Hyperbaric Oxygen Therapy and Trauma

This issue of Critical Care Nursing Quarterly is devoted to hyperbaric oxygen (HBO) and hyperbaric oxygen therapy (HBOT). Hyperbaric oxygen therapy is the process of administering oxygen at a higher percentage than 21%, the ambient mixture around us, under pressure. Hyperbaric oxygen therapy has had a vivid and often misunderstood reputation, until its coming of age in the 20th century. In this issue, many of its current uses are explored, with history, nursing, and medical considerations. While HBOT has been traditionally used in diving accidents for patients with decompression sickness, called 'the bends," modern HBOT is used in areas such as carbon monoxide poisoning, clostridial myonecrosis, and compromised skin grafts and wound healing; in addition, its use is the subject of research in many other areas.

As HBOT becomes more available across patient populations, all nurses, but particularly critical care nurses, must be aware of the protocols and processes involved with this specialized therapy. As more therapies become available, and more procedures are recognized by insurance and patient funding, these patients will become increasingly prevalent in the acute care setting. With the use of HBOT, patients with nonhealing wounds, who previously would have been treated over time with antibiotics and surgical intervention, now have another intervention open to them, with the potential to shorten hospital stay time. HBOT has been shown to be a useful adjunct in life and limb-threatening infections from organisms including clostridia, Enterobacteriaceae, and bacteroides. Patents with osteomyelitis, severe anemia, and acute thermal burns have shown improvement with HBOT. These patients are frequently seen in the acute care setting, often in the intensive care unit.

Sanchez discusses the use of hyperbaric oxygen in 2 groundbreaking areas: Neonates and Stroke. Use of HBOT in the treatment of neonates is described with a pilot study of 8 patients, treated for necrotizing enterocolitis and hypoxic ischemic encephalopathy. The prevalence of stroke and its response to HBOT within the first 72 hours is reviewed via meta-analysis.

Dougherty discusses the role of hyperbaric oxygen in crush injuries. The author explains the mechanics and physiology of hyperbaric oxygen treatment and its effects on human tissues. Specific to crush injuries, hyperbaric oxygen therapy treats edema, ischemia, and vasoconstriction.

Dyer, White, Doohee, Elkins, and Slayton present an excellent paper reporting clinical findings in regard to the relationship between arterial carbon dioxide tension and end-tidal carbon dioxide tension in intubated adults with traumatic brain injuries who required emergency craniotomies. This research provides vital information for those providers who are responsible for managing anesthesia during emergency craniotomies.

Finally, Paez and Wilcox discuss the specialty of hyperbaric nursing. The authors discuss the treatment of patients with hyperbaric therapy, and the responsibilities of the hyperbaric nurse specialist, noting the unique conditions for both patient and nurse. Appropriate patient selection and clearance, medication administration, and many other aspects of patient care are considered prior to hyperbaric treatment.

This issue of Critical Care Nursing Quarterly has sought to identify the past, present, and future of hyperbaric oxygen therapy and provides new approaches to medical and trauma management of vital interest to critical care personnel. We hope it is both informative and pertinent to your clinical practice.

-Amy Carney, PhD, NP

Issue Editor