Kaur
Hyperbaric oxygen therapy improved healing of chronic ulcers in the short term
Clinical Bottom Line
| 1. HBOT improved several measures of wound healing 2. No significant difference in the number of wounds healed at 30 days |
Citation/s:1.Kaur S, Pawar M, Banerjee N, Garg R. Evaluation of the efficacy of hyperbaric oxygen therapy in the management of chronic nonhealing ulcer and role of periwound transcutaneous oximetry as a predictor of wound healing response: A randomised prospective controlled trial. Journal of Anaesthesiology and Clinical Phaarmacology 2012;28(1):70-75.
Lead author's name and fax: Sarbjot Kaur. Contact [drrgarg@hotmail.com]
Three-part Clinical Question: For patients with chronic, non-healing ulcers of mixed aetiology, does the addition of HBOT result in improved wound healing?
Search Terms: nonhealing wounds, transcutaneous oximetry
The Study: Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Adult patients presenting with wounds not responsive to four weeks of 'conventional' treatment
Control group (N = 15; 15 analysed): Continued conventional treatment with debridement, antibiotics, daily dressing as required and managed by referring doctor.
Experimental group (N = 15; 15 analysed): As above plus 100% oxygen at 2.5 ATA for 90 minutes daily six days each week in a monoplace chamber to a total of 30 sessions.
The Evidence:
Outcome |
Time to Outcome |
Control Group Rate |
HBO Group Rate |
Relative risk reduction |
Absolute risk reduction |
Number needed to treat |
|
Healed wound |
30 days |
0 |
0.20 |
INF |
0.20 |
5 |
95% CI: |
-0.402 to 0.002 |
NNT 2 to INF NNH 412 to INF | ||||
|
Exudate resolved |
30 days |
0.20 |
0.73 |
266% |
0.53 |
2 |
95% CI: |
116% to 417% |
0.23 to 0.84 |
1 to 4 | |||
|
Granulation tissue present |
30 days |
0.400 |
0.80 |
100% |
0.40 |
3 |
95% CI: |
20% to 180% |
0.08 to 0.72 |
1 to 13 | |||
|
Amputation |
30 days |
0.33 |
0.07 |
80% |
0.27 |
4 |
95% CI: |
-1% to 100% |
-0.004 to 0.54 |
NNT 2 to INF NNH 251 to INF | |||
|
Improved wound score |
30 days |
0.33 |
0.67 |
100% |
0.34 |
3 |
95% CI: |
1% to 202% |
0.003 to 0.67 |
NNT 1 to INF NNH 303 to INF | |||
Non-Event Outcomes |
Time to outcome/s |
Control group |
HBO group |
P-value |
|
Wound area change (median cm-sq) |
30 days |
+26% |
-59% |
0.001 |
|
Change in PtcO2 (mmHg) |
30 d |
+11.8 | -5.7 | Not given |
Appraised by: Mike Bennett; Tuesday, 31 July 2012Email: m.bennett@unsw.edu.au
Kill or Update By: July 2021
Comments:
1. Short term outcomes reduce the applicability of this study.
2. Unblinded design reduces confidence in the results given the subjective nature of many of the outcomes.
3. Authors report a positive correlation between increasing peri-wound PtcO2 and markers of wound healing, and a negative correlation with amputation. Other authors report that PtcO2 on air is not predictive of healing.
4. In the HBO arm, three patients had ear discomfort, two had claustrophobia and one had each of headache and tinnitus.
5. Wound scores were a five point scale from 4 (necrotic tissue) to 0 (epithelialised completely).
