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Evidence summaries

Hyperbaric Oxygen Therapy for Chronic Wounds

Addition of hyperbaric oxygen therapy (HBOT) to standard wound care regimen in people with foot ulcers due to diabetes appears to improve wound healing by 6 weeks but this benefit might possibly not be evident at longer-term follow-up at 1 year. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 12 studies with a total of 577 subjects.

10 trials with 531 patients dealed with diabetic foot ulcers. Pooled data showed an increase in the rate of ulcer healing (RR 2.35, 95% CI 1.19 to 4.62) with hyperbaric oxygen therapy (HBOT) at 6 weeks but this benefit was not evident at longer-term follow-up at one year (RR 9.53, 95% CI 0.44 to 207.76). There was no statistically significant difference in major amputation rate (RR 0.36, 95% CI 0.11 to 1.18; 5 studies, n = 312).

One trial with 16 patients dealed with venous ulcer. This trial reported data at six weeks (wound size reduction) and 18 weeks (wound size reduction and healing rate) and suggested a significant benefit of HBOT in terms of reduction in ulcer area only at 6 weeks (mean difference (MD) 33%, 95% CI 18.97 to 47.03). One trial with 30 patients dealed with non-healing diabetic ulcers as well as venous ulcers. For these mixed ulcers there was a significant benefit of HBOT in terms of reduction in ulcer area at the end of treatment at 30 days (MD 61.88%, 95% CI 41.91 to 81.85) No trials dealed with arterial and pressure ulcers.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding) and by imprecise results (wide confidence intervals), and upgraded by large magnitude of effect.

    References

    • Kranke P, Bennett MH, Martyn-St James M et al. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev 2015;(6):CD004123. [PubMed].

Primary/Secondary Keywords