Hyperbaric Oxygen for Crush Injuries and Compartment Syndromes

Crush injuries and skeletal muscle compartment syndromes are two related conditions that arise as a consequence of trauma. Common features include ischemia and hypoxia at the injury site, a gradient of injury, and the potential for self perpetuation of the injury. Management of severe forms of these injuries almost always requires surgery. The mechanisms of hyperbaric oxygen (HBO) are logical interventions for the pathophysiological for these conditions and HBO should be used when the seriousness of the injuries results in high complication rates even with optimal surgical and medical interventions. Crush injuries and skeletal muscle compartment syndromes are approved indications for HBO according to Medicare and Undersea and Hyperbaric Medical Society guidelines. It is considered an acute type 2 indication by the European Consensus Conference on Hyperbaric Medicine. Effect of HBO which decrease morbidity in crush injuries include tissue hypoxia correction and edema reduction. These effects help to provide a favorable environment for fibroblast function, neutrophil oxidative killing, and angiogenesis. Other beneficial effects of HBO for crush injuries include pertubation of the reperfusion injury and maintenance of red blood cell deformability. The ability for blood cells to deform is essential for maintaining flow and preventing sludging in the microcirculation. Consequently, HBO is a logical intervention for those crush injuries where high complication rates can be anticipated. Surgical and and orthopedic interventions for crush injuries are based on the type of injury and should be independent of the decision whether or not to use HBO. That is HBO should not be used as excuse to delay surgery or not to do surgery. However, when the decision to use HBO is made, it should be started as soon after the injury as possible. If there are delays in starting surgery, and HBO is available, it should be given while awaiting the availability of the operating room. Reference: Bakker, DJ, Cramer, FS. 2002. Hyperbaric Surgery. Best Publishing Company, USA, pp. 341-345.