Adjuvant Hyperbaric Oxygen Therapy in the Management of Crush Injury and Traumatic Ischemia: An Evidence-Based Approach

Abstract

Hyperbaric oxygen therapy (HBO) has been recommended as an adjunct treatment in acute traumatic ischemia and crush injury. Several animal models have shown better outcomes when HBO is used in crush injury and compartment syndrome. Animal and in vitro models have suggested that these beneficial effects may be mediated by attenuation of ischemia-reperfusion injury. We did a systematic review of the literature using the Eastern Association for the Surgery of Trauma (EAST) recommendations for evidence-based reviews. An electronic search using Medline, OVID technologies, and the Cochrane database was performed. Only clinical papers published between 1966 and December 2003 with at least five patients that included enough information to evaluate were selected. A group of trauma experts reviewed the selected articles and scored them applying the instrument developed by the EAST practice management guidelines committee. Nine documents fulfilled the inclusion criteria for a total of approximately 150 patients. Most documents were retrospective, uncontrolled, and case series lacking a standardized methodology (class III). There was one prospective controlled randomized trial with some limitations on its design. We determined that eight of nine studies showed a beneficial effect from HBO with only one major complication. We concluded that adjunctive HBO is not likely to be harmful and could be beneficial if administered early. Well designed clinical studies are warranted.

The Clinical and Economic Potential of Hyperbaric Oxygen Therapy in the Treatment of Diabetic Ulceration and Other Conditions

“…• necrotizing fasciitis 3,[8][9][10][11][12][13][14] • gas gangrene 8,9,15 • selected organ abscess 3,16 • acute traumatic peripheral ischemia 3,8 • crush injuries, especially if used early in treatment 17 • compromised skin grafts 8 • chronic refractory osteomyelitis 8,18 • delayed wound healing 3 • burns exceeding 20% of body surface 1 • radiation-induced nonhealing wounds, 19,20 osteonecrosis, 3,8,9,[21][22][23][24][25] and proctitis [26][27][28] There is some enthusiasm to use HBOT in the treatment of sports and other acute musculoskeletal injuries, but the evidence in support of efficacy is lacking. [29][30][31][32][33][34]…”

Syndrome de compression traumatique: à propos d’un cas

“…Certaines études ont montré l'intérêt de l'oxygénothérapie hyperbare dans l'amélioration de l'hypoxie liée au crush syndrome [ 9 , 10 ]. La prise en charge chirurgicale du membre écrasé se fait généralement en 3 temps: stabilisation de la fracture, le plus souvent par un fixateur externe en raison des lésions cutanées et musculaires; réparation des lésions vasculaires, le plus souvent par la réalisation des pontages et enfin les aponévrotomies de décharges pour lutter contre le syndrome de loges, celui-ci est définie par une pression de loges supérieure à 30mmHg avec des signes de souffrance vasculo-nerveuses.…”

Hyperbaric oxygen therapy: its use in medical emergencies and its development in Hong Kong

“…54 A systematic review of nine studies involving 150 patients with crush injury showed that HBOT is likely to be beneficial if administered early. 55 A larger and more rigorous RCT on open tibial fractures with severe associated soft-tissue injury will be published in the near future. 56 For compartment syndrome, no RCT has been published, but the use of HBOT is supported by animal studies and small case series.…”