Having known folks who have been badly burned and having myself been badly burned, today’s discussion is thermal burns. But rather than re-inventing the wheel and simply authoring a similar article today, we share an interesting publication from the Undersea and Hyperbaric Medical Society (UHMS). UHMS are the global society to which most hyperbaric units belong and to whose standards many subscribe. Most health care authorities around the world acknowledge the UHMS as expert and adopt their list of indications for the commissioning of HBOT.
Granted, there are advocates for and in favour of the wider use of HBOT and the promotion of research into emerging and off label indications, and the use of experimental therapy where no other therapy has proved successful. We fall into this category, however we do also acknowledge that the 14 recognised indications by the UHMS are those which have greater scientific support at this time. There is certainly a middle ground to be found between the “cure all” mindset and the position that HBOT is limited to just the 14 indications. As mentioned before, the list of 14 was once upon a time a list of 1 and is evolving continuously as positive outcomes are observed.
Thermal burns falls into this area, in-between what are established and accepted as conditions for which HBOT is indicated, and those considered as emerging indications or conditions which are beginning to be thought of as those which can benefit from the administration of HBOT. The observable evolution of a global standard of practice.
Thermal burns are directly on the list of approved indications advocated by the UHMS, in the article cited here the UHMS conclude:
“Adjunctive HBO2 therapy can benefit each of these problems directly, and shows promise in the treatment of inhalation injury.”
Summarising their article to some degree follows:
Figures for the United States state that in the region of 2 millions burn cases are brought to medical attention annually. This leads to 14 000 deaths, 20 000 injures requiring specialist unit care, 75 000 requiring hospitalisation with about 25 000 remaining hospitalised for up to 2 months with the primary goal being rapid wound healing as key to survival.
Following a thermal burn injury, it is established that for as much as up to 72 hours following the initial injury, tissue degradation continues. Essentially, this means the burn continues to worsen for up to three days. During this time the underlying micro-vascular structure becomes compromised, capillary permeability increases, and oxygen delivery is compromised leading to tissue and cell death.
We previously discussed various aspects of wound healing and how injuries progress and how the natural response of inflammation and edema can complicate healing. This leads to the compromising of tissue viability. In the articles dealing with inflammation, wound healing and hypoxia, these mechanism are better explained. The UHMS article details this also.
Without repeating many of the other articles explanations, the long and short of this is that the physiological result of a burn is lowered or completely compromised oxygen delivery to the wound site. This as a direct result of the inflammation and initial tissue damage. This delays healing to the point where tissue loses its viability and progresses into the deeper layers of the burn and becomes unrecoverable. In these cases massive scarring is the end result, or in the worst of cases, infection can be fatal. The key to preventing this is rapid healing and the restoration of oxygen transport to the wound in the first 72 hours following the injury event. That is, before the tissue loses it’s viability from the now hypoxic conditions present.
Additional fluids present, caused by increased permeability of capillaries and the loss of the micro-circulation, delays or prevents healing in a thermal burn as can be observed by monitoring a burn in the days following injury. It is why burns take so long to heal. In most cases they leave behind significant scarring from tissue loss and become susceptible to infection. HBOT can arrest this wound progression in the 3 days following an injury event preventing the wound from worsening and also jump-starting and accelerating the healing process. After the initial 3 day period, HBOT accelerates healing and hastens recovery.
It is widely accepted that the application of hyperbaric oxygen therapy reduces inflammation, reduces and reverses edema, and restores oxygen delivery to wound sites. These are the key factors in thermal burn injury. During recovery, in the presence of a compromised vascular structure, HBOT delivers oxygen via blood plasma and up-regulates the growth of new capillaries. Referred to previously as being triggered by the vascular endothelial growth factor (VEGF) in the article on hypoxia.
Infection remains the leading cause of death in cases of death caused by burns. It is also well established that HBOT has significant anti-bacterial and antibiotic properties and helps fight and prevent infection in the same way it does in necrotising infections.
HBOT is a viable, affordable and effective therapy for thermal burns and can restore tissue viability and oxygenation to oxygen deprived tissue.
This is not to say don’t go to hospital or a specialised burns unit in the event of an accident. Not at all.
In emergency cases go directly to A&E or the ER.
The argument being made here is for more hyperbaric chambers in more hospitals and burn units and for wider follow up treatment with hyperbaric oxygen in non-hospital environments to improve outcomes and reduce the financial burden on the healthcare system.