SLR - January 2023 - Jesse Miller
Title: Local Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot UlcersReference: Pasek J, Szajkowski S, Oleś P, Cieślar G. Local Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers. Int J Environ Res Public Health. 2022 Aug 24;19(17):10548. doi: 10.3390/ijerph191710548. PMID: 36078262; PMCID: PMC9518160.
Level of Evidence: Level 2
Scientific Literature Review
Reviewed By: Jesse Miller
Residency Program: Beaumont Farmington Hills, Michigan
Podiatric Relevance: Hyperbaric oxygen therapy is important when it comes to difficult to heal foot ulcers. This article was unique in that it attempted to put out a clinical trial to help collect data for the efficacy of HBO therapy in healing wounds after reviewing for other studies, which showed less statistical significance.
Methods: The study had 45 patients who have long term diabetes who had not undergone revascularization yet. The age range of the patients were 40-85. The patients were then placed in a HBO therapy tube and then subjected to 30 minutes of treatment at 2.5ATA at 5L/min flow rate of oxygen. This therapy was performed 30 times total, from 2 series of 15 daily therapies excluding the weekends. There were 4 weeks between series. The wound sizes were then measured using statistica 13 package, which uses a computer to measure the exact wound edges. The study also compared the pain levels of the patients before and after having the hyperbaric oxygen therapy.
Results:There was a statistically significant decrease in the mean ulcer size before and after treatment. The usual prior wound size is 8.54 +/- 3.34 cm2 and the wound size after the hyperbaric oxygen therapies was 4.23 +/- 3.323 cm2. Pain decreased from 4.64 +/- 1.68 to 1.51 +/-0.92. There were no increases in the surface areas of the ulcers.
Conclusions: The amount of patients in this study was not high enough to be able to draw any conclusions as the population is not representative of all of the patients who might try hyperbaric oxygen therapy. The authors concluded that using hyperbaric oxygen therapy to close wounds does help to reduce the surface area of the treated wounds and reduces perceived pain for patients. I feel that this study shows that hyperbaric oxygen therapy helps to close the wounds, but these also seem like more ideal situations than we normally see in our clinical situations. I feel that this study shows that if you do everything for a wound and are strictly compliant that you could do the hyperbaric oxygen therapy and help close a wound much quicker than dressing changes alone. This article would not make me think that hyperbaric oxygen therapy would help every patient, but it makes me think that it is an option that can be pursued in the event of a non-infected, difficult wound which might benefit from hyperbaric oxygen therapy.