CRUSH INJURY, COMPARTMENT SYNDROME AND OTHER ACUTE TRAUMATIC ISCHEMIAS
Hyperbaric oxygen therapy must be initiated as soon as possible after the injury and must be used as an adjunct to standard surgical treatment, including vascular repair as indicated.
RATIONALE: Crush injury involves severe trauma to bone, soft tissue, nerve, and vascular structures. Viability may be questionable. There is a gradient of injury ranging from viable compromised tissue to that which is irreparably damaged. Compartment syndromes and threatened reimplantations can additionally produce various degrees of ischemia, edema, and tissue damage. Therapy should be initiated within 48 hours after the injury to be most effective, preferably within the first 4 to 6 hours. With 100% oxygen inhalation at increased pressure, plasma-dissolved oxygen is delivered to marginally perfused tissues in the wound sustaining viability, enhancing leukocyte killing, and reducing edema.
SOURCE: UHMS Publication CR(HBO) 1996
OSTEOMYELITIS (Refractory)
Cases accepted for adjunctive hyperbaric therapy must be judged to be refractory to adequate surgical debridement, appropriate parenteral (or equivalent) antibiotics, and nutritional support. Hyperbaric oxygen provides periodic elevation of bone and tissue oxygen tensions from hypoxic to normal or hyperoxic levels. This promotes angiogenesis, increased leukocyte killing, aminoglycoside transport across bacterial cell walls, and osteoclast activity in removing necrotic bone. Judgement in declaring a given case refractory or critical must be made jointly by the surgeon and the hyperbaric physician.
RATIONALE: Following anecdotal case reports of successful use of adjunctive hyperbaric oxygen therapy in the 1960's, controlled animal studies have clearly demonstrated the benefit of hyperbaric oxygen. Published clinical series that utilized adjunctive hyperbaric oxygen therapy for chronic refractory osteomyelitis and follow-up data have confirmed the controlled animal data. When used according to guidelines, hyperbaric oxygen is clinically efficacious and cost effective. In a limited review, cost effectiveness was five-fold in favor of using hyperbaric oxygen for refractory osteomyelitis.
SOURCE: UHMS Publication CR(HBO) 1996