Comment on Fedorko et al. Hyperbaric Oxygen Therapy Does Not Reduce Indications for Amputation in Patients With Diabetes With Nonhealing Ulcers of the Lower Limb: A Prospective, Double-Blind, Randomized Controlled Clinical Trial. Diabetes Care 2016;39:392–399

Summary: Hyperbaric oxygen therapy (HBOT) serves as “primary” or “adjunctive” therapy in a wide range of pathologies. It is considered the mainstay of management for potentially life-threatening conditions such as carbon monoxide poisoning, decompression illness, and gas embolisms. Moreover, HBOT has been utilized for decades as an adjunctive therapy in a variety of medical disciplines, including chronic wounds, which affect approximately 6.5 million Americans annually. In general, chronic wounds are characterized by hypoxia, impaired angiogenesis, and prolonged inflammation, all of which may theoretically be ameliorated by HBOT. Nonetheless, the cellular, biochemical, and physiological mechanisms by which HBOT achieves beneficial results in chronic wounds are not fully understood, and there remains significant skepticism regarding its efficacy. This review article provides a comprehensive overview of HBOT, and discusses its history, mechanisms of action, and its implications in management of chronic wounds. In particular, we discuss the current evidence regarding the use of HBOT in diabetic foot ulcers, while digging deeply into the roots of controversy surrounding its efficacy. We discuss how the paucity of high-quality research is a tremendous challenge, and offer future direction to address existing obstacles.

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“…However, these studies too have been subject to criticism due to several methodological errors. 60 – 62 …”

Section: Methodsmentioning

confidence: 99%

Hyperbaric Oxygen Therapy: Descriptive Review of the Technology and Current Application in Chronic Wounds

Hajhosseini

Kuehlmann

Bonham

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…Also, contrary to the assertion by Löndahl et al (1), transcutaneous oxygen pressure measurement (TcPO 2 ) has very poor negative predictive value (7), which limits its clinical/research usefulness.…”

mentioning

confidence: 58%

Response to Comments on Fedorko et al. Hyperbaric Oxygen Therapy Does Not Reduce Indications for Amputation in Patients With Diabetes With Nonhealing Ulcers of the Lower Limb: A Prospective, Double-Blind, Randomized Controlled Clinical Trial. Diabetes Care 2016;39:392–399

et al. 2016

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“…No actual amputations were performed in this study. Therefore, the exclusion of this study appears justified …”

Section: Resultsmentioning

confidence: 99%

“…Therefore, the exclusion of this study appears justified. [53][54][55] Characteristics of included studies Table 1 gives an overview of the characteristics of the included studies. HBOT protocols varied between 60 and 120 minutes and between 2.0 and 2.5 ATA, for three to 6 days a week.…”

Section: Resultsmentioning

confidence: 99%

Hyperbaric oxygen therapy for nonischemic diabetic ulcers: A systematic review

Lalieu

Brouwer

Ubbink

et al. 2019

Wound Repair Regeneration

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Diabetic foot ulcers are a common complication of diabetes, which affects 25% of patients and may ultimately lead to amputation of affected limbs. Research suggests hyperbaric oxygen therapy improves healing of these ulcers. However, this has not been reflected in previous reviews, possibly because they did not differentiate between patients with and without peripheral arterial occlusive disease. Therefore, we performed a systematic review of published literature in the MEDLINE, Embase, and Cochrane CENTRAL databases on nonischemic diabetic foot ulcers with outcome measures including complete ulcer healing, amputation rate (major and minor), and mortality. Seven studies were included, of which two were randomized clinical trials. Two studies found no difference in major amputation rate, whereas one large retrospective study found 2% more major amputations in the hyperbaric oxygen group. However, this study did not correct for baseline differences. Two studies showed no significant difference in minor amputation rate. Five studies reporting on complete wound healing showed no significant differences. In conclusion, the current evidence suggests that hyperbaric oxygen therapy does not accelerate wound healing and does not prevent major or minor amputations in patients with a diabetic foot ulcer without peripheral arterial occlusive disease. Based on the available evidence, routine clinical use of this therapy cannot be recommended. However, the available research for this specific subgroup of patients is scarce, and physicians should counsel patients on expected risks and benefits. Additional research, focusing especially on patient selection criteria, is needed to better identify patients that might profit from this therapy modality.

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Comment on Fedorko et al. Hyperbaric Oxygen Therapy Does Not Reduce Indications for Amputation in Patients With Diabetes With Nonhealing Ulcers of the Lower Limb: A Prospective, Double-Blind, Randomized Controlled Clinical Trial. Diabetes Care 2016;39:392–399

Cited by 6 publications

References 5 publications

Hyperbaric Oxygen Therapy: Descriptive Review of the Technology and Current Application in Chronic Wounds

Hyperbaric Oxygen Therapy: Descriptive Review of the Technology and Current Application in Chronic Wounds

Response to Comments on Fedorko et al. Hyperbaric Oxygen Therapy Does Not Reduce Indications for Amputation in Patients With Diabetes With Nonhealing Ulcers of the Lower Limb: A Prospective, Double-Blind, Randomized Controlled Clinical Trial. Diabetes Care 2016;39:392–399

Hyperbaric oxygen therapy for nonischemic diabetic ulcers: A systematic review

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