Hyperbaric oxygen therapy reduces thermal wound complications and length of stay in hospitals, study finds

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oxygenHyperbaric oxygen therapy (HBOT) can reduce thermal wound complications, length of stay in hospitals due to thermal burns, intercellular adhesion molecule 1 (ICAM-1) mRNA gene expression, and ICAM-1 serum level, a case-control study published in Annals of Medicine and Surgery concludes.

“The damaging effects of thermal burns need to be managed holistically in order to create a suitable environment for wound healing,” study author Mendy Hatibie Oley (University Sam Ratulangi; R D Kandou Hospital; Hyperbaric Centre Siloam Hospital; all Manado, Indonesia) et al write. The investigators set out to evaluate the effects of HBOT on the healing of thermal burns and its relationship with ICAM-1.

“More than two-thirds of deaths due to thermal burns occur in underdeveloped and developing countries in Africa and the Asia-Pacific region,” they write. “Thermal burns can also cause high morbidity, prolonged hospitalisation, disability, and limitations in performing daily activities, not to mention generate high costs.”

Oley and colleagues explain that the inflammatory process that occurs due to burns increases the production of pro-inflammatory cytokines, which in turn stimulate the production of ICAM-1 via nitrogen oxide cells. The receptor of ICAM-1, a human protein coded by the ICAM-1 mRNA gene, attaches to endothelial cells such that leukocytes can firmly attach to the endothelial surface. When that binding occurs, leukocytes spread and slowly migrate through the endothelium.

“HBOT works by increasing the pressure of oxygen such that it can directly diffuse into various tissues,” the authors describe. “The inhalation of 100% oxygen at pressures greater than sea level at 2–2.5atm absolute (ATA) for 90–120min, twice daily, is recommended by the Undersea and Hyperbaric Medical Society. The effects of increased oxygen supply include angiogenesis, the inhibition of aerobic bacterial growth, increased fibroblast proliferation, increased leukocyte activity, reduced tissue oedema, and vascular contraction, the last of which reduces stromal fluid transudation and the occurrence of oedema.”

Hoping to see these benefits in action, the investigators randomly divided twenty patients with thermal burns into two groups: the cohort that received HBOT, and the control arm.

Levels of the ICAM-1 mRNA gene and ICAM-1 serum, along with the degree of wound epithelialisation, were examined before and after treatment. Laboratory and physical findings between the groups were compared.

In the HBOT group, thermal wound complications were significantly reduced (p=0.006) compared with the control group, while length of stay in hospital was substantially reduced (p=0.001). ICAM-1 serum levels strongly correlated with ICAM-1 mRNA gene expression (R2=0.909, p<.001). The expression of the ICAM-1 mRNA gene (12.32±1.31 vs. 10.79±1.38) and ICAM-1 serum level (231.46±37.20 vs. 158.23±68.30) in patients with at least a 50% burn area exceeded those of patients with a smaller burn area.

HBOT significantly decreased (p<.05) the expression of the ICAM-1 mRNA gene and ICAM-1 serum level (p=0.004). The number of HBOT sessions strongly correlated with ICAM-1 serum level (p=0.043) but poorly correlated with ICAM-1 mRNA gene expression (p=0.22). The expression of the gene, however, strongly correlated with ICAM-1 serum level (r=−0.988, p<0.001).

Oley and colleagues conclude: “Our study revealed several benefits of HBOT, including its ability to reduce thermal wound complications, the length of hospital stays due to thermal burns, and both ICAM-1 mRNA gene expression and ICAM-1 serum level. Those effects of HBOT have proven supportive in holistically managing thermal burns. A limitation of our study, however, was that the speed of epithelisation between the HBOT group and control group was not compared, such that no significant correlation could be captured. Other applications of HBOT in managing thermal burns should be further examined in future studies.”

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