The hyperbaric chamber as an adjuvant treatment in traumatology

In particular, hyperbaric oxygenation treatment (HBOT) is used in the treatment of trauma of different origins, which affect different organs and tissues. Some injuries that require surgery and can be treated with HBOT include acute traumatic ischemia, compartment syndrome, compromised grafts and flaps, infectious processes and traumatic burns.

Traumatisms compromise the health of the traumatized patient, since they trigger a regional or general state of hypoxia by compromising the perfusion of some tissues and, therefore, their viability. Under hypoxic conditions, angiogenesis becomes slower and even nil, decreases the function of fibroblasts and the formation of collagen is compromised. At the cellular level, hyperoxia solves all these functions, since they are dependent on O2.

In situations of injuries and cerebral ischemia, the state of hypoxia is responsible for neuronal damage, inefficient synapses and alterations in irrigation and perfusion. These phenomena are due to the alteration of metabolism and neuronal activity in hypoxia. The aim of therapies in cerebral ischemia is to rescue normal tissue, which is at risk of suffering irreversible damage due to O2 deprivation and the consequent energetic and metabolic alteration.

Therefore, therapeutic measures focus on improving blood flow and preserving cellular function. In this context, HBOT plays an important role in neuronal protection during ischemic situations, through the action of hyperoxia by reducing lipo-peroxidation in situations of ischemia and ischemia-reperfusion processes. HBOT can reduce the inflammatory state and cerebral edema, favor the repair of axons, stimulate their growth and maintain the integrity of the blood-brain barrier.

It also favors the redistribution of cerebral blood flow, relieving intracranial pressure and its symptoms. It attenuates motor deficits, decreases the risks of sequelae and prevents recurrent cerebral circulatory disorders, improving survival after neurological trauma. In cases of injury and traumatic injury that affect the central nervous system, HBOT promotes neuroprotection and neurogenesis, in a concomitant manner with angiogenesis and improvement in brain flow, and promotes neuroplasticity.

For example, the use of 40 sessions of HBOT (1.5ATA) during one month, proved to be safe and effective in patients with chronic crush injuries, observing improvements in cognitive tests, physical and imaging (SPECT), in the quality of life and pain relief. It was also observed that HBOT accelerates neurological recovery after spinal cord injury, improving mitochondrial function in the motor cortex and spinal cord, reversing hypoxia and reducing edema. In cases of osteomyelitis (OM), increasing the pO2, HBOT promotes healing and reduces the likelihood of infections, inhibiting the growth of anaerobic micro-organisms, which affect bone tissues.

The mechanisms through which HBOT acts in the treatment of osteomyelitis, include the stimulation of the phagocytic action of leukocytes in hypoxic tissues, osteogenesis and neo-vascularization, the activation of osteoclasts in the removal of bone debris. The treatment of HBO (2.5 ATA, 2 hours, 5 sessions / week, 50 days) showed eradication of the infection, without recurrence or complications. In OM and other severe infections, HBOT has direct and indirect antimicrobial effects and avoids the systemic inflammatory response, helping to delimit viable nonviable tissue, reducing the extent of debridement, amputations, and morbidity and mortality.

HBOT is indicated in traumatized patients to maintain tissue viability and muscle aerobic metabolism, reduce post-traumatic edema and improve capillary perfusion of the muscle, prevent ischemia / reperfusion injury, favor host response against infections, improve Scarring, reduce amputations, complications and peripheral nerve injuries that accompany these injuries.

In summary, HBOT is used as an adjuvant treatment in traumatology to accelerate recovery, relieve pain, reduce inflammation, the risk of infections and amputations, reconstitute perfusion, improve neuronal recovery and quality of life. The results of HBO therapy in patients with peripheral trauma, brain and spinal cord injury are promising and deserve further investigation.

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