Effectiveness and Safety of Hyperbaric Oxygen Therapy (HBOT) in Treating Diabetic Foot Ulcers (DFUs)

Abstract Introduction: 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 indicate that Hyperbaric Oxygen Therapy (HBOT) may be a current alternative for treating patients presenting with DFUs. Here, we seek to determine whether HBOT is clinically effective in wound healing of DFUs and reducing associated high amputation levels. Further, it examines whether HBOT is a safe therapy for treating diabetes patients with foot ulcers. Methods: A comprehensive search strategy was applied to eight databases (CINAHL, Medline, EMBAS, PsycINFO, Joanna Brigg’s Institute (JBI), Ovid, Cochrane Library and PubMed) 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 a 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 interpreted 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. Conclusion: HBOT is an effective, safe treatment, as an additional therapy for standard wound care, for DFUs in the short term, if at least 20 sessions are completed. HBOT reduces the risk for severe consequences, not the consequences per se, i.e. infection. Further rigorous examination by larger, well-designed RCTs is required to investigate the relative efficacy and cost-effectiveness of HBOT.