Paths to Practice Perfection
Home-Based Topical Oxygen Therapy During the COVID-19 Pandemic
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The 2020 COVID-19 pandemic has caused the focus of global medical communities to shift towards the treatment of patients with the coronavirus.  Unfortunately, patients with other chronic medical conditions have been left struggling to access care, or too frightened to seek it. Chronic wounds in particular affect a patient population at high risk for COVID-19 infection (diabetes, being >65 years of age, and cardiovascular co-morbidities)1,2. As a result, visits to wound centers in the U.S. decreased by 40% in weeks 12, 13, and 14 of 2020 compared to the previous year1. The lack of regular care can translate into poor outcomes for wound patients. An Italian study concluded that patients returning to wound care clinics after the country’s lockdown were more frequently diagnosed with gangrene (64% vs. an average of 29% in 2019), and were at a greater than three-fold risk of amputation3. As the pandemic enters its second (and third) waves across the globe, wound care clinicians have an opportunity to change the wound treatment paradigm to favour home-based care solutions that 1) reduce COVID-19 infection risk to the patient, 2) provide essential wound care to prevent amputations, and 3) provide relief to a hospital system in crisis.  An in-home technology for the delivery of supplementary oxygen to wounds that fulfills these needs is highlighted here, with proven effectiveness in chronic and hard to heal wounds of several etiologies.

The NATROX® Oxygen Wound Therapy from Inotec AMD is designed to deliver continuous topical oxygen (24 hours a day / 7 days a week). It's small, silent, portable and compatible with most secondary dressings.

The NATROX® device generates continuous sterile oxygen from the hydrolysis of water vapour found in air, and therefore doesn’t require any specialized medical connections, pressurized oxygen tanks etc. for its use.

NATROX® Oxygen Wound Therapy

NATROX® is effective in healing even advanced (Texas Grade III) DFUs4, and highly chronic wounds5. Kaufman et al (2018) reported an 83% reduction in venous leg ulcer area and a 47% wound closure rate, and a 74% reduction and 57% wound closure rate in arterial and diabetic foot ulcers6. We recently used the NATROX® system on a 56-year-old female patient, presented as the following case study7.  

Case Study:

  • Patient presented with a punch biopsy confirmed calciphylaxis lesion.
  • Medical history: End stage renal disease (awaiting kidney transplant), non-insulin dependent diabetes, amyloidosis, anemia, atrial fibrillation, calcinosis cutis, coronary artery disease, congestive heart failure, hyperlipemia, hypertension, insomnia, restless leg syndrome, tachycardia and vitamin D deficiency.
  • Key considerations: The need to heal quickly as removed from transplant list due to open lesion. Limit unnecessary exposure during COVID-19 pandemic.

The decision was made to include NATROX® in the patient’s wound care. 

To minimize the risk to the patient the lesion was treated with bi-weekly self application of NATROX® device coupled with weekly telemedicine visits. Complete wound closure was achieved in 9 weeks of topical oxygen therapy. 

Wound upon presentation

Wound fully closed after 9 weeks of NATROX®

Conclusion

Home-based topical oxygen delivery systems like the Natrox system offer distinct advantages over hospital-based therapies during the pandemic, particularly if they are coupled with telehealth-based wound monitoring technologies. In 2020 and beyond, efforts should be made to ensure wound patients are able to access advanced wound care from home whenever possible, to reduce exposure to COVID-19 and eliminate hospital overcrowding. 

References

  1. Rogers LC, Armstrong DG, Capotorto J, et al. Wound Center Without Walls: The New Model of Providing Care During the COVID-19 Pandemic. Wounds. 2020 Apr 24;32(7):178-185.
     
  2. Singh AK, Gillies CL, Singh R, et al. Prevalence of co-morbidities and their association with mortality in patients with COVID-19: A systematic review and meta-analysis. Diabetes Obes Metab. 2020.
     
  3. Caruso P, Longo M, Signoriello S, et al. Diabetic Foot Problems During the COVID-19 Pandemic in a Tertiary Care Center: The Emergency Among the Emergencies. Diabetes Care. 2020 Oct;43(10):e123-e124.
     
  4. Yu J, Lu S, McLaren AM, Perry JA, Cross KM. Topical oxygen therapy results in complete wound healing in diabetic foot ulcers. Wound Repair Regen. 2016 Nov;24(6):1066-1072.
     
  5. Hayes PD, Alzuhir N, Curran G, Loftus IM. Topical oxygen therapy promotes the healing of chronic diabetic foot ulcers: a pilot study. J Wound Care. 2017 Nov 2;26(11):652-660.
     
  6. Kaufman H, Gurevich M, Tamir E, Keren E, Alexander L, Hayes P. Topical oxygen therapy stimulates healing in difficult, chronic wounds: a tertiary centre experience. J Wound Care. 2018 Jul 2;27(7):426-433.
     
  7. Cole W, Yoder C, Coe S. The use of topical oxygen therapy to treat a calciphylaxis wound during a global pandemic: A case report. Wounds. 2020 Nov;32(11):294-298.