Since 1983
Advancing Hyperbaric Medicine
Physician-Led
Multidisciplinary Community
Evidence-Based
Education • Safety • Professional Excellence
Advancing Hyperbaric Medicine
Multidisciplinary Community
Education • Safety • Professional Excellence
The American College of Hyperbaric Medicine (ACHM) strongly supports the continued advancement and responsible integration of innovative technologies that improve our ability to evaluate, understand, and treat complex wounds. Near-infrared spectroscopy (NIRS) represents an exciting advancement in modern wound care and hyperbaric medicine. The ability to obtain objective, noninvasive information regarding tissue oxygenation provides clinicians with another important window into the physiology of a wound—information that can complement the physical examination and other established diagnostic tools.1-3 As medicine continues to move toward precision care, the ACHM believes that technologies that allow clinicians to measure tissue physiology rather than simply observe wound appearance have an important role in the future of wound management.
Oxygen is fundamental to wound healing,4 and tissue oxygenation is particularly relevant to hyperbaric medicine.5 Hyperbaric physicians routinely evaluate patients in whom tissue oxygenation, perfusion, vascular status, infection, inflammation, and the overall wound environment all contribute to healing. NIRS technology can provide valuable objective information that may help clinicians better understand these physiologic conditions.6,7 This is especially exciting because NIRS assessment can be performed noninvasively and without disturbing the wound, allowing clinicians to evaluate tissue in a manner that can complement traditional clinical assessment.3,6 The ACHM views NIRS as an important addition and diagnostic tool to the modern hyperbaric physician’s clinical toolbox.
Traditional wound assessment appropriately relies upon careful examination, wound measurements, vascular evaluation, imaging, laboratory information, and clinical judgment. Technology now gives us the opportunity to go further. NIRS allows clinicians to ask an additional and important question: What is happening physiologically within the tissue?
That information may assist clinicians in:
➢ Establishing an objective tissue-oxygenation baseline
➢ Evaluating areas of compromised tissue
➢ Monitoring physiologic changes during treatment
➢ Supporting assessment of treatment response
➢ Complementing vascular and wound evaluations
➢ Helping guide multidisciplinary wound-care discussions
➢ Building a more objective picture of the patient’s healing environment
Clinical studies have demonstrated that NIRS-derived measures of tissue oxygenation can be used to track wound progression over time and may help identify which wounds are likely to heal.8-11 NIRS has also been used to document changes in wound oxygenation following revascularization and hyperbaric oxygen therapy.7,12 The ACHM believes this represents an important step toward precision wound care.
The ACHM emphasizes that NIRS is intended to complement—not replace—clinical judgment and established standards of care. The wound-care physician remains responsible for integrating the complete clinical picture, including the patient’s history, examination, vascular status, wound characteristics, infection status, nutrition, glycemic control, debridement, off-loading, imaging, and other appropriate assessments. NIRS adds another dimension to that evaluation. It provides information that can be incorporated into the physician’s overall clinical decision-making process and may help us better understand how tissue is responding over time.
The ACHM recognizes that medical technology continues to evolve and that evidence surrounding emerging technologies should continue to develop. We strongly support ongoing research into NIRS technology, including studies examining clinical outcomes, standardized protocols, patient selection, reproducibility, and the relationship between measured tissue oxygenation and healing.2,15 At the same time, continued research should occur alongside responsible clinical use and innovation. The ACHM encourages clinicians, researchers, manufacturers, policymakers, and payers to work together to establish the strongest possible evidence base and to identify the patients and clinical circumstances in which NIRS provides the greatest value.
The future of wound care will increasingly involve technologies that allow clinicians to understand wounds at a deeper physiologic level. We are moving beyond simply asking, “Does the wound look better?” We are increasingly able to ask, “Is the tissue becoming healthier?”
That is an important evolution. For hyperbaric medicine in particular, where tissue oxygenation is central to the biologic effects of treatment, objective assessment of tissue oxygenation has tremendous potential to enhance patient evaluation and clinical decisionmaking.5-7 The ACHM believes that NIRS technology is an important part of this evolution.
The American College of Hyperbaric Medicine supports:
➢ Continued advancement of NIRS.
➢ Appropriate clinical use of NIRS as a diagnostic tool to comprehensive wound and
hyperbaric evaluation.
➢ Continued research and development of standardized clinical protocols.
➢ Objective measurement of tissue physiology as an important component of
precision wound care.
➢ Collaboration among clinicians, researchers, technology developers, and
policymakers.
➢ Thoughtful consideration of coverage policies that recognize the evolving role of
innovative technologies in modern wound care.
The American College of Hyperbaric Medicine believes that technology should help us see more, measure more, and ultimately understand our patients better. NIRS tissue oxygenation assessment represents an exciting opportunity to bring greater objectivity and physiologic understanding to wound care and hyperbaric medicine. As physicians, our responsibility is to continually seek better ways to evaluate our patients, improve our decision-making, and advance healing. NIRS is an important part of that future. The ACHM proudly supports continued innovation, responsible clinical implementation, and rigorous research to further define how this technology can improve the care of patients with complex wounds. The future of wound care is objective, physiologic, data-informed, and patient-centered—and NIRS technology has an important role in helping us get there.
Tyler Sexton, MD
President, American College of Hyperbaric Medicine