Hyperbaric Oxygen Therapy: Solution for Difficult to Heal Acute Wounds? Systematic Review

Abstract

BackgroundHyperbaric oxygen therapy (HBOT) is used to treat various wound types. However, the possible beneficial and harmful effects of HBOT for acute wounds are unclear.MethodsWe undertook a systematic review to evaluate the effectiveness of HBOT compared to other interventions on wound healing and adverse effects in patients with acute wounds. To detect all available randomized controlled trials (RCTs) we searched five relevant databases up to March 2010. Trial selection, quality assessment, data extraction, and data synthesis were conducted by two of the authors independently.ResultsWe included five trials, totaling 360 patients. These trials, with some methodologic flaws, included different kinds of wound and focused on different outcome parameters, which prohibited meta-analysis. A French trial (n = 36 patients) reported that significantly more crush wounds healed with HBOT than with sham HBOT [relative risk (RR) 1.70, 95% confidence interval (CI) 1.11–2.61]. Moreover, there were significantly fewer additional surgical procedures required with HBOT (RR 1.60, 95% CI 1.03–2.50), and there was significantly less tissue necrosis (RR 1.70, 95% CI 1.11–2.61). In one of two American trials (n = 141) burn wounds healed significantly quicker with HBOT (P < 0.005) than with routine burn care. A British trial (n = 48) compared HBOT with usual care. HBOT resulted in a significantly higher percentage of healthy graft area in split skin grafts (RR 3.50, 95% CI 1.35–9.11). In a Chinese trial (n = 145) HBOT did not significantly improve flap survival in patients with limb skin defects.ConclusionsHBOT, if readily available, appears effective for the management of acute, difficult to heal wounds.

Results of hyperbaric oxygenation in chronic wound healing – preliminary findings

“…Some of the factors influencing HBOT efficiency have not been identified so far -this fact increases the value of the prognostic signs identified by us. Similar results were shown in reports by Cochrane [5,[13][14][15].…”

“…Hyperbaric oxygenation therapy increases cellular pO 2 leading to more intense production of reactive oxygen species (ROS) and reactive nitrogen species (RNS). Thus HBOT can cause improvement in tissue perfusion and oxygenation, and also create sustained conditions for the wound healing process [5]. Hyperbaric oxygenation therapy can constitute a key element in maintaining optimal oxygenation, macroand microcirculation, and nutrition [6].…”

Oxigenoterapia hiperbárica para tratamento de feridas

“…According to the latest assessment, the use of HBOT as adjunct treatment to manage a refractory diabetic wound reduces the risk of major amputation (with an odds ratio of 0.236 and a confidence interval (CI) of 95%: 0.133 -0.418) and improves healing (with an odds ratio of 11.64 and IC 95%: 3.457 -39.196), with a level of evidence "A" (randomised controlled trials) and a grade of recommendation "l" (recommended) (15)(16)(17) .…”

“…A systematic review showed that HBOT appears to be effective for the treatment of complex acute wounds (15) . Hyperbaric oxygen improves the effects of acute traumatic ischaemia by means of four mechanisms, namely hyperoxygenation, vasoconstriction, influence on reperfusion, and factors associated with the patient (1) .…”

“…In addition to HBOT, these wounds are often treated with care techniques such as debridement, bandages, pressure relief strategies, adequate glucose control, nutrition and antibiotics (1,15) .…”