Clinical Hyperbaric Oxygen Therapy, Wound Perfusion, and Transcutaneous Oximetry

Abstract

Hyperbaric oxygen therapy (HBOT) is an important adjunct in the management of problem wounds which exist in chronic oxygen deficiency and in which the local oxygen tension is below optimal for healing. In the treatment of hypoxic and ischemic wounds, the most important effects of hyperbaric oxygenation are the stimulation of fibroblast proliferation and differentiation, increased collagen formation and cross-linking, augmented neovascularization, and the stimulation of leukocyte microbial killing. Ischemic soft tissues also benefit from hyperoxygenation through improved preservation of energy metabolism and reduction of edema. Hyperbaric oxygen is administered in either a multiplace or a monoplace hyperbaric chamber. Normally, pressures of 2 to 2.5 ATA are used for a period of 90 minutes once or twice daily. For an objective assessment of wound perfusion and oxygenation, transcutaneous oximetry provides a simple, reliable, noninvasive, diagnostic technique. It can be used for assessment of tissue perfusion in the vicinity of the problem wound. Transcutaneous oximetry may be used in the assessment of wound healing potential, selection of amputation level, and patient selection for HBOT. In diabetic patients with chronic foot ulcers peri-wound transcutaneous oxygen tensions (TcP(O2)) over 400 mmHg in 2.5 ATA hyperbaric oxygen or over 50 mmHg in normobaric pure oxygen predict healing success with adjuncted HBOT with high accuracy.

Hyperbaric oxygen therapy aggravates liver reperfusion injury in rats

“…These alterations are the result of the complex interactions between adenosine triphosphate depletion, adhesion and activation of leukocytes, Kupffer cells and platelets in hepatic sinusoids, release of proteases and phospholipases, complement activation, and formation of reactive oxygen species 1 . Surgical and pharmacological methods for the prevention and treatment of liver IRI have been described 2 . The myocardium becomes resistant to the deleterious effects of I/R when previously exposed to short periods of vascular occlusion led to the successful application of this technique, known as ischemic preconditioning, to liver resections and transplantation 8 .…”

“…Proteases, phospholipases, complement and reactive oxygen species also play a role 1 . The beneficial effects of HO on the treatment of diseases associated with tissue ischemia have been well established 2 . However, its clinical application to the liver is recent and is restricted to isolated cases of diseases such as chronic viral hepatitis 3 , postoperative liver failure in cirrhotic patients 4 , post-liver transplant artery ischemia 5 , and acute fulminant hepatitis 6 .…”

Bisfosfonatlara Bağlı Olarak Çene Kemiklerinde Gelişen Osteonekroz (Bon) ve Güncel Tedavi Yöntemleri

“…Lazer tedavisinin deri ve mukozanın beslenmesi üzerine etkinliği birçok araştırmacı tarafından in vivo ve in vitro çalışmalarda gösterilmiştir. Bu araştır-malarda, lazer biyostimülasyon tedavisinin, bisfosfonat kullanımına bağlı olarak çene kemiklerinde gelişen osteonekroz olgularında özellikle yumuşak dokuda gelişen enflamasyonun kontrol altına alınıp ağrının azaltılmasında önemli katkı sağladığı yönünde sonuçlar bildirilmektedir [39][40][41][42] . Ekstraoral kemik açılımlarının olduğu olgularda genel yaklaşım, flep kaldırıp nekrotik kemiğin çıkartılması, mukoza bütünlüğü sağlanacak şekilde yaranın kapatılması olmalıdır.…”

Reflections on the neurotherapeutic effects of hyperbaric oxygen

“…In this patient, HBOT may induce neuroplasticity in the stunned regions where there is a brain anatomy/physiology (e.g., SPECT/computed tomography) mismatch [1,2]. The anatomical/ physiological imaging should serve as part of the basic evaluation of every HBOT candidate, just like transcutaneous oximetry at the ulcer bed serves as a basic evaluation for patients suffering from peripheral non-healing wounds [23,24].…”