Overview of Hyperbaric Treatment of Thermal Burns
Thermal burns, or burns caused by heat, are a common injury in the United States. Every year, about 2 million people get burned and roughly 155 out of every million have to be hospitalized. Sadly, 6500 cases even result in death. Burns can lead to a slew of complications – they activate certain cells within our bodies, damage our tiny blood vessels, and cause swelling.
When someone has a serious burn, especially if it covers a big part of their body, it’s very important to get medical treatment. There are numerous reasons why it can be hard to treat thermal burns, but one method that can be used to speed up healing and improve results is hyperbaric oxygen therapy (HBO).
Burns create different zones of damage. The worst part is where the burn is – this is where the tissues have been destroyed – called the zone of coagulation. Around this, there’s an area where the blood vessels have been damaged, but not totally destroyed – called the area of stasis. The outermost area is where the skin turns red – called the zone of erythema. The blockage or destruction of small blood vessels in and around the burn can impact the body’s natural defenses and alter certain immune system functions. This tends to peak within the first 24 hours after the burn. Without proper treatment and lack of oxygen, it can lead to tissue death or “ischemic necrosis”. Not just this, these burns also cause swelling due to increase in the permeability of blood vessels.
The goal of burn treatments is to reduce swelling, keep as much tissue healthy as possible in the damaged area, preserve the small blood vessels, and boost the patient’s immune system to ward off infections. HBO therapy can help with these issues. Once the patient is stable, treatment focuses on patient survival, fast healing of the wound, reducing the appearance of scars or abnormal skin color, all in a cost-effective way. Quick treatment is crucial. Firstly, the patient needs to be rehydrated quickly and continuously, sometimes this requires several liters of fluid. Aiming to minimize fluid loss through the wound and slowing down bacterial growth is also important. Medicines are applied to the wound or taken orally to prevent and combat infections. Removal of dead or damaged tissue and placement of a skin graft or flap can provide control over bacterial growth and fluid loss.
The most dangerous aspect of a thermal burn is the risk of infection, which is the leading cause of death from burns. The protective skin barrier is lost, and bacteria can easily invade and grow. Besides infection, burns can lead to other health issues like pneumonia, respiratory failure, bacterial skin infection, urinary tract infection, and sepsis.
Since 1965, HBO therapy has been suggested to speed up the healing of thermal burns. It was found that this treatment helped heal burns quicker in coal miners who were being treated for carbon monoxide poisoning. The hypoxic or low-oxygen living tissue near the burns can be restored to normal oxygen levels with HBO therapy. Studies have shown that it can decrease swelling, help preserve blood flow, and enhance oxygen delivery to burned tissues. It also helps to deactivate white blood cell adhesion, which causes damage to body tissues.
While most studies of HBO therapy in burns have been conducted on animals, these have shown promising results. Among humans, the results have been varied but suggest that HBO therapy may be beneficial as part of an overall therapy plan. Some research has shown improved healing, fewer deaths, shorter hospital stays, and less need for surgery. However, some studies report little to no benefit from HBO therapy. Until more investigations are done, the jury’s still out on whether HBO therapy should be a standard treatment for thermal burns. Keep in mind that this is a specialized treatment that requires advanced skills and equipment, so it is not always advisable for those critically ill from burns.
Anatomy and Physiology of Hyperbaric Treatment of Thermal Burns
Thermal burns, or burns caused by heat, are sorted into four categories depending on how deep they go into the skin. The American Burn Association has provided four classifications: superficial, partial thickness, full thickness, and extension into deep tissues.
Superficial burns only affect the top layer of the skin, known as the epidermis. These burns don’t cause blisters, but they can be painful. They typically heal on their own within a week.
Partial thickness burns, also known as second-degree burns, impact both the top layer of skin and some portion of the second layer, known as the dermis. If these burns are on the superficial end, they can cause blisters and pain, but they typically heal within 21 days without leaving scars. However, deeper partial-thickness burns can damage hair follicles and sweat glands, cause severe pain, and lead to blisters. These burns can get infected and may need skin grafting if the burn is severe. It can take up to 9 weeks for these burns to heal, and they may leave thick, raised scars.
Full thickness burns, also known as third-degree burns, extend through the entire skin layer and can also harm the fatty layer beneath the skin known as subcutaneous tissue. These burns cause the skin to look waxy or grey to black, and the burned area may feel numb because of the extensive damage. The burned skin, known as an eschar, eventually falls off, leaving a bed of healing tissue known as granulation tissue. If a full-thickness burn doesn’t receive surgery, it heals by contracting, which means the skin pulls together and becomes tight. Unfortunately, these burns can’t heal on their own.
The fourth degree, or extension into deep tissues, refers to burns that go beyond the skin and fat layers to harm underlying soft tissues such as muscle or bone. These injuries can be life-threatening and require immediate medical attention.
