Kumar
The addition of hyperbaric oxygen therapy to standard wound care improved the chance of healing for diabetic foot ulcers.
Clinical bottom line:
|
1. The addition of hyperbaric oxygen to a comprehensive inpatient treatment regimen improved the chance of healing at 12 weeks from treatment start |
Citation/s: 1. Kumar A, Shukla U, Prabhakar T, Srivastava D. Hyperbaric oxygen therapy as an adjuvant to standard therapy in the treatment of diabetic foot ulcers. Journal of Anaesthesiology, Clinical Pharmacology. 2020 Apr;36(2):213.
Lead author's name and fax: Dr Usha Shukla : ushashukla1970@gmail.com
Three-part Clinical Question:For diabetic patients with problematic foot ulcers, does the addition of hyperbaric oxygen therapy to standard wound care result in any improvement in healing or prevention of amputation?
Search Terms: Diabetic feet; amputation; Wagner 2 to 4
The Study:Double-blinded concealed randomised controlled trial with intention-to-treat.
The Study Patients: Patients with diabetic foot ulcers of Wagner Grade 2 to 4 and admitted to hospital for care.
Control group (N = 30; 26 analysed): Standard care including blood glucose control, daily dressing, debridement as required, nutrition, pressure offloading and antibiotics as appropriate. Air breathing at 1.3 ATA for 90 minutes daily to a total of 36 treatments.
Experimental group (N = 30; 28 analysed): As above, but 100% oxygen breathing at 2.4 ATA.
The Evidence:
Outcome |
Time to Outcome |
Sham group |
Hyperbaric group |
Relative risk reduction |
Absolute risk reduction |
NNT |
|
Healed |
12 weeks |
0 |
0.73 |
100% |
0.73 |
1 |
95% CIs: |
0.58 to 0.89 |
1 to 2 | ||||
|
Major amputation |
12 weeks |
0.10 |
0 |
100% |
0.10 |
10 |
95% CIs: |
to 0.21 to – 0.01 |
NNT = 5 to INF NNH = 136 to INF | ||||
|
Minor amputation |
12 weeks |
0.40 |
0.07 |
82% |
0.33 |
3 |
95% CIs: |
33% to 100% |
0.13 to 0.53 |
2 to 8 | |||
Comments:
1. Well planned study but the report is quite short and some outcomes not clearly reported.
2. Also an indication of fewer operative procedures with HBOT, but detail is not clear.
3. All patients were admitted to hospital for the period.
Appraised by:Mike Bennett m.bennett@unsw.edu.au; Thursday, 5 August 2021
Kill or Update By:August 2025
