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HYPERBARIC OXYGEN THERAPY FOR DIABETIC ULCERS: SYSTEMATIC REVIEW AND META-ANALYSIS

Published online by Cambridge University Press:  17 July 2013

Daria O'Reilly ,
Anjori Pasricha ,
Kaitryn Campbell ,
Natasha Burke ,
Nazila Assasi ,
James M. Bowen ,
Jean-Eric Tarride  and
Ron Goeree
Daria O'Reilly
Affiliation:
Programs for Assessment of Technology in Health (PATH) Research Institute/St. Joseph's Healthcare Hamilton; Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University; Centre for Evaluation of Medicines
Anjori Pasricha
Affiliation:
Faculty of Medicine, University of Ottawa
Kaitryn Campbell
Affiliation:
Programs for Assessment of Technology in Health (PATH) Research Institute/St. Joseph's Healthcare Hamilton; Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University
Natasha Burke
Affiliation:
Programs for Assessment of Technology in Health (PATH) Research Institute/St. Joseph's Healthcare Hamilton; Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University
Nazila Assasi
Affiliation:
Programs for Assessment of Technology in Health (PATH) Research Institute/St. Joseph's Healthcare Hamilton; Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University
James M. Bowen
Affiliation:
Programs for Assessment of Technology in Health (PATH) Research Institute/St. Joseph's Healthcare Hamilton; Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University
Jean-Eric Tarride
Affiliation:
Programs for Assessment of Technology in Health (PATH) Research Institute/St. Joseph's Healthcare Hamilton; Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University; Centre for Evaluation of Medicines
Ron Goeree
Affiliation:
Programs for Assessment of Technology in Health (PATH) Research Institute/St. Joseph's Healthcare Hamilton; Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University; Centre for Evaluation of Medicines
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Abstract

Objectives: Approximately 10–15 percent of individuals with diabetes mellitus develop foot ulcers, which precede 85 percent of amputations. Increased oxygen, through the use of hyperbaric oxygen therapy (HBOT), has been suggested to encourage ulcer healing thus reducing the risk of amputation. The objective of this systematic review is to evaluate the efficacy of systemic HBOT for nonhealing ulcers of the lower limb in diabetes patients.

Methods: A systematic search, using controlled and keyword terms focusing on “HBOT” and “lower limb diabetic ulcers,” was conducted. Databases searched included Medline, EMBASE, CINAHL, PubMed, Wiley's Cochrane Library, and Biosis. Randomized controlled trials (RCTs) and observational studies were included. Pooled estimates of outcomes were determined when appropriate.

Results: Of the 654 citations identified, 157 articles underwent full-text review. Data were abstracted from twelve publications (six RCTs and six comparative observational studies). Pooled analysis of the RCT and observational data showed that treatment with HBOT reduced the risk of major amputation by 60 percent (p = .29) and 61 percent (p = .003) compared with standard wound care, respectively. The RCT data revealed that the relative risk of having an unhealed wound following HBOT was 0.54 (p = .10) and 0.24 (p < .0001) based on observational data.

Conclusions: Due to the limited RCT evidence, it is not possible to conclusively establish the benefits and harms of treating diabetic lower limb ulcers with HBOT. No significant effects on amputation rates were found in the RCT evidence and in the high quality studies, no difference was found.

Keywords

Hyperbaric oxygenationDiabetic footAmputationReviewMeta-analysisDiabetes mellitus
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 3 , July 2013 , pp. 269 - 281
Copyright
Copyright © Cambridge University Press 2013 

