Hyperbaric oxygen therapy or simply Oxygen Therapy, as it is called, involves exposing the body to higher concentration of oxygen at a pressure that is greater than usual, for the purpose of quicker healing of wounds. Wounds generally need oxygen to heal properly and exposing them to a higher concentration may speed healing. The wound healing management algorithm that is applied during the hyperbaric oxygen therapy improves clinical outcomes and, at the same time, remarkably reduce expenditures.
The science of wound healing says that oxygen plays key nutritional and cell signal roles throughout all the phases of wound healing and hyperbaric doses of oxygen are known to increase hypoxic wound oxygen tensions to normal or even supraphysiologic levels. In lay mans language, it increases the catalysts that help heal a wound faster. In response to higher oxygen levels, important cellular functions like angiogenesis, fibroplasia, epithelialization, and bacterial killing ensue at a more swift pace. In wound healing, if the bacterial burden is removed and a preliminary matrix is formed, it enables a rapid fibrous tissue formation and epithelial coverage. This is exactly what the high concentration of oxygen, supplied during the Oxygen therapy does. Removing bacterial burden and allowing resolution of any inflammation, which in turn facilitates the production of matrix, division of cells and the ultimate wound closure.
Oxygen therapy becomes a must in cases, where wound healing is impaired or dysfunctional. Where the patient is suffering from common diseases like diabetes, peripheral arterial or venous vascular disease, radiation and other situations, Oxygen Therapy becomes almost indispensable. New therapies of antibacterial control like the oxygen therapy are becoming more and more relevant as mankind is learning more about bacterial resistance to antimicrobial therapy every day. A problem that exists with respect to chronic wounds is that after a prolonged period of inflammation, there is generally poor quality of healing that operates. For instance, a wound that has not closed within a 3-week period from the date of its opening, has a 70% chance of developing excessive fibrotic hypertrophic scars. Tissue healing of a higher quality and durability can be achieved with better oxygenation of the wound as it results in faster extermination of the tissue from the inflammatory state. For instance, below knee level limb amputations have shown different healing rates at different pressures of oxygen at the amputation site:
- 11% healing at <20 mmHg
- 46% healing at 20mmHg – 30mmHg
- 97% healing at 30 mmHg and more
Oxygen Therapy: The Procedure
In case of an emergency situation, where the wound of a patient is critical, an immediate and thorough examination of airway patency, breathing and circulation is crucial, and in perilous illness such as peri-arrest, high-concentration oxygen should be administered via a face mask at 10-15L/min if the patient is hypoxic, with unceasing intensive care of pulse oximetry and treatment of a proper target range once the patient’s condition is stable.
There are a number of Oxygen delivery systems, classified as high pressure and low-pressure systems, that can be used to administer this high concentration oxygen and the selection as to which one should be used in a particular case, must be based on optimal prevention and treatment hypoxemia and efficient prevention complications of hyper-oxygenation.
Here are a few masks that one has to choose from, along with their utility:
- Nasal Cannula – Can provide 24% – 40 % oxygen concentration.
- Simple Face Mask – Can provide 40% – 60% oxygen concentration.
- Non-rebreather Mask – Can provide 60% – 80% oxygen concentration.
- Partial-rebreather Mask – Can provide 80% – 90% oxygen concentration.
- Face Tent – Can provide 28% – 100% oxygen concentration.
- Venturi Mask – Can provide 24% – 60% oxygen concentration but with increased precision.
Along with these masks, an important part of the HBOT of Hyperbaric Oxygen Therapy is an efficient anesthesia delivery system, such as the Bain Circuit. A Bain circuits is typically an anesthesia delivery system, which ensures that there is no rebreathing of the exhaled air, which is a must for HBOT to be effective and optimal.
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