Gordoben: Imported from Wikispaces

2018-01-20T23:23:57Z

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'''Adjunctive hyperbaric oxygen for the treatment of diabetic foot wounds resulted in a reduction in the rate of major amputation required to control infection.''' 

'''Clinical Bottom Line:''' 
1. The addition of hyperbaric oxygen to the treatment regimen for diabetic foot wounds resulted in a lower rate of major amputation. 
'''Appraised by:''' Mike Bennett and Simon Mitchell, Australia and New Zealand Hyperbaric Medicine Group, c/o ANZCA, St. Kilda Rd Melbourne; Friday, 16 April 1999 

'''Clinical Scenario:''' A patient presented for management of a diabetic foot ulcer and we wondered if the addition of hyperbaric oxygen would increase the chance of healing. 
'''Three-part Question:''' In patients with diabetic foot wounds, does the addition of hyperbaric oxygen therapy to a standard treatment regimen result in any improvement in wound healing, or reduction in amputation rate? 
'''Search Terms:''' Diabetic foot 

'''The Study:''' 
Non-blinded randomised controlled trial with intention-to-treat. 
Patients with chronic diabetic foot lesions (average duration 10 years) admitted for multi-disciplinary wound care. 
Control group (N = 15; 15 analysed*): Standard multiple therapy including surgical debridement, incision and drainage, regular dressing, antibiotics and insulin administration. 
Experimental group (N = 15; 15 analysed*): As above plus four sessions of oxygen breathing at 3ATA for 45 minutes over a period of 2 weeks. 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Control group''' || '''HBO group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Major amputation''' || unknown || 0.467 || 0.133 || 72% || 0.334 || 3 
|-
| '''95% CI:''' || || || || 6% to 100% || 0.029 to 0.639 || 2 to 35 
|-
|}

'''Non-Event Outcomes Time to outcome Control group HBO group P-value''' 
Ave hospital stay 
(days) discharge 47 40.6 NS 

'''Comments:''' 
1. Unblinded trial which may result in bias as the surgeon was aware of treatment group when deciding on need for amputation. 
2. There was a trend for shorter hospital stay with hyperbaric oxygen, but difference did not reach statistical significance. 
3. Unusual hyperbaric treatment protocol- only four treatments. 
*Note: actual numbers not present in the paper, we have assumed 15 in each group.

'''Expiry date:''' July 2021
References: 
1. Doctor N, Pandya S, Supe A. Hyperbaric oxygen therapy in diabetic foot. Journal of Postgraduate Medicine 1992; 38:112-114. 



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