HYPERBARIC-OXYGEN THERAPY IN THE MANAGEMENT OF CRUSH INJURIES - A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED CLINICAL-TRIAL

Hyperbaric Oxygen (HBO) therapy is advocated for the treatment of seve re trauma of the limbs in association with surgery because of its effe cts on peripheral oxygen transport, muscular ischemic necrosis, compar tment syndrome, and infection prevention, However, no controlled human trial had been performed until now to specify the role of HBO in the management of crush injuries, Thirty-six patients with crush injuries were assigned in a blinded randomized fashion, within 24 hours after s urgery, to treatment with HBO (session of 100% O-2 at 2.5 atmosphere a bsolute (ata) for 90 minutes, twice daily, over 6 days) or placebo (se ssion of 21% O-2 at 1.1 ata for 90 minutes, twice daily, over 6 days), All the patients received the same standard therapies (anticoagulant, antibiotics, wound dressings), Transcutaneous oxygen pressure (PtCO2) measurements were done before (patient breathing normal air) and duri ng treatment (HBO or placebo) at the first, fourth, eighth, and twelft h sessions, The two groups (HBO group, n = 18; placebo group, n = 18) were similar in terms of age; risk factors; number, type or location o f vascular injuries, neurologic injuries, or fractures; and type, loca tion, or timing of surgical procedures, Complete healing was obtained for 17 patients in the HBO group vs, 10 patients in the placebo group (p < 0.01), New surgical procedures (such as skin flaps and grafts, va scular surgery, or even amputation) were performed on one patient in t he HBO group vs, six patients in the placebo group (p < 0.05), Analysi s of groups of patients matched for age and severity of injury showed that in the subgroup of patients older than 40 with grade III soft-tis sue injury, wound healing was obtained for seven patients (87.5%) in t he HBO group vs, three patients (30%) in the placebo group (p < 0.05), No significant differences were found in the length of hospital stay and number of wound dressings between groups, For the patients with co mplete healing, the PtCO2 values of the traumatized limb, measured in normal air, rose significantly between the first and the twelfth sessi ons (p < 0.001). No significant change in PtCO2 value was found for th e patients whose healing failed, The Bilateral Perfusion Index (BPI = PtCO2 of the injured limb/PtCO2 of the uninjured limb) at the first se ssion increased significantly from 1 ata air to 2.5 ata O-2 (p < 0.05) , In patients with complete healing, the BPI was constantly greater th an 0.9 at 2.5 ata O-2 during the following sessions, whereas the BPI i n air progressively rose between the first and the twelfth sessions (p < 0.05), reaching normal values at the end of the treatment, In concl usion, this study shows the effectiveness of HBO in improving wound he aling and reducing repetitive surgery, We believe that HBO is a useful adjunct in the management of severe (grade III) crush injuries of the limbs in patients more than 40 years old.