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Cardiac autonomic function and peri-wound oxygen tensions were improved following a course of hyperbaric oxygen therapy.

Clinical bottom line:

1. A course of hyperbaric oxygen improved cardiac autonomic function from a compromised baseline.
2. Transcutaneous oxygen tensions increased with HBOT.

Citation/s:1. Sun TB, Yang CC, Kuo TB. Effect of hyperbaric oxygen on cardiac neural regulation in diabetic individuals with foot complications. Diabet Med. 2006 Apr;23(4):360-6.
Lead author's name and fax: Terry B. J. Kuo. E-mail: tbjkuo@ms33.hinet.net

Three-part Clinical Question:For adult diabetic patients with foot ulcer does the addition of hyperbaric oxygen, compared to standard wound care treatment alone, result in any improvement in cardiac autonomic regulation?
Search Terms: Diabetic foot, autonomic dysfunction, R-R variability

The Study:Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Type-2 diabetic patients referred for consideration of hyperbaric oxygen to treat a foot complication.
Control group (N = 15; 15 analysed): Standard wound management including tight blood glucose control with insulin, surgical debridement as required and wound dressing.
Experimental group (N = 23; 23 analysed): As above plus 100% oxygen breathing for 90 minutes at 2.0 ATA daily Monday to Friday to a total of 20 treatments.

The Evidence:

 

Measure

Control Group

HBOT Group

Difference

95% CI

Mean

SD

Mean

SD

R-R interval change at 4 weeks (ms)

-10.0

18

82.7

16.0

92.7

-64.2 to 250.0

HR variability change at 4 weeks (ln(ms-sq))

-0.31

0.11

0.88

0.12

1.19

1.18 to 1.20

Transcutaneous oxygen tension on air at 4 weeks (mmHg)

27.5

3.1

53.0

2.6

25.5

20.2 to 30.8

Comments:
1. The imbalance in numbers between control and HBOT groups is not explained in the paper. It is also not entirely clear if a sham treatment was used. I have assumed not for this review.
2. The main outcomes reported were changes in each group rather than between group comparisons. Some values here have been read from graphs. My analysis suggests no statistical improvement in between group comparison of R-R interval despite large observed difference. A real improvement seems likely.
3. Baseline values demonstrated that autonomic cardiac neural regulation was significantly impaired in these patients before the study intervention and changed little in the control group.
4. Improvements in autonomic function may improve both the incidence of cardiac events and improve wound healing and function after diabetic wound treatment.

Appraised by:Mike Bennett m.bennett@unsw.edu.au; Saturday, 14 August 2021

Kill or Update By: August 2024

 

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