Hyperbaric chamber proves useful as wound care tool
By Dr. William Ennis August 9, 2011 3:48PM
Updated: September 24, 2012 6:25AM
Nearly five million Americans suffer from chronic, or non-healing, wounds.
The failure of wounds to heal is often related to an underlying condition, such as diabetes, rheumatoid arthritis, lupus or sickle cell anemia. It also is common among people who are immobilized.
Medicare guidelines indicate a number of situations where, if a wound will not heal following a 30-day course of appropriate treatment, hyperbaric oxygen therapy may be used as an adjunct treatment. Applications include necrotizing infections, pressure and venous ulcers, compromised skin grafts and flaps following surgery; delayed radiation tissue damage following therapy; radiation cystitis or proctitis and traumatic injury.
It also is valuable as a prophylactic measure for people who require tooth extraction or surgery in an area that has previously undergone radiation therapy. The most recently approved application, diabetic ulcers, has quickly become the leading application in the United States.
This therapy involves the use of a hyperbaric chamber, like the one now available at the Wound Center at Franciscan St. James Health in Olympia Fields. Essentially, the chamber is a long, clear tube with room for the patient to lie down.
Inside, the patient is surrounded by 100 percent oxygen, compressed to the same pressure as going under water. In fact, this process is known as “diving.”
Normally, people breathe approximately 21 percent oxygen, the most of which is carried in hemoglobin, the oxygen-carrying molecule in our blood. In a non-healing wound, blood flow becomes blocked, starving the wound tissue of healing oxygen. Hemoglobin capacity must be increased to deliver needed oxygen to the wound.
Compressed in the hyperbaric chamber, the healing oxygen is forced into the patient’s blood plasma, through the body’s tissues to a much greater extent than otherwise possible.
The effectiveness of each hyperbaric treatment can be determined by measuring the oxygen in the tissue. A healthy person’s blood oxygen reads 40 or 50. In cases with complications from diabetes or an otherwise hindered blood supply it can range from zero to three. After a week of hyperbaric chamber therapy, these numbers generally rise to between 15 and 25, which is enough to promote healing. Hyperbaric oxygen therapy is administered for two hours a day, five days a week until adequate improvement is shown.
This therapy can be life-changing in some cases. A recent news story told of a man who had been treated with radiation for bladder cancer and eventually developed hypoxia, which caused him to pass large enough quantities of blood to significantly lower his blood count. His only option was to undergo hyperbaric chamber therapy. After 30 treatments, his bladder was able to heal.
While not to be considered a “miracle cure,” studies have shown amputation rates have been reduced when hyperbaric oxygen therapy was used in conjunction with wound treatment protocols. The blood oxygen level measurements provided by this equipment also can play a vital role in predicting the success of a procedure such as an amputation, as well as in determining how to proceed.
New applications currently are being studied, including a randomized trial being performed by the military for soldiers with traumatic brain injury. Positive results could extend the use of hyperbaric oxygen therapy for treatment of brain injury as well as other neurological applications including stroke.
Propelled by such factors as the aging population, obesity and diabetes, the need for wound care is on the rise. As knowledge of the device spreads, more patients are requesting it.
William Ennis, DO, is director of the St. James Center for Comprehensive Wound and Disease Management and medical director, professor of surgery at the University of Illinois at Chicago. Franciscan St. James Health is a member of the Southland Health Alliance.