CRUSH INJURY - COMPARTMENT SYNDROME

 

  • Hyperbaric Oxygenation (HBO) has been recommended as an adjunct treatment in acute traumatic ischemia and crush injury. Traumatic injury causes widespread capillary damage, inflammation and tissue hypoxia.

  • Hypoxia results in a negative cascade fostering further neurovascular injury leading to compounding disability. Hyperbaric Oxygenation impacts tissue hypoxia - 'the earlier intervention - the better clinical outcome'.

Crit Care Nurs Q. 2013 Jul-Sep;36(3):299-309. doi: 10.1097/CNQ.0b013e318294ea41.

The role of hyperbaric oxygen therapy in crush injuries

Dougherty JE.

Source

California State University, San Marcos, California.

Abstract

Hyperbaric oxygen therapy has been approved for primary or adjunctive care in 14 indications. A hyperbaric environment exists when a patient's whole body is physically exposed to 100% oxygen and pressure that is greater than one atmosphere absolute. Hyperbaric oxygen therapy works through the ideal gas laws and is effective as an adjunctive therapy in the treatment of crush injuries. Oxygen is considered a drug and can have contraindications and adverse effects. Hyperbaric therapy works through several different mechanisms in the crush injury. Effects of hyperoxygenation, reduction of edema, infection control enhancement, blood vessel and collagen formation, and reduction of free radicals and reperfusion injury help in healing in patient with crush injuries.

 

Hyperbaric oxygen therapy in extremity trauma

J Am Acad Orthop Surg. 2004 Nov-Dec;12(6):376-84.

Greensmith JE. St Elizabeth Hospital, Appleton, WI 54915, USA.

Abstract

Hyperbaric oxygen therapy potentially can provide enhanced oxygen delivery to peripheral tissues affected by vascular disruption, cytogenic and vasogenic edema, and cellular hypoxia caused by extremity trauma. After appropriate resuscitation, macrovascular repair, and fracture fixation/stabilization, adjunctive hyperbaric oxygen therapy can enhance tissue oxygen content. In patients with crush injury or early compartment syndrome, hyperbaric oxygen therapy may reduce the penumbra of cells at risk for delayed necrosis and secondary ischemia. Animal experiments and human case series suggest the benefits of such therapy, and recent randomized, prospective studies on trauma patients have confirmed its efficacy in those with extremity trauma. However, more data are necessary to determine additional indications as well as optimal timing and dosing for hyperbaric oxygen therapy.

 

Neuropsychiatr Dis Treat. 2010 Dec 6;6:785-9.

Hyperbaric Oxygen ameliorates worsening signs and symptoms of post-traumatic stress disorder

Eovaldi B, Zanetti C.

Source

Department of Medicine, Chicago College of Osteopathic Medicine, Chicago, IL, USA. eovaldi@gmail.com

Abstract

Hyperbaric Oxygen therapy at 2.4 atmospheric pressure absolutes for 90 minutes per day ameliorated the signs and symptoms of agitation, confusion, and emotional distress in a 27-year-old male seven days following a traumatic accident.

Hyperbaric Oxygen was used to treat the patient's crush injury and underlying nondisplaced pelvic fractures which were sustained in a bicycle versus automobile traffic accident. Its effect on the patient's neuropsychiatric symptoms was surprising and obvious immediately following the initial hyperbaric Oxygen treatment. Complete cognitive and psychiatric recovery was achieved by the seventh and final hyperbaric Oxygen treatment.

We propose that hyperbaric Oxygen was effective in improving the patient's neuropsychiatric symptoms by reducing cerebral oxidative stress, inflammation, vasogenic edema, and hippocampal neuronal apoptosis.

Further investigation into the use of hyperbaric Oxygen as a novel therapy for the secondary prevention of post-traumatic stress disorder that often accompanies post-concussive syndrome may be warranted. We acknowledge that hyperbaric Oxygen therapy has been shown to have a strong placebo effect on neurologic and psychiatric diseases.

