Managing Burns with HBOT
Studies have shown that hyperbaric oxygen therapy when used as an adjunct in a comprehensive program of burn care can significantly improve mortality and the severity of patient suffering, reduce time in bed, and lessen the need for surgery. The area subjacent to a third degree burn is hypoxic when compared to normal skin, and that the oxygen tension can only be raised by oxygen administered at pressure. The ongoing tissue damage seen in thermal injury arises from failure of surrounding tissue to supply borderline cells with oxygen and nutrients necessary to sustain viability. The impediment of circulation below the injury leads to desiccation of the wound, as fluid cannot be supplied via the thrombosed or obstructed capillaries. Regeneration cannot take place until equilibrium is established. The longer the period before equilibrium is established, the worse the resultant damage and residual scarring is. Due to the decreased oxygen supply, the likelihood of superimposed infection is increased.
Not only does early timely intervention reduce the above complications, it also reduces the need for grafting. In some series a reduction of 75% has been shown. A significant reduction in mortality has also been shown, when HBOT is used in severe burn victims.
A forgotten secondary aspect to these burn victims is associated lung damage that may occur. The incidence of adult respiratory distress syndrome is significantly reduced. There is also no evidence of oxidative stress on the lungs secondary to HBOT. In the case of necessary skin grafting, the healing of the grafts taking successfully is augmented, and the healing time shortened.
In summary, the prompt introduction of HBOT in burn victims significantly affects positive outcomes with earlier mobility, increased amount of healing, lesser degrees /incidences of infection, and less scarring.
- George Allibone M.D.