Overview of Hyperbaric Therapy for Wound Healing
Hyperbaric oxygen therapy (or HBO2) is a medical treatment with multiple applications. It’s regulated by an international organization known as the Undersea and Hyperbaric Medical Society which has endorsed 14 different uses of HBO2. Additionally, there are many health situations where this therapy might prove beneficial, even if it’s not officially approved. HBO2 involves putting a patient in a special chamber that can be pressurized up to three times the normal air pressure at sea level.
To give you an idea, imagine being underwater at a depth of 33 feet (10 meters), or having 14.7 pounds of weight placed on every square inch of your body (101 kilopascals) – that’s what one atmosphere pressure is like. When combined with breathing in 100% pure oxygen, this increased pressure can have many positive effects on your body.
For example, it can greatly improve the healing process of chronic wounds, which has been demonstrated in several scientific studies. One of the key benefits of hyperbaric oxygen therapy is the drastic increase of oxygen in your bloodstream. At sea level, the normal oxygen concentration is about 3 mL for every liter of your blood. However, at three times the normal air pressure and while breathing 100% pure oxygen, this concentration can skyrocket up to 60 mL per liter. Research has shown that such high concentration can keep pigs alive even without any red blood cells, and it definitely meets the oxygen needs of most body tissues in humans.
Beyond just supplying oxygen, this therapy also enhances blood supply in tissues with decreased blood flow, reduces swelling around those tissues, and makes some antibiotics more effective. Plus, it’s been found to stop bacterial growth, neutralize toxins produced by specific bacteria, and improve the bacteria-fighting ability of white blood cells in areas of the body where oxygen is in short supply. HBO2 also helps prevent the release of harmful molecules, reducing constriction of blood vessels, swelling, and cell damage in certain injuries.
Anatomy and Physiology of Hyperbaric Therapy for Wound Healing
Refractory diabetic wounds, or hard-to-heal wounds common with diabetes, can be infected for a long time (chronically) or suddenly (acutely). The blood flow might be inadequate because of problems with the small arteries in the far parts of the body. The larger arteries might also be affected. Venous congestion, where blood pools in certain areas of the body, can also create wounds, especially if there are other problems that are common in people with diabetes, like nerve damage (neuropathy) and swelling (edema).
Why do People Need Hyperbaric Therapy for Wound Healing
The Undersea and Hyperbaric Medical Society has approved hyperbaric oxygen therapy for a range of conditions. Hyperbaric oxygen therapy is a treatment where patients breathe in pure oxygen in a pressurized room or tube. This helps your lungs gather more oxygen and promote healing.
The conditions that can be treated with this therapy include decompression sickness (which can occur in divers), acute arterial gas emboli (when an air bubble gets into your blood vessels), necrotizing fasciitis (a serious infection that causes tissue death), and gas gangrene (another serious infection that causes tissue death). This therapy can also be used to treat refractory osteomyelitis (a bone infection), acute blood loss anemia (a decrease in blood cells due to sudden blood loss), and failed skin grafts. Additionally, it’s used for chronic radiation injuries (from cancer treatments), carbon monoxide poisoning, acute thermal burns, compartment syndromes (increased pressure in a muscle compartment leading to nerve damage), compression injuries, cranial abscess (brain abscesses), and artery-related issues. The therapy is also indicated for acute sensory hearing loss.
There are other conditions, like autism, stroke, and ADHD (Attention Deficit Hyperactivity Disorder), which are considered “off-label” uses for hyperbaric oxygen therapy. This means that while some people might try using the treatment for these conditions, we don’t have verifiable scientific evidence that it works for these yet.
For wound healing, hyperbaric oxygen therapy is specifically used when there are Wagner grade 3 diabetic wounds that are not getting better even after 30 days of standard treatment. The Wagner scale is a system for categorizing the severity of wounds in people with diabetes. Here is a quick breakdown of the scale:
- Grade 0: The skin is intact, without any wounds.
- Grade 1: There is a superficial, or surface-level, wound.
- Grade 2: The wound has reached the level of the bone or tendon.
- Grade 3: There are signs of abscess (pus accumulation), osteomyelitis (bone infection), or tendonitis (tendon inflammation).
- Grade 4: Gangrene, or tissue death, is present in the forefoot or toes.
- Grade 5: Gangrene has spread to affect the entire foot.
When a Person Should Avoid Hyperbaric Therapy for Wound Healing
Hyperbaric oxygen therapy, a treatment that involves breathing pure oxygen in a pressurized room or tube, may not be suitable for everyone. One main concern is something called barotrauma, or physical injury caused by changes in air pressure. In simple terms, this happens when a closed air-filled space in the body, like the lung or middle ear, gets damaged. This damage comes from trapped gases expanding as the pressure changes during the treatment. This can lead to a tear or rupture of the enclosed chamber, like bursting an eardrum or lung. The greatest risk is for people with a condition called untreated pneumothorax, or collapsed lung. If such a patient undergoes this therapy, their condition could rapidly worsen, which could be life-threatening.
There are other more moderate risks, too. People with lung conditions like pulmonary blebs (little air sacs on the lungs) or emphysema (a lung disease that causes breathing difficulties) might not be suitable for the therapy if they have problems with trapped carbon dioxide in their lungs.
Moreover, certain medications might complicate hyperbaric oxygen therapy. Disulfiram, for example, can increase the risk of oxygen toxicity during the treatment because it blocks an enzyme that protects against this risk. Other drugs, like Cisplatinum and mafenide acetate, might interfere with wound healing. And yet another drug, Bleomycin, can cause inflammation in the lung tissue.
