HBO
IN PROPHYLAXIS OF INFECTION IN OPEN WOUND.
Practical recommendations.
The prophylaxis of infection in open wound (WI) is an
actual problem.
The mechanization of everyday life causes, in
particular, improvement of hard mechanical violations, often added with shock
and sharp bleedings.
One of the principal phenomenon in pathogenesis is
hypoxia. This is the reason for application of hypoxia in treating of WI.
It is also proved that HBO improves metabolism; micro
circulation; prevents from trombosis and inflation. All that assists the
regeneration and reparation on zone of trauma.
Clinic application of HBO for 120 patients divided in 2
groups: main (with application of HBO) and control (without it) with hard open
trauma of extremities represented the efficiency of HBO in prophylaxis of
infection. The percent of
complications (Purulence; osteomielitis; sepsis) in main group was 2,4 times
less than in control one.
Indication for application of HBO in prophylaxis of WI.
Hypoxia in sharp period of trauma can severely violate
central hemodynamics; local circulation and micro circulation in zone of
trauma; external respiration and immunity in period from 1 - 3 day after
trauma.
Central hemodynamics was investigated by means of tetra
polar reography.
For patients of age younger 45 hyperkinetic circulation
responded the tissue hypoxia. For those older 45 a myocard dystrophy and
cardiac ishemia of stenocardy of rest and tension developed. Usual was the
development of hypokinetic circulation. Reovasography of violations of damaged
extremities and radioisotope investigations represented the violation of
arterial and venose circulation, caused by improved vascular tonus, in zone of
trauma.
Hard trauma usually causes the violation of external
respiration; wave respiration, inlet breathes and compensatory
hyperventilation syndrome. The gaseous composition of capillary blood remained
unchanged because of hyperfunctional loading of myocard of respiration.
Some indexes of immunity also changed after trauma.
HBO lessened the loading of myocard in period of
hypercinetic circulation by reduction of oxygental shortage in body. This
oxygenation of cardiac muscle also improved its squeezing ability.
Normalization of metabolism in tissue diminished
hypertonus in vessels and improved micro circulation. This caused acceleration
of healing the wound.
HBO bettered oxygenation of tissue; this is the
protective mechanism against violations of compensatory system.
Thus the prevention of WI after hard open trauma is
caused by influence of HBO on violations of central hemodynamics; local
circulation; micro circulation; external respiration and immunity.
Indications for HBO.
HBO is indicated for prophylaxis of:
1. amputations;
2. open squeezes of extremities;
3. vast wounds of extremities with skin detachment and
violations of tissue, vessels and nerves;
4. trauma of crus and foot (for this localization the
infection is usual).
Absolute contraindications are lung caverns and
epilepsy; conditional ones are otorhinolaryngologic diseases and
claustrophobia.
Application and regime of HBO in prophylaxis of WI.
An individual approach is needed with taking into
account age, additional diseases, degree of pathology and sensitivity to
hyperbaric oxygen.
For better prophylaxis of WI HBO would be started as
soon as possible after surgeonal treating of wounds, but no later than 3-d day
after it. Roentgenoscopy of lung is compulsory in advance.
For prophylaxis of otorhinolaryngologic diseases
ephedrine or naphtysine solutions are desirable.
All kinds of oil and creams as well as metal
accessories would be removed from the skin before the procedure; the dress
would be cotton-sewed.
Before the first five procedures an inter muscular
injection of 50% solution of analgin (2 ml.) is desirable to lessen the pain
in wound during the compression. Later this isn't required (probably because
the body is customizing to hyperbaric oxygen.
The damaged zone of body would be placed on a rubber roller to be on
the top of it. For the control during the procedure electrodes are applied.
Among 120 patients HBO was contraindicated for 12
(10%): because of otorhinolaryngologic diseases - for 10; because of
claustrophobia - for 2.
The regime of HBO in important for preventing the
infections. In "Oka-MT" the lower figure of pressure that prevents
infection is 1,8AT; compression time - 15-20 min.; isopression period - 40-60
min. this would be unchanged for all course (8 - 10 procedures; once a day).
If the trauma is hard, first three days 2 procedures a day can be applied with
compulsory break no less than 3 hours.
We believe pressure of 2AT as not dangerous one (after
treating of above 1000 patients) for sicks. As the result the period of
inflation reduces by 5 - 7 days. A dry necrosis is formed as the border of
wound. During the procedure tender tissue changes its color to pink; tissue
liquid appears.
The contraindication for large pressure (2AT) are
ishemia with pulse violation; pneumosclerosis; emphysema of lung with
respiratory deficiency. The pressure would be reduced to 1,8AT or even lower.
For control pulse, existence of cardiac pain and improvement of respiratory
rhythm can be used. Certainly the pressure below 1,8AT can't prevent WI;
nevertheless it can positively influent the state of sick.
Anyhow HBO by no means can substitute other kinds of
therapy of WI.
In Sclifosovsky Institute HBO is used in complex of
measures, including surgeonal operation; antibiotic's application; other
medicines (hyperimmunal devices, etc.); transfusional therapy for the
correction of metabolism.
Professor
B. Komarov,
Professor
Yu. Isakov,
Doctor
I. Byalik,
Doctor
Z. Atroschenko.