Hyperbaric Oxygen Therapy for Diabetes-Related Foot Wounds

Hyperbaric Oxygen Therapy for Diabetes-Related Foot Wounds

What is hyperbaric oxygen? Hyperbaric oxygen therapy (HBO2) is a medical treatment in which a patient breathes 100% oxygen while inside a high-pressure air chamber. HBO2 has been used for more than 40 years to help people recover from illnesses such as carbon monoxide poisoning. Today it is also used to treat problem wounds. Studies have shown that HBO2 can play an important role in the treatment of wounds such as foot ulcers, which sometimes occur in persons with diabetes. Oxygen applied directly to body surface areas is not HBO2 therapy and is not considered useful treatment. How does HBO2 work? The body needs oxygen to heal itself. White blood cells need oxygen to fight infections. Tissues need oxygen to repair themselves and make new blood vessels. Without enough oxygen, wounds do not heal. The air we breathe contains 21% pure oxygen. Breathing 100% pure oxygen through a facemask increases oxygen in the bloodstream. Breathing 100% oxygen while in a pressurized chamber gives patients 10-15 times more oxygen than using just the facemask. That extra oxygen in the bloodstream is what aids the healing process. How does HBO2 therapy help diabetic feet?

People with diabetes can develop foot ulcers because of poor circulation and nerve damage in the feet. A person with loss of feeling in his or her feet may step on a sharp object or wear ill-fitting shoes and not feel any pain. The resulting cuts and sores may go unnoticed and become infected. Some people diabetes cannot get enough oxygen to foot ulcers because blood vessels in their legs and feet have hardened due to poor circulation. Blood moves more slowly through these hardened vessels, depriving the wound of oxygen. HBO2 therapy does not always cure diabetic foot ulcers, nor is it the first treatment that should be tried. Foot wounds often require surgery or other treatments. HBO2 does not work well if these other problems are not solved first. Increasing blood flow to the wound is important, and staying off of an open foot wound can also help healing. HBO2 therapy can help deliver extra oxygen to foot ulcers when other treatments alone are not enough. What are the chambers like? What does it feel like in there? In a mono-place chamber, the patient lies on a stretcher that slides into a large tube. This tube is then pressurized with 100% oxygen. HBO2 therapy is painless. In a mono-place chamber, the patient lies down comfortably and may listen to music, watch television, or even take a nap during the therapy session. They may feel fullness in their ears as they adjust to changes in air pressure at the start of the session. This is similar to what a patient feels in an airplane when landing. What if the patient has low blood glucose while in the chamber? Patients with diabetes have their blood glucose levels checked before entering the HBO2 chamber. Then, they can have a snack, if needed, to prevent low blood glucose. If the patient feels symptoms of low blood glucose or need any other kind of help, they can communicate with the attendants. HBO2 therapy chambers are monitored from the outside by people using advanced controls and computer systems. Mono-place chambers have two-way intercom systems so that patients can speak with attendants outside the chamber.

Do patients have to do anything special to prepare for HBO2 Therapy? There are several things to consider before starting HBO2 therapy: 

• Smoking: Nicotine makes blood vessels narrow. This limits the flow of blood and oxygen. Therefore, you should not use tobacco until all your HBO2 treatments are completed. 
• Medications: Some medicines change the way your body handles oxygen. It is important for patients to tell their health care team about all their medications, including any nonprescription drugs. 
• Report Illnesses: Cold or flu symptoms such as fever, cough, sore throat, nausea, headache or body aches may cause a delay in your treatment. These symptoms should be reported to your team as soon as possible. • Clothing: Patients will be given special clothes to wear during therapy. 
• Wound Dressings: There is no added benefit from oxygen coming into contact with the skin. Therefore, wound dressings are left on during treatments. 
• Personal Items: Most personal belongings aren’t allowed in the HBO2 chamber. Don’t bring in: 

           -  Tobacco products, matches or lighters
           -  Jewelry or other metal objects Electronic items, such as stereos or games
           -  Hair spray, make up, perfumes, deodorants or lotions
           -  Dentures or partial plates
           -  Contact lenses 

• Claustrophobia: If the fear of closed-in places is a problem, physicians may prescribe patients medication to relax them. How long will I get this therapy? Most wounds require 30-40 HBO2 treatments. The treatments are usually given daily, 5-6 days per week, for 90 minutes. As the health care team, you will decide how many treatments your patients need. Are there any side effects? Some patients report crackling or popping in their ears between visits. This can be eased by using the same tips shown for dealing with ear problems while in the chamber. Patients may have to have tubes put in their ears to relieve ear pain. Rarely, patients having HBO2 therapy have temporary changes in eyesight. If this happens, vision will return to normal within 6-8 weeks.

Hyperbaric Oxygen

Oksigen Hiperbarik

Terapi oksigen hiperbarik merupakan bentuk pengobatan, penderita harus berada dalam ruangan bertekanan  dan bernafas dengan oksigen murni 100% pada tekanan udara lebih besar dari pada udara atmosfer normal, yaitu sebesar 1 atm (760 mmHg). Keadaan ini dapat dialami oleh seseorang pada waktu menyelam atau berada dalam ruangan udara bertekanan tinggi (hyperbaric chamber) yaitu suatu ruangan kedap udara terbuat dari perangkat keras yang mampu diberikan tekanan lebih besar 1 atm (ruang kompresi) besarta sumber oksigen dan sistem penyalurannya ke dalam ruang rekompresi tersebut.

Dua efek penting yang mendasar pada terapi oksigen hiperbarik adalah:

• Efek mekanik meningkatnya tekanan lingkungan atau ambient yang memberikan manfaat penurunan volume gelembung gas atau udara seperti pada terapi penderita dekompresi akibat kecelakaan kerja penyelaman dan gas emboli yang terjadi pada beberapa tindakan medis rumah sakit.
• Efek peningkatan tekanan parsial oksigen dalam darah jaringan yang memberikan manfaat terapiutik: bakteriostatik pada infeksi kuman anaerob, detoksikasi pada keracunan karbon monoksida, sianida dan hidrogensulfida, reoksigenasi pada kasus iskemia akut, crush injury, compartment syndrome maupun kasus iskemia kronis, luka yang tidak sembuh, nekrosis radiasi,skin graft preparation dan luka bakar.

Terapi hiperbarik untuk pertama kalinya digunakan pada penyakit dekompresi (DeCompression Ilness), yaitu suatu penyakit yang dialami oleh penyelam dan pekerja tambang bawah tanah akibat penurunan tekanan saat naik ke permukaan secara mendadak. Dari berbagai penelitan terungkap bahwa oksigen hiperbarik mempunyai manfaat lebih, tidak terbatas pada kasus - kasus penyelaman saja. Suatu contoh terapi oksigen hiperbaik yang berhasil digunakan dalam mempercepat proses penyembuhan luka. Terapi oksigen hiperbaik sebenarnya merupakan terapi penunjang pada proses penyembuhan luka, Sedangkan perawatan utamanya sendiri adalah debridement dan penjahitan jika diperlukan.

Namun demikian oksigen hiperbarik dapat mempercepat proses penyembuhan luka, sehingga jaringan yang hipoksia memperlihatkan hasil yang baik pada terapi oksigen hiperbarik. Hal ini ditegaskan dalam hasil konfrensi kedokteran hiperbarik tahun 1991 di Ancona Italia, bahwa luka yang sulit sembuh (delayed wound healing) termasuk dalam kelompok Accepted Chronic Indication untuk terapi Oksigen Hyperbaric.