A clinical practice guideline for the use of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers

UHMS CPG Oversight Committee

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Background: The role of hyperbaric oxygen (HBO<inf>2</inf>) for the treatment of diabetic foot ulcers (DFUs) has been examined in the medical literature for decades. There are more systematic reviews of the HBO<inf>2</inf>/DFU literature than there have been randomized controlled trials (RCTs), but none of these reviews has resulted in a clinical practice guideline (CPG) that clinicians, patients and policy-makers can use to guide decision-making in everyday practice. Methods: The Undersea and Hyperbaric Medical Society (UHMS), following the methodology of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group, undertook this systematic review of the HBO<inf>2</inf> literature in order to rate the quality of evidence and generate practice recommendations for the treatment of DFUs. We selected four clinical questions for review regarding the role of HBO<inf>2</inf> in the treatment of DFUs and analyzed the literature using patient populations based on Wagner wound classification and age of the wound (i.e., acute post-operative wound vs. non-healing wound of 30 or more days). Major amputation and incomplete healing were selected as critical outcomes of interest. Results: This analysis showed that HBO<inf>2</inf> is beneficial in preventing amputation and promoting complete healing in patients with Wagner Grade 3 or greater DFUs who have just undergone surgical debridement of the foot as well as in patients with Wagner Grade 3 or greater DFUs that have shown no significant improvement after 30 or more days of treatment. In patients with Wagner Grade 2 or lower DFUs, there was inadequate evidence to justify the use of HBO<inf>2</inf> as an adjunctive treatment. Conclusions: Clinicians, patients, and policy-makers should engage in shared decision-making and consider HBO<inf>2</inf> as an adjunctive treatment of DFUs that fit the criteria outlined in this guideline. The current body of evidence provides a moderate level of evidence supporting the use of HBO<inf>2</inf> for DFUs. Future research should be directed at improving methods for patient selection, testing various treatment protocols and improving our confidence in the existing estimates.

Original languageEnglish (US)
Pages (from-to)205-247
Number of pages43
JournalUndersea and Hyperbaric Medicine
Volume42
Issue number3
StatePublished - 2015

ASJC Scopus subject areas

  • Physiology (medical)
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

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