Abstract
Diabetic wounds are a worldwide problem with significant effects for those whose wounds fail to heal as expected and who go on to require amputation. Standard care is generally effective in healing diabetic ulcers, but in some cases, adjunctive Hyperbaric Oxygen (HBO) may be beneficial. Oxygen is essential throughout the wound healing processes including antimicrobial activity, growth factor production, angiogenesis and collagen synthesis. HBO has been shown to have a number of benefits to wound healing in diabetics, including reduction of infection, reduction of pathological inflammation and stimulation of angiogenesis. HBO is administered in a chamber which is pressurized to the desired level and patients breathe 100% oxygen. Those with diabetic ulcers usually receive 20 to 60 treatments in total alongside conventional care. Transcutaneous oxygen pressure (TcPO 2 ) is a useful method for determining whether HBO is likely to be of benefit to the patient. This, along with thorough assessment and prescreening of patients, can ascertain the suitability for treatment and reduce the risk of side effects. A number of clinical studies have been published demonstrating improved healing and a reduction in amputation rates for patients with diabetic ulcers. However, there is some inconsistency in the treatment regimens administered in some of the controlled trials. This paper provides an overview of the practicalities of treatment and the research supporting the use of HBO for diabetic lower extremity ulcers.
Highlights
Hyperbaric oxygen (HBO) therapy is the intermittent inhalation of oxygen at pressures greater than the atmosphere
This paper provides an overview of the practicalities of treatment and the research supporting the use of HBO for diabetic lower extremity ulcers
The following pages will give an overview of HBO, including a brief overview of mechanisms of action and the practicalities of administration followed by a review of the research on diabetic ulcers and HBO
Summary
Hyperbaric oxygen (HBO) therapy is the intermittent inhalation of oxygen at pressures greater than the atmosphere. Boerema and colleagues [1] used HBO to assist with cardiopulmonary surgery and published ‘Life without Blood’ in 1960. Finding that it could inhibit anaerobic infections, Brummelkamp, et al [2] successfully treated gas gangrene using HBO. Diabetic lower extremity ulcers are one of those with a substantial number of research trials supporting its administration. It forms part of the care package in many diabetic care facilities throughout the world for patients with diabetic lower extremity ulcers that are not responding to conventional treatment. The following pages will give an overview of HBO, including a brief overview of mechanisms of action and the practicalities of administration followed by a review of the research on diabetic ulcers and HBO
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