Effectiveness of hyperbaric oxygen therapy in non-healing ulcerations – meta-review

Czech version

Authors: M. Klugar ^1,2; A. Pokorná- ^{1 3}; M. Hájek ^4,5; J. Klugarová ^1,2
Authors‘ workplace: České národní centrum Evidence-Based Healthcare a Knowledge Translation (Cochrane České republiky, České CEHBC: JBI centrum excelence, GRADE centrum Masarykovy Univerzity), Institut biostatistiky a analýz, LF MU, Brno ¹; Ústav zdravotnických informací a statistiky ČR, Praha ²; Katedra ošetřovatelství a porodní asistence, LF MU, Brno ³; Centrum hyperbarické medicíny, Městská nemocnice Ostrava ⁴; Katedra biomedicínských oborů, LF Ostravské univerzity v Ostravě ⁵
Published in: Cesk Slov Neurol N 2019; 82(Supplementum 1): 47-51
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2019S47

Overview

Aim: The objective of this meta-review was to investigate effectiveness of hyperbaric oxygen therapy (HBO) in different types of non-healing ulceration. Non-healing ulcerations are usually associated with hypoxia, poor perfusion and low oxygen consumption. It is known during HBO that it leads to hyperoxygenation – multiple increase in oxygen partial pressure in both blood and tissues occurs. The supply and availability of oxygen in the tissues is substantially increased.

Methods: 10 relevant systematic reviews were retrieved by systematic search strategy. Most recent work of those above mentioned is publication from 2019, which is showing effect of HBO on treatment of pressure ulcers and prevention of amputation regarding pressure ulcers.

Conclusions: It has been proven from the sources identified in the review that HBO has a beneficial effect on the healing of diabetic ulcerations, and is effective in prevention of amputation regarding diabetic ulcers. However, due to relatively low methodological quality, inconsistency and impression of primary studies, we would assess the certainity of this results as low according to GRADE methodology.

Příprava tohoto článku byla podporována grantem „Klinické doporučené postupy“ CZ.03.2.63/0.0/0.0/15_039/0008221.

Keywords:

hyperbaric oxygen therapy – hyperoxia – non-healing ulcers – diabetic foot ulcer – meta-review

Sources

1. Kirsner RS. The wound healing society chronic wound ulcer healing guidelines update of the 2006 guidelines – blending old with new. Wound Repair Regen 2016; 24(1): 110–111. doi: 10.1111/ wrr.12393.

2. Pokoná A, Benešová K, Mužík J et al. Data sources formonitoring of non-healing wounds in a national healthinformation system-epidemiology of non-healingwounds – Analysis of the national register ofhospitalized patients in 2007–2015. Cesk Slov Neurol N 2017; 80/ 113 (Suppl 1): S8–S17. doi: 10.14735/ amcsnn2017S8.

3. Kranke P, Bennett MH, Martyn-St James M et al.Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev 2015; 24(6): CD004123. doi: 10.1002/ 14651858.CD004123.pub4.

4. Antalova N, Pokorna A, Hokynkova A et al. Factors influencing recurrence of the pressure ulcers after plastic surgery-retrospective analysis. Cesk Slov Neurol N 2018; 81/ 114 (Suppl 1): S23–S28.

5. Chmelař D, Kašíková A, Martineková P et al. Effect of hyperbaric air on endotoxin from Bacteroides fragilis strains. Folia Microbiol (Praha) 2018; 63(3): 283–290. doi: 10.1007/ s12223-017-0564-1.

6. Thom SR, Bhopale VM, Velazquez OC et al. Stem cellmobilization by hyperbaric oxygen. Am J Physiol HeartCirc Physiol 2006; 290(4): H1378–H1386. doi: 10.1152/ ajpheart.00888.2005.

7. Milovanova TN, Bhopale VM, Sorokina EM et al. Hyperbaric oxygen stimulates vasculogenic stem cell growth and differentiation in vivo. J Appl Physiol 2009; 106(2): 711–728. doi: 10.1152/ japplphysiol.91054.2008.

