Effects of adding adjunctive hyperbaric oxygen therapy to standard wound care for diabetic foot ulcers: a protocol for a systematic review with meta-analysis and trial sequential analysis

Abstract

IntroductionDiabetic foot ulcer represents a major health problem globally. Preliminary studies have indicated that systemic treatment of diabetic foot ulcer patients with hyperbaric oxygen therapy have beneficial effects on wound healing, risk of amputation, glycaemic control, atherosclerosis, inflammatory markers and other clinical and laboratory parameters. This protocol for a systematic review aims at identifying the beneficial and harmful effects of adding hyperbaric oxygen therapy to standard wound care for diabetic foot ulcers.Methods and analysisThis protocol was performed following the recommendations of the Cochrane Collaboration and the eight-step assessment procedure suggested by Jakobsen and colleagues. We plan to include all relevant randomised clinical trials assessing the effects of hyperbaric oxygen therapy in the treatment of diabetic foot ulcer versus any control group with any intervention defined as standard wound care or similar, together with sham interventions. Our primary outcome will be: all-cause mortality, serious adverse events and quality of life. Our secondary outcomes will be: healing of index wound, major amputation and wound infection. Any eligible trial will be assessed and classified as either high risk of bias or low risk of bias, and our conclusions will be based on trials with low risk of bias. The analyses of the extracted data will be performed using Review Manager 5 and Trial Sequential Analysis. For both our primary and secondary outcomes, we will create a ‘Summary of Findings’ table and use GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment to assess the quality of the evidence.Ethics and disseminationWe use publicly accessible documents as evidence, there is no participant involvement at an individual level and an institutional ethics approval is not required. The results of the review will be sought published in a peer-reviewed journals, also in the event of insignificant results or null results, and thereby it will be disseminated to clinicians and public available.PROSPERO registration numberCRD42019139256.

Photoacoustic monitoring of angiogenesis predicts response to therapy in healing wounds

“…Compared to other commonly employed techniques such as ankle brachial index, TCOM and so on, PA imaging is the best predictor for wound healing (AUC = 0.915, Table 2). PA classification could allow wound specialists to change their course of treatment if the wound is not responding to conventional treatment protocols 15,25,53,54 . This would in turn improve outcomes, reduce amputations, healing time and costs.…”

Hyperbaric Oxygen Therapy: An Effective Auxiliary Treatment Method for Large Jaw Cysts

“…The infection of large bone defects filled with bone substitute after enucleation is still a serious issue in the treatment of large cysts [13]. Therefore, a new and effective treatment method is much needed, and HBOT has been suggested as a promising solution [17][18][19]. Therefore, we conducted a randomized controlled clinical trial to assess the effects of HBOT during the treatment of patients whose bone defects were filled with bone substitute after enucleation.…”

“…Hyperbaric oxygen therapy (HBOT) is a kind of treatment whereby patients inhale 100% oxygen at super-atmospheric pressure and has been widely used in refractory diseases, osteomyelitis, compromised skin graft and flap, anaerobic and so on 17 . There are many studies that showed that HBOT could inhibit the growth of anaerobic bacteria, ease inflammation, and promote ossification 18 , 19 . Therefore, we propose that HBOT could help to reduce the risk of postoperative complications, as well as promoting ossification after enucleation.…”

Therapeutic effects of hyperbaric oxygen

“…It can also have therapeutic importance in wounds from burns and diabetic ulcers. 34 35 36 It has a positive role in compromised flaps and can increase the effective size of composite graft survival, and improve prognosis of flap survival. Generally the skin grafts contain different tissue types with varying sizes that lack proper blood supply and are depended on the host for nutrient.…”