2. 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

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

4. 1-Introduction

5. 1-Introduction Definition of HBOT: -High-dose O2(100%)
-High pressure O2(1ATA<)to3
-Short-time(20 min-60min)
-Airways inhalation
-Blood diffusion

7. 1-Introduction
Portable(<1/4 ata)

8. 1-Introduction
Military/Industrial(>=6 ata)

9. 1-Introduction
Monoplace(3ata)

10. 1-Introduction
Multiplace(3ata)

11. 1-Introduction
HBOT protocol

12. 1-Introduction
UHMS
ECHM

13. 1-Introduction

14. 1-Introduction

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

16. 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.

17. 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

18. 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 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

19. 2-Basic aspects

20. 2-Basic aspects

21. 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 cc/100cc
Hgb Oxygen Transport
Hgb Saturation curve
PaO O2 Diffusion
T , CO2, H+,DPG

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

23. 2-Basic aspects

24. 2-Basic aspects

25. 2-Basic aspects

26. 2-Basic aspects

27. 2-Basic aspects

28. 2-Basic aspects Oxygen in wound:
-Control the proliferation of fibroblasts
-Regulationof the cellular response to growth factors
-Hydroxylation of proline and lysine

29. 2-Basic aspects HBOT in chronic wound:
-Increases the capability of the leukocytes to kill pathogenic bacteria
-Promotes the rate of epithelialization
-Promotes neoangiogenesis

30. 2-Basic aspects

31. 3-Clinical considerations

32. 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

33. 3-Clinical considerations

34. 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
> > > > 700

35. 3-Clinical considerations

36. 3-Clinical considerations

37. 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

38. 3-Clinical considerations

39. 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.