Thermal Burns

Serious burns can be caused by chemicals, electricity, heat and fire.  They can be among the most painful of conditions and are very difficult to treat.  Every year, about 38,500 Americans are burned so badly that skin grafts are required for the patient’s survival.  Another 80,000 burn victims each year don’t need skin grafts but require medical assistance.

HBOT helps burn patients heal faster and with fewer complications.  In first-degree burns, only the top layer of the skin involved; the skin is red but unbroken and there is no danger of infection.  Second degree burns involve deeper layers of the skin with redness and blistering.  There may be a massive loss of fluid and dehydration may deepen the wound.  In third degree burns all layers of the skin are affected.  The skin may be charred and because of the loss of nerve endings there may initially be little pain.

The severity of the burns also depends on how much of the skin area is affected.  Small burns are considered to cover up to 15% of the body’s surface.  Moderate burns cover 15-49% of the body, large burns cover 50-56% of the body, and massive burns cover 70% or more.  Both the degree and the size of the burn are factored in when deciding how serious the condition is.  Second and third degree burns require emergency treatment.  These burns often lead to shock and become infected.

For a burn to heal the burned area must develop new skin very quickly and cleanly.  In serious cases skin grafts have to be used.  Skin grafts can be taken from other parts of the body that aren’t burned or an artificial skin substance may be used.  In some burns the body can create the new skin itself.  The ability to do this depends on the number of skin cells surviving, the migration of healthy cells into the wound, the ability of the surviving and migrating cells to reproduce and the development of new capillaries.63

HBOT for the treatment of burns was discovered accidentally in 1965 in Japan.  There was an explosion in a coal mine and many of the miners had carbon monoxide poisoning.  They were rushed to the hospital for HBOT treatment.  Days later it was discovered that the burns of the patients that had received HBOT were healing faster and with fewer infections than those of the other miners.

The use of HBOT within the first 24 hours after injury is important in a successful recovery.  It can help wounded cells survive by constricting blood vessels in the area, resulting in less fluid loss so the wounded cells have a better chance of not drying out.  HBOT also supplies the wound with extra oxygen through the super saturated plasma.  The extra oxygen helps wounded cells to survive and reproduce.  By helping to build a new network of capillaries, HBOT enables healthy cells to migrate to the site of the wound.

Other benefits of HBOT in burn patients include helping to prevent shock and/or circulatory failure caused by extensive fluid loss; inhibiting infection by helping support the immune system, especially the white blood cells; and working synergistically with antibiotics.  HBOT aids in the survival of skin grafts and flaps, and in the growth of new skin, reduces the need for fluid replacement and helps the patient with other problems associated with burns such as smoke inhalation and carbon monoxide poisoning.

All these factors help to speed the healing process and increase survival rates among burn patients.  Neubauer reports a study64 that showed that hospitalization and mortality rates among severely burned patients who received HBOT were reduced by a third, compared with those patients who did not receive HBOT.  The HBOT treated patients also needed one-third less fluid replacement.

Another study cited by Neubauer was done in 1974 by Dr. G.B. Hart.  He looked at 191 burn patients treated with HBOT and concluded that the patients had reduced healing time, fewer complications, and lower mortality rates if they were treated within 24 hours after injury.  Healing time was directly related to the number of burns and amount of body surface involved.

HBOT is not a stand-alone therapy for burn patients but has been shown to play a significant role in the treatment of serious burns.

Neubauer also mentions the work of Dr. Richard Grossman, a burn expert and plastic surgeon.  He developed an HBOT treatment program at Sherman Oaks Community Hospital in Sherman Oaks, California.  HBOT is given within four hours of the patient’s admission to the burn unit.  The pressure is given at between 2 and 2.5 ATA.  The length of the treatment is decided on a case by case basis.  Dr. Grossman also uses HBOT both before and after operating on burn patients.

Notes:
63Neubauer, 76.
64Neubauer, 78.