Transcript Sample Document Title - St. Joseph Mercy Oakland

The Role of Hyperbaric Oxygen
Therapy and Wound Healing
Brian G. Halloran, MD
Medical Director, Center for Wound Care
and Hyperbaric Medicine
St. Joseph Mercy Hospital
Ann Arbor, Michigan
Objectives
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Provide background on role of hyperbaric
oxygen treatment for chronic wounds and other
FDA-approved conditions
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Inform how evidence-based practice and a
multi-disciplinary wound team can optimize
treatment and healing for ORL/HN disease
Disclosures
Commercial Interest-St Joseph Mercy Health
System
Financial Relationship-Physician Purchased
Services and Medical Director
Conflict of Interest-Exempt, given the non-profit
status of SJMHS
What is a Wound Center?
A Wound Center Treats Chronic Wounds
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Chronic wounds have prolonged proinflammatory stimulus
• One time or repeated injury → fail to proceed through normal
phases of wound healing
• Present for at least 4 weeks, to months, to years
Types of Chronic Wounds
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Infectious wounds
Ischemic wounds
Radiation wounds
Surgical wounds
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Arterial ulcers
Venous ulcers
Diabetic ulcers
Pressure ulcers
Chronic wounds are not defined by size,
complexity or failure to heal
with your initial therapy
What is Hyperbaric Oxygen Therapy?
HBOT is breathing 100% oxygen while under
increased atmospheric pressure
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Have You Ever Been
in a Hyperbaric Chamber?
Elevation
Air Pressure
Sea Level
14.7 psi
Denver
12.1 psi
Mount Everest
4.6 psi
34,000 feet
3.6 psi
Airplane cabin at
33,000 feet
10.9 psi
Oxygen Physiology
Atmospheric Pressure Breathing Gas
Measured PaO2
1.0
Room air (21% oxygen)
90-95 mmHg
1.0
100% oxygen
507 mmHg
3.0
100% oxygen
1721 mmHg
Since more oxygen is in solution in plasma
while under pressure, it can reach areas
where RBCs may not be able to pass
HBO Mechanisms of Action
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HBOT increases the generation of oxygen free radicals, which
have bacteriostatic/bactericidal actions
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HBOT stimulates stem cells to produce and release growth
factors
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Vasculogenic stem cells are mobilized to areas of wounding
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Since fibroblast proliferation and collagen synthesis are
oxygen-dependent, angiogenesis can occur in ischemic tissue
Effects of Hyperoxygenation
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Plasma quickly becomes saturated with O2
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Elevated O2 levels in blood stream return to normal
within 10 minutes after completing hyperbaric
exposure
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O2 tension in muscle tissue remains elevated for 12 hours post-exposure
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O2 tension in subcutaneous tissue remains elevated
up to 4 hours post-exposure
3 Main Effects of HBOT
1)
Delivery of O2 to hypoperfused tissue
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Limits ischemic damage
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Promotes collagen synthesis
2)
Generation of Oxygen Free Radicals
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Helps kill bacteria
3)
Vasoconstriction
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Decreases tissue edema
FDA-Approved Indication for HBOT
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Air/Gas embolism
Carbon monoxide
poisoning
Cyanide poisoning
Gas gangrene
Crush injury
Decompression
sickness
Diabetic foot wounds
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Necrotizing soft tissue
infections
Osteoradionecrosis
Delayed radiation injury
Compromised skin
graft/flaps
Central retinal artery
occlusion
Refractory
osteomyelitis
Intracranial abscess
Off-label Uses of HBOT
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AIDS/HIV
Autism
Alzheimer’s disease
Asthma
Bell’s palsy
Brain injury
Cerebral palsy
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Hepatitis
Migraine
Multiple sclerosis
Parkinson’s disease
Spinal cord injury
Sports injury
Stroke
Applications
Proposed or Studied for ORL-HNS
• Osteoradionecrosis
• Chondroradionecrosis
• Enhancement of graft/flap viability
• Tracheocutaneous fistula
• Skull base osteomyelitis
• Sudden SNHL
• Bells’s Palsy
• Radiation sensitization
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Radiation Injury
Marx Triad
• Hypocellularity, Hypovascularity, Hypoxia
Endarteritis Obliterans
• From progressive capillary loss and tissue fibrosis
Manifests as:
• Pigmentary skin changes, tissue induration, loss of
elasticity, local erythema, tenderness/pain, osteoavascular necrosis, tissue ulcers
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HBOT for Radiation Injury
Hyperoxygenation
• Increased oxygen gradient to central hypoxic
area
Angiogenesis
• Is oxygen-dependent
Increased Capillary Density
• Occurs after multiple HBOT treatment sessions
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HBOT and Cancer Growth
Theoretical
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Cellular turnover/division is oxygen-dependent
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Does HBOT enhance tumor growth?
Current Experiments
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Cell culture and mouse models of SCCa showed no
difference between HBOT and normal O2
Systematic Reviews
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Have failed to support any concern
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Malignant neoplasm may follow a different pathway of
angiogenesis than wound healing
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Summary
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HBOT is breathing 100% oxygen while under
increased atmospheric pressure
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Most benefits derived from 30-40 treatments of 90minutes at 2.4 atm
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Supported ORL-HNS indications for ORN, CRN,
radiation-soft tissue injury and flap/graft survival
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Cost are significant ($15K), but savings likely in
proven indications
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Comments and/or Questions
©2015 Trinity Health - Livonia, MI
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Break!
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