8. JBI. Joanna Briggs Institute Reviewers’ Manual: 2017 edition. The University of Adelaide, South Australia: The Joanna Briggs Institute 2017.

9. Elraiyah T, Tsapas A, Prutsky G et al. A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. J Vasc Surg 2016; 63 (Suppl 2): S46–S58. doi: 10.1016/ j.jvs.2015.10.007.

10. Golledge J, Singh TP. Systematic review and meta-analysis of clinical trials examining the effect of hyperbaric oxygen therapy in people with diabetes-related lower limb ulcers. Diabet Med 2019; 36(7): 813–826. doi: 10.1111/ dme.13975.

11. Ji-dong HE, Xiao-hua WU, Li LI et al. Hyperbaric oxygen therapy as adjunctive treatment for diabetic foot ulcers: a systematic review. Chinese Journal of Evidence-Based Medicine 2014; 12(2014): 1476–1481.

12. Stoekenbroek RM, Santema TB, Legemate DA et al. Hyperbaric oxygen for the treatment of diabetic foot ulcers: a systematic review. Eur J Vasc Endovasc Surg 2014; 47(6): 647–655. doi: 10.1016/ j.ejvs.2014.03.005.

13. Zhao D, Luo S, Xu W et al. Efficacy and safety of hyperbaric oxygen therapy used in patients with diabetic foot: a meta-analysis of randomized clinical trials. Clin Ther 2017; 39(10): 2088–2094. doi: 10.1016/ j.clinthera.2017.08.014.

14. Peters EJ, Lipsky BA, Aragón-Sánchez J et al. Interventions in the management of infection in the foot in diabetes: a systematic review. Diabetes Metab Res Rev 2016; 32 (Suppl 1): 145–153. doi: 10.1002/ dmrr.2706.

15. Hitchman LH, Totty JP, Raza A et al. Extracorporeal shockwave therapy for diabetic foot ulcers: a systematic review and meta-analysis. Ann Vasc Surg 2019; 56: 330–339. doi: 10.1016/ j.avsg.2018.10.013.

16. de Smet GH, Kroese LF, Menon AG et al. Oxygen therapies and their effects on wound healing. Wound Repair Regen 2017; 25(4): 591–608. doi: 10.1111/ wrr.12561.

17. Santema TB, Stoekenbroek RM, van Steekelenburg KC et al. Economic outcomes in clinical studies assessing hyperbaric oxygen in the treatment of acute and chronic wounds. Diving Hyperb Med 2015; 45(4): 228–234.

18. Klugar M, Hájek M, Klugarová J. Aktuální vědecké důkazy účinnosti hyperbarické oxygenoterapie u vybraných chronických indikací-přehled systematických review. Pracov Lék 2018; 70(3–4): 139–145.

19. Santema KT, Stoekenbroek RM, Koelemay MJ et al. Hyperbaric oxygen therapy in the treatment of ischemic lower-extremity ulcers in patients with diabetes: results of the DAMO2CLES multicenter randomized clinical trial. Diabetes Care 2018; 41(1): 112–119. doi: 10.2337/ dc17-0654.

20. Chen CY, Wu RW, Hsu MC et al. Adjunctive hyperbaric oxygen therapy for healing of chronic diabetic foot ulcers: a randomized controlled trial. J Wound Ostomy Continence Nurs 2017; 44(6): 536–545. doi: 10.1097/ WON. 0000000000000374.

21. Klugarová J, Klugar M, Marečková J et al. Metodologie tvorby systematických review; Efekt hyperbarické oxygenoterapie na úmrtnost pacientů po kraniotraumatu: dílčí výsledky systematického review. Cesk Slov Neurol N 2015; 78/111(5): 555–561.

22. Klugar M, Klugarova J. Using evidence synthesis and clinical practice guidelines in everyday decision-making process: is it real or a dream? Int J Evid Based Healthc 2019; 17 (Suppl 1): S1–S2. doi: 10.1097/XEB.0000000000000171.