Acute Thermal Burn Injury

Hyperbaric Oxygen is used as a valuable adjunct to traditional management of extensive thermal burns. The theory underlying this comes from Gruber (1970) who showed that third degree burn tissue is hypoxic in comparison to normal skin and only oxygen under pressure can address this. Other animal studies have shown that HBO will reduce oedema, improve healing times and increase survival.Hyperbaric Oxygen is used as a valuable adjunct to traditional management of extensive thermal burns. The theory underlying this comes from Gruber (1970) who showed that third degree burn tissue is hypoxic in comparison to normal skin and only oxygen under pressure can address this. Other animal studies have shown that HBO will reduce oedema, improve healing times and increase survival.Nylander et al (1984) showed a reduction in generalised oedema in animals inflicted with a scald burn if treated with HBO.

Kaiser (1992) showed in rabbits treated with HBO, wounds remained much smaller than controls with the same size burn injury. Those treated also developed less oedema, did not convert from partial thickness to full thickness burns and preserved tissue ATP levels.

Bilic (2005) reproduced these effects in a randomised controlled trial in deep second-degree burns on rats. In addition, a significant reduction in time to epithelial regeneration(p<0.05) was seen.

Clinical studies have shown also shown an improvement in outcome. Hart (1974) performed an initial small RCT which showed a reduction in fluid requirements and shorter mean healing time. Two further RCTs are also worth mentioning.Merola (1978) found in patients with partial thickness burns that those receiving HBO had a shorter healing time.Brannen (1997) had mixed outcomes. However, the study had some serious limitations. There was a significant delay in administration of hyperbaric oxygen in some patients and this data was not examined separately. There were also problems with the way the groups were split and other confounding factors were not accommodated within the data analysis. Outcomes showed no reduction in hospital stay, number of surgical procedures or mortality. However, there was a reduction in fluid loss from wounds and thus fewer dressing changes. Analysis later showed a reduction in overall cost of care.

Retrospective case series studies by multiple other authors have shown

• Improved healing
• Reduced hospital stay
• Reduced need for surgery
• Reduced wound sepsis.

For information and references regarding this indication please contact us on info@ddrc.org.

Treatment course would be decided on a case by case basis.

Cases that are accepted are often serious but survivable.

• Greater than 20% TBSA and/or with involvement of the hands, face, feet or perineum
• Deep partial or full thickness injury.

Further information regarding the Referral and Funding process can be found here.

References

The Royal College of Surgeons of Edinburgh

          Hyperbaric Oxygen Therapy Indications (2014)

Lindell K, Weaver MD EditorsUndersea and Hyperbaric Medical Society13th                                 Edition 2014: P113-138

Bilic (2005)

Bilic I, Petri NM, Bota B“Effects of hyperbaric oxygen therapy on experimental burn wound healing in rats: a randomised controlled study”Undersea Hyperb Med2005;32(1):1-9

Brannen (1997)

Brannen AL, Still J, Haynes M et al“A randomised prospective trial of hyperbaric oxygen in a referral burn centre population”Am Surg1997;63:205-208

Gruber (1970)

Gruber RP, Brinkley B, Amato JJ, Medelson JA“Hyperbaric oxygen and pedicle flaps, skin grafts and burns.Plast and Recon Surg1970;45:24-30

Hart (1974)

Hart GB, O’Reilly RR, Broussard ND, Cave RH, Goodman DB, Yanda RL“Treatment of burns with hyperbaric oxygen”Surg Gynaecol Obstet1974 Nov;139(5):69-696

Kaiser(1992)

Kaiser W, Voss KInfluence of hyperbaric oxygen on the edema formation in experimental burn injuriesIugoslaw Physiol Pharmacol Acta.1992;28(9):87-98

Merola (1978)

Merola L, Piscitelli F“Considerations on the use of HBO in the treatment of burns”Ann Med Nav1978;83:515

Nylander (1994)

Nylander G, Nordstrom H, Eriksson E.“Effects of Hyperbaric oxygen on oedema formation after scald burn”Burns Incl Therm Inj1984 Feb;10():193-196