HBO
IN COMPLEX TREATING OF ANAEROBIC INFECTION
Just
recently the treating of anaerobic infection (AI) has been a principle problem:
often lethality; usual complications. Since HBO has applied the belief in
success has appeared.
During
the HBO-procedure the concentration of oxygen in blood improves by 20 times;
this certainly makes the unsuitable environment for anaerobic microbes. But
the influence of oxygen on AI is much more complex and multichannel, as
represented:
Scheme
1. Mechanism of acting of HBO on AI.
Action
on micro flora:
a)
bacteriostatic;
b)
bactericidal;
c)
violating the synthesis of toxins;
d)
transforming the cultural, biochemical and virulent properties.
Action
on macroorganism:
a)
acceleration of reparation of transgressed organs and systems; b) activation
of phagocytic neutrophiles;
c)
improvement the amount of active neutrophiles;
d)
improvement the function of parenchimatous organs;
e)
stimulation erythro- and leucopoes;
f)
limitation the zone, damaged by AI;
g)
strengthening of reparation in focus of AI;
h)
diminishing the hypoxia;
i)
improvement of tension of oxygen in tissue.
The
indication is unproblematic: HBO is always desirable in case the AI. As the
absolute contraindications are absent, the conditional ones are rejected in
such emergency.
The
paracentesis of ears would be made if needed; as well it would be done for
unconscious patient; in case of cardiovascular or respiratory deficiency;
traumata of head. All oils or creams would be removed from skin.
At
the beginning of course the investigations of blood and urine; protein in
blood and fractions of protein; nitric residues and sugar in blood;
acid-alkaline balance and state of electrolytes. For determination of gases
the roentgenography of damaged tissue would be done. If the AI is localized in
extremity, the dynamics development of is determined according to Nikolaev's
method.
Bacteriologic
investigations are required for diagnosis as well as for determination of
degree of disease; the complex investigations are not needed; this would be an
express-diagnosis of presence of AI.
Surgeonal
treating of AI (incisions, necroectomies, amputations), been the principle
method of treating, changes to an additional one to HBO-therapy. This is, in
particular, because the patient is delivered to clinic very sick; any active
actions (even deleting of necrosed tissue) immediately causes the development
of toxemia; thus only HBO, based on its broad abilities can be applied.
Patients
with suppression of vessels by tissue inflation the white gangrene can
develop; thus after 1-2 procedures fasciotomy would be done.
Since
HBO is taken into account in treating of AI, the pathologic period can be
divided into four periods.
1.
The development of AI. It begins from the very beginning of disease and
finishes when HBO is applied - this takes usually 1-2 days - when the local
focus of disease develops as well as general state.
The principal task is to deliver the sick to the clinic,
that is equipped with barochamber. If it is impossible to do within 12 hours,
a usual operation would be done. The sooner HBO starts, the better.
Isopression would be done at 2AT, according to program:
Program of persuing of HBO at AI.
|
day
No. |
amount
of |
time
breaks (min.) |
interval
between procedures,
hours |
|||||
|
|
|
1
proc |
2
proc |
3
proc |
4
proc. |
1-2 |
2-3 |
3-4 |
|
1 |
4 |
80 |
80 |
60 |
60 |
4 |
6 |
6 |
|
2 |
3 |
60 |
45 |
45 |
--- |
8 |
8 |
-- |
|
3 |
2 |
45 |
45 |
--- |
--- |
12 |
-- |
|
|
4 |
1 |
45 |
--- |
--- |
--- |
12 |
-- |
--
|
Experimental data proves the efficiency of HBO against the most common excitator cl.perfringens and second one, cl. aedematiens; the method of persuing the HBO here still remains.
2. When the recreation begins (displayed in
lessening of intoxication, temperature of body; normalization of sleep and
appetite; stopping of development of necrosis in focus), the second period
starts - period of lessening the anaerobic infection. It usually comes after
3-4 procedures of HBO. The micro biological analysis performs reduction of
forms of excitators of disease and on contrary, the flora appears. The
fagocitar activity of neutrophiles restores - the purulent outlet from wound
appears.
The investigation of specific toxin by means of
reaction of flocculation and lecitinasal activity performs its absence. This
period usually lasts for 2-3 days.
As in first period, the main include in treating
makes HBO, antibiotic therapy and restoration of losses of water, electrolytes
and proteins.
The wound can already be ordered: exclusion of dead
tissue, disclosing of pockets and bladders would be done. More radical
surgeonal invasions are yet contraindicated because of danger of new flash of
anaerobe infection.
3. Period of purulent infection and rejection of
necroses. Clinical and bacteriological displays of anaerobic infection are
absent. But existence of vast wounds, usual secondary infection cause new
worthening of state. The main aim of treating in that period prevention of
sepsis and weakening of sick; suppressing of purulent infection. HBO can
stimulate the reparative processes.
A good stump can hardly be received at that period;
but sometimes the amputation is necessary because of obvious unsuitability of
extremity, complicated by vast wound or osteomyelitis.
4. After the wound becomes clean, the fourth period
arrives. The reparative treating is applied; reamputation and plastic
operations are done, if needed. The gas bacillus antitoxin suppresses only one
selected toxin with no influence on the others. On the other hand, large
injection of external protein usually results in worthening of state of sick.
As an alternative to antitoxin therapy HBO can be recommended. If the
application of HBO was started no more than 12 hours from the start of
disease; the antitoxins are of no use; otherwise the treating would be done as
usual.
Anyhow, after the HBO starts, antitoxins would be
excluded from treating.