An Update on the Appropriate Role for Hyperbaric Oxygen: Indications and Evidence (original) (raw)

Hyperbaric Oxygen Therapy: Solution for Difficult to Heal Acute Wounds? Systematic Review

World Journal of Surgery, 2011

Background Hyperbaric oxygen therapy (HBOT) is used to treat various wound types. However, the possible beneficial and harmful effects of HBOT for acute wounds are unclear. Methods We undertook a systematic review to evaluate the effectiveness of HBOT compared to other interventions on wound healing and adverse effects in patients with acute wounds. To detect all available randomized controlled trials (RCTs) we searched five relevant databases up to March 2010. Trial selection, quality assessment, data extraction, and data synthesis were conducted by two of the authors independently. Results We included five trials, totaling 360 patients. These trials, with some methodologic flaws, included different kinds of wound and focused on different outcome parameters, which prohibited meta-analysis. A French trial (n = 36 patients) reported that significantly more crush wounds healed with HBOT than with sham HBOT [relative risk (RR) 1.70, 95% confidence interval (CI) 1.11-2.61]. Moreover, there were significantly fewer additional surgical procedures required with HBOT (RR 1.60, 95% CI 1.03-2.50), and there was significantly less tissue necrosis (RR 1.70, 95% CI 1.11-2.61). In one of two American trials (n = 141) burn wounds healed significantly quicker with HBOT (P \ 0.005) than with routine burn care. A British trial (n = 48) compared HBOT with usual care. HBOT resulted in a significantly higher percentage of healthy graft area in split skin grafts (RR 3.50, 95% CI 1.35-9.11). In a Chinese trial (n = 145) HBOT did not significantly improve flap survival in patients with limb skin defects. Conclusions HBOT, if readily available, appears effective for the management of acute, difficult to heal wounds. This article is based on a Cochrane review first published in The Cochrane Library 2010, Issue 10 (see http://www.thecochranelibrary. com/ for information). Cochrane reviews are regularly updated as new evidence emerges and in response to feedback; and The Cochrane Library should be consulted for the most recent version of the review.

Predictors for success of hyperbaric oxygen therapy for problematic wounds

Wound Medicine, 2020

between 2012 and 2017. The inclusion criterion was all patients with either acute or chronic wounds with delayed wound healing treated with hyperbaric oxygen therapy (HBOT). Wound improvement was the primary outcome. Results: Eighty-eight patients were included. Sixty-eight patients (77 %) had improved wound healing while 20 (23 %) had a poor treatment outcome. In the improved wound healing group, the outcome of wound healing was classified into 2 groups: Group 1-40 patients (58.8 %) experienced wound healing while Group 2-28 patients (41.2 %) experienced decreased wound size and reduced pain. The factors prognostic for a poor treatment outcome were arterial occlusion (OR 19.667, 95 % CI 5.740-67.378), diabetes (OR 3.405, 95 % CI 1.198-9.679), and bone exposure (OR 10.389, 95 % CI 2.763-39.058). Conclusion: Among patients with problematic wounds undergoing HBOT, the factors associated with a poor prognosis were arterial occlusion, DM, and wound with bone exposure.

Hyperbaric Oxygen Therapy for Chronic Wounds

Advances in Skin & Wound Care, 2010

Background: Chronic wounds are common and present a health problem with significant effect on quality of life. The wide range of therapeutic strategies for such wounds reflects the various pathologies that may cause tissue breakdown, including poor blood supply resulting in inadequate oxygenation of the wound bed. Hyperbaric oxygen therapy (HBOT) has been suggested to improve oxygen supply to wounds and therefore improve their healing.

Safety and efficacy of hyperbaric oxygen therapy in chronic wound management: current evidence

Chronic Wound Care Management and Research, 2015

The breathing of pure oxygen under pressure to treat tissue damage has been employed for almost 45 years and has been investigated in prospective, retrospective, and randomized controlled trials. The physiological effects of oxygen treatment on wound tissue are profound, and include activation of immune cells, changes in cytokine production, and modulation of inflammatory and bactericidal mediators. Hyperbaric oxygen influences the biochemistry of whole cells, altering cell proliferation, angiogenesis, clotting, and tissue regeneration. The precise effects of hyperbaric oxygen on individual cell types and tissues are only beginning to be revealed in both animal and human studies. Many independent studies using hyperbaric oxygen adjunctively with standard wound care have observed improved healing, in particular for diabetic foot ulcers, and can result in a significant reduction in major amputations. Side effects occur infrequently, but myopia, ear barotrauma, and rarely oxygen toxicity have been reported. As antibiotics become less available, and clinician time and complex dressings become more expensive, use of hyperbaric oxygen as a means of treating a variety of wound types may become an increasingly appropriate option for treatment.

Hyperbaric Oxygen Therapy: Exploring the Clinical Evidence

Advances in skin & wound care, 2017

To provide information about hyperbaric oxygen therapy (HBOT), its mechanisms, indications and safe applications based on clinical evidence. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Recall the physiology of wound healing and the mechanisms of action of HBOT.2. Identify current applications of HBOT based on clinical evidence as well as its risks and contraindications. Treating chronic wounds and infections are challenging medical problems worldwide. Hyperbaric oxygen therapy (HBOT), the administration of 100% oxygen at pressures greater than 1.4 atmosphere absolute in a series of treatments, can be used as an adjunctive therapy in many wound care settings because it improves oxygenation and neovascularization and decreases inflammation in chronic wounds. A growing number of st...

Clinical Effectiveness of Hyperbaric Oxygen Therapy in Complex Wounds

Journal of the American College of Clinical Wound Specialists, 2014

Hyperbaric Oxygen (HBO, HBO 2) 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 cm 2 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 5 1.24 ! 10 26). After 10 HBO treatments, the wound size statistically significantly reduced by an additional 16.9% (p 5 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.

Hyperbaric Oxygen Therapy: Side Effects Defined and Quantified

Advances in Wound Care, 2017

Hyperbaric oxygen therapy (HBOT) is an important advanced therapy in the treatment of problem wounds, including diabetic foot ulcers and late effect radiation injury. HBOT remains among the safest therapies used today. Nonetheless, there are side effects associated with HBOT. It is important for providers to be able to identify, understand, and quantify these side effects for prevention, management, and informed consent. Recent Advances: The past two decades have seen significant advancements in our understanding of the underlying mechanisms of HBOT. This has led to a better understanding of the underlying reason for clinical benefit. It has also led to a better understanding of its side effects. Moreover, more recent literature allows for better quantification of these side effects. This review will highlight these side effects. Critical Issues: Wound healing in the case of problem nonhealing wounds requires the use of various advanced treatment modalities, including HBOT. HBOT has been shown to significantly improve healing rates in certain problem wounds, including advanced diabetic foot ulcers and late effect radiation injury. It is provided in a variety of clinical settings by providers with varying levels of expertise. It is important for those providing this therapy to understand the potential side effects. Future Directions: Research in HBOT has led to significant advancements in the area of wound healing. At the same time, there remains a variety of treatment protocols used at different institutions. It is important to quantify risk and benefit at different treatment pressures and times to better standardize treatment and improve patient care.