hyperbaric oxygen therapy

sehealth.org

hyperbaric oxygen therapy

C A R D I O L O G Y

Patients diagnosed

with peripheral artery

disease (PAD) have

reduced blood flow

and oxygen to the lower

extremities due to narrowed

or clogged arteries. While early

signs are often asymptomatic, patients

often present with later stage

claudication, swelling or discoloration

in the legs or with chronic, non-healing

wounds or ulcers in the lower

extremities.

Rapid evaluation and treatment of

chronic wounds is critical to avoiding

major complications such as

amputation. At the Southeast Wound

Care and Hyperbaric Medicine center,

specialists are available to assess and

treat chronic wounds and offer

adjunctive therapies for PAD patients.

Laura Holmes, MD, is the

only board-certified

specialist in both

hyperbaric medicine and

wound care in Cape Girardeau.

“Heart patients most likely also have

peripheral vascular disease. In addition,

we see many patients with the added

complication of diabetes,” says Laura

Holmes, MD, director of the Center.

“When they have a non-healing wound

or ischemic ulcer, we need to work

collaboratively with interventional

radiologists, vascular surgeons,

cardiologists and podiatrists to treat

both the ulcer and the underlying

peripheral artery disease.”

Ischemic ulcers are twice as

common in patients with both

diabetes and peripheral artery

disease versus just diabetes.

hyperbaric

oxygen

therapy

Adjunctive Treatment for Patients

with Peripheral Artery Disease

In a survey of Medicare beneficiaries

between 2006 and 2008 and published

by the Agency for Healthcare Research

and Quality in 2011, researchers found

that the incidence of ischemic ulcers

was more than two times greater in

patients diagnosed with both diabetes

and peripheral artery disease versus

just diabetes. In fact, the prevalence of

macrovascular complications in each of

the three years studied was just over 65

percent.

HYPERBARIC OXYGEN

THERAPY

In some cases where PAD patients

have developed ischemic ulcers,

hyperbaric oxygen therapy (HBOT) is

an ideal adjunctive therapy to other

medical interventions. “It is thought

that pressurized oxygen triggers

angiogenesis, the growth of new blood

vessels, as well as stem cell

development,” says Dr. Holmes.

The key is to determine which patients

will benefit from HBOT. Since the mid-

1990s, several research studies have

found that transcutaneous oxygen

monitoring (TCOM) is a powerful

predictor of healing potential and an

indicator of whether or not hyperbaric

oxygen treatments may help with

healing.

Dr. Holmes uses TCOM in combination

with a comprehensive evaluation to

help select patients who may benefit

from hyperbaric oxygen therapy.

“Here, we tend to err on the side of

treating if there is any chance the

patient can avoid amputation,” says Dr.

Holmes. “In my 10 years of offering

hyperbaric therapy, I’ve found that the

fine science of hyperbaric medicine is

not necessarily knowing when to place

people in a hyperbaric chamber, it’s

knowing when to stop because there is

no more benefit.”

SoutheastHEALTH has two

hyperbaric chambers.

The treatment involves a lengthy

commitment from patients who must

come five days a week for two or three

months. “It takes about three weeks to

trigger angiogenesis and keep it

progressing, so there’s a huge

commitment on a patient’s time to

complete a course of therapy,” says Dr.

Holmes.

Referrals for adjunctive hyperbaric

oxygen therapy to treat chronic wounds

come from both cardiac specialists and

primary care physicians. Initial patients

at the Southeast Wound Care and

Hyperbaric Medicine center undergo a

comprehensive evaluation along with

baseline blood tests and tissue cultures

from the site of the wound. TCOM tests

as well as an ankle-brachial index will

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c o n s u l t

S o u t h e a s t H E A L T H


To avoid complications

such as amputation, rapid

evaluation and treatment of

chronic wounds is critical.

EXPEDITE REFERRALS FOR

PATIENTS WITH…

be performed to

evaluate oxygen

levels and blood

flow to the

lower

extremities.

• Large open wounds more than

an inch across

• Non-healing wound that has

not improved over several

weeks

• Any wound that involves a

tendon ligament, bone or joint

• Ischemic leg wounds

• Wound in patients with

co-morbidities such as diabetes

or cardiovascular disease

“You should be

quicker to pull

the trigger on

wound problems in

patients with multiple

medical concerns because

they are more difficult to

treat,” adds Dr. Holmes.

573-334-9637 or 866-334-9637

310 South Silver Springs Road

Cape Girardeau, Mo. 63703

CONDITIONS THAT MAY BE BENEFITED

BY HYPERBARIC OXYGEN THERAPY

The Undersea and Hyperbaric Medical Society approves the

use of hyperbaric oxygen therapy for the following conditions:

• Air or gas embolism

• Carbon monoxide

poisoning

• Cyanide poisoning

• Clostridial myositis

• Myonecrosis

• Crush injury

• Compartment

syndrome

• Acute traumatic

ischemias

• Decompression

sickness

• Arterial insufficiencies

• evere anemia

• Intracranial abscess

• Necrotizing soft tissue

infections

• Osteomyelitis

• Delayed radiation

injury

• Compromised grafts

and flaps

• Acute thermal burn

injury

• Idiopathic sudden

sensorineural hearing

loss

c o n s u l t S o u t h e a s t H E A L T H 2 5

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