Huang ET, Mansouri J, Murad MH, Joseph WS, Strauss MB, Tettelbach W, Worth ER, UHMS CPG Oversight Committee., et al.
Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, In.... Date of publication 2015 May 1;volume 42(3):205-47.
1. Undersea Hyperb Med. 2015 May-Jun;42(3):205-47.
A clinical practice guideline for the use of hyperbaric oxygen therapy in the
treatment of diabetic foot ulcers.
Huang ET, Mansouri J, Murad MH, Joseph WS, Strauss MB, Tettelbach W, Worth ER;
UHMS CPG Oversight Committee.
Collaborators: Huang ET, Feldmeier J, LeDez K, Le PN, Mansouri J, Moon R, Murad
MH.
BACKGROUND: The role of hyperbaric oxygen (HBO2) for the treatment of diabetic
foot ulcers (DFUs) has been examined in the medical literature for decades. There
are more systematic reviews of the HBO2/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 HBO2
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 HBO2 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 HBO2 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 HBO2 as an adjunctive
treatment.
CONCLUSIONS: Clinicians, patients, and policy-makers should engage in shared
decision-making and consider HBO2 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 HBO2 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.
PMID: 26152105 [Indexed for MEDLINE]
