HYPERBARIC OXYGEN �THERAPY (HBOT) IN WOUND CARE

Wound Care Training Module

Wound Care Training Module - National Wound Care Committee

Wound Care Training Module

Wound Care Training Module - National Wound Care Committee

1. Introduction
2. Mechanism of Action
3. Absolute Contraindications
4. Relative Contraindications
5. Emerging Concepts of HBOT

Content

Wound Care Training Module - National Wound Care Committee

Content

Wound Care Training Module - National Wound Care Committee

INTRODUCTION

• Intermittently breathing pure (100%) oxygen at greater than ambient pressure.
• Oxygen as a drug and hyperbaric chamber as a dosing device.
• Elevating tissue oxygen tension is the primary effect.

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Wound Care Training Module - National Wound Care Committee

• HBOT may be used as an Adjunct Therapy in the Following Condition;

• Diabetic Foot Ulcer
• Osteoradionecrosis of Mandible
• Clostridial myositis and myonecrosis (gas gangrene)
• Crush injury, compartment syndrome, acute traumatic ischaemias

• Enhance healing of wounds (acute and chronic)
• Necrotizing fasciitis
• Chronic osteomyelitis
• Thermal burns

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Wound Care Training Module - National Wound Care Committee

MECHANISM OF ACTION

• Angiogenesis in ischaemic tissues
• Both bacteriostatic and bactericidal actions
• Inhibition of Clostridium perfringens alpha toxin synthesis
• Vasoconstriction
• Enhancing Collagen synthesis
• Leukocyte oxidative killing

Wound Care Training Module - National Wound Care Committee

• Treatment Process;
• Place patient in chamber
• Type A, Multiplace (2-14 patients) or Type B, Monoplace (1 person) chamber
• Pressures applied inside the chamber are usually 2-3 times ambient atmosphere pressure.
• Treatments may take 2-8 hours
• Beware of any possible complications

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Wound Care Training Module - National Wound Care Committee

Wound Care Training Module - National Wound Care Committee

ABSOLUTE CONTRAINDICATIONS

• Untreated pneumothorax (barotrauma)
• Patient on drugs/medication as follows
• Bleomycin (intestitial pneumonitis)
• Cisplatin (impaired wound healing)
• Disulfiram (oxygen toxicity)
• Doxorubicin (cardiotoxicity)
• Sulfamylon (impaired wound healing)

Wound Care Training Module - National Wound Care Committee

RELATIVE CONTRAINDICATIONS

• Asthma (may cause pneumothorax)
• Claustrophobia (may cause anxiety)
• Congenital spherocytosis (may cause severe hemolysis)
• COPD (may cause loss of hypoxic drive leads to dyspnea)
• Eustachian tube blockage (may cause tympanic membrane rupture)

Wound Care Training Module - National Wound Care Committee

RELATIVE CONTRAINDICATIONS

• High fever (may cause seizure)
• Pacemaker (may cause malfunction)
• Epidural pain pump (may cause deformation)
• Pregnancy (unknown effect)
• Seizures (may cause lower threshold)
• URTI (may cause barotrauma)

Wound Care Training Module - National Wound Care Committee

Example of Chronic Non Healing Diabetic Foot Ulcers Treated with HBOT

Wound Care Training Module - National Wound Care Committee

Example of Chronic Non Healing Diabetic Foot Ulcers Treated with HBOT

Wound Care Training Module - National Wound Care Committee

Example of Chronic Non Healing Diabetic Foot Ulcers Treated with HBOT

Wound Care Training Module - National Wound Care Committee

EMERGING CONCEPTS OF HBOT

• Increasing interest and research regarding HBOT as adjunct treatment in wound healing.
• Use of HBOT in other fields e.g. multiple sclerosis, cerebral palsy, and vegetative coma is also being explored.

Wound Care Training Module - National Wound Care Committee

TAKE HOME MESSAGES

• HBOT is used only as adjunctive treatment.

Wound Care Training Module - National Wound Care Committee

REFERENCES

• Hyperbaric Oxygen Therapy: Solution for Difficult to Heal Acute Wounds? Systematic Review. Anne M Eskes, Dirk T Ubbink, Maarten J Lubbers, Cees Lucas, Hester Vermeulen. World Journal of Surgery. New York: Mar 2011. Vol. 35, Iss. 3; pg. 535
• How to manage the diabetic foot. Anonymous. Nursing Times. London: Apr 02, 2011.  
• Overview of Hyperbaric Oxygen Therapy (Medscape) 
• Pearls for Practice: Hyperbaric Oxygen Therapy (HBOT) and Heel Ulcers
• Rena G Diem. Ostomy Wound Management. King of Prussia: Sep 2011. Vol.57, Iss. 9;pg. 8
• 'New' approaches to venous congestion. Renée A Beach, Adam J Mamelak. Expert Review of Dermatology. London: Dec 2010. Vol. 5, Iss. 6; pg. 589 
• Hyperbaric Oxygen Therapy for wound healing. James Wright, e-medicine. New York. May 2011

Wound Care Training Module - National Wound Care Committee

THANK YOU

Wound Care Training Module - National Wound Care Committee