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Hyperbaric Oxygen Therapy For Acute Traumatic Ischemia

Medical information reviewed by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor
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Discover the hyperbaric medicine center opened in our clinic. Centrokinetic has the top-performing hyperbaric chamber in Bucharest, with multiple medical and anti-aging uses. The Baroks chamber has 5 seats, and operates at a constant pressure of 2.5 atmospheres, being fully automated and having protocols for each condition, and can be used individually for each patient. 

Hyperbaric oxygen therapy - benefits

Patients who use the clinic's hyperbaric therapy services benefit from:

  • The only medically accredited hyperbaric therapy chamber in Bucharest, which operates at 2.5 atmospheres (those for aesthetic use go to 1 atmosphere and have no medical benefits).
  • A safe medical procedure, without irradiation, without pain, without other side effects. 
  • The specialized medical team consists of recovery doctors, orthopedists, rheumatologists, neurologists, and neurosurgeons, meaning a multidisciplinary team specialized in all diseases that can be treated with hyperbaric therapy. 
  • Premium conditions at a fair price. Our clinic is recognized for the conditions offered and for the care of each patient. But we do not need to pay exorbitant prices to have access to quality medical services. At Centrokinetic you can find an affordable and fair price. But note that we do not have a contract with the National Health Insurance House (we do not offer state reimbursed services)

Centrokinetic is keeping contact with prestigious clinics and universities in Belgium, the Netherlands, France, and Greece to constantly update treatments to provide patients with the best medical solutions.

What is traumatic ischemia?

Limb trauma, which leads to direct tissue damage, plus local hypoxic disorders caused by the resulting edema, causes acute peripheral ischemia. Trauma can range from mild to irreversible and can involve major blood vessels and nerve damage. In the case of severe injuries, amputations may be necessary. Sometimes, vascular reconstructions may be necessary for the limb to be saved. Examples of trauma include injuries from crushing and thermal injury. Even without major vascular damage, tissue damage can lead to edema that causes tissue hypoxia, leading to more edema. This vicious cycle can lead to crushing syndrome, which is then a surgical emergency to save the limb.

Treatment in traumatic ischemia

Surgical treatment and hyperbaric oxygen are not concurrent treatment modalities but are best used to complement each other in order to provide the best outcome for the patient.
Treatment of acute traumatic peripheral ischemia is one of the 13 indications for hyperbaric oxygen treatment approved by the Medical Society of Hyperbaric Therapy. 

The organization states that when a patient has acute traumatic peripheral ischemia or when a patient suffers injuries from crushing tissues, involving fractured limbs, HBO therapy is a valuable treatment that doctors can use in combination with other therapeutic measures, otherwise patients may lose their limb functions, full limb or even life.

Anatomy

After an acute traumatic injury to the limbs, damage to the blood vessels will lead to bleeding in the coagulated tissues and subsequent stasis in the vessels, leading to hypoxia in the cells and inability to maintain cellular metabolic demand. The resulting edema causes high blood pressure, causing more ischemia and hypoxia, leading to cell death and water retention. Once blood flow is restored, subsequent ischemic injury occurs. The endothelial layer of the vessels is affected by accumulating fluid, causing edema, in addition to the progressive obstruction of blood flow caused by neutrophils adhering to the wall of the injured vessel.

Hyperbaric oxygen works in many ways to help those acute changes at the cellular level. First, it produces vasoconstriction by about 20%, which means less fluid flow (blood and plasma) in the affected area, but since the dissolved oxygen in the plasma is at least doubled, there is a net oxygen supply increase. This vasoconstriction results in less edema and an increased distance of oxygen diffusion. Also, hyperbaric oxygen reduces the adhesion of neutrophils to the affected endothelium, preventing the appearance of ischemia.

Indications 

Emergency surgical treatments, such as revascularization and fracture stabilization, should be a priority taking place before hyperbaric oxygen treatments. In some less urgent cases, hyperbaric oxygen treatments can help the surgeon save more functional tissue to minimize tissue loss and reduce the risk of amputations. The decision to use and the frequency of hyperbaric oxygen must be made in close collaboration with the surgeon and depends on the type of lesion, the severity of the lesion, and the specific condition of the patient. It is best to use the Gustillo system for classifying lesions by crushing open fracture tissues while adding to the equation the general condition of the patient that includes, age, smoking, steroid use, condition, cardiovascular and renal function. This system improves patient selection and treatment algorithms. Analyzing the effects of hyperbaric treatments is an important part of the clinical care of these patients and is best done in close collaboration with the surgical and hyperbaric team after several predetermined hyperbaric treatments.

Contraindications

There are no direct contraindications for hyperbaric oxygen in acute traumatic peripheral ischemia unless an emergency is delayed. There are few absolute contraindications to hyperbaric oxygen, such as insecure tension pneumothorax.

