By James Calder
Oxygen is a colorless, odorless, and tasteless gas, which we all need to live, that also contains substantial promise for treating non-healing wounds. In the wound care community of health care, we have long utilized an advanced wound treatment called hyperbaric oxygen therapy (HBOT).
Wound care patients enter a sealed machine called a hyperbaric chamber for treatment. Once inside, they receive pure oxygen (the oxygen concentration in air is about 21%) at greater than atmospheric pressure. The treatment helps push more oxygen further into the tissues. For patients with limited blood flow and poor oxygen perfusion, it can really help heal wounds faster.
Pure oxygen can help wounds heal faster
To tackle the complexities of healing wounds within a hyperbaric chamber, I spoke to our in-house expert Matthew Treadway - a nationally certified hyperbaric technologist and Wound Care Advantage's Hyperbaric Education Administrator.
"Essentially, a hyperbaric chamber allows greater-than-normal amounts of oxygen to be carried in the bloodstream and dissolved into body tissues," said Treadway. "This increase in oxygen promotes angiogenesis (new blood vessel formation) and rapid wound healing."
In wound healing, time is essential.
"Overall, the advantage is that the patient has a much higher chance of healing more quickly," he said. "It could also mean a longer life for the patient. As you know, many patients die within 5 years following an amputation--HBOT gives them the chance to avoid that."
Saving limbs with hyperbaric oxygen therapy at UCLA
UCLA Health System, a Wound Care Advantage hospital partner, is a great example of a hospital using hyperbaric oxygen therapy in their treatment plans for wound care patients. In this UCLA video patient Walter Johansen is treated with HBOT at Ronald Reagan UCLA Medical Center. Johansen, a diabetic for 16 years, had an advanced non-healing diabetic wound on his toe that got to the bone, causing numbness in his feet. If left untreated, this could typically result in a lower extremity amputation. A unique healing plan that included both HBOT and other advanced wound care procedures allowed the staff at UCLA to heal this wound, potentially saving his life.
The types of wounds treated with HBOT
According to the Undersea & Hyperbaric Medical Society there are 14 nationally approved indications for HBOT. Treadway stated that indications for HBOT in an outpatient wound care setting include the following:
- preparation and preservation of compromised skin grafts/flaps,
- chronic refractory osteomyelitis (chronic bone infection),
- osteoradionecrosis (radiation damage to the bone),
- soft tissue radionecrosis (radiation damage to soft tissue),
- diabetic patients with open wounds on their feet
Requirements for HBOT wound care treatment
It is important to remember that hyperbaric oxygen therapy alone is not enough to heal non-healing wounds. HBOT works in conjunction with medications and other wound care treatments. According to Treadway, most patients must have a minimum of 30 days of conservative wound care treatments prior to being eligible for HBOT. "All patients should also be thoroughly evaluated by a physician with hyperbaric expertise, in which they cover all logistical details, risks, benefits, etc." In addition, HBOT must also be cleared through the patient's insurance prior to treatment.
Time well spent in the chamber
At WCA, the average time in the chamber is about 110 minutes per session. According to Treadway, the first 10 minutes are spent compressing the patient to "depth," or the increase over normal atmospheric pressure. The patient remains at this depth (pressure) for 90 minutes, with the remaining 10 minutes for decompression. Extra time is built in before and after each treatment to allow for the patient to change into a hospital gown and have their vitals taken.
At Wound Care Advantage Centers, HBOT is prescribed in increments of 20 treatments.
"The patient is evaluated throughout and the physician determines the need to continue beyond that," Treadway said. "The exact number of treatments depends on the wound status, healing progress, co-morbidities, and patient compliance (attendance, diet, and smoking cessation). Our goal is to heal patients as quickly as possible."
Safety is extremely important in hyperbaric chambers
From installation of chambers to treatment of patients, rigorous safety procedures are followed when dealing with hyperbaric chambers. Hyperbaric chambers need tremendous amounts of oxygen. Our team at Palmdale Regional Medical Center recently installed a 1500-gallon cryogenic oxygen tank, as seen in this Vine video (https://vine.co/v/bYQIDYPMM7J) just to service four hyperbaric chambers.
It is vitally important to have HBOT treatments conducted by qualified, trained individuals operating the chambers. "The main reason is patient safety, which is our number one concern," Treadway said. "We are working with pure oxygen and with people who have a number of health conditions. It is important to have physicians, nurses and technicians that know what to do in an emergency situation (CPR, emergency preparedness, HBO safety preparedness)."