Hyperbaric oxygen (HBO) is used as an adjunct for the management of crush injuries, compartment syndromes and other acute traumatic peripheral ischemias. The rationale for using HBO is to counteract tissue hypoxia and the consequences of hypoxia that arise secondary to trauma.
|Primary Injury||In all of these cases, the primary injury includes:
|Secondary injury||Later, secondary injury occurs, including:
|Patient selection||Objective assessment of these injuries is desirable, so that patients can be selected for Hyperbaric Oxygen treatment with some prediction of success. The most accessible method is by using transcutaneous oxygen (TcPO2) measurements. However, there is no conventional system for this; and cases are selected on a trial-of-treatment basis.|
The rarity of each of these conditions in any one centre makes it unlikely that many surgeons have seen what can be achieved by using Hyperbaric Oxygen in addition to conventional management. Controlled trials are also difficult to perform, since the ethics of with-holding Hyperbaric Oxygen form the control group are doubtful.
|Evidence / References||Kindwall E (ed), Hyperbaric Medicine Practice 2nd ed., Chapter 30&31.
Philips JC, Understanding HBOT and its Use in the treatment of Compromised Skin Grafts and Flaps, Plast Surg Nurs. 2005 April/June; 25(2):72-80
William A. Zamboni and Himansu R. Shah. Skin grafts and Flaps (Compromised) HBO Therapy Committee Report 2003 – UHMS, Inc. 2003
Garcia-Covarrubias L, McSwain NE Jr. Van Meter K, Bell RM – Adjuvant HBOT in the management of crush injury and traumatic ischemia: an evidence based approach. Am Surg. 2005 feb;71(2): 144-51.
Strauss M.B. Crush Injuries and skeletal Muscle-Compartment syndromes. HBO Committee Report 2003