Hyperbaric oxygen therapy as treatment of diabetic foot ulcers

Abstract

SummaryHyperbaric oxygen therapy (HBO) could be described as a short-term, highdose oxygen inhalation and diffusion therapy, delivered systemically through airways and blood, achieved by having the patient breathing concentrated oxygen at a pressure higher than 1 absolute atmosphere. In clinical practice, monoplace or multiplace hyperbaric chambers are used to achieve this. Treatment is usually given as daily 90-to 120-min-long HBO sessions at pressures between 2.0 and 2.5 absolute atmosphere, aiming for 30-40 treatment sessions. The use of HBO as treatment of diabetic foot ulcers has been founded on weak scientific ground, although the outcomes from previous studies are in concert with the conclusions from preclinical studies and supports the theoretical framework of HBO reversing hypoxia-induced pathology. Two well-designed randomized double-blind trials have put HBO on firmer ground and may justify adjunctive HBO treatment to a selected group of patients with nonhealing diabetic foot ulcers. Some health economic studies suggest potential cost effectiveness, but these studies are limited by deficient primary clinical data and should be interpreted with caution. Several issues remain to be addressed, such as developing robust criteria to improve treatment protocols, determining which patients are likely to benefit, and when to start and stop treatment.

The modified Pirogoff's amputation in treating diabetic foot infections: surgical technique and case series

“…There is increasingly strong evidence that hyperbaric oxygen therapy can significantly improve the healing of diabetic wounds in the short term (12, 13) and the authors used this modality as an adjunctive therapy to improve wound healing in the postoperative period.…”

Adjunct Methods of the Standard Diabetic Foot Ulceration Therapy

“…HBO can be applied as an adjunctive therapy for patients with severe soft tissue foot infections and osteomyelitis who have not responded to conventional treatment, though the available data are insufficient [32, 71, 72, 109, 110]. …”

“…A review of 6 studies prepared by Roeckl-Wiedmann et al [69] demonstrated that additional application of HBOT reduced the risk of amputation in 118 patients. Other double-blinded, randomized, and placebo-controlled clinical trials presented by Löndahl et al [33, 70, 71] proved applicability of HBOT in DFU adjunct therapy. Complete healing of the index ulcer (acc.…”

Restoring Vascular Function with Hyperbaric Oxygen Treatment: Recovery Mechanisms

“…Hyperbaric oxygenation (HBO 2 ) is the therapeutic or experimental application of 100% oxygen at a pressure level higher than atmospheric pressure [1,2]. The delivery of oxygen under high pressure increases arterial and tissue pO 2 in the body and this has beneficiary effects on many conditions where reduced tissue oxygenation does not meet the metabolic needs.…”

“…With HBO 2 , the amount of dissolved oxygen in the plasma increases, facilitating delivery of oxygen independent of hemoglobin [3,4]. This is achieved by various patterns of hyperbaric exposure, mostly with repetitive hyperbaric sessions ranging from 90-120 min at pressures of 2.0-2.5 bar, used on humans with clinical conditions or on animals as experimental models [1,2,5,6,7]. HBO 2 is clearly connected with beneficial effects for some conditions with vascular pathology.…”