DDRC Healthcare, Plymouth, Devon

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HBO & Crush Injury

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Crush Injuries: The value of this approach is well illustrated in crush injuries which, in addition to soft tissue trauma, may also feature broken bones, neurological injury, and vascular damage. Surgery can be employed to stabilise fractures and to repair nerves and vessels, but there are no surgical interventions that address tissue damage at the microvascular level.

The best evidence for the use of HBO therapy comes from a controlled trial performed by Bouachour, Cronier et al. (Bouachour G, Cronier P, Gouello JP, Toulemonde JL, Talha A, Alquier P. 1996. Hyperbaric oxygen therapy in the management of crush injuries: a randomised, double-blind, placebo-controlled clinical trial. J Trauma, Injury, Infection and Clin Care, 41: 333-339). Following initial surgery within six hours, 36 cases of Gustilo and Anderson grade two or three crush injury were randomised within 24 hours of surgery to either treatment with HBO (100% O2 at 2.5 ATA for 90 minutes, twice daily for six days), or sham hyperbaric treatment (21% O2 at 1.1 ATA, identical treatment schedule). The two groups were similarly treated with antibiotics, anticoagulants and wound dressings and were similar in respect of age, co-morbidities and injury patterns. Results showed that 17 patients achieved complete healing in the HBO group, compared to ten in the sham group (p<0.01). Following blind reassessment, six patients in the sham group, but only one patient in the treatment group required a second surgical intervention (p<0.05). Sub-group analysis revealed that the addition of HBO had been especially effective in patients aged over 40 with grade three injuries. In this sub-group, there were seven successes and one failure in the HBO group, but three successes and seven failures in similarly aged patients treated with sham therapy (p<0.005).

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