Effectiveness of Hyperbaric Oxygen Therapy in Question

The use of Hyperbaric Oxygen Therapy (HBOT) for diabetic foot ulcers neither improved the likelihood that a wound would heal nor prevented amputation, according to a new study.

Researchers at the University of Pennsylvania (Philadelphia, USA) conducted a longitudinal observational cohort study to compare the effectiveness of HBOT with other conventional therapies for the treatment of a diabetic foot ulcer, and prevention of lower extremity amputation. The authors studied 6,259 individuals with diabetes, adequate lower limb arterial perfusion, and foot ulcer extending through the dermis, representing 767,060 person-days of wound care. To address treatment selection bias, the authors used propensity scores to determine the tendency for selection of HBOT.

The results showed that in the propensity score-adjusted models, individuals receiving HBOT were less likely have healing of their foot ulcer and more likely to have an amputation. Additional analyses, including the use of an instrumental variable, were conducted to assess the robustness of the results to unmeasured confounding; HBOT was not found to improve the likelihood that a wound might heal or to decrease the likelihood of amputation in any of these analyses. The study was published on February 21, 2013, in Diabetes Care.

“HBOT did not appear to be useful for the prevention of amputation and did not improve the likelihood that a wound would heal in a cohort of patients defined by Centers for Medicare and Medicaid Services eligibility criteria,” concluded lead author David Margolis, MD, PhD, and colleagues of the department of dermatology.

HBOT involves the breathing of pure oxygen while in a sealed chamber that has been pressurized at 1.5 to 3.0 times normal atmospheric pressure. The first known chamber was built by a British clergyman named Henshaw in the 1600s. Research has shown HBOT can help when used as a mainstream treatment for the prevention and treatment of osteoradionecrosis, as well as more than a dozen health problems such as decompression sickness, carbon monoxide poisoning, gangrene, brain abscess, and injuries in which tissues are not getting enough oxygen.

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