Rationale: Diabetes mellitus can damage blood vessels, compromising blood flow and oxygen circulation. Resulting tissue hypoxia may contribute to failure of wounds to heal. Hyperbaric oxygen therapy (HBOT) has been proposed as a treatment adjunct to wound care to improve oxygenation and promote healing when a diabetic patient has chronic foot ulcers despite standard wound therapy alone.
Technology Description: HBOT is administered when patients enter and remain in a compression chamber that delivers pressurized pure oxygen, thus breathing the pressurized oxygen. In the hyperbaric chamber, the elevated concentration and pressure of the oxygen increase the amount of oxygen dissolved in the patient’s blood. Pressure at sea level is 1 atmosphere absolute (ATA). In clinical research on diabetes-related chronic foot ulcers, HBOT is typically delivered at 2.2 to 2.5 ATA for 60 to 120 minutes per session, with 20 to 40 sessions given either daily or twice daily for 5 or 6 days per week. These treatment sessions most typically occur in 90-minute sessions 5 times per week.
Controversy: HBOT is a time-intensive and costly treatment with safety risks and questionable clinical efficacy.
Key Questions: For the adjunctive treatment of chronic foot ulcers in adults with diabetes mellitus:
- What is the efficacy of HBOT in terms of improved wound healing and reduction in the incidence of amputation?
- What complications are associated with HBOT?
- Have definitive patient selection criteria been established for HBOT for diabetes-associated foot ulcers?
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