The EXPLORE Trial: A Feasibility Study Using Fluorescence Angiography to Evaluate Perfusion in the Oxygen-Rich Environment
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Abstract: Introduction: Hyperbaric oxygen therapy (HBOT) is defined as breathing 100% oxygen at a pressure ≥1.4 atmospheres absolute (ATA). Adjunct HBOT is one modality used for treatment of certain complex wounds. The resulting increase in oxygen delivery to wounded tissue has been associated with reduced edema, reduced inflammation, improved infection control, increased collagen deposition, and increased angiogenesis. However, there remains a relative paucity of evidence supporting the use of HBOT in the treatment of certain acute and chronic, non-healing wounds. This feasibility study was undertaken to evaluate the ability of fluorescence angiography to provide real-time visualization and objective assessment of changes in local tissue perfusion over a standard course of HBOT. Materials and Methods: This single-center, prospective, feasibility study included a total of 34 subjects with wounds of various etiologies deemed eligible for treatment with adjunct HBOT. Fluorescence angiography was performed pre- and post-HBOT sessions 1, 5, 10, 15, and 20. The imaging sequences were analyzed to determine the effects of HBOT on local tissue perfusion to the wounds. Results: A total of 22 subjects received a minimum of 10 HBO sessions with associated pre- and post-fluorescence angiography performed and analyzed. Fluorescence angiography was able to provide both real-time visualization and objective assessment of changes in tissue perfusion over the course of adjunct HBOT. Conclusion: The results of this feasibility study suggest that serial fluorescence angiography can detect short- and long-term changes in wound area tissue perfusion associated with HBOT. These findings may assist in the selection and monitoring of patients undergoing HBOT. Authors: Jonathan F. Arnold, MD, ABPM-UHM, CWS-P, Medical Director, Great River Wound and Hyperbaric Medicine Clinic, Great River Medical Center, West Burlington, Iowa, Melissa Roscum, RN, BSN, CHT, CWCA, Staff Nurse, Great River Wound and Hyperbaric Medicine Clinic, Great River Medical Center, West Burlington, Iowa |
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