Study of efficacy of hyperbaric oxygen therapy in chronic wounds in diabetic patients
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252018Keywords:
Hyperbaric oxygen therapy, Diabetic wounds, Infection control, Wound healingAbstract
Background: Diabetic patients are prone to chronic wounds that are difficult to heal due to impaired blood flow, immune dysfunction, and prolonged hyperglycemia. Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunctive treatment for diabetic wounds. This study aimed to evaluate the efficacy of HBOT in treating chronic wounds in diabetic patients.
Methods: A prospective observational study was conducted at Sassoon General Hospital, Pune, Maharashtra from July 2022 to March 2024. A total of 34 diabetic patients with chronic non-healing ulcers were consecutively recruited and randomized into two groups: the test group (standard wound care + HBOT) and the control group (standard wound care only). Primary parameters included wound healing rate and reduction in ulcer area, while secondary parameters involved infection rates, time to appearance of serous discharge, and hospital stay duration. Data were analyzed using statistical package for the social sciences (SPSS) 26.0, with significance set at p<0.05.
Results: The HBOT group showed a significantly greater reduction in ulcer area, granulation tissue formation was notably faster compared to the control group. Infection rates were lower in the HBOT group, with a higher proportion of sterile cultures on day and HBOT patients also had a shorter hospital stay compared to controls.
Conclusions: HBOT significantly improved wound healing rates, infection control, and reduced hospital stay duration in diabetic patients with chronic wounds.
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References
Pradhan L, Nabzdyk C, Andersen N, Logerfo F, Veves A. Inflammation and neuropeptides: the connection in diabetic wound healing. Expert Rev Mol Med. 2009;11. DOI: https://doi.org/10.1017/S1462399409000945
Megallaa MH, Ismail AA, Zeitoun MH, Khalifa MA. Association of diabetic foot ulcers with chronic vascular diabetic complications in patients with type 2 diabetes. Diabetes Metab Syndr. 2019;13(2):1287-92. DOI: https://doi.org/10.1016/j.dsx.2019.01.048
Tellechea A, Leal EC, Veves A, Carvalho E. Inflammatory and Angiogenic Abnormalities in Diabetic Wound Healing: Role of Neuropeptides and Therapeutic Perspectives. Open Circ Vasc J. 2010;3:43-55. DOI: https://doi.org/10.2174/1874382601003010043
Perez-Favila A, Martinez-Fierro M, Rodriguez-Lazalde JG, Cid-Baez MA, Zamudio-Osuna MJ, Martinez-Blanco M, et al. Current Therapeutic Strategies in Diabetic Foot Ulcers. Medicina (Kaunas). 2019;55(11):714. DOI: https://doi.org/10.3390/medicina55110714
Tellechea A, Pradhan-Nabzdyk LK, Logerfo FW, Veves A. Neuropeptides, Inflammation, and Diabetic Wound Healing: Lessons from Experimental Models and Human Subjects. In: Veves A, Giurini JM, LoGerfo FW, editors. The Diabetic Foot. 4th Edition. New York: Humana Press; 2018;131-54. DOI: https://doi.org/10.1007/978-3-319-89869-8_8
Rosenblum BI, Pomposelli FB Jr, Giurini JM, Gibbons GW, Freeman DV, Chrzan JS, et al. Maximizing foot salvage by a combined approach to foot ischemia and neuropathic ulceration in patients with diabetes: A 5-year experience. Diabetes Care. 1994;17(9):983-7. DOI: https://doi.org/10.2337/diacare.17.9.983
