Hyperbaric Oxygen Therapy and Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischemias
Crush injury involves severe trauma to bone, soft tissue, nerve, and vascular structures. Acute traumatic ischemia occurs when there is a severe injury to a limb and the circulation of the extremity becomes compromised. This ischemic compromise may be severe enough to place the entire extremity at risk for necrosis and amputation. Secondary complications such as infection, non-healing wounds and non-union of bones can occur.
Ischemia can result either from injury to the large blood vessels, as in open fractures with interruption of major arteries, or at the microcirculation level, as in severe crush injuries and skeletal muscle compartment syndromes. The immediate threat to the limb is whether blood flow is sufficient to maintain viability of the tissues.
Post-traumatic edema, which is associated with traumatic injuries and ischemia (inadequate blood flow) further reduce oxygen availability to tissues.
When tissue oxygen tensions fall below 30 mmHg, the responses to infection and ischemia are weakened. Specifically, white blood cell killing becomes defective or nonexistent and host repair processes slow or stop.
The primary rationale for using HBO2 is that it increases tissue oxygen tensions to levels which make it possible for healing to occur. At 2 ATA, the blood oxygen content is increased and sufficient oxygen becomes physically dissolved in the blood to keep tissues alive. Edema reduction is another effect of hyperoxygenation.
In effect, HBO2 maintains oxygen delivery while blood flow is improved in the microcirculation by the edema reducing effect of vasoconstriction. Thus, the immediate effects of HBO2 are threefold in acute traumatic ischemia:
a) enhanced oxygenation at the tissue level,
b) increased oxygen delivery per unit of blood flow, and
c) edema reduction.
Therapy should be initiated within 48 hours after the injury; however, to be most effective, treatment should be started within the first 4 to 6 hours.
References:
1. |
Bouachour G, Cronier P, Gouello JP, Toulemonde JL, Talha A, Alquier P. Hyperbaric oxygen therapy in the management of crush injuries: A randomized double-blind placebo-controlled clinical trial. J Trauma 1996;41:333-339. |
2. |
Gustilo R. Management of Open Fractures and their Complications. W. B. Saunders, Philadelphia 1982;202-208. |
3. |
Hyperbaric Oxygen Therapy Committee. Crush injuries, compartment syndromes, and other acute traumatic ischemias. In: Hyperbaric Oxygen Therapy: 1999 Committee Report. Hampson NB, ed. Undersea and Hyperbaric Medical Society, Kensington, MD 1999;17-21. |
4. |
Strauss M. Crush injury, compartment syndrome and other acute traumatic peripheral ischemias. In: Hyperbaric Medicine Practice. Kindwall EP and Whelan HT, eds. Best Publishing, Flagstaff, AZ 1999;753-778. |
Source: Hyperbaric Oxygen Therapy: A Committee Report. Undersea and Hyperbaric Medical Society. 1999 Revision
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