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Hyperbaric Oxygen Therapy
Hyperbaric Oxygen Therapy is a method of delivering high doses of oxygen to the body. It is done by breathing 100% oxygen through a mask or hood while inside a pressurized air chamber. The extra oxygen not only helps wounds to heal, it helps the body fight infection.
Physician Adoption of Hyperbaric Oxygen Therapy in the Treatment of Chronic Wounds
Hyperbaric oxygen therapy, a treatment alternative for chronic wounds, has been used for several decades yet little is known about factors that influence physicians to incorporate this therapy into practice. To assess wound care physician knowledge of, attitudes toward, and adoption of hyperbaric oxygen therapy and to identify factors associated with physician adoption of this therapy, a 23-item questionnaire, based on Rogers? diffusion of innovation model, was developed by the authors and distributed to 653 American Academy of Wound Management Board-certified physicians. Of the 246 (43%) physicians in the study population who responded to the study survey, 167 (68%) reported they had used or referred patients for hyperbaric oxygen therapy during the past 12 months. More than half of the respondents reported a relatively high level of familiarity with and a positive attitude toward the effects of hyperbaric oxygen therapy on wound healing. Physician adoption of hyperbaric oxygen therapy was significantly associated with a community of >100,000 residents (adjusted odds ratio = 2.29, 95% confidence interval = 1.05 to 5.04); patient request for hyperbaric oxygen therapy (adjusted odds ratio = 5.38, 95% confidence interval = 2.50 to 11.56); positive attitude toward (adjusted odds ratio = 3.38, 95% confidence interval = 1.49 to 7.66) and high level of familiarity with hyperbaric oxygen therapy (adjusted odds ratio = 5.33, 95% confidence interval = 1.72 to 6.49); and practice location in either Florida or Texas (adjusted odds ratio = 3.44, 95% confidence interval = 1.24 to 9.54). Although the majority of the respondents reported adoption of hyperbaric oxygen therapy, most adopters are concentrated only in a few geographic areas. Despite the limitations of this study, especially the potential effects of sampling and response bias, the results help explain factors that have facilitated and hindered the adoption of this technology into practice. KEYWORDS: hyperbaric oxygen, diffusion of innovation, diabetic ulcers,
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Brown Recluse Spider Bites: A Complex Problem Wound. A Brief Review and Case Study
Brown recluse spiders (Loxosceles reclusa) are responsible for virtually all documented cases of spider bites leading to significant necrosis. The actual spider bite often goes unnoticed for as long as 4 to 6 hours, which makes diagnosis and, therefore, appropriate treatment, difficult. The spider bite generally results in either a necrotic wound or systemic symptoms that can lead to hemolysis. The patient described in this article experienced both complications. Dapsone and hyperbaric oxygen therapy brought the adverse response to the bite under control. The patient was hospitalized for 7 days during treatment for hemolysis and an extensive, necrotic wound. Efforts are underway to develop an assay to provide a definitive diagnosis for the brown recluse spider bite, but none is yet commercially available. Antivenom is scarce; capture of the offending spider appears to be most helpful in the diagnosis and proper treatment of spider bites. KEYWORDS: hyperbaric oxygen therapy, Loxosceles reclusa, arachnidism, envenomation, necrotizing wounds
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Hyperbaric Oxygen Therapy Used to Treat Radiation Injury: Two Case Reports
Extremities, especially the hands, are the sites most affected by local radiation injury.1-3 Diagnosis of Acute Radiation Syndrome Diagnosis of acute radiation syndrome is based on clinical features and laboratory tests. Direct contamination is not uncommon in local radiation injury.8 Management Medical management of radiation injury depends on the level of emergency. Table 2 &...
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Topical Hyperbaric Oxygen and Electrical Stimulation: Exploring Potential Synergy
Treatment of chronic wounds involves interventions ranging from dressings to surgery. Modalities gaining popularity in clinical settings include topical hyperbaric oxygen and electrical stimulation. A prospective, uncontrolled study was conducted to obtain preliminary observations and data about the effects of topical hyperbaric oxygen therapy and topical hyperbaric oxygen used with electrical stimulation on the healing of chronic wounds. All subjects were geriatric residents of long-term care facilities with Stage III or Stage IV pressure ulcers. Topical hyperbaric oxygen was applied daily to the wounds of eight subjects; three also received electrical stimulation. Initial wound size ranged from 87.75 cm2 to 7.04 cm2 with an average size of 30.1 +/- 28.5 (mean +/- sd) cm2. Healing times ranged from 8 to 49 weeks. After 4 weeks of treatment with topical hyperbaric oxygen, wound size decreased an average of 34.4% +/- 22.9%. Incidentally, the wounds of five of the eight subjects decreased more than 20%, for an average of 51.8% +/- 17.9%. No significant differences in healing were observed between patients receiving topical hyperbaric oxygen alone and those receiving topical hyperbaric oxygen/electrical stimulation. Preliminary data indicate that topical hyperbaric oxygen facilitates wound healing and full closure for pressure ulcers in patients with and without diabetes mellitus. A multicenter, prospective, randomized, double-blind controlled study is currently under way.
