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Hyperbaric Oxygen Chambers Deliver Healing to Chronic Wounds

Cover Story

Issue: June 2009

By: Juliet Farmer

The use of hyperbaric chambers to treat patients is not a new concept. The U.S. Air Force has been using them for over three decades to treat aviators and aircrew trainees who suffer decompression sickness. Today, the Air Force also uses it to treat carbon monoxide poisoning, problem wounds such as non-healing ulcers and compromised skin grafts, radiation soft tissue damage, chronic infections, and burns.

One such chamber is located at Travis Air Force Base, to which the UC Davis Health System’s Department of Internal Medicine in Sacramento refers patients. The unit, located at the David Grant Medical Center, the Air Force’s largest medical facility on the West Coast, is 40 miles west of Sacramento and houses the second largest hyperbaric chamber in the country, capable of holding 17 patients and two technicians. The chamber is in use daily for 10 to 20 patients with difficult wounds and graft healing problems.

Less common is the use of hyperbaric chambers in non-military hospitals. In Castro Valley, Eden Medical Center administers hyperbaric oxygen (HBO) therapy to treat acute ischemias, such as acute peripheral arterial insufficiency, crush injuries, compartment syndrome, reperfusion injuries, suturing of severed limbs, air or gas embolisms, and anemia; chronic ischemias, such as diabetic wounds of the lower extremities, chronic non-healing wounds, and compromised skin grafts and flaps; delayed radiation tissue injuries, including osteoradionecrosis, soft-tissue radionecrosis, radiation-induced cystitis, prostatitis and proctitis, and prophylactic pre- and post-treatment for patients undergoing dental surgery of a radiated jaw (following radiation treatment for head and neck cancer); infections such as chronic refractory osteomyelitis, gas gangrene (Clostridial myositis and myonecrosis), progressive necrotizing infections (necrotizing fasciitis), including mixed aerobes and anaerobes, and refractory actinomycosis and other mycoses; and carbon monoxide poisoning, cyanide poisoning, decompression illness (also known as “the bends”), and thermal burns.

How it Works

Hyperbaric oxygen therapy involves applying oxygen at a pressure greater than one atmosphere (one atmosphere is ambient pressure at sea level). In hyperbaric oxygen chambers, the patient breathes 100% oxygen intermittently while the pressure of the treatment chamber is increased to 2 to 3 atmospheres for a prescribed amount of time. This exposure increases the amount of oxygen in the patient's blood being delivered to organs and tissues in the body, which in turn promotes the healing of wounds.

There are three types of hyperbaric oxygen treatment: systemic hyperbaric oxygen (HBO), which is administered in full body chambers; topical hyperbaric oxygen (THBO), which is applied directly to the base of an open wound at a pressure slightly above atmospheric, e.g. 1.03 atmospheres; and disposable, topical hyperbaric oxygen devices, which are designed to be used one time and discarded.

“Breathing in 100% oxygen in a pressurized chamber for wound care dissolves extra oxygen into the blood plasma, so the plasma receives 15 times as much oxygen as normal,” explains Jackie Burleson, Eden Medical Center’s Manager of Respiratory Therapy. “This extra oxygen provides capillary growth. The dead tissues get new blood flow, which, in turn, promotes healing in the affected area.”

Because this pure oxygen can penetrate areas that oxygen-carrying red blood cells normally cannot, tissues that receive poor blood flow are assisted, which stimulates the growth of new blood vessels, promoting healing. The pure oxygen also allows more white blood cells to reach affected areas, which helps fight further infection. The pure oxygen can even deactivate certain bacteria toxins, destroy some groups of bacteria, and increase the effects of certain antibiotics.

Treatment Protocol

Each HBOchamber treatment consists of three stages--compression, treatment, and decompression. Compression typically takes 7 to 8 minutes, during which time the patient may feel eardrum pressure (similar to that experienced in an airplane as the eardrum responds to changes in cabin pressure). During this time, the chamber may be noisy and feel warm. Once the desired pressure is reached, HBOtreatment begins. This stage can last up to two hours, during which time patients can watch TV or sleep. At all times, a Certified Hyperbaric Technologist is monitoring treatment. At treatment conclusion, it takes about 7 to 8 minutes for the chamber to decompress, during which time the patient might experience a ‘crackling’ sensation in his or her ears. When the pressure is back to normal, the temperature drops and the patient might feel cold.

“This process is repeated 20 to 30 times, with treatment five days a week, with weekends off,” says Burleson. “At Eden, we strive to ‘partner up’ with our patients. They have to take care of the wound and keep it clean, etc., and we try to give them as much of a normal lifestyle as possible. With this therapy, consistency is important. Just doing [hyperbaric oxygen therapy] once, taking a week off and then doing it again won’t work. Consistency keeps the growth going.”

Burleson says the perfect example of a patient that needs to be ‘partnered up’ with is one with a diabetic ulcer. “There has to be a level of trust, camaraderie even, with them,” she observes. “We want them to do what we ask them to do. This treatment is one small portion of overall wound care, and it’s pointless to treat with this expensive modality if they throw it out the window when they get home. Most of our patients do try really hard.”

She reiterates the fact that this treatment is not a stand alone solution. “Hyperbaric chamber therapy will not do any good if the wound isn’t cared for outside the treatment. Wound healing is a crucial and slow process, but this can help save someone from the possibility of losing a toe, foot or leg.”

While Burleson cautions that oxygen toxicity is an issue (“Oxygen is a drug,” she notes), there are no lasting side effects associated with this treatment.

Daily Operations

Eden has been using a hyperbaric chamber for over 20 years to treat radiation of the mandible; carbon monoxide poisoning; post-surgery wounds of the knee, ankle, etc.; and, occasionally, decompression illness. Burleson says she’s seen it used more for wound care in the last 16 years, with a dramatic increase in the past two years. She credits the recent increase to physicians becoming aware of the treatment option, as well as patients, such as the diabetic community, doing their “homework.”

Eden treats about 30 patients per year of varying ages, including young people with severe breaks. “Any time there’s an injury in an area with not a lot of vasculature, such as joints like the ankle or in some parts of the hand where it doesn’t get good blood flow normally, this treatment is an option. For wound treatment, we get the best results we’ve seen. And for carbon monoxide poisoning, we see instantaneous results,” Burleson notes.

While Burleson speculates that HBO treatment is not yet widespread, due mainly to treatment time and equipment expense, she does think it will may be relied upon in the near future for other medical issues.

“Currently, it’s not as well known, and some physicians are skeptical that results can be credited to the chamber itself and not other adjunctive therapies. For physicians who don’t know about it, it’s easy to dismiss,” she explains. “I think that we may soon see more HBOuse for vasoconstruction, to decrease edema in injured tissue, to decrease inter-cranial pressure, and for brain or spinal chord injuries, severe burns, and immunosuppressant diseases.” (Recently, Reuters Health reported that HBOtherapy can improve language ability, social interaction, and other functions in children with autism, according to a report in the March 2009 issue of BMC Pediatrics.)

In the meantime, Burleson prides herself on the condition of Eden’s chamber. “We have the chamber thoroughly inspected annually,” Burleson says. “At a lot of other facilities across the country that have one, no one department takes ownership of the chamber, so upkeep falls by the wayside. At Eden, we all take pride in it. We take care of it, and who benefits but the patient in the end?”

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