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 oxygen therapy healing as experimental or unproven. Others may be aware of its efficacy but wait too long to refer patients—missing an important therapeutic window.
HBOT Mechanisms
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.
Discover the mechanisms of HBOT and how it promotes healing. Learn about its efficacy in wound care, the importance of patient compliance, and optimal timing for hyperbaric oxygen therapy.
A Glimpse at the Evidence of HBOT for Healing
Many studies and clinical trials have shown that hyperbaric oxygen therapy (HBOT) is effective in treating wounds. In fact, wound care centers across the United States report regular success with HBOT. However, its use is still somewhat limited, possibly because many healthcare providers and patients aren't fully aware of it. Negative media reports and some research limitations also play a role in this.
Some healthcare providers are skeptical about HBOT's benefits. They mention issues like selective bias, underpowered studies, and the lack of comprehensive research or meta-analyses. They also point out that HBOT studies often use different doses, treatment courses, and follow-up periods, which makes it hard to assess its overall effectiveness.
However, these criticisms seem to hold HBOT to a higher standard than other treatments. For instance, studies on ultrasound therapy for wound healing also vary in frequencies, pulses per second, and treatment courses. The same goes for physical therapy. Despite these variations, both treatments are widely accepted because the overall research shows positive outcomes.
The basic science and animal studies on how HBOT works are quite strong, and many human studies have shown excellent results when patients stick to the treatment plan.
A recent investigation published in Advances in Wound Care examined the outcomes of individuals suffering from severe diabetic foot ulcers, classified as Wagner grade 3 or 4. The research revealed that those who underwent conventional wound treatment without hyperbaric oxygen therapy (HBOT) experienced a healing success rate of approximately 54%.
In contrast, patients who received partial HBOT treatment, but did not complete the entire discipline, saw an improvement in their healing rate, with around 60% of wounds resolving. Notably, those who adhered to the full HBOT treatment protocol achieved a significantly higher healing rate of 74%.
The Role of Patient Compliance in Hyperbaric Oxygen Therapy
Patient compliance refers to how closely a patient's actions follow medical advice and instructions. It can either be complete, partial, erratic, nil, or over-compliant.
A typical HBOT course at our health centre involves 90-minute sessions each day, five days a week, for four to eight weeks. Sticking to the full course is crucial for success.
According to our health centre’s previous records, patients who follow through with their HBOT treatments have a higher healing rate and a lower chance of needing amputations compared to those who are less consistent.
Just as we wouldn’t expect a partial prescription of antibiotics to cure an infection or half a course of chemotherapy to effectively treat cancer, HBOT needs to be fully adhered to for the best results.
Patients need to attend all their appointments, and healthcare providers should help facilitate this, whether by arranging transportation or providing reminders. Patients play a key role in their own successful outcomes.
It's also important to understand that non-healing wounds can lead to amputation, which has very high five-year mortality rates, similar to advanced cancer.
Patients may find comfort in knowing that HBOT has become more comfortable and convenient over the years. The chambers are now wider and fully transparent to help reduce claustrophobia. Many chambers are equipped with microphones and speakers for continuous communication with the care team, and screens so patients can watch shows or movies during their sessions.
When is the Right Time to Go For HBOT?
HBOT should be viewed as an adjunctive therapy. It shouldn’t be your first choice for wound treatment, but it also shouldn't be the last resort.
Using HBOT only as a "last thing" might cause you to miss a critical therapeutic window. Delays can lead to serious complications like infections or necrosis, which may result in the need for amputation.
Medicare coverage guidelines outline the necessary steps before considering HBOT for wound care:
Address related health conditions.
Control blood sugar levels and improve nutrition.
Offload pressure from the foot with a specialized orthotic or brace.
Manage pain effectively.
Maximize blood flow.
Treat any infections.
If you’ve taken all these steps and the wound still isn’t healing, it might be time to consider HBOT. Selecting the right patients involves choosing those who will adhere to safety protocols and complete the treatment course.
It's also important to address any relative contraindications, such as uncontrolled blood sugar, hypertension, or congestive heart failure.
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