Routine Patients for HBOT
Once referred to the Hyperbaric Unit, each individual is clinically assessed by a doctor who will decide upon an appropriate hyperbaric treatment regime. The patient normally attends the Hyperbaric Unit for 20 – 40 treatments, (one or two sessions per day) depending upon the severity of the condition. Each chamber session lasts 90 minutes at depth.
Hyperbaric Oxygen Therapy
The protocol of 20 sessions of hyper-baric oxygen therapy (HBOT) prior to surgery and 10 sessions post-op (20/10 protocol) is the most commonly used for surgery in complex radiation tissue damage. A different, more direct protocol is used in more serious diagnoses where frank soft tissue and/or osteoradionecrosis are present.
In addition to our routine treatments we also provide a 24 hour emergency service for diving accidents, carbon monoxide poisoning and other life threatening conditions that require hyperbaric oxygen therapy (HBOT). Patients can be referred to us either from an Intensive Care Unit (ICU), Accident & Emergency Department or self referral as in the case of diving accidents/skin bends.
Any condition precluding the patient from treatment will be identified during the initial assessment. During the course of the treatment a doctor, or tissue viability nurse, will monitor your progress. During hyperbaric oxygen therapy patients are comfortably enclosed in a hyperbaric chamber. A fully trained attendant accompanies patients into the chamber at all times. The chamber is slowly pressurised to 2.4 atmospheres absolute – the equivalent of 14 metres of seawater. Whilst under pressure the patient breathes 100% oxygen through a face mask or a transparent air hood. This combination of oxygen and pressure physically dissolves oxygen in the plasma. At 2.4 atmospheres the patient’s arterial oxygen partial pressure is approximately 1500mm Hg (PaO2).
Nevertheless, the Marx 20/10 protocol has now been studied and found to be effective with randomised prospective studies in at least 3 areas of head and neck post-radiation surgery, bone graft reconstruction, soft tissue vascular flaps and tooth removal. Therefore, it is presently the definitive protocol whenever any elective surgery or wounding is performed within irradiated tissues. Transcutaneous pulse oximetry is a simple, reliable, non-invasive diagnostic technique that provides an objective assessment of local tissue oxygenation. It can be used for serial assessment of the soft tissue envelope surrounding problem wounds. Uses of transcutaneous pulse oximetry in the problem wound includes the assessment of healing potential, selection of amputation level and patient selection for hyperbaric medicine.
Upon arrival at the Hyperbaric Unit all emergency patients are received into the two-bed Resuscitation Room where Advanced Life Support (ALS) can be continued. Once stabilised, the patient can be transferred directly into the hyperbaric chamber where full treatment, including ventilatory support, full patient monitoring and patients who are fully inotrope dependent. After hyperbaric oxygen treatment the patient will be transferred to a ward in the main hospital or to the Intensive Care Unit. With the facilities at the Hyperbaric Unit, we play an increasingly important role in the management of life-threatening conditions in patients who were previously considered too unstable to transfer and treat. Examples include necrotising fasciitis, thermal burns and severe blood loss anaemia.
Accurate prediction of wound healing potential is essential, to avoid the increased morbidity rate that accompanies ischaemic breakdown of failed debridements and amputations.
For more information or to book on any of our training courses, please call us on 0151 638 3897.
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