April 2003 Letters to the Editor
The Topical Hyperbaric Oxygen Therapy Debate
In response to the article, "Topical Hyperbaric Oxygen and Electrical Stimulation: Exploring Potential Synergy" (Ostomy/Wound Management. 2002;48(11):42-50), by definition, hyperbaric oxygen therapy involves the entire body, increased atmospheric pressure, and the patient breathing 100% oxygen. The increased oxygen pressure and oxygen concentration help wound healing. 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.
It is important to note that the effects of hyperbaric oxygen therapy result from a systemic oxygen-enriched blood stream and not from the oxygen's direct contact topically.
The patients described in the article were at normal atmospheric pressure, 14.7 psi at sea level (normobaric conditions), breathing only 20% oxygen. The application of topical oxygen is exactly that. Limb chambers are occasionally used for wound healing and these are not hyperbaric either.
Kathryn Burghart, AHCRN, Scottsdale, Ariz.
To ignore the potential of a treatment due to the constraints of a definition limits the potential for research in our field. Many treatments are available for wound care, but without sufficient research, the effects of these treatments will not be known. The research cited was an exploratory study to evaluate the effectiveness of topical hyperbaric oxygen (THBO) as well as THBO used with electrical stimulation.
Systemic hyperbaric oxygen can have potentially dangerous side effects for some patients. Topical hyperbaric oxygen may provide patients with an alternative wound care treatment. Topical hyperbaric oxygen used for the treatment of wounds has been reported to decrease infection and increase healing.1-4 A great deal of research is required in all areas of wound management including systemic hyperbaric oxygen. Exploratory projects leading to further research in a particular area only begin to scratch the surface relative to cause and effect.
Our research evaluates the efficacy of treatments and seeks to better understand the biochemical changes associated with wound treatment. As we continue to explore modalities used to treat wounds, we hope that others also are evaluating the effects of treatments and that together we can learn how the treatments affect the wound to improve patient care and increase successful healing in shortened periods of time.
Laura E. Edsberg, PhD, Daemen College, Amherst, NY
1. Heng, MC, Pilgrim JP, Beck FWJ. A simplified hyperbaric oxygen technique for leg ulcers. Arch Dermatol. 1984;120:640-645.
2. Heng MCY, Harker J, Csathy G, et al. Angiogenesis in necrotic ulcers treated with hyperbaric oxygen. Ostomy/Wound Management. 2000;46(9):18-32.
3. Ignacio DR, Pavot AP, Azer RN, Wisotsky L. Topical oxygen therapy treatment of extensive leg and foot ulcers. J Am Podiatr Medi Assoc. 1985;75:196-199.
4. Fischer BH. Topical hyperbaric oxygen treatment of pressure sores and skin ulcers. Lancet. 1969;2:405-409.
No-Rinse Bed Bath and Skin Tears
With regard to the article, "No-Rinse, One-Step Bed Bath: The Effects on the Occurrence of Skin Tears in a Long-Term Care Setting" (Ostomy/Wound Management. 2003;49(1);64-67), a piece of information appears to be missing. The authors have clearly shown the decreased need for skin tear care products and the related decrease in cost of care for those products. However, I see no reference to the cost of the no-rinse bathing product. I realize the focus of the study was not primarily on cost comparison, but because decreased costs are pointed out in several areas, it seems only balanced to include the cost effect of this product as well.
If cost of product is higher than the reported savings, an argument still could be made that the spending of healthcare dollars for prevention and healthy maintenance is at least as important as spending for treatment and repair. Can we put a price on preventing pain and suffering? Skin tears may be seen as minor wounds to many, but to those who experience them, skin tears are not minor. They hurt!
Ruth Hall, RN, BSN, CWCN/COCN, Ozarks Medical Center, West Plains, Missouri
The average wholesale price for the no-rinse cleanser is $1.45 for 8 oz. Unfortunately, we did not measure the amount of cleanser used. I agree that, even if the costs are comparable, preventive care is certainly favored. Besides product costs, the indirect savings through decreased nursing time was recognized during this study.
Plante and Regan1 presented a poster on their work that also addressed a difference in bathing time and associated costs: 16 minutes with the no-rinse cleanser and 29 minutes with soap and water. They listed a cost-savings per nursing assistant per 30 days as $278.40.
Terry Coggins, RN, MSN, CWOCN
1. Plante L, Regan M. Impact of one-step, no-rinse bathing on cost of care and skin tear occurrence in the long-term care setting. Poster session presented at the annual meeting of the Association for the Advancement of Wound Care. Atlanta, Ga.;1996.