Why do People Need Hyperbaric Treatment of Thermal Burns
Hyperbaric oxygen therapy (HBO), a treatment that involves breathing pure oxygen in a special room or tube, is recommended for burns that reach the second layer of the skin (dermis) or even deeper. The need for this therapy can depend from case to case. However, it’s proven to be beneficial if the patient has damage caused by inhaling smoke or hot air, slow wound healing, considerable swelling (edema), or burn covering a large area of skin. Hyperbaric oxygen therapy can support these patients in their recovery.
If a patient has received a skin transplant or a specific type of skin surgery known as a flap, HBO therapy can improve the success rate of these procedures as it promotes better healing. This is due to the increased oxygen supply to the damaged tissues of the body, which in turn speeds up the healing process.
How is Hyperbaric Treatment of Thermal Burns performed
If Hyperbaric Oxygen (HBO) therapy is chosen for treatment, it should be started as quickly as possible after the injury occurred. During the first 24 hours, it’s recommended to have three HBO sessions, and then two sessions per day thereafter. Each of these sessions lasts for about 90 minutes, and the level of oxygen used is typically set between 2.0 and 2.4 times the normal air pressure. The therapy is usually continued for around 20 to 30 sessions, but the exact number will depend on how severe the injury is and how well the patient responds to the treatment.
While undergoing HBO therapy, patients are closely watched using special blood pressure cuffs that are safe for use in the HBO chamber. If patients have trouble breathing, they can be given assistance with a ventilator within the HBO chamber, which is quite common for those who have breathed in smoke or dangerous fumes.
It’s especially important to manage the patient’s fluid levels properly when dealing with burns, and this should be started before HBO therapy begins. In the first few days after the burn injury, they may need several liters of fluids, and pumps might be needed to help move these fluids around the body against the increased pressure in the HBO chamber during the treatment sessions.
Possible Complications of Hyperbaric Treatment of Thermal Burns
Hyperbaric therapy, a treatment in which a patient breathes pure oxygen, is generally safe. However, like all treatments, it can cause some side effects that patients should be aware of. The most common one is barotrauma, which is injury caused by change in air or water pressure affecting parts of the body such as ears and sinuses.
Barotrauma occurs more commonly in the middle ear, causing problems like leaked fluid and tiny breaks in the eardrum. This happens to about 2% of patients. Practicing special techniques to balance pressure can help control this. It can also take place in the sinuses, especially in people who have ongoing conditions like allergies or colds. These patients should be checked carefully before therapy and may be given medicines to reduce swelling or blockages in the nose.
A less common but important side effect is pulmonary barotrauma, which affects the lungs. Before starting treatment, patients should be thoroughly checked to make sure they don’t have pneumothorax, or a collapsed lung. This needs to be fixed before starting hyperbaric therapy. In fact, a collapsed lung that hasn’t been treated is the main reason not to do hyperbaric therapy.
There is a small chance of getting seizures due to hyperbaric therapy. These seizures happen to about 0.011% of patients according to a study. People who get them often have been taking medicines like insulin, steroids, type of thyroid treatment, or drugs that stimulate the heart and blood vessels. These patients should be watched carefully during treatment. If a seizure does happen, the amount of oxygen in the hyperbaric chamber should be lowered immediately, seizure-controlling drugs should be given, and the treatment should be stopped as soon as possible.
What Else Should I Know About Hyperbaric Treatment of Thermal Burns?
Hyperbaric oxygen (HBO) therapy is a treatment that involves breathing pure oxygen in a special chamber where the air pressure is about two and a half times greater than the normal pressure in the atmosphere. This therapy can be especially beneficial within the first 24 hours of experiencing a burn for several reasons. Here’s how it helps:
1. It can reduce swelling (known as edema) by narrowing the blood vessels, reducing the risk of burn shock, a severe response body may have to a large burn.
2. It can lessen wound infections by killing bacteria.
3. It can support the growth of new skin cells (a process called epithelialization).
4. It can help skin flaps and grafts (tissue transplanted from one area of the body to another) stay healthy.
5. It can effectively treat injuries caused by carbon monoxide poisoning or smoke inhalation.
6. It can lower the amount of fluids a patient needs for treatment.
7. It can fight against low oxygen in tissue (ischemia) by lifting oxygen levels in areas with low oxygen to higher than normal levels (hypoxic tissue).
Furthermore, 24 hours after sustaining burn injuries, HBO therapy can provide these benefits:
1. It can alleviate a paralytic ileus, which is a temporary stoppage of the bowel movements.
2. It can reduce the occurrence of Cushing ulcers, which are stomach ulcers caused by severe stress or head injury.
3. It can lessen hypertrophic scarring (thick, raised scars) and ulceration (formation of ulcers).
4. It can counter burn-related brain problems (burn encephalopathy) or swelling in the brain (cerebral edema).
5. It can shorten the length of a hospital stay.
6. It can lessen the requirement for surgery.
In short, HBO therapy can play a huge role in the treatment and recovery of burn patients, but it should be noted that each case is unique and the course of treatment may vary based on the patient’s specific circumstances and overall health status.
