|
Clinically Approved Indications for Hyperbaric Oxygen (HBO)
Diabetic Foot Ulcers
At any given time approximately one million diabetic patients have lower limb ulcers. Impeded wound healing appears to be a major factor contributing to limb loss. Studies have proven that HBO treated patients are 8 to 40 percent less likely to undergo leg amputations than the non-HBO treated patients.
Compromised Skin Grafts/Flaps/Replants
Following ischemia, or vascular repair in cases where there has been decreased microcirculation or hypoxia, HBO has been demonstrated to maximize the viability and final functional level of the compromised nerve and muscle tissue.
Necrotizing Soft Tissue Infections
As an adjunct to debridement and systemic antibiotics, HBO adversely affects anaerobic bacterial growth by direct toxic mechanisms and decisively increases white cell bacteria killing. Published studies indicate its routine use can decease mortality by two-thirds.
Thermal Burns
Adjunctive to standard treatment in a burn center, HBO helps maintain microvascular integrity, minimizes edema, and provides the substrate necessary to maintain viability and final functional level of the compromised nerve and muscle tissue.
Radiation Tissue Damage
In proper coordination with surgical treatment, HBO has totally reoriented the approach to repairing necrosis. It has been shown to stimulate growth of functioning capillaries, fibroblastic proliferation, and collagen synthesis in the radiated bone and soft tissue itself. Previously irradiated tissue can heal normally with the grafting of soft tissue and bone.
Air or Gas Embolism
HBO, the primary treatment of air embolism, decreases the size and increases the diffusion gradient of embolized gas. It reduces mortality and remediates the development of permanent neurological damage. There is no alternative therapy.
Decompression Sickness
HBO is the primary treatment, as it establishes a favorable diffusion gradient to rapidly resolve the inert gas bubbles and provide oxygenation to ischemic and hypoxic tissue. There is no alternative therapy.
Problem Wounds
In a hyperbaric environment, wound healing is stimulated by increases in fibroblast proliferation, collagen production and capillary angiogenesis. HBO can restore a favorable cellular milieu in which healing and antibacterial mechanisms are enhanced.
Refractory Osteomyelitis
HBO is used as an adjunct to antibiotics, debridement, nutritional support, and reconstructive surgery in cases of refractory osteomyelitis, particularly in the presence of localized or systemic host compromise. HBO is demonstrably effective in sternal wound infections.
Crush Injury/Other Acute Traumatic Ischemias
HBO increases tissue oxygen tensions to levels which allow host responses to infections and ischemia to become functional. Effects include enhanced oxygenation at the tissue level, increased oxygen delivery per unit of blood flow, and edema reduction.
Clostridial Myonecrosis (Gas Gangrene)
Recommended treatment is a combination of HBO, surgery, and antibiotics. When used early in the treatment program and before surgery, HBO saves lives as it requires less dramatic surgery, radically diminishes the need for amputations, and brings the rapid cessation of alpha-toxin production, which is the lethal complication of gas gangrene.
Carbon Monoxide Poisoning and Smoke Inhalation
Considered mandatory for severe CO poisonings, HBO hastens carboxyhemogloben dissociation beyond a rate achievable by breathing pure oxygen at sea level, mitigating tissue poisoning and markedly reducing permanent neurological damage. When CO is complicated by cyanide poisoning, HBO may have a direct effect in reducing toxicity.
Exceptional Blood Loss Anemia
In exceptional cases (religious objections and certian hemolytic anemias) when cross-matched tranfusion is not possible, the intermittent use of HBO dissolves enough oxygen in the severely anemic patient to support basic metabolic needs until sufficient RBCs are restored.
|