Other conditions that could complicate this treatment include sinusitis, a history of seizures, pregnancy and having certain implanted devices like pacemakers. Claustrophobia, or fear of enclosed spaces, could also be an issue, particularly in smaller treatment chambers.
Equipment used for Hyperbaric Therapy for Wound Healing
Hyperbaric oxygen therapy is a treatment that involves breathing pure oxygen in a specially designed chamber, which is either small and can fit only one person (monoplace), or larger to fit several people and a supervising doctor (multiplace). These larger chambers can cater to different patients’ needs, for example, people who need extra equipment like ventilators that wouldn’t fit in a smaller chamber. This therapy is controlled carefully to ensure the levels of oxygen and air are correct, and that carbon dioxide is effectively removed. Regular inspections are required, and the staff must be properly trained to manage these treatments safely. There is even a person in charge of safety at the facility to make sure everything is run according to specific rules.
The most dangerous things that could happen during this therapy are either a problem with the chamber itself, or a fire starting. Thankfully, rigorous inspections and the careful attention of staff should prevent any issues with the chamber. As oxygen is a fuel for fires, steps are taken to reduce the risk of fires starting. To have a fire, you need something that burns easily, a source of ignition like a spark or flame, and oxygen. To manage these risks, patients have to follow strict rules about what they can bring into the chamber. Objects like oils or electronics that could start a fire aren’t allowed. Patients have to wear approved gowns instead of everyday clothes, and are also connected to devices that eliminate static electricity that could create sparks. Also, any electronic equipment not approved for use in the chamber must be used elsewhere.
Who is needed to perform Hyperbaric Therapy for Wound Healing?
Doctors and every staff member, including those in charge of cleaning, need special education on a treatment method called hyperbaric medicine and its equipment, known as chambers. Hyperbaric medicine involves breathing in pure oxygen in a special room or a small tube. The overseeing doctors have to go through a training course that takes at least 40 hours to finish.
Doctors can also become specialists in this field by doing an in-depth study called a fellowship, which lasts for a year. The technicians supporting the doctors also need to complete a 40-hour course in hyperbaric medicine.
Besides, there’s a designated safety officer. This person has received additional training in safety and upkeep. Even the cleaning team needs to know the special precautions needed when cleaning the smooth plastic (acrylic) single-person chambers and all the unique details in looking after and maintaining chambers made for multiple people.
Preparing for Hyperbaric Therapy for Wound Healing
Before a doctor recommends a kind of treatment called hyperbaric oxygen therapy for a wound, the patient must first try standard wound treatments for a minimum of thirty days. These typical treatments may include mechanical and chemical cleaning of the wound, using wound care products like alginates and collagens, and addressing any related issues like potential infection, poor nutrition, or relieving any pressure on the wound. After these methods have been tried, it’s necessary that the patient’s insurance provider agrees to cover the cost of the new treatment.
Next, patients go through an introduction to what the therapy involves, and a thorough medical examination to make sure there are no health conditions that would interfere with the therapy. The patient must also have the ability to clear their ears by a method called a Valsalva manoeuvre – that’s a way to equalize the pressure in your ears. Condition of the eardrums and breath sounds are checked before and after each session to ensure there’s no pressure-related injury known as barotrauma. If someone has a fear of small spaces, which is known as claustrophobia, they might not be suitable for the type of therapy chamber used in this procedure.
The patients are carefully taught about what is allowed and not allowed inside the therapy chambers, as well as possible risks connected to the therapy. People with wounds usually need a special test called transcutaneous oximetry (TCOM) to confirm that their wound will likely get better with this treatment. Things like blood sugar and blood pressure levels are checked before each session as these numbers may change during the therapy.
How is Hyperbaric Therapy for Wound Healing performed
Treatments using a high-pressure oxygen chamber, or “hyperbaric dives”, have a predetermined plan that is based on the type of illness or condition being treated. Each session in the oxygen chamber usually lasts about two hours, every day. During these sessions, you would take two 10-minute breaks from inhaling oxygen, to prevent a condition known as oxygen seizures. The oxygen pressure inside the chamber is usually set at 2.4 atmospheres (ATM), which is a way of measuring pressure, and the oxygen is set at 100% pure.
A standard treatment plan typically involves 33 of these sessions. However, depending on how you respond to the treatment, your doctor may recommend extending the number of sessions.
Possible Complications of Hyperbaric Therapy for Wound Healing
The most frequent issue that can happen during hyperbaric oxygen therapy – a type of treatment where you breathe in pure oxygen – is something called barotrauma. Barotrauma is damage caused by pressure changes, like what you might experience when you’re in an airplane. This type of damage happens when gases inside your body expand but can’t escape.
The most common type of barotrauma is harm or irritation to your tympanic membrane, or eardrum. Sometimes, though, it can lead to more severe injuries such as a punctured lung, ruptured small blood vessels, or damage to your ear canals. Some very serious risks include seizures, lung congestion or bleeding, and even chamber fires and explosions.
What Else Should I Know About Hyperbaric Therapy for Wound Healing?
Hyperbaric oxygen therapy, which involves breathing in pure oxygen in a pressurized room or tube, adds another tool for physicians to use in treating difficult, long-term wounds. While it may not work for everyone, it has shown significant benefits for many patients dealing with specific wound-healing problems.
