Eskes A, Vermeulen H, Lucas C, Ubbink DT, et al.
The Cochrane database of systematic reviews. Date of publication 2013 Dec 16;volume (12):CD008059.
1. Cochrane Database Syst Rev. 2013 Dec 16;(12):CD008059. doi:
10.1002/14651858.CD008059.pub3.
Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds.
Eskes A(1), Vermeulen H, Lucas C, Ubbink DT.
Author information:
(1)Quality Assurance & Process Innovation, Academic Medical Centre, University of
Amsterdam & Amsterdam School of Health Professions, Meibergdreef 9, Amsterdam,
Netherlands, 1105AZ.
Update of
Cochrane Database Syst Rev. 2010;(10):CD008059.
BACKGROUND: Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute
wounds (such as those arising from surgery and trauma). However, the effects of
HBOT on wound healing are unclear.
OBJECTIVES: To determine the effects of HBOT on the healing of acute surgical and
traumatic wounds.
SEARCH METHODS: We searched the Cochrane Wounds Group Specialised Register
(searched 9 August 2013); the Cochrane Central Register of Controlled Trials
(CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to July Week
5 2013); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, August 08,
2013); Ovid EMBASE (2010 to 2013 Week 31); EBSCO CINAHL (2010 to 8 August 2013).
SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing HBOT with other
interventions such as dressings, steroids, or sham HOBT or comparisons between
alternative HBOT regimens.
DATA COLLECTION AND ANALYSIS: Two review authors conducted selection of trials,
risk of bias assessment, data extraction and data synthesis independently. Any
disagreements were referred to a third review author.
MAIN RESULTS: Four trials involving 229 participants were included. The studies
were clinically heterogeneous, which precluded a meta-analysis.One trial (48
participants with burn wounds undergoing split skin grafts) compared HBOT with
usual care and reported a significantly higher complete graft survival associated
with HBOT (95% healthy graft area risk ratio (RR) 3.50; 95% confidence interval
(CI) 1.35 to 9.11). A second trial (10 participants in free flap surgery)
reported no significant difference between graft survival (no data available). A
third trial (36 participants with crush injuries) reported significantly more
wounds healed (RR 1.70; 95% CI 1.11 to 2.61), and significantly less tissue
necrosis (RR 0.13; 95% CI 0.02 to 0.90) with HBOT compared to sham HBOT. The
fourth trial (135 people undergoing flap grafting) reported no significant
differences in complete graft survival with HBOT compared with dexamethasone (RR
1.14; 95% CI 0.95 to 1.38) or heparin (RR 1.21; 95% CI 0.99 to 1.49).Many of the
predefined secondary outcomes of the review were not reported. All four trials
were at unclear or high risk of bias.
AUTHORS' CONCLUSIONS: There is a lack of high quality, valid research evidence
regarding the effects of HBOT on wound healing. Whilst two small trials suggested
that HBOT may improve the outcomes of skin grafting and trauma, these trials were
at risk of bias. Further evaluation by means of high quality RCTs is needed.
DOI: 10.1002/14651858.CD008059.pub3
PMID: 24343585 [Indexed for MEDLINE]
