A systematic review of “The Effectiveness and Safety of Hyperbaric Oxygen Therapy (HBOT) in Treating Diabetic Foot Ulcers (DFUs)”

Abstract

Background Abstract Diabetic foot ulcers (DFUs) are one of the more dangerous complications of diabetes, contributing to morbidity, mortality, and major financial strain, potentially affecting patients’ quality of life. Therefore, an effective DFU treatment is needed to both heal and reduce severe consequences, such as amputation. Studies into effective multiple therapeutic interventions for DFUs suggest hyperbaric oxygen therapy (HBOT), a more ancient intervention, though controversy has arisen over its suitability for treating DFUs. Purpose This SR aimed to answer the research question of whether or not HBOT was an effective and safe treatment for DFUs. Methods A comprehensive search strategy was applied to eight databases (CINAHL, Medline, EMBAS, PsycINFO, JBI, Ovid, Cochrane Library and PubMed) through University of Nottingham's e-library, to obtain relevant randomised controlled trials (RCTs). Stringent pre-defined inclusion and exclusion criteria were applied regarding eligibility of the retrieved studies. A manual search of the references contained in these studies was performed alongside a search of e-libraries and medical websites. Eight RCTs were included, shown in PRISMA flow diagram; data were extracted using the JBI's data extraction tool before being critically appraised using the JBI critical appraisal tool. Findings were then summarised and interpretated using narrative synthesis. Results Three main themes emerged from the included studies: the effect of HBOT on ulcer healing, its effect on amputation rate, and HBOT safety (i.e., concerns about adverse events and oxidative stress). Most studies concluded that HBOT assists in size reduction and accelerates healing of DFUs. Furthermore, a low frequency of HBOT-related adverse effects was reported. Most studies, however, noted no additional benefits of HBOT related to reducing amputation rates. Conclusion HBOT as an additional therapy for standard wound care is an effective, safe treatment for DFUs in the short term, if at least 20 sessions are completed. Further rigorous examination by larger, well- designed RCTs is needed, to investigate the relative efficacy and cost-effectiveness of HBOT.