Hyperbaric Oxygen Therapy - An Adjunct to Optimal Combat Trauma Management

摘要

Although wound statistics from Operation Iraqi Freedom are still being analyzed, a preliminary analysis of casualty data demonstrates that approximately 70% of the injured combatants sustained trauma to their extremities.(Malcolm 2004) During the acute management of these injuries at Echelon II and III medical facilities, approximately 75 - 100 major vascular reconstructions and 180 limb amputations were performed. Anecdotal reports reveal that a number of the wounded combatants required tissue grafting, flap reconstruction, revision amputation or treatment for resistant infection subsequent to their evacuation to tertiary care facilities. Indeed, of the 560 surgical procedures performed for combat related injuries aboard the USNS Comfort, approximately 31% were noted to be sufficiently complicated by persistent tissue necrosis, wound infection, graft failure or delayed wound healing that further surgical management was required.(Helmers 2004) Residual ischemia has been shown to play a role in each of these processes. Hyperbaric Oxygen (HBO2) has been shown to be an effective in reversing ischemia and limiting wound healing complications in hospital-based, clinical care settings. It is proposed that HBO2 therapy could be applied in Echelon II and III operational environments to similarly limit the extent of surgical debridements, improve tissue flap and graft survival, decrease wound infection rates, speed complex wound healing and, ultimately, reduce the morbidity experienced by wounded combatants. This paper discusses the physiologic mechanisms underlying HBO2 therapy's clinically beneficial effects, examines potential roles for HBO2 in the optimal management of combat-related trauma, and provides practical suggestions for HBO2 treatment.