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Equipment

There are 2 types of hyperbaric chambers: single-seat chambers and multi-seat chambers. Single-seat rooms can accommodate one person. They are usually made of a transparent acrylic tube, with the patient's access through a metal door located at one end. In single-site chambers, 100% oxygen is used to pressurize the tube while the patient breathes oxygen from the chamber. Some of the single-seat rooms are equipped with a separate breathing mask to provide air when taking a break. Single-seat cameras can be equipped with fans, infusion pumps, and physiological monitoring capabilities to provide high-acuity care. The single-seat rooms can fit into a standard hospital room and can be connected to the hospital's oxygen and air supply system.

The multi-seat rooms are made of steel with acrylic viewing ports and can accommodate between 2 and more than 20 people. They are pressurized with air, while patients breathe oxygen, either through a well-fixed mask or through a special hood, which is sealed around the neck with a special rubber element. For any potential air breaks, patients will breathe air from the room. These multi-seat rooms are often large complexes with large compressors, air tanks, and oxygen tanks.

Both types of rooms require special manufacturing and installation instructions, which are governed by special fire protection codes, such as NFPA 99 in the United States. A transcutaneous oximeter can help determine the level of oxygen pressure in the room air during hyperbaric treatments. It has been shown that HBO has a positive predictive response of 0.88 for healing when a level above 200 mm Hg is reached during treatment. 

Technology

The participating hyperbaric medicine specialist will prescribe the time, pressure, and respiratory gas in a treatment table for the patient (and if the treatment is scheduled in a room with several places, he will also plan the treatment profile for the companions inside). Common treatment tables for acute traumatic peripheral ischemia include 2 absolute atmospheres (ATA) for 2 hours or 2.4 ATA for 90 minutes. The number of rows in the suggested treatment table varies depending on the type of injury. 

To prevent ischemic lesions that may occur after conventional treatment, a single treatment may be sufficient. In case of serious injuries, a much more aggressive program of 8 treatments may be necessary. For an imminent crush syndrome, 3 treatments are recommended (2 twice a day on the first day and 1 on the second day). While any established syndrome requires a fasciotomy, hyperbaric oxygen can be useful after fasciotomy to treat residual problems, such as tissue ischemia, massive swelling, or nerve damage, and may require treatment twice a day for up to 7 days. 

What are the effects of oxygen therapy on the body?

  • Decreases inflammation
  • Increases the body's oxygen saturation by 20-30%
  • Increases the body's immunity
  • Increases blood circulation and stimulates the formation of new capillaries
  • Decreases toxins in the body
  • Stimulates the production of new blood cells
  • Increases healing rate

Complications 

Hyperbaric oxygen is usually well tolerated. Occasionally, patients who have difficulty leveling may develop ear barotrauma. This can usually be resolved with nasal decongestants and rarely requires placement of myringotomy tubes by an otolaryngologist. Pulmonary barotrauma is very rare; however, the possibility of lung trauma should be considered when patients develop ascending chest pain. Pulmonary and cerebral toxicity with oxygen is not usually a problem because exposures are relatively short when used for traumatic acute peripheral ischemia.

Clinical significance

Acute peripheral ischemia can be devastating and can lead to permanent loss of the limb or function. The cost of amputation with rehabilitation and the resulting lost productivity far outweighs the cost of rescue and reconstruction, including even the use of adequate hyperbaric oxygen therapy, which adds only about 10% to the total cost. Hyperbaric oxygen therapy is an adjuvant therapy often overlooked by surgeons and can help reduce the vicious cycle of edema, ischemia, and hypoxia, as well as reduce the harmful effects of an ischemic injury that occurs after treatment. Unfortunately, hyperbaric oxygen is often addressed only to alleviate late complications, rather than to be applied early helping to reduce tissue loss. 

IN CASE YOU HAVEN'T ALREADY HEARD ABOUT US

Centrokinetic is the place where you will find clear answers and solutions for your motricity problems. The clinic is dedicated to osteoarticular diseases and is divided into the following specialized departments:

  • Orthopedics , a department composed of an extremely experienced team of orthopedic doctors, led by Dr. Andrei Ioan Bogdan, primary care physician in orthopedics-traumatology, with surgical activity at Medlife Orthopedic Hospital, specialized in sports traumatology and ankle and foot surgery. .
  • Pediatric orthopedics , where children's sports conditions are treated (ligament and meniscus injuries), spinal deformities (scoliosis, kyphosis, hyperlordosis) and those of the feet (hallux valgus, hallux rigidus, equine larynx, flat valgus, hollow foot).
  • Neurology , which has an ultra-performing department, where consultations, electroencephalograms (EEG) and electromyography (EMG) are performed. 
  • Medical recovery  for adults and  children , department specialized in the recovery of performance athletes, in spinal disorders, in the recovery of children with neurological and traumatic diseases. Our experience is extremely rich, treating over 5000 performance athletes.
  • Medical imaging , the clinic being equipped with ultrasound and MRI, high-performance devices dedicated to musculoskeletal disorders, and complemented by an experienced team of radiologists: Dr. Sorin Ghiea and Dr. Cosmin Pantu, specialized in musculoskeletal imaging.

Find the latest news by following the Facebook and YouTube accounts of the Centrokinetic clinic.  

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