Hyperbaric Oxygen Therapy Is Proven to Help Heal Wounds
Hyperbaric oxygen therapy (HBOT) is an effective treatment for wound care and has been used for that purpose for decades. Yet some healthcare providers still view HBOT as experimental or unproven. Others may be aware of its efficacy but wait too long to refer patients—missing an important therapeutic window.
HBOT is best known as an antidote to decompression sickness in scuba divers and carbon monoxide poisoning. Evidence also shows that the therapy can drastically increase healing for certain patients as part of a comprehensive wound care plan.
It’s important to understand the utility of HBOT, as well as the proper timing for its use and the importance of patient adherence to the treatment.
What is hyperbaric oxygen therapy (HBOT)?
HBOT delivers concentrated oxygen in a pressurized chamber and can help heal wounds from the inside out. It works by:
- Reducing swelling
- Fighting infection
- Building new blood vessels through angiogenesis
- Encouraging growth of healthy tissue through fibroblast cell proliferation
It can help people with wounds from a variety of etiologies, including:
- Diabetic wounds in the lower extremities
- Effects of radiation on skin and soft tissues (for example, after treatment for breast cancer, head and neck cancer, or soft-tissue sarcoma)
- Osteomyelitis that has not responded to surgical debridement and antibiotics
- Osteoradionecrosis (for example, death of bone tissue in the jaw)
Evidence for hyperbaric oxygen therapy wound healing
Many basic science research studies and randomized, controlled trials have demonstrated HBOT’s effectiveness in wound care treatment. And wound care centers throughout the United States have regular clinical success with HBOT. However, its use remains somewhat limited, possibly due to lack of awareness among healthcare providers and patients, troubling media reports of off-label uses, and research limitations.
For example, some healthcare providers doubt HBOTs evidence base, citing selectivity bias, poorly powered studies, and lack of comparative research or meta-analyses. They maintain that HBOT research studies often use different doses, courses, endpoints, and follow-up periods, making it impossible to truly assess broad effectiveness.
However, those arguments seem to hold HBOT to a higher evidentiary standard than other areas of medicine. Take, for example, ultrasound therapy for wound healing. Those studies have all used slightly different frequencies, pulses per second, and treatment courses. The field of physical therapy has similar research limitations. But both are accepted as evidence-based, effective treatment modalities because the overall literature shows positive outcomes.
The animal research and basic science on HBOT’s mechanisms of action are quite strong. And many individual studies in humans have shown excellent results in patients who adhere to the course of treatment.
For example, a recent study in Advances in Wound Care examined how patients with Wagner grade 3 or 4 diabetic foot ulcers responded to treatment. Patients who received standard wound care but not HBOT had a healing rate of approximately 54%. Those who accepted some HBOT treatments but did not complete their prescribed course achieved healing rates of about 60%. Those who completed the full course of HBOT achieved 74% healing rates.
When to refer for HBOT
HBOT is an adjunctive therapy: It should not be the first wound treatment you think of—but nor should it be the last. If you use HBOT as a “treatment of last resort,” then you may miss an important therapeutic window. Delays can put patients at risk for serious complications, such as infection or necrosis that would require amputation.
Medicare coverage determinations outline the steps that come before HBOT for wound care.
- Address related comorbidities.
- Control blood sugar and improve nutrition.
- Offload the foot with a specialty orthotic or brace.
- Manage pain.
- Maximize blood flow.
- Treat infection.
If you have taken all of those steps but still have a significant stalled wound, then it may be time to consider HBOT. Patient selection involves choosing those who will follow safety protocols and are likely to complete the course of treatment. Also, ensure that you address any relative contraindications, such as uncontrolled blood sugar, hypertension, or congestive heart failure.
Hyperbaric oxygen adherence
A typical course of HBOT is 90 minutes per day in a specialized chamber, five days per week, for four to eight weeks. Patient commitment and adherence to the full course of HBOT are vital to treatment success. According to a recent Healogics analysis, patients with good adherence experience high rates of healing and low rates of amputation, as compared to those who are less consistently adherent.
As healthcare providers, we would not expect a partial prescription of antibiotics to eliminate an infection. We know that half a course of chemotherapy is not likely to successfully combat cancer. Similarly, with HBOT, we must use this therapy in patients who are likely to adhere, facilitate their appointment attendance (e.g., arranging transportation), and remind them that they are a partner in successful outcomes.
Some may be motivated by the fact that non-healing wounds can lead to amputation. Furthermore, amputation is associated with very high five-year mortality rates that are comparable to rates seen in advanced cancer.
It may comfort patients to know that the HBOT experience has evolved to be more comfortable and convenient over the years. The chambers are wider and completely transparent to mitigate potential claustrophobia. Many contain microphones and speakers for continuous communication with the care team, as well as screens so patients can watch shows or movies.
HBOT as part of comprehensive wound care
Hyperbaric oxygen therapy is one component of successful medical management of wounds that may be considered as part of a comprehensive wound treatment plan. A wound care center can combine this modality with debridement, skin substitutes, advanced dressings, and more for the best chance at healing and limb preservation.
By William J. Ennis
William J. Ennis, DO, MBA, MMM, CPE, is chief medical officer of Healogics, the nation’s leading provider of advanced wound care. He also serves as the Catherine and Francis Burzik Professor of Wound Healing and Tissue Repair and chief of the Section of Wound Healing at the University of Illinois at Chicago’s Division of Vascular Surgery.