Crush injuries are traumatic ischemia that cause such severe damage to tissues from the energy transfer that tissue survival is in question .
Crush injuries occur when body tissues are severely traumatized such as in motor vehicle accidents, falls, and gun shot wounds. These injuries frequently occur in the extremities. When crush injuries are severe, the rate of complications such as infection, non-healing of fractures, and amputations range up to 50%.
Usually, two or more tissues are injured severely enough that their survival is unsure. Edema due to tissue hypoxia has detrimental effects on wound healing and infection control. It interferes with oxygen availability for cells that already have increased oxygen needs.
Hyperbaric Oxygen therapy (HBOT) when used as an adjunct to orthopedic surgery and antibiotics, shows promise as a way to decrease complications from severe crush injuries. HBO2 increases oxygen delivery to the injured tissues, reduces swelling and provides an improved environment for healing and fighting infection.
A second harmful effect of edema is the collapse of capillaries. The edema fluid increases the interstitial pressure around the capillaries. Once the interstitial fluid pressure exceeds the capillary perfusion pressure in a closed space, the capillary bed collapses, and flow in the microcirculation ceases. Bacteria grow almost without restraint if circulation is disrupted at the site of injury. With the disruptions of the blood supply, antibiotics can no longer reach the injury or infection site.
In the hypoxic environment, neutrophils lose the ability to generate the reactive oxygen species that kill bacteria. As tissue oxygen is much reduced in acute traumatic peripheral ischemia and decreases a local site’s ability to handle infection, impaired wound healing, and wound contracture are additional secondary problems. A wound will not heal unless there are sufficient oxygen tensions for fibroblasts to function .
A tissue oxygen tension of 30mmHg is required for fibroblasts to mobilize and produce the collagen matrix needed for neovascularisation and wound repair.
Vasoconstriction is a secondary effect of HBOT. This leads to edema reduction. Hyperbaric oxygen exposure causes a 20% reduction in blood flow. With decreased blood flow, extravasation of fluid in the area of injury is decreased. Since capillary resorption of extracellular fluid continues, the net effect is edema reduction. Edema reduction of 20% or more has been observed in laboratory studies .
Increased oxygen content in the blood from HBOT compensates for the decreased flow. Moreover, flow in the microcirculation is improved as edema decreases and reduces external pressure around the microcirculation. HBOT reduces the amount of skeletal muscle necrosis. It also reduces post-injury muscle necrosis and edema.
HBOT for crush injuries should be started as soon as feasible. It is also used as an adjunct for the management of compartment syndromes and other acute traumatic peripheral ischemia.
When used as an adjunct to orthopedic surgery and antibiotics, hyperbaric oxygen (HBO2) therapy shows promise as a way to decrease complications from severe crush injuries.
Hyperbaric Oxygen Therapy (HBOT) is a good adjuvant in Trauma and compartment syndrome after initial surgical intervention as it reduces tissue edema, increases tissue oxygenation, decreasing infection thus minimizing tissue necrosis.
A well equipped trauma center should include hyperbaric oxygen therapy as part of its emergency services and hyperbaric oxygen therapy will become an integral part of trauma management of these injuries in hospitals.
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