From the Guidelines
Hyperbaric oxygen therapy (HBOT) is conditionally recommended as an adjunctive treatment for wound healing in patients with diabetes-related foot ulcers, with initial improvements typically seen within 10-30 sessions. The most recent and highest quality study on this topic is from 2024, which found that HBOT can improve wound healing and reduce ulcer area, although the evidence is still limited and the certainty of the evidence is low 1. The study suggests that HBOT works by increasing tissue oxygen levels, stimulating angiogenesis, enhancing white blood cell activity, reducing inflammation, and promoting collagen production for tissue repair. Key considerations for HBOT include:
- Patient selection: HBOT is most suitable for patients with diabetes-related foot ulcers who have failed standard of care and have access to established hyperbaric units 1.
- Treatment regimen: A standard HBOT regimen involves 90-120 minute sessions at pressures of 2.0-2.5 atmospheres absolute (ATA), administered 5 days per week for a total of 20-40 sessions, depending on wound severity and patient response.
- Monitoring and adjustment: Regular wound assessment during treatment is essential to monitor progress and adjust the treatment plan if necessary.
- Potential benefits and risks: HBOT may reduce the risk of amputation and improve wound healing, but it also requires significant resources and may not be suitable for all patients, particularly those with general frailty and comorbid conditions 1. Overall, 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 Wound Healing Time to Improvement
- The time to improvement in wound healing using hyperbaric oxygen therapy (HBOT) can vary depending on the type and severity of the wound, as well as the individual patient's response to treatment 2, 3.
- A study published in 2004 found that HBOT significantly reduced the risk of major amputation in patients with diabetic foot ulcers, and may improve the chance of healing at 1 year 2.
- Another study published in 2012 found that HBOT was effective in the healing of diabetic foot ulcers, but that this benefit was not evident at long-term follow up 3.
- A 2017 review of clinical evidence found that HBOT can be used as an adjunctive therapy in many wound care settings, and that it improves oxygenation and neovascularization and decreases inflammation in chronic wounds 4.
- More recent studies have also explored the use of topical oxygen therapy as an alternative to HBOT, and have found that it can increase the pO2 levels within the wound base center, decrease the size of the wound, and decrease the time to wound healing 5.
- The role of HBOT in the treatment of wounds continues to be studied, and it is recognized as a Medicare-approved treatment for chronic nonhealing wounds and radiation necrosis 6.
- Key factors that influence the effectiveness of HBOT include the underlying etiology of the wound, the severity of the wound, and the individual patient's response to treatment 2, 3, 4, 5, 6.