From the Guidelines
Hyperbaric Oxygen Therapy (HBOT) should be considered as an adjunctive treatment for diabetic foot ulcers, but its use should be individualized and based on a thorough assessment of the patient's condition and the availability of HBOT facilities. The evidence for the use of HBOT in diabetic foot ulcers is mixed, with some studies showing benefit and others showing no effect 1. A recent guideline update suggests that HBOT may be beneficial in improving wound healing and reducing amputation rates, but the evidence is not strong enough to make a definitive recommendation 1. The use of HBOT should be considered on a case-by-case basis, taking into account the patient's overall health, the severity of the foot ulcer, and the availability of HBOT facilities.
Some key points to consider when evaluating the use of HBOT for diabetic foot ulcers include:
- The patient's overall health and ability to tolerate HBOT
- The severity of the foot ulcer and the presence of any underlying conditions that may affect wound healing
- The availability of HBOT facilities and the expertise of the healthcare team
- The potential benefits and risks of HBOT, including the risk of oxygen toxicity and the potential for improved wound healing
It is also important to note that HBOT is not a replacement for standard wound care, and patients should continue to receive comprehensive wound care, including debridement, dressing changes, and off-loading, in addition to HBOT 1.
In terms of the Indian context, the use of HBOT for diabetic foot ulcers may be limited by the availability of HBOT facilities and the cost of treatment. However, for patients who have access to HBOT facilities and can afford the treatment, it may be a useful adjunctive therapy to consider. Ultimately, the decision to use HBOT should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.
From the Research
Hyperbaric Oxygen Therapy (HBOT) Overview
- HBOT is a medical treatment that involves administering 100% oxygen at increased atmospheric pressure to enhance oxygen delivery to tissues 2.
- The therapy has been utilized for a wide range of medical conditions, including severe infections, non-healing wounds, and COVID-19 2, 3.
Applications of HBOT
- HBOT has been shown to enhance tissue oxygenation, reduce inflammation, and modulate oxidative stress, thereby improving clinical outcomes in patients with severe COVID-19 2.
- The therapy's ability to increase dissolved oxygen levels in blood and tissues makes it particularly beneficial in conditions like COVID-19, where hypoxemia and inflammation are prominent 2.
- HBOT has also been used in the treatment of diabetic foot ulcers, with some studies suggesting that it can promote ulcer healing and reduce amputation rates 4, 5, 6.
HBOT for Diabetic Foot Ulcers
- A systematic review and meta-analysis found that HBOT increased the healing rate of diabetic foot ulcers, shortened the healing time, and reduced the incidence of major amputation 5.
- A clinical practice guideline for the use of HBOT in the treatment of diabetic foot ulcers recommends its use as an adjunctive treatment for patients with Wagner Grade 3 or greater DFUs who have just undergone surgical debridement of the foot or have shown no significant improvement after 30 or more days of treatment 6.
- However, the evidence for the use of HBOT in patients with Wagner Grade 2 or lower DFUs is inadequate, and further research is needed to determine its effectiveness in these patients 6.
Future Directions
- Further research is warranted to optimize treatment protocols and confirm long-term benefits of HBOT in various medical conditions, including COVID-19 and diabetic foot ulcers 2, 3, 5, 6.
- The inclusion of HBOT in future clinical research could provide additional support in the clinical management of multiple pathologies 3.