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).

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