Treatment protocol

The recommended treatment schedule is three treatments at a pressure of 220-280 kPa for 90 minutes of oxygen therapy at pressure within the first 24 hours of treatment, followed by twice daily HBO for three days (i.e. a total of 7 treatments). After the acute phase of the first three days therapy should be continued for at least five days or longer if clinical judgement suggests that HBO treatment should continue (for instance because of infection, delayed wound healing or ischemic complications of flap repair surgery).

It is most important to begin with adjuvant HBO therapy as soon as possible after the trauma, because the majority of damage to microcirculation from ischemia occurs within the first four to six hours of reperfusion. It is important to understand that not only primary ischemia time is crucial, but even time from reperfusion to HBO treatment.

The treatment regime in our institution therefore warrants an immediate start of HBO treatment after the first surgical debridement. Patients are kept under anaesthesia at least during this first HBO treatment and only extubated - according to their clinical situation- after their return to the ICU. We are placing myringotomy tubes in those patients prophylactically to avoid problems with ear clearing. During the following days these patients sometimes have to be treated after surgical interventions when they are still drowsy from anaesthesia. Position of the myringotomy tubes has to be controlled daily.

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