Episode 180. Hyperbaric Oxygen Therapy with Dr Neil Banham

On a recent vacation to Exmouth on Western Australia’s far North coast, home to the amazing Ningaloo National Park, I had the pleasure of meeting Anaesthetist and outdoor adventurer Dr Neil Banham.

I discovered that when Neil wasn’t kiteboarding, his daytime job was Director of Hyperbaric Medicine at Fiona Stanley Hospital in Perth.

Our conversation exposed my deep ignorance of the potential use of HBOT beyond the management of air and gas embolism and piqued my interest in the various conditions that ay assis

Hyperbaric Oxygen Treatment (HBOT) exposes an individual to near 100% oxygen inside a treatment chamber at pressures higher than sea level. For clinical purposes, the pressure must equal or exceed 1.4 atmospheres absolute (ATA). Most HBOT in Australasia is performed at 2 ATA.

HBOT was first used in the early 20th century and by the US Navy in the 1940s to treat decompression sickness (“the bends”). In the 1960s it was used for carbon monoxide poisoning, and its use has since expanded. There are currently 15 approved indications accepted by the Undersea and Hyperbaric Medical Society. These fall under urgent and non-urgent conditions, and the Medicare Benefits Schedule includes specific item numbers for many of them.

Urgent conditions include: air embolism, central retinal artery occlusion, carbon monoxide poisoning, clostridial myonecrosis (gas gangrene), compromised surgical grafts and flaps, crush injuries and compartment syndromes, acute arterial insufficiency, decompression sickness, intracranial abscess, necrotizing soft tissue infections, exceptional blood loss anaemia, specific acute thermal burns, and idiopathic sudden sensorineural hearing loss.

Non-urgent conditions include delayed radiation injuries (soft tissue or osteoradionecrosis). HBOT for radiation cystitis has proven effective in over 80% of cases in published literature. A typical course is 30 sessions (2.5 hours per day, five days a week for six weeks) – a significant commitment. HBOT is also indicated for radiation proctitis, chronic refractory osteomyelitis, and some problematic wounds such as grade 3–4 diabetic foot ulcers.

There is growing interest in its application in inflammatory bowel disease, including ulcerative colitis and Crohn’s disease. A recent systematic review and meta-analysis of 118 patients treated with HBOT for perianal fistulizing Crohn’s demonstrated clinical response and remission rates of 75% and 55% respectively, warranting further consideration. Several studies also show improvements using HBOT as adjunctive therapy for hospitalised ulcerative colitis flares, and its role here will be watched with interest.

Contraindications include untreated pneumothorax, uncontrolled hypertension, congestive cardiac failure with ejection fraction below 35%, claustrophobia, congenital spherocytosis, uncontrolled diabetes, chronic sinus conditions, and advanced emphysema (“blue bloater”). Other factors include avoiding disulfiram, which blocks superoxide dismutase, and doxorubicin.

As in every field of medicine, delving into specialty subjects highlights deep knowledge and expertise. With curiosity at a high, I was privileged to hold this conversation with Neil about practical issues of HBOT, how it works, and its value across many indications. There is much to learn and reflect on in relation to the clinical problems we face.

Please welcome Neil to the podcast.

References: Dr Neil Banham: ⁠FSH.Hyperbaric@health.wa.gov.au⁠ Role of hyperbaric oxygen therapy in patients with inflammatory bowel disease: Kaur et al. ⁠www.co-gastroenterology.com⁠ Hyperbaric oxygen therapy for refractory perianal Crohn’s disease: Tome et al, Gastroenterology & Hepatology, Vol 20, Issue 4, April 2024 Hyperbaric Patient Selection: DuBose et al: StatPearls, July 31, 2023. ⁠www.ncbi.nlm.gov/books