

Hyperbaric oxygen therapy in preventing mechanical ventilation in COVID-19 patients a retrospective case series

Wound Centers and COVID 19

From: SerenaGroup® Executive Team

Date: March 18. 2020

Re: Wound Centers and COVID 19

Recently, the CMS/ HHS and others have encouraged health care delivery systems to consider reducing, delaying, canceling or closing departments that provide non-emergent care.   As your partner in providing advanced wound care, we would like to share our perspective during the COVID19 crises.  SerenaGroup® is strongly encouraging our partner hospitals and clinics to continue wound care services. SerenaGroup CEO, Dr. Thomas Serena stresses that caring for patients suffering from acute and chronic wounds is urgent and essential. This population is at high risk for infectious complications related to their wounds. Left untreated these patients will return to the emergency room septic requiring intensive care services including mechanical ventilation. Closing the wound clinic is more likely to exacerbate the problems we all face in dealing with COVID19. We suggest that the wound clinic staff take every precaution in caring for patients including calling the patients prior to their appointment to ask about COVID19 symptoms, adjusting the schedule to prevent patients from waiting together in the waiting room, and of course handwashing and wearing protective clothing.  Below are FAQ’s to consider,

Is outpatient wound care emergent?

Answer: It is urgent and prevents exacerbation of the current crises.  Patients return to the advanced wound care center weekly. A robust body of literature has shown that this decreases complications such as amputation, infection, sepsis and death. Changing the dressings, cleansing the wound with antiseptics, debriding and applying an antimicrobial dressing dramatically reduces the risk of infectious complications. When patient do not return to the clinic weekly their risk of infection with septic complications rises sharply. The average wound clinic patient has 10 co-morbidities. An infectious complication in this group of patients rapidly leads to sepsis and admission to the ICU. Closing the wound clinic is likely to increase the utilization of ICU beds and ventilators.

Are the patients considered stable or maintenance care?

Answer: No.   Wound care patients have multiple co-morbid conditions (diabetes, lymphedema, infection, congestive heart failure, renal insufficiency, malnutrition and immunosuppression).   Closing or reducing access to care will increase the risk of infectious complications and the need for intensive care.

Should on-going care be delayed?

Answer: This patient population typically has procedures that are time limiting throughout their course of care.  They may have a Total Contact Cast (TCC), Multi-layered Compression (MLC), Cultured Tissue Products (CTP), Negative Pressure Wound Therapy (NPWT), all of which need to be removed at least weekly; some more frequently.

What would happen if the above care was delayed?

Answer: The TCC is designed to be replaced weekly.  If not replaced, progress of the Diabetic Foot Ulcer cannot be managed and there is the potential that the cast would decrease its ability to protect the off-loaded wound and the friction against the skin may create another wound.

Answer- The MLC is designed to reduce edema in the extremity and wick fluid away from the venous leg ulcer.  Periodic replacement allows for reducing edema and removing the exudate from the ulcer.  

What about Hyperbaric Oxygen Therapy (HBOT)?

Answer: This patient population needs to receive HBOT daily.  HBOT is comparable to Radiation Therapy for the Cancer patients:  each day of treatment builds from the previous day’s treatment to promote healing.  Delaying or cancelling this could have a negative impact on the patient and increase the risk of complications.