Does hyperbaric oxygen therapy (HBOT) improve wound healing?

From the Guidelines

Hyperbaric oxygen therapy (HBOT) should not be routinely used as an adjunctive treatment to enhance wound healing and prevent amputation in patients with diabetic foot ulcers, as the evidence supporting its use is mixed and of low certainty (1). The treatment involves breathing 100% oxygen in a pressurized chamber, typically at 2.0-2.5 atmospheres absolute (ATA), for 90-120 minute sessions. However, the majority of studies on HBOT are at high risk of bias, and the certainty of evidence is low (1). Some key points to consider when evaluating the use of HBOT for wound healing include:

• The evidence at low risk of bias behind the use of hyperbaric oxygen therapy is limited (1)
• The majority of studies were at high risk of bias although there was one good quality study showing evidence of benefit on the critical outcomes of healing and time to healing (1)
• People with diabetes require assessment for suitability for hyperbaric oxygen therapy; and those with general frailty and comorbid conditions may have to be excluded from this treatment modality due to increased risks of adverse events (1)
• Reported undesirable effects were small, but hyperbaric oxygen therapy requires large costs and although several poor quality in‐trial studies have demonstrated cost savings with its use, these fail to account for costs of construction of hyperbaric oxygen units (1)
• The use of HBOT may be considered as an adjunct therapy where standard of care alone has failed, but this should be done on a case-by-case basis and with careful consideration of the potential benefits and risks (1).

From the Research

Hyperbaric Oxygen Therapy (HBOT) and Wound Healing

• HBOT is an important adjunct in the management of problem wounds, particularly those with chronic oxygen deficiency 2.
• The therapy stimulates fibroblast proliferation and differentiation, increases collagen formation and cross-linking, and enhances neovascularization, leading to improved wound healing 2.
• HBOT also benefits ischemic soft tissues by preserving energy metabolism and reducing edema 2.

Effects of HBOT on Chronic Wounds

• In people with diabetic foot ulcers, HBOT significantly reduces the risk of major amputation and may improve the chance of healing at 1 year 3.
• HBOT also improves wound healing in the short term, but not in the long term, in patients with diabetic foot ulcers 4.
• There is some evidence to suggest that HBOT may be beneficial in reducing ulcer area in patients with venous ulcers 3, 4.

Safety and Efficacy of HBOT

• HBOT is considered safe, with mild and transient side effects 5.
• However, the evidence for the efficacy of HBOT in wound healing is not consistent, and more trials are needed to properly evaluate its benefits and harms 3, 4.
• The application of HBOT to patients with chronic wounds may be justified where facilities are available, but economic evaluations should be undertaken to assess its cost-effectiveness 3.

Future Research Directions

• Further research is needed to define the patients who can benefit most from HBOT and to determine the optimal treatment protocols 3, 4.
• Collaborative, international, randomized prospective clinical trials are necessary to establish the efficacy of HBOT in wound healing and to inform clinical practice 6.