What is the Role of Hyperbaric Oxygen in the Management of Diabetic Foot Disease?

Abstract

Systemic hyperbaric oxygen (HBO) is accomplished when a patient is breathing 100% oxygen in an environment with increased barometric pressure. A typical HBO treatment protocol of diabetic foot ulcer involves 20 to 40 sessions. Treatment is usually given as daily 90- to 120-minute HBO sessions at pressures between 2.0 and 2.5 absolute atmospheres. The wide use of HBO as treatment of diabetic foot ulcers over the past decades has been founded on weak scientific ground (ie, few and small prospective studies with methodologic limitations on top of case series). However, the consistency in positive outcome in these trials evaluating HBO on ulcer healing is noteworthy because these findings are in concert with data from in vitro and physiologic studies supporting the theoretic framework of HBO reversing hypoxia-induced pathology. Two well-designed randomized double-blinded placebo-controlled studies have in recent years put HBO on firmer ground as treatment of a selection of diabetic patients with chronic foot. Some evidence indicates that microvascular parameters such as transcutaneous (partial) oxygen pressure (TcPO(2)) could be useful in predicting which patients will benefit from therapy. Health economic studies suggest potential cost-effectiveness of HBO. But because these analyses are limited by their deficient primary clinical data, they should be interpreted with caution. Thus, HBO is only indicated in a selected group of patients with chronic diabetic foot ulcers. Several key issues remain to be addressed such as developing robust criteria to determine which patients are likely to benefit and when to start and stop treatment.

The Role of Hyperbaric Oxygen in the Treatment of Diabetic Foot Ulcers

“…Overall, the long-term ulcer healing rates of nonrandomized studies (77% with HBO vs 25% with standard treatment) are similar to 1-year followup data from the 2 double-blinded randomized control trials (54% vs 24%, respectively). 67 Impact on amputation. The outcome of unsuccessful treatment of diabetic foot ulcers is usually amputation, especially in cases of inadequate peripheral circulation.…”

Clinical results of the application of a hemoglobin spray to promote healing of chronic wounds

“…But, it seems to be important that the vascular system is functional and therefore HBOT may be less effective in the degenerated tissue of chronic leg ulcers [13]. Nevertheless, hyperbaric oxygen therapy is becoming an accepted treatment due to an increasing number of studies showing potential mechanisms of action, in particular as an adjunctive therapy.…”

Hyperbaric Medicine for the Hospital-Based Physician

“…56,57 Transcutaneous oxygen measurements obtained during HBO 2 can help predict if a wound will heal or if amputation may be necessary. 56 In the recent randomized blinded trial by Löndahl et al, 58 56 Nondiabetic patients with ischemic, nonhealing wounds may benefit from HBO 2 , but prospective clinical trial evidence is lacking. The fundamental mechanisms by which HBO 2 facilitates healing are the same regardless of whether diabetes is present.…”