Thermal or Extensive Burns
Thermal burns are a complex, destructive heat injury characterized by a zone of coagulation, a surrounding area of stasis (stagnation of blood or other fluids) and a border of erythema (skin redness from capillary dilation). Ischemic tissue death quickly follows burns. Obstructed capillaries block circulation below the injury.
Edema forms rapidly in injured areas, and in distant, uninjured tissue, dramatically extending damage. Red cells clump, white cells adhere to venular walls, and platelets clot in the distant microvasculature. Surrounding tissue fails to supply borderline cells with oxygen and nutrients, continuing tissue damage.
Benefits From Hyperbaric Oxygen Treatment
- HBOT minimizes edema and provides oxygen to deprived areas. Blocks white cells from adhering to endothelial cell walls, interrupting the process of blood vessel damage. reduces healing time for major burns, particularly if burns are 2nd degree.
- Fourth degree burns, most often seen in high voltage electrical injuries, benefit from reduced fascial compartment pressures. Injured muscle swelling is reduced by preserving aerobic glycolysis, and later by reducing risk of anaerobic infection.
- Decreases need for grafting, reduces hospital length of stay, and decreases total health care cost.
- Cianci et al (1989) presented the following:
- In patients with burns involving 18-39% of total body surface, there was a 37% reduction in the length of hospital stay.
- In patients with 40-80% of total body surface, there was a reduction in the number of surgical procedures for debridement and grafting.
- (1990) HBO as an adjunct to comprehensive management of patients with burns has resulted in a statistically significant 25% reduction in the length of hospital stay (p<0.012), and 19% reduction in overall cost of care.