November 30, 2022 • 12 mins
More than just a treatment for scuba and deep sea divers experiencing decompression sickness, hyperbaric oxygen therapy has evolved during the last 70 years and become an option for more than a dozen other conditions. In part two of this episode, Owen J. O’Neill, MD, MPH, and John Peters, two experts in undersea and hyperbaric medicine, discuss the research driving this field forward, including a clinical trial conducted during the height of the Covid-19 pandemic that offered patients an alternative to ventilation. The study was led by Dr. O’Neill, medical director Division of Undersea and Hyperbaric Medicine at Phelps Hospital. He joins the podcast, along with Mr. Peters, executive director of the Undersea & Hyperbaric Medical Society.
Listen to Part 1
Chapters:
- 00:56 - Hyperbaric oxygen therapy research
- 01:55 - Treating Covid-19 with hyperbaric oxygen hood
- 04:50 - Recognizing excellence in hyperbaric medicine
- 06:10 - Hyperbaric medicine training
- 07:41 - What to look for when seeking hyperbaric medicine
- 08:46 - Standardizing care
- 10:50 - The future of hyperbaric medicine
Mather Hospital Northwell Health Wound Treatment Center
75 N Country Rd
Port Jefferson, NY 11777
Contact us: (631) 476-2768
Department of Undersea & Hyperbaric Medicine | Phelps Hospital Northwell Health
701 North Broadway
Sleepy Hollow, NY 10591
Contact us: (914) 366-3690
Wound Care and Hyperbaric Medicine | Long Island Jewish Valley Stream
900 Franklin Avenue
Valley Stream, NY 11580
Contact us: (516) 256-6576
Wound Care and Hyperbaric Medicine | Northern Westchester Hospital at Chappaqua Crossing
480 Bedford Rd
Chappaqua, NY 10514
Contact us: (914) 458-8771
Comprehensive Wound Care Center
1999 Marcus Avenue, Suite M6
Lake Success, NY 11042
Contact us: (516) 233-3780
Hyperbaric medicine and wound care | Plainview
888 Old Country Road
Plainview, NY 11803
Contact us: (516) 719-2298
270 Park Ave. Huntington, NY 11743 Contact us: (631) 385-5915
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
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
(00:25):
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
(00:46):
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
(01:10):
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.
(01:35):
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
(01:57):
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
(02:19):
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.
(02:42):
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.
(03:04):
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
(03:27):
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
(03:49):
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
(04:11):
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
(04:32):
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
(04:53):
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
(05:16):
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
(05:37):
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
(05:58):
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
(06:20):
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
(06:41):
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
(07:04):
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
(07:26):
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,
(07:49):
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
(08:13):
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
(08:34):
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?
(08:57):
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
(09:19):
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?
(09:39):
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.
(10:00):
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
(10:22):
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
(10:44):
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
(11:05):
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
(11:27):
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
(11:48):
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,
(12:10):
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.
(12:32):
You can subscribe to 20-minute Health talk wherever podcasts are
available.
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
(00:25):
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
(00:46):
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
(01:10):
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.
(01:35):
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
(01:57):
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
(02:19):
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.
(02:42):
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.
(03:04):
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
(03:27):
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
(03:49):
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
(04:11):
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
(04:32):
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
(04:53):
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
(05:16):
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
(05:37):
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
(05:58):
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
(06:20):
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
(06:41):
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
(07:04):
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
(07:26):
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,
(07:49):
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
(08:13):
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
(08:34):
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?
(08:57):
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
(09:19):
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?
(09:39):
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.
(10:00):
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
(10:22):
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
(10:44):
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
(11:05):
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
(11:27):
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
(11:48):
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,
(12:10):
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.
(12:32):
You can subscribe to 20-minute Health talk wherever podcasts are
available.
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