Clinical Challenges in the Treatment of Hemodialysis Patients with Hyperbaric Oxygen Therapy

Clinical Challenges in the Treatment of Hemodialysis Patients with Hyperbaric Oxygen Therapy

To the Editor

We have read with great interest the article by Chen et al., “Adjuvant hyperbaric oxygen therapy in the treatment of hemodialysis patients with chronic osteomyelitis.”[1] This paper is of interest because they report the successful use hyperbaric oxygen (HBO) therapy for the treatment of chronic refractory osteomyelitis in hemodialysis patients. They found that eight of the ten patients were completely healed with the use of HBO therapy as an adjunct. However, the authors fail to give information whether they have experienced any problems during the application of HBO therapy to hemodialysis patients.

In our hyperbaric medicine department, we have been treating hemodialysis patients with HBO therapy for several indications, including diabetic foot infection, peripheral arterial disease, necrotizing soft tissue infection, and osteomyelitis for 12 years. It is well known that patients on chronic hemodialysis treatment have reduced physical work capacity compared to the healthy subjects.[2] The hemodialysis treatment frequently takes 4–4.5 hours, and patients usually were exhausted after hemodialysis.[3] We observed that, though not all, a significant number of hemodialysis patients can not tolerate HBO therapy after hemodialysis treatment on the same day. If the patient will undergo HBO therapy on dialysis days, HBO therapy is performed first, and then the patient undergoes dialysis. In some patients, we perform HBO therapy only on off-dialysis days. In addition, we do not perform HBO therapy on weekends to reduce the risk of pulmonary oxygen toxicity.

The HBO treatments can be carried out either in a monoplace or a multiplace (walk-in) hyperbaric chamber. The former accommodates a single patient and is compressed with pure oxygen. The patient breathes oxygen from the ambient environment in the chamber. The multiplace chambers are capable of treating two or more patients at the same time. They are compressed with air, and the patient breathes oxygen from a tight-fitting face mask or hood. In our department, there is a multiplace chamber that accommodates 17 patients at the same time. We observed that the hemodialysis patients often can not inhale effectively form a tight-fitting mask and takes off the mask frequently. Therefore, we suggest the use of monoplace chambers for the treatment of hemodialysis patients, as patients do not need to wear a face mask or hood. If the HBO center has only a multiplace chamber, wearing a hood rather than a tight fitting mask will be more comfortable for the patient and more effective.

In our opinion, the measures listed above increases the adherence of hemodialysis patients to the HBO treatment and influence the success rate of the treatment.