• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Course Login

WoundEducators.com | Online Wound Care Certification Courses

Your online source for wound care certification.

  • Courses
  • About Us
    • Meet The Team
    • Risk-Free Guarantee
    • Accredited Wound Care Course Info
    • Student Testimonials
    • Our Mission to Help
  • Why Certify?
    • What’s Included
    • How Hard is Wound Care Certification?
    • Wound Care Certification Cost
    • Wound Care Certification for Nurses
    • Getting Started: Wound Care Certification
  • Resources
    • Sign up for Our Newsletter
    • Search Wound Care Jobs
    • Post a Wound Care Job
    • Submit Your Resume
    • I Completed My Wound Care Course – Now What?
    • Wound Care CE Hours Online
    • Wound Care Recertification Process
  • Certifications
    • Compare Wound Care Certification Options
    • ABWM® Wound Care Certifications
      • The CWCA® Certification
      • The CWS® Certification
      • The CWSP® Wound Care Certification
    • The WCC® Certification
    • The AWCC® Wound Care Certification
    • The CWCN® Certification
  • Blog
  • FAQ’s
  • Contact

Hyperbaric Oxygen Therapy

October 29, 2012 Leave a Comment

0
SHARES
ShareTweetGoogle +Linkedin
PinterestRedditTumblrStumbleuponDiggDelicious

Wound ischemia is thought to be the most common cause of healing failure in a chronic wound.1 Furthermore, the rate of wound healing can be correlated directly with the level of tissue oxygenation. There is, therefore, a strong rationale for the use of oxygen therapy to promote wound healing in difficult-to-heal wounds.1

Hyperbaric oxygen therapy (HBOT) refers to an adjunctive treatment modality in which a patient inhales 100% oxygen under an elevated pressure for a pre-specified period of time.1–4 Pressure is applied at 2 to 3 atmospheres absolute, which is the sum of the atmospheric pressure (1 atm) plus an additional hydrostatic pressure equivalent to one or two atmospheres.2 Treatment may be performed individually or in a hyperbaric oxygen chamber capable of treating up to 14 patients simultaneously. Treatments tend to last around 1.5 to 2 hours, depending on the indication, and may be repeated between one and three times a day.2

 Oxygen therapy in various forms has been used for various ailments including leprosy since the mid seventeenth century. However, it was not until the 1970s when this modality was researched systematically in a series of well-executed randomized trials.1

Rationale and Mechanism of Action

Oxygen is essential to normal wound healing, playing a pivotal role in almost all of the processes involved. The condition in which tissue oxygen levels are reduced to below around 30 mmHg is known as ischemia or tissue hypoxia, and this state fundamentally impairs the normal cellular processes and inhibits wound healing.1

The roles of oxygen in the wound healing process are too numerous to cover in depth. However, as examples, oxygen is essential in all cellular metabolic processes, including fibroblast proliferation, collagen synthesis, exportation of collagen from the fibroblast cell membrane and neoepithelialization.1 Moreover, angiogenesis at the edges of a wound is driven by the oxygen gradient between the poorly oxygenated wound center and oxygen rich wound periphery. Improved oxygen delivery enhances this oxygen gradient and promotes wound repair. Finally, a lack of oxygen reduces the resistance of tissues to infection, while high oxygen concentration enhances the ability of leukocytes to produce free radicals, causing bacterial death.1

HBOT promotes wound healing by restoring or increasing oxygen levels to allow the normal wound repair processes to occur. The principal mechanisms of this modality are based the on intracellular generation of reactive species of oxygen and nitrogen, which are known to play a central role in cell signal transduction cascades (see Figure 1).

Uses of and Evidence for Hyperbaric Oxygen Therapy

The benefit of HBOT has been shown in the treatment of hypoxic and ischemic wounds in randomized trials and systematic reviews.1,3  For example, the modality has been shown to be effective for patients with diabetic foot ulcers, and to significantly reduce the risk of major amputation and improve the chance of healing at 1 year.1.3  One literature review based on a combination of clinical trials, nonrandomized trials, cohort studies, retrospective analyses, and case series showed evidence that HBOT promotes healing of arterial ulcers, calciphylactic ulcers, refractory vasculitic ulcers, and osteomyelitis, as well as the success of treatment for compromised flaps and grafts. Two Cochrane systematic reviews, however, showed that the potential value of HBOT for open fractures and burns was unclear.1