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October 2002 Industry News
For more information please call 215-369-9812 or email: info@strategic-sales-solutions.com. - OWM National coverage for hyperbaric oxygen therapy The Centers for Medicare and Medicaid (CMS) have issued an intent to issue a formal National Coverage Determination pertaining to diabetic wounds of the lower extremity. For information, please visit www.dorland.com. - OWM ...
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April 2003 Letters to the Editor
The treatment provides one or more of the following effects: * Increased oxygen delivery to injured tissues * Infection control * Blood vessel formation (neovascularization) * Preservation of damaged tissues * Elimination of toxic gasses. Laura...
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Wound Instillation ? The Next Step in Negative Pressure Wound Therapy. Lessons Learned from Initial Experiences
Negative pressure wound therapy uses a reticulated sponge and subatmospheric pressure to facilitate healing of a variety of wounds. The therapy appears to assist wound healing by decreasing wound bacterial burden and edema while facilitating granulation tissue formation. The latest development in negative pressure wound therapy allows clinicians to instill a solution into the wound and is indicated for use when patients receiving negative pressure wound therapy would benefit from the controlled delivery of topical wound treatment solutions and suspensions. A retrospective analysis of five cases was conducted to describe initial experiences with instillation and negative pressure wound therapy (average treatment time on negative pressure wound therapy with instillation 15 days, range 5 to 24 days). In two of the five cases where traditional negative pressure wound therapy was tried, the wound appearance and culture data both improved following instillation of antibiotics in a saline solution. In all cases where used, instillation of a topical anesthetic appeared to effectively minimize wound pain that is occasionally associated with negative pressure wound therapy. Negative pressure wound therapy with instillation and possibly hyperbaric oxygen therapy may be initiated from the onset of treatment to manage high-risk wounds that appear severely infected and may be limb-threatening if located on an extremity. Controlled clinical studies to ascertain the efficacy and cost-effectiveness of this treatment modality are needed. Keywords: pain, wounds, infection, irrigation, vacuum-assisted closure, instillation
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Diabetic Heel Ulcers: A Major Risk Factor for Lower Extremity Amputation
Of all the ulcers seen in patients with diabetes, heel ulcers are the most serious and often lead to below-the-knee amputation. Management of heel ulcers requires a thorough knowledge of the major risk factors for ulceration in the heel area and a standardized program of local ulcer care, metabolic control, early control of infection, and improvement of blood supply to the foot. The most common risk factors for ulceration in the heel region include immobility of the lower limbs, diabetic neuropathy, structural deformity, and peripheral arterial occlusive disease. Patient education regarding foot hygiene, skin care, and proper footwear is crucial to reducing the risk of an injury that can lead to heel ulceration. A careful foot examination that tests for neuropathy and arterial insufficiency can identify patients at risk for heel ulcers and appropriately classify patients with ulcers into different grades to design proper therapeutic plans for management. Team management programs that focus on education, prevention, regular foot examinations, aggressive intervention, and proper use of therapeutic measures can significantly reduce the risk of lower-extremity amputations from heel ulcers. Keywords: heel ulcers, diabetes, offloading pressure, lower extremity amputation
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Industry News
Industry News Industry News: Industry News - Research, education, and technology merger strives to create gold standard in wound care Two of the nation’s leaders in the $7 billion global wound care industry have merged. Both privately owned companies offer development and management of outsourced wound healing centers and hyperbaric oxygen facilities. With wound...
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A Case Study of Negative Pressure Wound Therapy to Manage Acute Necrotizing Fasciitis
Acute necrotizing fasciitis is a devastating infectious process that requires immediate surgical debridement. Intravenous antibiotic treatment, hyperbaric oxygen therapy, and wound management are considered the standard of care. Subsequent wound closure is achieved with split-thickness skin grafting, delayed surgical closure, or healing by secondary intention. When a patient refuses additional surgical treatment or is no longer a surgical candidate, as was the case with a patient who presented with acute necrotizing fasciitis caused by Clostridium perfringens in the upper extremity, secondary intention healing is the only treatment option. Following surgery and intravenous antibiotic treatment, her wounds were managed with topical negative pressure wound therapy. No adverse events occurred and the wounds were almost completely healed 63 weeks following surgery. Research to develop evidence-based protocols of care for the closure of these wounds is needed. KEYWORDS: necrotizing fasciitis, wound vac, negative pressure wound therapy
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