Hyperbaric Oxygen Therapy: Evidence Based Role in Diabetic Foot (original) (raw)
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HYPERBARIC OXYGEN THERAPY – AN ADJUVENT IN TREATMENT FOR DIABETIC FOOT
As Diabetes issues are increasing widely, and because of Diabetic feet, mortality rate is increasing rapidly. Even Foot complications are one of the most serious and Diabetes mellitus is giving more unpredicted and unpreventable complications, hence indirectly burden on healthcare resources are getting increased. The treatment associated with diabetes complications are very costly. Standard treatments to treat diabetic foot ulcers are generally fail, as a result adjunctive therapies must be considered.In these circumstances, use of systemic Hyperbaric Oxygen Therapy (HBOT) as an adjunctive therapy for diabetic foot is safe, reasonable and cost effective modality.HBOT in diabetic ulcers has proven its role in promoting oxygenation, enhancing immune mechanisms, fibroblast proliferation and other benefits. It is now accepted as a useful adjunctive treatment in diabetic patients with severe ulcers. It is confirmed to be an effective treatment when combined with careful attention to diabetic foot wounds.
Diabetes mellitus (DM) is a metabolic disease in which the body has difficulty producing insulin which leads to high blood glucose levels. Consequently, people suffering from DM can have damage organs, blood vessels, and nerves which resulting in getting diabetic foot ulcer (DFU). Other therapeutic interventions are offered if the DFU does not heal with normal standard wound care. One of which is hyperbaric oxygen therapy (HBOT) that will increase the oxygen supply to wounds. However, the effectiveness of this therapy is not clearly known till present. Thus, the review of this paper aimed to report on the results of analysis of research that focuses on the effect HBOT on diabetic foot ulcer healing. Relevant literature was searched in Google Scholar and PubMed used keywords "hyperbaric oxygen therapy" "diabetic foot ulcer" "wound healing", and "chronic ulcer". Five articles that met the inclusion criteria based on the results of the analysis. Although there was some indication of a beneficial effect of wound healing process, it is currently unknown which patients are likely to benefit from HBOT and which patients are not. KEYWORD: hyperbaric oxygen therapy, diabetic foot ulcer, wound healing
Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers
Journal of Diabetes and its Complications, 2002
Background: The cause of diabetic foot ulcers is multifactorial, e.g., neuropathy and angiopathy, leading to functional disturbances in the macrocirculation and skin microcirculation. Adequate tissue oxygen tension is an essential factor in infection control and wound healing. Hyperbaric oxygen (HBO) therapy, daily sessions of oxygen breathing at 2.5-bar increased pressure in a hyperbaric chamber, has beneficial actions on wound healing including antimicrobial action, prevention of edema and stimulation of fibroblasts. The aim of the present study was to investigate the long-term effect of HBO in treatment of diabetic foot ulcers. Methods: Thirty-eight diabetic patients (30 males) with chronic foot ulcers were investigated in a prospective study. The mean age was 60 ± 13 years and the mean diabetes duration 27 ± 14 years. All patients were evaluated with measurements of transcutaneous oxygen tension (tcPO 2 ), peripheral blood pressure, and HbA 1c . All patients had a basal tcPO 2 value lower than 40 mmHg, which increased to 100 mmHg, or at least three times the basic value, during inhalation of pure oxygen. Seventeen patients underwent 40 -60 sessions of HBO therapy, while 21 patients were treated conventionally. The follow-up time was 3 years. Results: 76% of the patients treated with HBO (Group A) had healed with intact skin at a follow-up time of 3 years. The corresponding value for patients treated conventionally (Group B) was 48%. Seven patients (33%) in Group B compared to two patients (12%) in Group A went to amputation. Peripheral blood pressure, HbA 1c , diabetes duration, and basal values of tcPO 2 were similar in both groups. Conclusions: Adjunctive HBO therapy can be valuable for treating selected cases of hypoxic diabetic foot ulcers. It seems to accelerate the rate of healing, reduce the need for amputation, and increase the number of wounds that are completely healed on long-term follow-up. Additional studies are needed to further define the role of HBO, as part of a multidisciplinary program, to preserve a functional extremity, and reduce the short-and long-term costs of amputation and disability. D
Systemic hyperbaric oxygen therapy: lower-extremity wound healing and the diabetic foot
Diabetes Care, 2000
OBJECTIVE: To document peer-reviewed medical publications that have reported on hyperbaric oxygen (HBO) therapy as an adjunct to standard lower-extremity wound care, focusing on publications dealing with the diabetic foot. RESEARCH DESIGN AND METHODS: A review of the medical literature was conducted using MEDLINE. Research articles involving HBO treatment and the diabetic foot were critiqued to identify factors that may have been a source of bias. RESULTS: Of the published reports on human studies, seven involved diabetes-related foot pathology. Five of these studies, two of which were randomized, included a control group that did not receive HBO therapy The controlled diabetic foot studies included an average of 28 subjects in the HBO therapy group (range 10-62) and an average of 16.2 subjects in the non-HBO control group (range 5-33). Most of the published reports have several potential sources of bias, including, but not limited to, inadequate evaluation of comorbid conditions re...
