Role of hyperbaric oxygen therapy (HBOT) in the chronic wound management Dr.Ebadi.A.Aerspace&subaquatic medicine specialist Health research center ,Chamran martyr hospital,Tehran,Iran The 1st international and 3rd national congress of wound and tissue repaire October 26-28th,2016 Tehran-Iran

Titles 1-Introduction 2-Basic aspects 3-Clinical considerations

1-Introduction

1-Introduction Definition of HBOT: -High-dose O2(100%) -High pressure O2(1ATA<)to3 -Short-time(20 min-60min) -Airways inhalation -Blood diffusion

1-Introduction Portable(<1/4 ata)

1-Introduction Military/Industrial(>=6 ata)

1-Introduction Monoplace(3ata)

1-Introduction Multiplace(3ata)

1-Introduction HBOT protocol

1-Introduction UHMS ECHM

1-Introduction

1-Introduction

Adjuant Therapy in chronic wound 1-Introduction Adjuant Therapy in chronic wound Dressing offloading Phototherapy Hyperbaric Oxygen therapy Graft Antibiotic

1-Introduction Chronic wounds: -Fails to heal within a reasonable period(4-6w) by the use of conventional methods. -Due to :Arterial insufficiency, diabetes, cancer, infections, stress and use of corticosteroids.

1-Introduction Chronic wounds: -Venous -Arterial -Diabetic and -Pressure/decubitus -Infectious -In 2009, approximately 6.5 million people required medical intervention for chronic wounds in the USA alone at cost of US$25 billion

درمطالعه‌ای که در سال 1380 در ايران بر اساس متد DALY (disability adjusted life year)و به‌صورت ارزيابي سال‌های از دست رفته انجام شد، بار پاي ديابتي و قطع عضو 7000 سال و با افزودن بار ناشي از نوروپاتي به رقمي حدود 40000 سال يعني دو برابر بار ناشي از عارضه چشمي يا کليوی ديابت رسيد. بنابراين با فراهم نمودن زمينه بهبودی زخم ، بسياري از اين هزينه‌ها نظير هزينه دوره درماني و طول مدت بستری کاهش خواهد يافت. از طرف ديگر بيش از 85 درصد قطع عضوهای ديابتي قابل پيشگيري‌اند. با توجه به عوارض شديد و هزينه‌های سنگين ناشي از زخم پای ديابتي، 50 درصد کاهش در ميزان قطع اندام تحتاني افراد ديابتي به‌عنوان يکی از اهداف اصلي در درمان بيماران ديابتي مطرح شده است. از جمله اقدامات پيشگيرانه، رويکرد تيمي به معضل پای ديابتي است. دكتر باقر لاريجاني رييس مركز تحقيقات غدد درون‌ريز و متابوليسم دانشگاه علوم پزشكي تهران - تابستان 1388 http://emri.tums.ac.ir

2-Basic aspects

2-Basic aspects

OXYGEN TRANSPORT in body O2 content Hgb ×1.34cc× SaO2 ₌ 19.7cc PaO2 / 100 × 0.3cc ₌ 20 cc /100cc 5cc/100cc use Venous O2 Content 15 cc/100cc Hgb Oxygen Transport Hgb Saturation curve PaO2 O2 Diffusion T , CO2, H+,DPG

O2 transport physiology in body Micro Angiopathy + Optimal Oxygen Delivery with PaO2 O2 transport physiology in body ATA=760 2050 = 2.7 ATA FiO2=%100 PP=2050 PAO2=1700 PvO2=100 PaO2=1700 RH LH PvO2=100 5.0cc PaO2=1700 O2 content=19.8 PCO2 > 40 O2 content=24.8 2 ATP + Lactate+H C6H12O6 36ATP + 6H2O + 6CO2

2-Basic aspects

2-Basic aspects

2-Basic aspects

2-Basic aspects

2-Basic aspects

2-Basic aspects Oxygen in wound: -Control the proliferation of fibroblasts -Regulationof the cellular response to growth factors -Hydroxylation of proline and lysine

2-Basic aspects HBOT in chronic wound: -Increases the capability of the leukocytes to kill pathogenic bacteria -Promotes the rate of epithelialization -Promotes neoangiogenesis

2-Basic aspects

3-Clinical considerations

3-Clinical considerations Transcutaneous oximetry(TCOM) -Transcutaneous oxygen pressure (tcpO 2 ): Non invasive method and its measurements have been shown to correlate with wound healing. -These measurements are taken on the area surrounding the wound and not directly on the wound surface. TCOM

3-Clinical considerations

3-Clinical considerations NORMAL TCPO2 VALUES IN HEALTHY SUBJECTS 100% O2/2.4 ATA 100% O2/2.0 ATA 100% O2/1 ATA 21% O2/1 ATA 1312±112 - 450±54 67±12 Chest a 1027±164 596±146 b 281±78 49±14 Calf (male) a 1174±127 720±216 b 367±59 59±12 Calf (female) a 919±214 547±195 b 280±82 63±13 Midfoot a > 50 > 200 > 350 > 700

3-Clinical considerations

3-Clinical considerations

3-Clinical considerations Prominent Tcpo2 value: -Normal in Air:40-80 mmHg -TcP O 2 < 15 mmHg in sea level predicts failure to HBOT -TcP O 2 > 20 mmHg in room air predicts a positive response to HBO -The value should double on 100% oxygen

3-Clinical considerations

3-Clinical considerations The treatments should last for 1–2 h and should be repeated every 24 h. -Cell cycle of human fibroblasts, which lasts about 24 h, and the duration of mitosis, which takes about 1 h.