 

Am Surg. 2005 Feb;71(2):144-51.

Adjuvant hyperbaric Oxygen therapy in the management of crush injury and traumatic ischemia: an evidence-based approach

Garcia-Covarrubias L, McSwain NE Jr, Van Meter K, Bell RM.

Source

Department of Surgery, Tulane University School of Medicine and Charity Hospital, New Orleans, Louisiana 70112, USA.

Abstract

Hyperbaric Oxygen therapy (HBO) has been recommended as an adjunct treatment in acute traumatic ischemia and crush injury. Several animal models have shown better outcomes when HBO is used in crush injury and compartment syndrome. Animal and in vitro models have suggested that these beneficial effects may be mediated by attenuation of ischemia-reperfusion injury. We did a systematic review of the literature using the Eastern Association for the Surgery of Trauma (EAST) recommendations for evidence-based reviews. An electronic search using Medline, OVID technologies, and the Cochrane database was performed. Only clinical papers published between 1966 and December 2003 with at least five patients that included enough information to evaluate were selected. A group of trauma experts reviewed the selected articles and scored them applying the instrument developed by the EAST practice management guidelines committee. Nine documents fulfilled the inclusion criteria for a total of approximately 150 patients. Most documents were retrospective, uncontrolled, and case series lacking a standardized methodology (class III). There was one prospective controlled randomized trial with some limitations on its design. We determined that eight of nine studies showed a beneficial effect from HBO with only one major complication. We concluded that adjunctive HBO is not likely to be harmful and could be beneficial if administered early. Well designed clinical studies are warranted.

 

Hyperbaric Oxygen therapy in extremity trauma

Hyperbaric Oxygen therapy potentially can provide enhanced Oxygen delivery to peripheral tissues affected by vascular disruption, cytogenic and vasogenic edema, and cellular hypoxia caused by extremity trauma. After appropriate resuscitation, macrovascular repair, and fracture fixation/stabilization, adjunctive hyperbaric Oxygen therapy can enhance tissue Oxygen content. In patients with crush injury or early compartment syndrome, hyperbaric Oxygen therapy may reduce the penumbra of cells at risk for delayed necrosis and secondary ischemia. Animal experiments and human case series suggest the benefits of such therapy, and recent randomized, prospective studies on trauma patients have confirmed its efficacy in those with extremity trauma.

 

Hyperbaric Oxygen therapy in the treatment of open fractures and crush injuries

This article focuses on the use of hyperbaric Oxygen therapy (HBOT) in the treatment of open fractures and crush injuries. Based on the clinical evidence and cost analysis, medical institutions that treat open fracture and crush injuries are justified in incorporating HBOT as a standard of care. Both Medicare and Undersea and Hyperbaric Medical Society guidelines list crush injuries as an approved indication for HBOT. Emergency physicians should familiarize themselves with this emerging treatment modality because of their role in the early management of these injuries. Emerg Med Clin North Am. 2007 Feb;25(1):177-88.

 

J Am Acad Orthop Surg. 2004 Nov-Dec;12(6):376-84.

Hyperbaric Oxygen therapy in extremity trauma

Greensmith JE.

Source

St Elizabeth Hospital, Appleton, WI 54915, USA.

Abstract

Hyperbaric Oxygen therapy potentially can provide enhanced Oxygen delivery to peripheral tissues affected by vascular disruption, cytogenic and vasogenic edema, and cellular hypoxia caused by extremity trauma. After appropriate resuscitation, macrovascular repair, and fracture fixation/stabilization, adjunctive hyperbaric Oxygen therapy can enhance tissue Oxygen content. In patients with crush injury or early compartment syndrome, hyperbaric Oxygen therapy may reduce the penumbra of cells at risk for delayed necrosis and secondary ischemia. Animal experiments and human case series suggest the benefits of such therapy, and recent randomized, prospective studies on trauma patients have confirmed its efficacy in those with extremity trauma. However, more data are necessary to determine additional indications as well as optimal timing and dosing for hyperbaric Oxygen therapy.