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References

REFERENCES

1.Schaper, NC, Apelqvist, J, Bakker, K. The International Consensus and practical guidelines on the management and prevention of the Diabetic Foot. Curr Diab Rep. 2003;3:475–479.CrossRefGoogle ScholarPubMed
2.Reiber, GE, Edward, JB, Smith, DG. Lower extremity foot ulcers and amputations in diabetes. In: Harris, MI, Cowie, CC, Stern, MP, Boyko, EJ, Reiber, GE, Bennett, PH, eds. Diabetes in America. 2nd ed.Washington: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1995:409–427.Google Scholar
3.Rakel, A, Huot, C, Ekoe, J-M. Canadian Diabetes Association technical review: The diabetic foot and hyperbaric oxygen therapy. Can J Diabetes. 2006;30:411–421.CrossRefGoogle Scholar
4.Mayfield, JA, Reiber, GE, Sanders, LJ, et al.Preventive foot care in diabetes. Diabetes Care. 2004;27 (Suppl 1):S63–S64.Google ScholarPubMed
5.Wagner, FW Jr.The dysvascular foot: A system for diagnosis and treatment. Foot Ankle. 1981;2:64–122.CrossRefGoogle Scholar
6.National Diabetes Education Program. Foot health and diabetes: Prevalence of foot symptoms and complications. National Diabetes Education Program. Bethesda, MD: National Insitutes of Health; 2004.Google Scholar
7.Bowering, K, Ekoe, J-M, Kalla, TP. Foot care. Can J Diabetes. 2008;32 (Suppl 1):S143–S146.Google Scholar
8.Frykberg, RG. A summary of guidelines for managing the diabetic foot. Adv Skin Wound Care. 2005;18:209–214.CrossRefGoogle ScholarPubMed
9.Abidia, A, Laden, G, Kuhan, G, et al.The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: A double-blind randomised-controlled trial. Eur J Vasc Endovasc Surg. 2003;25:513–518.CrossRefGoogle ScholarPubMed
10.Faglia, E, Favales, F, Aldeghi, A, et al.Change in major amputation rate in a center dedicated to diabetic foot care during the 1980s: Prognostic determinants for major amputation. J Diabetes Complications. 1998;12:96–102.CrossRefGoogle Scholar
11.Faglia, E, Favales, F, Aldeghi, A, et al.Adjunctive systemic hyperbaric oxygen therapy in treatment of diabetic foot ulcer A randomized study. Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine; 1996; Grafica Victoria, Bologna. 1996;391–399.Google ScholarPubMed
12.Tibbles, PM, Edelsberg, JS. Hyperbaric-oxygen therapy. N Engl J Med. 1996;334:1642–1648.CrossRefGoogle ScholarPubMed
13.Roeckl-Wiedmann, I, Bennett, M, Kranke, P. Systematic review of hyperbaric oxygen in the management of chronic wounds. Br J Surg. 2005;92:24–32.CrossRefGoogle ScholarPubMed
14.Hailey, D, Jacobs, P, Perry, DC, et al.Adjunctive hyperbaric oxygen therapy for diabetic foot ulcer: An economic analysis [technical report no 75]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2007.Google Scholar
15.Kranke, P, Bennett, MH, Martyn-St James, M, et al.Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2012;4:CD004123.Google Scholar
16.Goldman, RJ. Hyperbaric oxygen therapy for wound healing and limb salvage: A systematic review. PM R. 2009;1:471–489.CrossRefGoogle ScholarPubMed
17.Wang, C, Schwaitzberg, S, Berliner, E, et al.Hyperbaric oxygen for treating wounds: A systematic review of the literature. Arch Surg. 2003;138:272–279.CrossRefGoogle ScholarPubMed
18.Londahl, M, Fagher, K, Katzman, P. What is the role of hyperbaric oxygen in the management of diabetic foot disease? Curr Diab Rep. 2011;11:285–293.CrossRefGoogle ScholarPubMed
19.Jadad, AR, Moore, RA, Carroll, D, et al.Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials. 1996;17:1–12.CrossRefGoogle ScholarPubMed
20.Wells, GA, Shea, B, O'Connell, D, et al.The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital; 2008.Google Scholar
21.Khan, KS, Kunz, R, Kleijnen, J, Antes, G. Step 4: Summarizing the evidence. Systematic Reviews to Support Evidence-based Medicine: How to review and apply findings of healthcare research. London: The Royal Society of Medicine Press; 2007:47–59.Google Scholar
22.Doctor, N, Pandya, S, Supe, A. Hyperbaric oxygen therapy in diabetic foot. J Postgrad Med. 1992;38:112–114.Google ScholarPubMed
23.Duzgun, AP, Satir, HZ, Ozozan, O, et al.Effect of hyperbaric oxygen therapy on healing of diabetic foot ulcers. J Foot Ankle Surg. 2008;47:515–519.CrossRefGoogle ScholarPubMed
24.Kessler, L, Bilbault, P, Ortega, F, et al.Hyperbaric oxygenation accelerates the healing rate of nonischemic chronic diabetic foot ulcers: A prospective randomized study. Diabetes Care. 2003;26:2378–2382.CrossRefGoogle ScholarPubMed
25.Faglia, E, Favales, F, Aldeghi, A, et al.Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomized study. Diabetes Care. 1996;19:1338–1343.CrossRefGoogle ScholarPubMed
26.Londahl, M, Katzman, P, Nilsson, A, Hammarlund, C. Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care. 2010;33:998–1003.CrossRefGoogle ScholarPubMed
27.Baroni, G, Porro, T, Faglia, E, et al.Hyperbaric oxygen in diabetic gangrene treatment. Diabetes Care. 1987;10:81–86.CrossRefGoogle ScholarPubMed
28.Kalani, M, Jorneskog, G, Naderi, N, et al.Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers. Long-term follow-up. J Diabetes Complications. 2002;16:153–158.CrossRefGoogle ScholarPubMed
29.Lyon, KC. The case for evidence in wound care: Investigating advanced treatment modalities in healing chronic diabetic lower extremity wounds. J Wound Ostomy Continence Nurs. 2008;35:585–590.CrossRefGoogle ScholarPubMed
30.Oriani, G, Meazza, D, Fava, R, et al.Hyperbaric oxygen therapy in diabetic gangrene. J Hyperbaric Med. 1990;5:171–175.Google Scholar
31.Zamboni, WA, Wong, HP, Stephenson, LL, Pfeifer, MA. Evaluation of hyperbaric oxygen for diabetic wounds: A prospective study. Undersea Hyperb Med. 1997;24:175–179.Google ScholarPubMed
32.Lin, TF, Chen, SB, Niu, KC. The vascular effects of hyperbaric oxygen therapy in treatment of early diabetic foot. Undersea Hyperb Med. 2001;28:67.Google Scholar
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