For decades, burns remain one of the major problems putting a financial burden on patients as well as the state. According to WHO, 180,000 deaths are caused by burn cases each year. It puts a significant liability on the health care system because of prolonged medication, hospital stay, infections, and high costs. Hyperbaric oxygen therapy (HBOT) is recently been found to be effective as adjunctive therapy along with the usual treatment for severe burn cases. HBOT refers to the provision of a high concentration of oxygen (up to 95%) at 2ATA pressure in an enclosed chamber.
HBOT was found effective to heal the second-degree burn wounds of affected coal miners in 1965. The therapy helped the affected people recover from second and third-degree burns due to the delivery of oxygen to the nearby cells of wounds. Most of the studies aiming at wound healing kinetics are performed on animal models and further clinical studies are needed to prove its efficiency and safety.
Classification of burns
Before knowing about the efficacy of HBOT for burns, it is important to know about the types of burns. The burn wounds can be classified on the basis of severity as:
1. Superficial or First-degree burns
It is analogous to mild sunburn that involves only the top layer (epidermis). The burnt site becomes painful and red, but without blisters. It is temporary and there is no long-term tissue damage associated with it. It might lead to darkening or lightening of the skin.
2. Partial-thickness or Second-degree burns
Second-degree burns are characterized by blistering, glossy appearance, severe pain, burning, and leakage of tissue fluid. It affects the epidermis and dermis.
3. Full-thickness or Third-degree burns
It is a severe case where all the layers of skin get damaged, followed by patchy skin, blackening, and scaling. The affected person may not feel pain as all the tissue gets damaged and the pain may be due to those specific areas where the wound is confined to the top two layers of the skin.
4. Deep or Fourth-degree burns
These burns involve all skin layers, tendons, muscles, and even bones. These cases are vulnerable to chronic infection and may be fatal.
HBOT is not needed for first-degree burns, and in most cases implied for second and third-degree burns.
Mechanism of action of HBOT
HBOT floods the body cells with plenty of oxygen that rejuvenates and heals. The skin tissue around second and third-degree burns becomes hypoxic due to damage to cells. When cells get damaged along with blood vessels, the blood supply to the cells gets affected, resulting in insufficient oxygen supply. Healing requires a series of reactions for which proper oxygenation is critical. In such hypoxic conditions, it is hard for skin to undergo neovascularization, cell division, proliferation, angiogenesis, and epithelialization.
This lack of oxygen in the burn site and surrounding tissues causes cell death and dead cells are attacked by immune cells, called ischemia-reperfusion injury. Within 2 to 3 days of injury, HBOT saturates the cells nearby the damaged area, activating the normal metabolism that keeps them alive. As a result, the immunogenic response against these cells is suppressed and normal healing and tissue regeneration start over.
The beneficial effects of HBOT are beyond these initial days of injury. In the long-term, HBOT helps in healing due to the following facts:
● Promotes tissue growth
● Accelerates neovascularization
● Increases microcirculation
● Boosts fibroblasts production
● Enhances collagen production
● Reduces inflammation
● Controls infection
● Lessens the chances of developing gangrene (caused by anaerobic bacteria)
In a nutshell, HBOT works magically for severe burn cases and mostly it is accompanied by usual treatment procedures at hospitals. It is a potent therapy to control the rates of morbidity and mortality due to burns.
Boost in immunity
HBOT regulates stem cell proliferation, which ultimately increases white blood cell function. The immunity of the individual enhances due to the increased functioning of WBCs. Infections in deep wounds contribute significantly to the death rate. Healthy immune functioning reduces the risk of getting secondary infections via damaged skin tissue. Skin is the main line of defense acting as a physical barrier, and deep burn wounds invite pathogenic bacteria and fungi to feed host tissue. HBOT boosts immunity which is critical to fighting pathogenic microorganisms.
Speedy healing
Sufficient oxygen supply helps wounds heal faster than in a hypoxic environment. Furthermore, HBOT lessens the scarring and fatality to more than 80 percent. Physical scars cause long-term emotional and mental sickness in the affected individuals. Skin rejuvenation and reduced scaring in HBOT users relieve them from social pressures and bullies, and they can spend a healthy life again.
Recommended dose
The recommended dose by the Undersea &Hyperbaric Medical Society is the inhalation of pure oxygen at 2-2.5 atm pressure for 90-120 min, twice daily. But for cases of burns, one can have only therapeutic HBOT. In therapeutic HBOT, doctors use a hard shell hyperbaric oxygen chamber depending upon the medical history and severity of the wound. Softshell hyperbaric oxygen chamber cannot be used for burn cases as it is operating at less oxygen pressure and mild.
Risks associated with HBOT for burns
As mentioned before in the article, HBOT for burn cases is always done by medical professionals for therapeutic purposes. Consequently, the users must not get worried about the risks associated with it because everything is fairly watched out by physicians, however, the users must provide their medical history in detail. Earache, nausea, seizures, and other such mild symptoms may occur and must be addressed timely.
When it comes to the selection of hyperbaric oxygen chambers, then Oxyhelp hyperbaric oxygen chambers are matchless in their quality, performance, cost, and user-friendliness.
Conclusion
Though we have limited data available for HBOT used in burn cases. But according to reports, HBOT is a potential candidate to relieve the pain and misery of burn cases when combined with conventional treatments. It not only speeds up healing but also reduces scar formation and prevents the development of secondary infections due to microbial invasion.
