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2018-01-20T23:25:09Z

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'''The addition of hyperbaric oxygen to conventional treatment of diabetic foot ulcers may improve amputation risk and healing rate over three years.''' 

'''Clinical Bottom Line:''' 
1. Trend to improved healing and lower amputation rate with hyperbaric oxygen that does not reach statistical significance. 
'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Friday, 28 February 2003 

'''Clinical Scenario:''' A diabetic with limb-threatening foot lesions. 
'''Three-part Question:''' For diabetic patients with limb-threatening foot lesions, does the addition of hyperbaric oxygen to a comprehensive wound care regime, result in any reduction in the rate of major amputation or increased chance of wound healing? 
'''Search Terms:''' Diabetic angiopathies, diabetic foot 

'''The Study:''' 
Non-blinded randomised allocation first 28 patients, next 10 allocated by availability of HBO, intention-to-treat unclear. 
Patients with chronic limb-threatening diabetic foot lesions (>2 months) that had failed to heal with standard therapy. 
Control group (N = 21; 21 analysed): 'Conventional' treatment with multidisciplinary team. 
Experimental group (N = 17; 17 analysed): All conventional measures plus 40 (4 subjects) or 60 sessions of 100% oxygen at 2.5 ATA for 90 minutes daily 5/7. 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Control Group''' || '''HBO Group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Healed''' || 3 years || .48 || .76 || 58% || 0.28 || 4 
|-
| '''95% CI:''' || || || || -3% to 100% || -0.02 to 0.58 || NNT'''2 to INF NNH=268 to INF 
|-
| '''Amputation''' || 3 years || .33 || .12 || 64% || 0.210 || 5 
|-
| '''95% CI:''' || || || || -13% to 100% || -0.04 to 0.46 || NNT'''2 to INF NNH=23 to INF 
|-
|}

'''Comments:''' 
1. Randomisation partial only and method not described. 
2. Small trial (38 patients only) with low power to detect a significant difference. 
3. The clinical improvement suggested is highly significant. 
4. Conventional regimen sounds comprehensive and all patients were not suitable for vascular reconstruction. 

'''Expiry date:''' July 2021
'''References:''' 
1. Kalani M, Naderi N, Lind F. Hyperbaric oxygen therapy for wound healing and limb salvage in diabetic foot lesions: three year follow-up. Undersea and Hyperbaric Medicine 2000; 27(suppl):44-45. 
2. Kalani M, Jorneskog G, Naderi N, Lind F, Brismar K. Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers. Long term follow-up. Journal of Diabetes and its Complications 2002; 16:153-158.



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Gordoben: Imported from Wikispaces