Effect of Hyperbaric Oxygen Therapy on Healing of Diabetic Foot Ulcers
Journal of Foot & Ankle Surgery, 2008
Hyperbaric oxygen therapy can be used as an adjunct to standard wound care in the treatment of diabetic patients with foot ulcers. We undertook a prospective, randomized investigation of the use of hyperbaric oxygen therapy versus standard therapy for the treatment of foot ulcers in diabetic patients. A number of demographic variables were analyzed in regard to wound healing. We noted that foot ulcers in patients in the hyperbaric oxygen therapy group were more likely to heal, and were more likely to undergo amputation distal to the metatarsophalangeal joint compared with those patients receiving standard therapy without hyperbaric oxygen. We feel that hyperbaric oxygen therapy should be considered a useful adjunct in the management of foot ulcers in diabetic patients.
2021
Background: Foot ulcer is one of the complications that causes major problems in the world for diabetics. If the wound on the foot is not treated immediately, it will lead to complications and the risk of amputation of the extremity. Thus, a strategy is needed in the prevention and treatment of diabetic foot ulcers. Hyperbaric oxygen therapy is hypothesized to affect the wound healing process, reduce exudate, lower inflammatory response, and the risk of amputation. This study aimed to systematically review the relevant research of hyperbaric oxygen therapy to accelerate the healing of diabetic foot ulcer. Subjects and Method: This was a systematic review using PRISMA Flow Diagram guidelines. The articles published in PubMed, Science Direct, ProQuest, and the Cochrane Library databases, from 2011 to 2021. The study population was patients with diabetic foot ulcer. Intervention was hyperbaric oxygen therapy. Comparison was non hyperbaric oxygen therapy. Outcome was endothelial growth factor serum. The inclusion criteria were randomized controlled trial and full-text in English. The eligible articles were assessed qualitatively. Results: A total of 7 randomized control trials from Egypt, Australia, Taiwan, India, Indonesia, and Malaysia was included in this study. Endothelial growth factor serum was high in the hyperbaric oxygen therapy group compared to the control group. Conclusion: Hyperbaric oxygen therapy has benefit on the wound healing process in patients with diabetic foot ulcer.
Harefuah, 2007
Chronic wounds of the lower limbs are a cause of severe morbidity in diabetic patients. Low oxygen tension around the wound is one of several critical factors, which mutually enhance the progression of a chronic ulcer. Hyperbaric oxygen therapy (HBO) is believed to improve wound healing by enhancing oxygen tension around the wound. While conventional therapies for diabetic foot ulcer are based on scientific evidence, HBO treatment lacks evidence-based support regarding its cost effectiveness and efficacy. Recently, several publications emerged, which improve our knowledge regarding this subject. This paper briefly reviews the pathophysiology of chronic diabetic ulcers and the possible advantage of HBO therapy in this clinical setting. The article also summarizes the results of relevant publications, in which appropriate scientific measures were applied. In conclusion, there is evidence that HBO therapy reduces the need for major amputations among diabetic patients with chronic ulcer...
Counterpoint: Hyperbaric Oxygen for Diabetic Foot Wounds Is Not Effective
Clinical Infectious Diseases, 2006
Background. Diabetic foot ulceration is common, affecting 1.0%-4.1% of diabetic persons per year and up to 25% in a lifetime. Diabetic foot ulcers are multifactorial in origin, and many are slow to heal and/or are complicated by infection, frequently leading to amputation. Hyperbaric oxygen therapy has been suggested for numerous indications, and it is recognized by funding agencies for a smaller number including diabetic foot wounds. Methods. I reviewed the literature about the history and practice of hyperbaric oxygen therapy and key issues relevant to efficacy, effectiveness, and cost-effectiveness. Results. Although recognized for reimbursement by Medicare and major insurers, the evidence base for hyperbaric oxygen therapy for diabetic foot care remains weak. A systematic review for the Cochrane Collaboration concluded that hyperbaric oxygen therapy may have value in treating diabetic wounds, but the studies reviewed all had methodological weaknesses, and the positive effect of treatment was not seen in the single reviewed randomized trial to include a sham treatment arm. Hyperbaric oxygen therapy consumes very substantial resources-and has the potential to consume far more-that could be better spent on other aspects of management or prevention of diabetic foot ulceration. Conclusions. Hyperbaric oxygen therapy should not be offered for diabetic foot wounds until large-scale, adequately blinded, controlled, and powered randomized studies have clearly demonstrated efficacy and cost effectiveness in the healing of ulcers and the prevention of major amputation. The worldwide epidemic of type 2 diabetes has brought to attention its common complications of foot ulceration, secondary infection, and subsequent major limb amputation [1, 2]. Diabetic foot ulceration is driven predominantly by the effects of peripheral neuropathy on foot biomechanics (foot deformity being associated with high pressures in specific weight-bearing areas) and on protective sensation [3]. Once established, ulceration may extend to deep underlying structures, including bone and joint. Softtissue infection, chronic septic arthritis, and chronic osteomyelitis are all frequent events that impair wound
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society
The purpose of this study was to compare the effect of standard wound care with adjunctive hyperbaric oxygen therapy (HBOT) to standard wound care alone on wound healing, markers of inflammation, glycemic control, amputation rate, survival rate of tissue, and health-related quality of life in patients with diabetic foot ulcers (DFUs). Prospective, randomized, open-label, controlled study. The sample comprised 38 patients with nonhealing DFUs who were deemed poor candidates for vascular surgery. Subjects were randomly allocated to an experimental group (standard care plus HBOT, n = 20) or a control group (standard care alone, n = 18). The study setting was a medical center in Kaohsiung City, Taiwan. Hyperbaric oxygen therapy was administered in a hyperbaric chamber under 2.5 absolute atmospheric pressure for 120 minutes; subjects were treated 5 days a week for 4 consecutive weeks. Both groups received standard wound care including debridement of necrotic tissue, topical therapy for W...