Review Article
Clinical Effectiveness of Hyperbaric Oxygen Therapy in Complex Wounds

https://doi.org/10.1016/j.jccw.2015.03.003Get rights and content

Abstract

Hyperbaric Oxygen (HBO, HBO2) Therapy is a non-invasive therapy. It has been applied as adjuvant treatment in many medical conditions over the past 50 years. Different treatment protocols have been proven effective for specifically indicated conditions. To evaluate the clinical effectiveness of Hyperbaric Oxygen (HBO) Therapy as an adjunctive treatment for patients with complex wounds. In this prospective cohort study, 40 patients with complex wounds were included. All patients received HBO. HBO was delivered with 100% oxygen for 90 min at 2.0–2.4 ATA. Wound sizes were assessed by one wound surgeon before, during, and every 2 weeks for a total of 12 months after HBO. An analysis of demographic data, wound size and wound photography was performed. Over the 22-month period ending October 31, 2013, 40 patients (21 men and 19 women) with a mean age of 59.73 (range, 29–88) with complex wounds were included. All complex wounds studied were at least 6 months old. The mean wound size was 16.72 cm2 in diameter. Thirty-one patients with complex wounds healed after the completion of a series of HBO treatments (77.5%). Two orocutaneous fistulas were completely closed without further surgery. After 5 HBO treatments, the wound size reduced by 29.7% on average (p = 1.24 × 10−6). After 10 HBO treatments, the wound size statistically significantly reduced by an additional 16.9% (p = 0.0002). There were no complications in this study. Wound healing process was accelerated by HBO. Significant wound size reduction was noted after 5 HBO treatments. Because the biggest reduction in wound size occurred within the first 10 HBO treatments, it is important to conduct these first treatments without interruption. HBO is an effective and safe treatment modality for complex wounds.

Graphical Abstract

Hyperbaric Oxygen (HBO) Therapy was delivered with 100% oxygen for 90 min at 2.0 to 2.4 ATA.

Wound Size by day-of-treatment: The relationship between initial wound size (%) and the wound size by days of treatment. Wound healing process was accelerated by HBO. HBO can be an effective and safe treatment modality for complex wounds.

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Introduction

Hyperbaric Oxygen (HBO, HBO2) Therapy is a clinical treatment where patients breathe 100% oxygen in an enclosed hyperbaric oxygen chamber at a pressure greater than one atmosphere. Current information indicates that pressurization should be to 1.4 ATA or higher.1 HBO has been proven effective for many medical conditions. The Undersea and Hyperbaric Medicine Society (UHMS) has approved 14 medical indications.1 In addition, there are other conditions that may benefit from HBO. The therapeutic efficacy of HBO can be mainly explained by the simple physical relationships determining gas concentration, volume, and pressure. Breathing 100% oxygen at atmospheric pressures of up to 3 atm raises the arterial partial pressure of oxygen in the blood (PaO2) to more than 2000 mm Hg. This elevation leads to increased oxygen levels in the blood and tissue, control of infection, stimulated angiogenesis, increased collagen deposition, and reduced edema and inflammation.2, 3, 4, 5, 6, 7 HBO has been promoted as an adjunctive treatment for complex wounds. Siriraj Hospital, Thailand currently uses HBO treatment for many indications, including complex wounds.8, 9 Treatment of complex wounds represents a significant financial burden on the health care system. The purpose of this study is to evaluate the clinical effectiveness of the Hyperbaric Oxygen Therapy conducted at Siriraj HBO/wound care center as an adjunctive treatment for the patients with complex wounds. In practice the term of complex wounds tend to refer wounds with one or more complicating factors. The type of wounds considered complex are diabetic foot ulcers, leg ulcers, irradiated wounds, wound fistulas, ischemic wounds, refractory chronic wounds and wounds that have failed to heal within six months.

Section snippets

Patient Population

Forty patients with complex wounds who were treated at Siriraj HBO/wound care center were eligible for enrollment between January 2012 and October 2013. Staff at Siriraj HBO/wound care center did the medical and nursing follow-up. Definition of complex wound is the term used more recently to group those well-known difficult wounds, either chronic or acute, that challenge medical and nursing teams. These complex wounds were defined as non-healing wounds in patients with either vascular problem,

Results

Forty patients, 21 male and 19 female, with complex wounds were included after informed consent and institutional ethics approval. They all received HBO treatment. Total treatments were 1087 sessions. The mean wound size was 16.72 cm2. Demographic data of the patients were illustrated in Table 1.

HBO enhanced the wound healing process. All patients showed clinical continuous improvement under HBO. Thirty-one patients (77.5%) healed completely after HBO treatment. Two patients who were suffering

Discussion

Hyperbaric oxygen (HBO, HBO2) is a primary and adjunctive therapy for medical conditions. In the early 1960s, HBO was widely used in a variety of medical indications.1 Numerous studies have revealed the efficacy of HBO. It also has been shown to be an effective method for treating complex wounds. Complex wounds are challenging to manage, with many associated problems. The main problems include having to deal with underlying diseases such as diabetes, vascular problems, history of radiation

Conclusion

Hyperbaric oxygen therapy has a role in modern medical practice. In most cases, it is safe and severe side effects are rare. There are many indications for HBO treatment. The results suggest that HBO has been shown to be an effective method for treating complex wounds. It significantly improved wound healing. However, HBO does not replace quality wound care. HBO should be used in addition to, but not as a replacement of aggressive wound treatment.

Acknowledgments

The authors thank Jim Sheffield of International ATMO, Nix Wound Care & Hyperbaric Medical Center, San Antonio, Texas for his input and the Hyperbaric staffs of the Siriraj Hyperbaric Medical Center/Wound Care Center for helping to conduct the study.

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    Disclosure: None of the authors have any disclosures to make.

    The authors have no financial conflict of interest to declare in this study.

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