The most recent systematic review identified five separate randomized trials that evaluated the effectiveness of hyperbaric oxygen therapy compared to other interventions on wound healing.3 One trial in 36 patients showed that significantly more crush wounds healed with HBOT than with sham HBOT [relative risk (RR) 1.70, 95% confidence interval (CI) 1.11–2.61]. This study also reported that significantly fewer additional surgical procedures were required with HBOT (RR 1.60, 95% CI 1.03–2.50), and significantly less tissue necrosis was found (RR 1.70, 95% CI 1.11–2.61). A further study evaluated showed that the rate of burn-wound healing was significantly greater with HBOT compared with routine burn care (P < 0.005). A British trial showed that HBOT resulted in a significantly higher percentage of healthy graft area in split skin grafts (RR 3.50, 95% CI 1.35–9.11), while a Chinese trial showed that HBOT did not significantly improve flap survival in patients with limb skin defects. On the basis of a systematic review of these trials, the authors concluded that HBOT appears effective for the management of acute, difficult-to-heal wounds.3

 Risks and Side Effects

HBOT is generally well tolerated, and is not normally considered to pose significant risks to patients. The most frequent side effect is middle ear barotraumas, which can present as hyperemia of the ear drum to ear drum perforation in the most serious case. Other serious, but rare, side effects include brain oxygen toxicity, oxygen lung toxicity, and transient myopia.1

There are a small number of absolute contraindications to HBOT, of which the most important is uncontrolled pneuomothorax. Other absolute contraindications include recent or current treatment with adriamycin, bleomycin, doxorubicin, or disulfiram. The modality should also be used with a degree of caution in individuals with respiratory infection, severe asthma or chronic obstructive pulmonary disease, fever, steroid treatment, seizure disorders, history or optic neuritis, and claustrophobia.1

Conclusion

There is good, randomized evidence available for the effectiveness of HBOT as adjuvant treatment for hypoxic wounds, and this modality is recommended by different medical societies, health organizations and healthcare agencies.1 However, it should be remembered that HBOT is only ever an adjuvant approach to mainstream wound management. The management of all chronic wounds should be built around the fundamentals of a multidisciplinary approach and optimal topical wound treatment.1

hbo

Learn More With Our Wound Care Education Options

Interested in learning more about wound care and certification? Browse through our wound care certification courses for information on our comprehensive range of education options to suit healthcare professionals across the full spectrum of qualifications and experience.

References

  1. Kulikovsky M, Gil T, Mettanes I, Karmeli R, Har-Shai Y. Hyperbaric oxygen therapy for non-healing wounds. Isr Med Assoc J. 2009 Aug;11(8):480-5. Review.
  2. Thom SR. Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg. 2011 Jan;127 Suppl 1:131S-141S.
  3. Eskes AM, Ubbink DT, Lubbers MJ, Lucas C, Vermeulen H. Hyperbaric oxygen therapy: solution for difficult to heal acute wounds? Systematic review. World J Surg. 2011 Mar;35(3):535-42.
  4. Sen CK. Wound healing essentials: let there be oxygen. Wound Repair Regen. 2009 Jan-Feb;17(1):1-18.

Categories: Adjunctive Modalities

About the Author

Laurie Swezey's avatar

Laurie Swezey, founder and president of WoundEducators.com, has been a Registered Nurse for more than a quarter century, with most of those years dedicated to wound treatment. Ms. Swezey is a Certified Wound Care Nurse and a Certified Wound Specialist.

Reader Interactions

Leave a Comment Cancel

This site uses Akismet to reduce spam. Learn how your comment data is processed.

sidebar

Blog Sidebar

Free Preview!

Sign up for our newsletter and enjoy a Free Preview of our Wound Care Certification Course!

Support Our “Where There’s a Wound, There’s a Way!™” Foundation

fundraiser logo

Join our “Where There’s a Wound, There’s a Way!™” fundraising campaign  Learn more

Payment Information

All major credit cards & PayPal accepted. All transactions are performed via a SSL secure server to ensure your privacy.

payments accepted visa mastercard amex discover paypal

Copyright © 2009-2021 WoundEducators.com
Wound Care Certification Courses | Risk Free Guarantee | Terms and Policies

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking “Accept”, you consent to the use of ALL the cookies.
Cookie settingsACCEPT
Manage consent

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary
Always Enabled
Necessary cookies are absolutely essential for the website to function properly. These cookies ensure basic functionalities and security features of the website, anonymously.
CookieDurationDescription
cookielawinfo-checbox-analytics11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checbox-functional11 monthsThe cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checbox-others11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-necessary11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-performance11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy11 monthsThe cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.
Functional
Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features.
Performance
Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.
Analytics
Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
Advertisement
Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. These cookies track visitors across websites and collect information to provide customized ads.
Others
Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet.
SAVE & ACCEPT