WHAT IS A PRESURE ULCER?
Pressure ulcers (also called decubitus ulcers or "bedsores") develop when there is injury to the skin and underlying tissue due to pressure for an extended period of time. This constant pressure reduces the blood supply to that area, preventing the delivery of vital nutrients and oxygen. Pressure ulcers most commonly occur in patients confined to a wheelchair or bed.
WHAT DO PRESSURE ULCERS LOOK LIKE?
Pressure ulcers can appear differently depending on the severity of the injury. They can appear simply as a discoloration (or redness) of the skin or as complex as dead, black tissue (called necrosis) with exposure of underlying structures like muscle and bone. Sometimes the injury may appear as a purplish bruise, which suggests that there is damage to deeper underlying tissues. If you notice persistent redness, any suspicious discoloration or skin breakdown over a bony prominence, you should notify your doctor immediately.
WHAT ARE THE RISK FACTORS FOR GETTING A PRESSURE ULCER?
- BEING CONFINED TO A WHEELCHAIR
- IMMOBILITY OR BEING BEDRIDDEN FOR ANY REASON (PARALYSIS, HIP FRACTURE, COMA)
- URINARY OR BOWEL INCONTINENCE WHICH IRRITATES THE SURROUNDING SKIN
- POOR NUTRITION
- DECREASED SENSATION AROUND AFFECTED AREAS
- RECENT SURGERY OR ILLNESS
WHAT CAN I DO TO PREVENT A PRESSURE ULCER?
- REPOSITION YOURSELF WHILE IN BED AT LEAST EVERY 2 HRS, IN A CHAIR AT LEAST EVERY HOUR
- KEEP THE HEAD OF THE BED LOWERED TO LESS THAN 30 DEGREES
- ELEVATE YOUR HEELS OFF THE BED USING A PILLOW UNDER YOUR LOWER LEGS
- USE A PRESSURE RELIEVING MATTRESS OR A CUSHION IN YOUR CHAIR
- USE PROTECTIVE CREAMS IF YOU HAVE INCONTINENCE
- MAINTAIN A BALANCED DIET
- MAINTAIN PROPER HYDRATION
Contact your physician if your wound site becomes more painful, odorous, larger or if the amount of fluid coming out from the wound increases
THE IMPORTANCE OF WOUND CARE
Successful treatment of difficult wounds requires assessment of the entire patient and not just the wound. Systemic problems often impair wound healing; conversely, nonhealing wounds may herald systemic pathology.
Consider the negative effects of endocrine diseases (eg, diabetes, hypothyroidism), hematologic conditions (eg, anemia, polycythemia, myeloproliferative disorders), cardiopulmonary problems (eg, chronic obstructive pulmonary disease, congestive heart failure), GI problems that cause malnutrition and vitamin deficiencies, obesity, and peripheral vascular pathology (eg, atherosclerotic disease, chronic venous insufficiency, lymphedema).
In the United States the Undersea and Hyperbaric Medical Society, known as UHMS, lists approvals for reimbursement for certain diagnoses in hospitals and clinics. The following indications are approved (for reimbursement) uses of hyperbaric oxygen therapy as defined by the UHMS Hyperbaric Oxygen Therapy Committee:
- Air or gas embolism
- Carbon monoxide poisoning
- Carbon monoxide poisoning complicated by cyanide poisoning
- Central retinal artery occlusion
- Clostridal myositis and myonecrosis (gas gangrene)
- Crush injury, compartment syndrome, and other acute traumatic ischemias
- Decompression sickness
- Enhancement of healing in selected problem wounds
- Exceptional blood loss (anemia)
- Idiopathic sudden sensorineural hearing loss
- Intracranial abscess
- Necrotizing soft tissue infections (necrotizing fasciitis)
- Osteomyelitis (refractory)
- Delayed radiation injury (soft tissue and bony necrosis)
- Skin grafts and flaps (compromised)
- Thermal burns
Evidence is insufficient as of 2013 to support its use in autism, cancer, diabetes, HIV/AIDS, Alzheimer's disease, asthma, Bell's palsy, cerebral palsy, depression, heart disease, migraines, multiple sclerosis, Parkinson's disease, spinal cord injury, sports injuries, or stroke. Despite the lack of evidence, in 2015, the number people utilizing this therapy has continued to rise.
Recent studies have indicated that HBO therapy is recommended and warranted in those patients with idiopathic sudden deafness, acoustic trauma or noise-induced hearing loss within 3 months after onset of disorder.
HBOT in diabetic foot ulcers increased the rate of early ulcer healing but does not appear to provide any benefit in wound healing at long term follow-up. In particular, there was no difference in major amputation rate. For venous, arterial and pressure ulcers, no evidence was apparent that HBOT provides an improvement over standard treatment.
There are signs that HBOT might improve outcome in late radiation tissue injury affecting bone and soft tissues of the head and neck. In general patients with radiation injuries in the head, neck or bowel showed an improvement in quality of life after HBO therapy. On the other hand, no such effect was found in neurological tissues. The use of HBOT may be justified to selected patients and tissues, but further research is required to establish the best patient selection and timing of any HBO therapy.
There is tentative evidence for HBOT in traumatic brain injury. As of 2012 there is insufficient evidence to support its general use in TBI. In stroke HBOT does not show benefit. HBOT in multiple sclerosis has not shown benefit and routine use is not recommended.
A 2007 review of HBOT in cerebral palsy found no difference compared to the control group. Neuropsychological tests also showed no difference between HBOT and room air and based on caregiver report, those who received room air had significantly better mobility and social functioning. Children receiving HBOT were reported to experience seizures and the need for tympanostomy tubes to equalize ear pressure, though the incidence was not clear.
In alternative medicine, hyperbaric medicine has been promoted as a treatment for cancer, but there is no evidence it is effective for this purpose.
The ONLY absolute contraindication to hyperbaric oxygen therapy is untreated tension pneumothorax. The reason is concern that it can progress to tension pneumothorax, especially during the decompression phase of therapy. The COPD patient with a large bleb represents a relative contraindication for similar reasons.
Patients SHOULD NOT undergo HBO therapy if they are taking or have recently taken the following drugs:
- Doxorubicin (Adriamycin) – A chemotherapeutic drug. This drug has been shown to potentiate cytotoxicity during HBO therapy.
- Cisplatin – Also a chemotherapeutic drug.
- Disulfiram (Antabuse) – Used in the treatment of alcoholism.
- Mafenide acetate (Sulfamylon) – Suppresses bacterial infections in burn wounds