational purposes only and should not be considered medical advice.)

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Doug Morton Meet the Author
Doug Morton is vice president of sales at Eleet Cryogenics, located in Bolivar, Ohio, and on the Web at www.eleetcryogenics.com.