Key Insights On Using Hyperbaric Oxygen For Wounds

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   Research has shown that HBOT is cost effective in comparison to amputation and increases quality of life years.8,9 Dr. Fife notes the cost benefit of HBOT is enhanced by proper patient selection. Patients are best referred before tissue loss has progressed to the point where amputation is inevitable, says Dr. Fife. She notes that transcutaneous oximetry can be useful in screening out patients who are likely to get well without HBOT or patients who cannot be helped.

   Dr. Fife says one should not use HBOT as an alternative to proper revascularization. She says those on dialysis or those who have a transplant are less likely to benefit from HBOT, but are also less likely to benefit from any other intervention.

   Dr. Fife maintains that HBOT must be under the supervision of a properly trained advanced care practitioner who can manage complications.

    “When hyperbaric treatment is used in conjunction with standard wound care, researchers have demonstrated improved results in the healing of difficult or limb-threatening wounds in comparison to routine wound care alone,” she says.

Dr. DellaCorte is a Certified Hyperbaric Technologist. He is also a Fellow of the American College of Foot and Ankle Surgeons, and a Fellow of the American College of Foot and Ankle Orthopedics and Medicine. He is in private practice in Maspeth, N.Y.
Dr. Fife is an Associate Professor in the Department of Internal Medicine, Division of Cardiology at the University of Texas Health Science Center in Houston. She is the Director of Clinical Research at the Memorial Hermann Center for Wound Healing and Hyperbaric Medicine.

Dr. Suzuki is the Medical Director of Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo, Japan.




References:

1. Carter MJ, Fife CE, Walker D, Thomson B. Estimating the applicability of wound-care randomized controlled trials to general wound care populations by estimating the percentage of individuals excluded from a typical wound care population in such trials. Adv Skin Wound Care 2009; 22(1):316-24.
2. Faglia E, Favales F, Aldeghi A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. Diabetes Care 1996;19(12):1338-1343.
3. Mader JT, Shirtliff ME, Calhoun JH. The use of hyperbaric oxygen in the treatment of osteomyelitis. In: Hyperbaric medicine practice. Best Publishing Co., Flagstaff, Arizona, 1999, pp. 603-616.
4. Zamboni WA. Applications of hyperbaric oxygen therapy in plastic surgery. In: Oriani G, Marroni A, Wattel F, eds. Handbook on hyperbaric oxygen therapy. Springer-Verlag, New York, 1996.
5. Fife CE, Smart DR, Sheffield PJ, Hopf HW, Hawkins G, Clarke D. Transcutaneous oximetry in clinical practice: consensus statements from an expert panel based on evidence. Undersea Hyperb Med 2009; 36(1):43-53.
6. Fife CE, Buyukcakir C, Otto GH, Sheffield PJ, Warriner RA, Love TL, Mader J. The predictive value of transcutaneous oxygen tension measurement in diabetic lower extremity ulcers treated with hyperbaric oxygen therapy; a retrospective analysis of 1144 patients. Wound Rep Regen 2002; 10(4):198-207.
7. Fife CE, Buyukcakir C, Warriner R, Sheffield P, Love T, Otto G. Factors influencing the outcome of lower extremity of diabetic ulcers treated with hyperbaric oxygen therapy. Wound Repair Regen 2007; 15(3):322-331.
8. Cianci P, Petrone G, Drager S, Lueders H, Lee H, Shapiro R. Salvage of the problem wound and potential amputation with wound care and adjunctive hyperbaric oxygen therapy: an economic analysis. J Hyperbaric Med 1988; 3:127-141.
9. Guo S, et al. Cost effectiveness of adjunctive hyperbaric oxygen in the treatment of diabetic ulcers. Int J Technol Assess Health 2003; 19(4):731-737.







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ETC Biomedicalsays: June 11, 2010 at 11:39 am

Dear Editor,

In regards to your recent article, Key Insights On Using Hyperbaric Oxygen For Wounds, published in Volume 23, January 1, 2010:

Dr. Kazu Susuki’s and Dr. Caroline E. Fife’s concerns over equalization of pressure in patients’ middle ears and sinuses during compression is certainly an important one. Middle ear squeeze has been recognized as the most common complication in hyperbaric oxygen therapy. Likewise, as noted by Dr. Michael DellaCorte, pulmonary barotrauma resulting from impaired elimination of gas from the lungs of patients with COPD during decompression is another complication with potentially serious consequences relating to the effects of Boyle’s Law.

What is not mentioned in this discussion, however, is that methods to significantly reduce the incidence of middle ear barotrauma during compression, and to more effectively manage patients with COPD during decompression, have been developed. Dr. Benton P. Zwart of the U.S. Air Force investigated the consequences of pressure change conducted with a constant rate of volume change over time rather than a constant rate of pressure change over time.2 He reported that this approach significantly reduced the incidence of middle ear barotrauma and would, as a result of the same physical principles, make decompression safer for patients with COPD, emphysema, and asthma.

While implementing the pressure-change protocols investigated by Zwart on chambers with manual pneumatic control systems, and even rudimentary electronic control systems, is impractical, they have been implemented during both compression and decompression on chambers with computer-based automatic control systems. Feedback on the practical use of these methods over a number of years has confirmed Zwart’s findings.

Very truly yours,

Russell E. Peterson, Ph.D.
Technical Director
Environmental Tectonics, Corporation
Biomedical Systems
Southampton, Pennsylvania
www.etcbiomedical.com

1 Vrabec JT, Pirone C, Goble S, Mader JT. Middle ear barotrauma from hyperbaric oxygen therapy: Severity,
prevention and management. In: Mueller PHJ, Pirone C, Barach P, eds. Patient safety: Prevention and treatment of complications in hyperbaric medicine. Kensington, Maryland: Undersea and Hyperbaric Medical Society, Inc., 2002:107-113.

2 Zwart BP. The "smooth ride" profile: Development, implementation, and evaluation of a hyperbaric chamber descent and ascent based on a constant rate of volume change with time. Davis Hyperbaric Laboratory Report, Brooks AFB, Texas, 1998.

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