Use of in-chamber transcutaneous oxygen measurement to determine optimal treatment pressure in patients undergoing hyperbaric oxygen therapy

Introduction: Hyperbaric oxygen (HBO2) therapy is used to promote healing in select problem wounds. Transcutaneous oxygen measurement (TCOM) can be used to predict the re- sponse of these wounds to HBO2, with in-chamber TCOM values shown to be the most predictive. We evaluated the use of in-chamber TCOM values to determine optimal treatment pressure. Methods: A retrospective review was completed of patients undergoing HBO2 therapy for a lower-extremity wound and who had in-chamber TCOM. Data collected included TCOM values, treatment profile, and patient outcome. Results: A total of 142 patients were identified. The overall results demonstrated healing in 59%, minor amputation (below ankle) in 11.3%, and major amputation (above ankle) in 16.2% of patients. 79.3% of patients at 2 atmospheres absolute (ATA) and 86.6% of patients at 2.4 ATA had transcutaneous oxygen pressure (TcPO2) values >=250mmHg. Among those with TcPO2 <250mmHg at 2 ATA, 41% attained TcPO2>250mmHg at 2.4 ATA. Among those treated at 2 ATA the healing rate was 70.6% if TcPO2 >250mmHg, and 11.8% if TcPO2 <250mmHg (P<0.001). Among those treated at 2.4 ATA the healing rate was 33.3% if TcPO2 >250mmHg and 14.3% if TcPO2 <250mmHg (p<0.001). Discussion: Determining optimal therapeutic pressure for patients undergoing HBO2 is important to maximize ben- efit and minimize risk. This study indicates that in-chamber TCOM can be used to select an individualized optimal treatment pressure in patients undergoing HBO2 for lower-extremity wounds, including diabetic foot ulcers. This may result in better utilization of HBO2 and better outcomes.