Adjunctive
hyperbaric oxygen for the treatment of diabetic foot wounds resulted in a
reduction in the rate of major amputation required to control infection.
Clinical Bottom Line:
1.
The addition of hyperbaric oxygen to the treatment regimen for diabetic foot
wounds resulted in a lower rate of major amputation.
Appraised
by: Mike Bennett and Simon Mitchell,
Australia and New Zealand Hyperbaric Medicine Group, c/o ANZCA, St. Kilda Rd
Melbourne; Friday, 16 April 1999
Clinical
Scenario: A patient presented for
management of a diabetic foot ulcer and we wondered if the addition of
hyperbaric oxygen would increase the chance of healing.
Three-part
Question: In patients with diabetic foot
wounds, does the addition of hyperbaric oxygen therapy to a standard treatment
regimen result in any improvement in wound healing, or reduction in amputation
rate?
Search
Terms: Diabetic foot
The
Study:
Non-blinded randomised
controlled trial with intention-to-treat.
Patients with chronic diabetic
foot lesions (average duration 10 years) admitted for multi-disciplinary wound
care.
Control group (N = 15; 15
analysed*): Standard multiple therapy including surgical debridement, incision
and drainage, regular dressing, antibiotics and insulin administration.
Experimental group (N = 15; 15
analysed*): As above plus four sessions of oxygen breathing at 3ATA for 45
minutes over a period of 2 weeks.
The
Evidence:
|
Outcome |
Time to
Outcome |
Control
group |
HBO group |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Major
amputation |
unknown |
0.467 |
0.133 |
72% |
0.334 |
3 |
|
95% CI: |
|
|
|
6% to 100% |
0.029 to 0.639 |
2 to 35 |
Non-Event Outcomes Time to outcome
Control group HBO
group P-value
Ave
hospital stay
(days)
discharge
47
40.6
NS
Comments:
1. Unblinded trial which may
result in bias as the surgeon was aware of treatment group when deciding on need
for amputation.
2. There was a trend for shorter
hospital stay with hyperbaric oxygen, but difference did not reach statistical
significance.
3. Unusual hyperbaric treatment
protocol- only four treatments.
*Note: actual numbers not present in the paper, we have assumed 15 in each group.
Expiry date: September 2004
References:
1. Doctor N, Pandya S, Supe A.
Hyperbaric oxygen therapy in diabetic foot. Journal of Postgraduate Medicine
1992; 38:112-114.
