"Moderate to Major Thermal Burn Patient Could Benefit from Hyperbaric Oxygen Therapy in Wound Healing"

Introduction:

Hyperbaric oxygen therapy (HBOT) has been known for its benefit in wound healing from animal trials and clinical studies. Many clinical studies manifested various benefits in thermal burn patients. However, whether HBOT could reduce wound healing time is still not firmly established. We conducted a retrospective study to evaluate the effect of HBOT in wound healing rate, burn center stay, hospital stay, and debridement times in moderate to major thermal burn patients.

Patients and Methods:

There were 74 patients who had been admitted to Kaohsiung Medical University Hospital (KMUH) burn center with moderate to major burn injury between March 2007 and March 2014. The inclusion criterion was second to third degree thermal burn with at least 15% TBSA (total body surface area) involvement. We excluded patients younger than 18 years old and those having burn area larger than 40%. The remaining patient number with available medical burn wound records is 36. We divided the patients into two groups: the HBOT group as 18 patients who began to receive HBOT while in burn center and undergone standard burn care; and the non-HBOT group as other 18 patients who only undergone standard burn care. We compared age, TBSA, length of burn center stay, length of hospital stay, debridement times between these two groups.

In particular, we specifically calculated the individual reductions of burn wound percentage in eight separate regions in 27 patients (14 patients in HBOT group and 13 patients in non-HBOT group) whose medical records contained detailed wound area data. With this method, there were 70 and 70 wound area reduction rates per region obtained in these two groups respectively.

SPSS version 20.0 was adopted for data analysis.

Results :

There were no significant differences in age (42.67 ± 2.57 versus 45.17 ± 4.19 year; p value = 0.556), burn center stay (20.56 ± 1.93 versus 16.56 ± 1.73 days; p value = 0.111), hospital stay (31.89 ± 2.96 versus 24.39 ± 2.75 days; p value = 0.056), or debridement times (0.94 ± 0.25 versus 0.67 ± 0.20; p value = 0.399) between these two groups using paired T-test. However, the HBOT group had significantly larger TBSA than non-HBOT group (22.61 ± 1.52 versus 21.17 ± 1.47 percent; p value = 0.000).

When comparing the wound area reduction rate in 70 and 70 regions in the 27 patients whose medical records contained detailed wound area data, faster wound healing rate was found in HBOT group using independent T-test (0.25 ± 0.20 versus 0.20 ± 0.16 percent/day; p value = 0.035).

Discussion :

Even though it is clear that HBOT have many advantages in wound healing, there has been no strong evidence to support its benefit in burn wounds. There was only one randomized controlled trial (Hart et al. 1974) that showed shorted mean wound healing time in burn patients received HBOT than those didn’t to date. Other non- randomized controlled studies demonstrated various results.

We divided the wounds into eight different regions and calculated each wound healing rate at each region. This made us have more precise wound area reduction data. The result revealed faster wound healing rate was found in HBOT group.

The relatively larger TBSA in HBOT group patients might be the reason why there was no significantly difference between two groups in burn center stay, hospital stay and operation times.

Conclusion :

HBOT appears to have its benefit in moderate to major thermal burn adult patients in wound healing rate.