1. The Role of Hyperbaric Oxygen Therapy and Wound Healing
Brian G. Halloran, MD
Medical Director, Center for Wound Care and Hyperbaric Medicine
St. Joseph Mercy Hospital
Ann Arbor, Michigan

2. Objectives
Provide background on role of hyperbaric oxygen treatment for chronic wounds and other FDA-approved conditions
Inform how evidence-based practice and a multi-disciplinary wound team can optimize treatment and healing for ORL/HN disease

3. Disclosures
Commercial Interest-St Joseph Mercy Health System Financial Relationship-Physician Purchased Services and Medical Director Conflict of Interest-Exempt, given the non-profit status of SJMHS

4. What is a Wound Center? A Wound Center Treats Chronic Wounds
Chronic wounds have prolonged pro- inflammatory stimulus
One time or repeated injury → fail to proceed through normal phases of wound healing
Present for at least 4 weeks, to months, to years

5. Types of Chronic Wounds
Infectious wounds
Ischemic wounds
Radiation wounds
Surgical wounds
Arterial ulcers
Venous ulcers
Diabetic ulcers
Pressure ulcers
Chronic wounds are not defined by size, complexity or failure to heal
with your initial therapy

6. What is Hyperbaric Oxygen Therapy?
HBOT is breathing 100% oxygen while under increased atmospheric pressure
What is Hyperbaric Oxygen Therapy?

7. Have You Ever Been in a Hyperbaric Chamber?
Elevation
Air Pressure
Sea Level
14.7 psi
Denver
12.1 psi
Mount Everest
4.6 psi
34,000 feet
3.6 psi
Airplane cabin at 33,000 feet
10.9 psi

8. Oxygen Physiology
Atmospheric Pressure
Breathing Gas
Measured PaO2
1.0
Room air (21% oxygen)
90-95 mmHg
100% oxygen
507 mmHg
3.0
1721 mmHg
Since more oxygen is in solution in plasma while under pressure, it can reach areas where RBCs may not be able to pass

9. HBO Mechanisms of Action
HBOT increases the generation of oxygen free radicals, which have bacteriostatic/bactericidal actions
HBOT stimulates stem cells to produce and release growth factors
Vasculogenic stem cells are mobilized to areas of wounding
Since fibroblast proliferation and collagen synthesis are oxygen-dependent, angiogenesis can occur in ischemic tissue

10. Effects of Hyperoxygenation
Plasma quickly becomes saturated with O2
Elevated O2 levels in blood stream return to normal within 10 minutes after completing hyperbaric exposure
O2 tension in muscle tissue remains elevated for 1- 2 hours post-exposure
O2 tension in subcutaneous tissue remains elevated up to 4 hours post-exposure

11. 3 Main Effects of HBOT Delivery of O2 to hypoperfused tissue
Limits ischemic damage
Promotes collagen synthesis
Generation of Oxygen Free Radicals
Helps kill bacteria
Vasoconstriction
Decreases tissue edema

12. FDA-Approved Indication for HBOT
Air/Gas embolism
Carbon monoxide poisoning
Cyanide poisoning
Gas gangrene
Crush injury
Decompression sickness
Diabetic foot wounds
Necrotizing soft tissue infections
Osteoradionecrosis
Delayed radiation injury
Compromised skin graft/flaps
Central retinal artery occlusion
Refractory osteomyelitis
Intracranial abscess

14. Off-label Uses of HBOT AIDS/HIV Autism Alzheimer’s disease Asthma
Bell’s palsy
Brain injury
Cerebral palsy
Hepatitis
Migraine
Multiple sclerosis
Parkinson’s disease
Spinal cord injury
Sports injury
Stroke

15. Applications Proposed or Studied for ORL-HNS Osteoradionecrosis
Chondroradionecrosis
Enhancement of graft/flap viability
Tracheocutaneous fistula
Skull base osteomyelitis
Sudden SNHL
Bells’s Palsy
Radiation sensitization

16. Radiation Injury Marx Triad Hypocellularity, Hypovascularity, Hypoxia
Endarteritis Obliterans
From progressive capillary loss and tissue fibrosis
Manifests as:
Pigmentary skin changes, tissue induration, loss of elasticity, local erythema, tenderness/pain, osteo- avascular necrosis, tissue ulcers

17. HBOT for Radiation Injury
Hyperoxygenation
Increased oxygen gradient to central hypoxic area
Angiogenesis
Is oxygen-dependent
Increased Capillary Density
Occurs after multiple HBOT treatment sessions

18. HBOT and Cancer Growth Theoretical
Cellular turnover/division is oxygen-dependent
Does HBOT enhance tumor growth?
Current Experiments
Cell culture and mouse models of SCCa showed no difference between HBOT and normal O2
Systematic Reviews
Have failed to support any concern
Malignant neoplasm may follow a different pathway of angiogenesis than wound healing

19. Summary
HBOT is breathing 100% oxygen while under increased atmospheric pressure
Most benefits derived from treatments of 90- minutes at 2.4 atm
Supported ORL-HNS indications for ORN, CRN, radiation-soft tissue injury and flap/graft survival
Cost are significant ($15K), but savings likely in proven indications

21. Comments and/or Questions
©2015 Trinity Health - Livonia, MI

22. Break!