Hyperbaric oxygen therapy in managing systemic inflammatory response syndrome caused by ischemia-reperfusion injury following hand replantation and long-term outcomes: A report of two cases

Abstract

Introduction Ischemia-Reperfusion Injury (IRI) is a complication following the reperfusion of ischemic tissues; it requires immediate treatment, as it can lead to severe infection and tissue death. The purpose of this study was to demonstrate the ability of Hyperbaric Oxygen Therapy (HBOT) to treat SIRS (Systemic Inflammatory Response Syndrome) caused by IRI and to provide long-term functional assessment for a period of up to 5 years. Case presentation Two cases of avulsions of the hand at the levels of the wrist joint and the medial third forearm, severed by machetes. Both patients were male and in their twenties. Hand replantation was carried out after 30 minutes (medial third forearm case) and 11 hours (wrist joint case) of ischemic time. A couple of days after surgery, both patients experienced SIRS as a result of IRI. The patients were brought to the hyperbaric chamber and received 3 consecutive 90-min sessions of HBOT at 2.4 ATA 3 days in a row. The outcomes were compared in a table with each patient's vital signs and laboratory results, both before and after HBOT. A significant improvement was seen at the follow-ups in vital signs and laboratory results for both patients after HBOT administration. Long-term follow-up also showed satisfying results for hand function, proven by low DASH (Disabilities of the Arm, Shoulder, and Hand) scores. Conclusion HBOT was able to treat SIRS in both patients. Favorable long-term hand function results signify successful extremity replantation.

Hyperbaric oxygen therapy ameliorates the symptoms of post-concussion syndrome by inhibiting MMP-9 activity: a randomized controlled trial in Indonesia

“…The HBOT group also received 60-minute HBOT sessions, breathing in 100% oxygen at 2-3 ATA, three times during this study at weeks one, three, and five. 21 RPQ score Items in the questionnaires are divided into two groups. The first group (RPQ-3) consists of three items and the second group (RPQ-13) consists of 13 subsequent items.…”

“…An enzyme-linked immunosorbent assay (ELISA) was used to quantify MMP-9 levels in ng/mL, as described in the MMP9 Human ELISA Kit protocol (Invitrogen Corporation, Carlsbad, CA, USA), catalog number BMS2016-2. 9,21,24 Statistical analysis Microsoft Excel was used for data entry and R Statistical Software version 3.6.3 25 was used for all statistical analyses. For the categorical variables, frequency tables were used to assess distributions.…”

Hyperbaric Oxygen Therapy in Systemic Inflammatory Response Syndrome

“…This complication is caused by the quick release of toxins and free radicals, which were previously restrained by the lack of perfusion in the ischemic area, into the bloodstream. This is an oxidative injury that is further exacerbated by the release of inflammatory mediators, arterial vasoconstriction, thrombosis, and leucocyte adhesion to the endothelium [4,5].…”

Predicting hyperbaric oxygen therapy success using the decision tree approach

“…HBOT as an adjuvant or complementary therapy is widely applied today [ 10 , 11 , [17] , [18] , [19] ]. Several studies demonstrate the effectiveness of HBOT in wound healing and inflammation [ 4 , 12 , 20 , 21 ].…”