barcelona september 2013 oxygen therapy in normobarism trophic injuries of the lower limbs the...

Barcelona September 2013

Oxygen therapy in normobarism

Trophic injuries of the lower limbs

The reasoning

for the therapy




•Epidemiology

•It is estimated that this pathology affects

•1.5% of the population

• 5% of the population over 65 years




•Problem for the patient

•The sick person with such injuries, which by definiton are

chronic, is often incapable, suffering, malodorous, depressed




•Problem for society. The costs

•Direct costs

•Treatment, material, departments

•Public services and within the national health service

•insurance




•Problem for society. The costs

•Indirect costs

•Working days lost both by the patient and by family members involved and eventual costs for

insurance

•Social health consequences of inadequate treatment

•For the Patient

•infections, gangrene, amputation and in any case complications of

health and relationship .




•Social health consequences of

• inadequate treatment

•For the family

•infections, gangrene, amputation and in any case complications of

health and relationships .




•Social health consequences of inadequate treatment




•For the national health system

• greater costs for complications

Definition of ulcerLoss of substances linked to hemodynamic, hemorheologic

and coagulative modifications: in its genesis the use of microcirculation and consequent impairment of tissue

trophism is fundamental. It represents the epiphenomenon of various pathologies which have at their base an

insufficient hematic supply with consequent hypoxia and infection (Bimonte).

Madeyski’s Normobaric Chamber


Classification

1) Ulcers of venous stasis

2) Arterial ulcers

3) Traumatic ulcers

4) Collagen ulcers

5) Diabetic ulcers (Diabetic foot)



Physiopathology of the ulcer

Transcutaneous oximetry has shown at the level of the vasculopathic injuries a pO2 of 5-10 mm of Hg.

This value is incompatible with the life of the cells and impedes the proliferation and the action of the

leukocytes which require values of pO2 of 30-40 mm of Hg: from this derives the danger of infection.



Physiopathology of the ulcer Even the synthesis of the collagen starting from the

fibroblasts cannot disregard the oxygen.

In conditions of relative hypoxia an immature and not very stable collagen will be formed with

inevitable healing problems



For the re-epithelialization of the ulcera

a) An optimal supply of oxygen

b) Complete cleansing of the injury

c) Good perfusion of blood



POSSIBLE THERAPIES

Ulcer therapy concerns local and systemic factors.

1) Medical therapies 2) Surgical therapies 3) Therapy with hyperbaric chamber4) Therapy with normobaric oxygen5) Therapy with oxygen-ozone


Reasoning for oxygen hyperbaric therapy

Restores the distribution of O2 from the capillaries to the cells where this is impeded or to reduce the hematic

perfusion or for thickening of the means of transit (edema, pyogenic membrane, necrotic tissues)


Hyperbaric chamber Local chamber

The concentration of oxygen reaches 22%

The concentration of oxygen reaches 95%

Oxygen dissolved in the blood equal to 6 cc %

Oxygen dissolved in the blood equal to 2 cc %

DIFFERENCES BETWEEN THE HYPERBARIC AND LOCAL CHAMBERS


DIFFERENCES BETWEEN HYPERBARIC AND LOCAL

CHAMBERS

Substantially the hyperbaric chamber actsthanks to the increase in oxygen dissolved while the

local chamber acts thanks to the high concen-tration of oxygen at the level of the trophic injuries

Madeyski’s Normbaric Chamber


Advantages Disadvantages

Increase of O2 dissolved

Bactericidal action

Anti-edema action

Healing action

-Not borne by many patients.

-Cardiac,vestibular, psychological problems,etc.

-Limited number of centres.

-Transport problems.

-High costs

Hyperbaric Chamber


So called for the “similarity” with

the hyperbaric chamber

.




PORTABLE VERSION (HOME)


Advantages Disadvantages

High concentration of oxygen at the level of the

injury

Minor or no increase of oxygen dissolved in the

plasma

NO LOCAL OR SYSTEMIC SIDE EFFECTS

Madeyski’s normobaric chamber


CASE HISTORIES 2012

Casa di Cura Rizzola

Patients treated : 156Phlebostatic ulcers: 86

Diabetic ulcers: 42Arterial ulcers: 11Mixed ulcers: 07

Transplant ulcers 10


Methodology

Patients underwent daily sittings of one or two hours.

The number of sittings was variable with healing between 2 and 4 months on

average. Self medication only took place with saline solution


Subjective results

1) Reduction of secretion and cleansing of the injuries.

2) Improvement in the subjective symptomatology (pains, burns, itching,).


Objective results

1) Precocious appearance of a good tissue of granulation.2) Reduction of the diameter of the injury until complete closure in 70% of cases.3) Effect favouring subsequent transplants taking root in 85% of the sick people. 4) Result null in 15% of cases


Overview of ulcers treated

Casa di Cura Rizzola 2012

Barcelona september 2013

Overview of ulcers treated

Casa di Cura Rizzola 2012

Barcelona september 2013

•before therapy

•After 1 month of therapy

•After 2 months of therapy

•After 3 months of therapy

Conclusion

High compliance

Effectiveness documented

Low cost of purchase and of use Social cost

Easy availability

Absence of side effects

Rapid training of personnel


barcelona september 2013 oxygen therapy in normobarism trophic injuries of the lower limbs the...

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