Bouachour G, Cronier P, Gouello JP, Toulemonde JL, Talha A, Alquier P, et al.
The Journal of trauma. Date of publication 1996 Aug 1;volume 41(2):333-9.
1. J Trauma. 1996 Aug;41(2):333-9.
Hyperbaric oxygen therapy in the management of crush injuries: a randomized
double-blind placebo-controlled clinical trial.
Bouachour G(1), Cronier P, Gouello JP, Toulemonde JL, Talha A, Alquier P.
Author information:
(1)Service de Réanimation Médicale, Centre Hospitalier Universitaire, Angers,
France.
Hyperbaric Oxygen (HBO) therapy is advocated for the treatment of severe trauma
of the limbs in association with surgery because of its effects on peripheral
oxygen transport, muscular ischemic necrosis, compartment syndrome, and infection
prevention. However, no controlled human trial had been performed until now to
specify the role of HBO in the management of crush injuries. Thirty-six patients
with crush injuries were assigned in a blinded randomized fashion, within 24
hours after surgery, to treatment with HBO (session of 100% O2 at 2.5 atmosphere
absolute (ata) for 90 minutes, twice daily, over 6 days) or placebo (session of
21% O2 at 1.1 ata for 90 minutes, twice daily, over 6 days). All the patients
received the same standard therapies (anticoagulant, antibiotics, wound
dressings). Transcutaneous oxygen pressure (PtCO2) measurements were done before
(patient breathing normal air) and during treatment (HBO or placebo) at the
first, fourth, eighth, and twelfth sessions. The two groups (HBO group, n = 18;
placebo group, n = 18) were similar in terms of age; risk factors; number, type
or location of vascular injuries, neurologic injuries, or fractures; and type,
location, or timing of surgical procedures. Complete healing was obtained for 17
patients in the HBO group vs. 10 patients in the placebo group (p < 0.01). New
surgical procedures (such as skin flaps and grafts, vascular surgery, or even
amputation) were performed on one patient in the HBO group vs. six patients in
the placebo group (p < 0.05). Analysis of groups of patients matched for age and
severity of injury showed that in the subgroup of patients older than 40 with
grade III soft-tissue injury, wound healing was obtained for seven patients
(87.5%) in the HBO group vs. three patients (30%) in the placebo group (p <
0.05). No significant differences were found in the length of hospital stay and
number of wound dressings between groups. For the patients with complete healing,
the PtCO2 values of the traumatized limb, measured in normal air, rose
significantly between the first and the twelfth sessions (p < 0.001). No
significant change in PtCO2 value was found for the patients whose healing
failed. The Bilateral Perfusion Index (BPI = PtCO2 of the injured limb/PtCO2 of
the uninjured limb) at the first session increased significantly from 1 ata air
to 2.5 ata O2 (p < 0.05). In patients with complete healing, the BPI was
constantly greater than 0.9 to 2.5 ata O2 during the following sessions, whereas
the BPI in air progressively rose between the first and the twelfth sessions (p <
0.05), reaching normal values at the end of the treatment. In conclusion, this
study shows the effectiveness of HBO in improving wound healing and reducing
repetitive surgery. We believe that HBO is a useful adjunct in the management of
severe (grade III) crush injuries of the limbs in patients more than 40 years
old.
PMID: 8760546 [Indexed for MEDLINE]