Hajhosseini B, Kuehlmann B, Bonham C, Kamperman KJ, Gurtner G. Hyperbaric Oxygen Therapy: Descriptive Review of the Technology and Current Application in Chronic Wounds. Plast Reconstr Surg Glob Open. 2020;8. DOI: https://doi.org/10.1097/GOX.0000000000003136
Kaur S, Pawar M, Banerjee N, Garg R. Evaluation of the efficacy of hyperbaric oxygen therapy in the management of chronic nonhealing ulcer and role of periwound transcutaneous oximetry as a predictor of wound healing response: A randomized prospective controlled trial. J Anaesthesiol Clin Pharmacol. 2012;28:70-5. DOI: https://doi.org/10.4103/0970-9185.92444
Sureda A, Batle JM, Martorell M, Capó X, Tejada S, Tur J, et al. Antioxidant Response of Chronic Wounds to Hyperbaric Oxygen Therapy. PLoS One. 2016;11. DOI: https://doi.org/10.1371/journal.pone.0163371
Capó X, Monserrat-Mesquida M, Quetglas-Llabrés M, Batle JM, Tur J, Pons A, et al. Hyperbaric Oxygen Therapy Reduces Oxidative Stress and Inflammation, and Increases Growth Factors Favouring the Healing Process of Diabetic Wounds. Int J Mol Sci. 2023;24. DOI: https://doi.org/10.3390/ijms24087040
Chen-Yu C, Re-Wen W, Mei-Chi H, Hsieh C, Man-Chun C. Adjunctive Hyperbaric Oxygen Therapy for Healing of Chronic Diabetic Foot Ulcers: A Randomized Controlled Trial. J Wound Ostomy Continence Nurs. 2017;44:536-45. DOI: https://doi.org/10.1097/WON.0000000000000374
Bajuri MY, Ayesyah A, Nurhanani Ab, Hassan MR. The physiological, biochemical and quality of life changes in chronic diabetic foot ulcer after hyperbaric oxygen therapy. Med Health. 2017;12:210-9. DOI: https://doi.org/10.17576/MH.2017.1202.06
Lebel D, Gortzak Y, Nyska M, Katz T, Atar D, Etzion Y. Hyperbaric oxygen therapy for chronic diabetic wounds of the lower limbs--a review of the literature. Harefuah. 2007;146(3):223-7.
Hunter S, Langemo D, Anderson JW, Hanson D, Thompson PA. Hyperbaric Oxygen Therapy for Chronic Wounds. Adv Skin Wound Care. 2010;23:116-9. DOI: https://doi.org/10.1097/01.ASW.0000363517.55135.c2
Chen CE, Ko J, Fong C, Juhn R. Treatment of diabetic foot infection with hyperbaric oxygen therapy. Foot Ankle Surg. 2010;16(2):91-5. DOI: https://doi.org/10.1016/j.fas.2009.06.002
Flegg J, Byrne H, McElwain D. Mathematical Model of Hyperbaric Oxygen Therapy Applied to Chronic Diabetic Wounds. Bull Math Biol. 2010;72:1867-91. DOI: https://doi.org/10.1007/s11538-010-9514-7
Kendall A, Whatmore J, Harries L, Winyard P, Smerdon G, Eggleton P. Changes in inflammatory gene expression induced by hyperbaric oxygen treatment in human endothelial cells under chronic wound conditions. Exp Cell Res. 2012;318(3):207-16. DOI: https://doi.org/10.1016/j.yexcr.2011.10.014
Salama S, Eldeeb A, Elbarbary A, Abdel-Ghany SE. Adjuvant Hyperbaric Oxygen Therapy Enhances Healing of Nonischemic Diabetic Foot Ulcers Compared With Standard Wound Care Alone. Int J Low Extrem Wounds. 2019;18:75-80. DOI: https://doi.org/10.1177/1534734619829939
Fedorko L, Bowen J, Jones W, Oreopoulos G, Goeree R, Hopkins R, et al. Hyperbaric oxygen therapy does not reduce indications for amputation in patients with diabetes with nonhealing ulcers of the lower limb: A prospective double-blind randomized controlled clinical trial. Diabetes Care. 2016;39(3):392-9. DOI: https://doi.org/10.2337/dc15-2001
Ueno T, Omi T, Uchida E, Yokota H, Kawana S. Evaluation of hyperbaric oxygen therapy for chronic wounds. J Nippon Med Sch. 2014;81(1):4-11. DOI: https://doi.org/10.1272/jnms.81.4