A New Look at the Evidence for Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) is one of those newer wound care techniques that sounds exciting and credible, but which is still somewhat lacking in supporting clinical evidence. The theory behind HBOT is that improving oxygenation around a wound that is currently hypoxic, and therefore slow to heal, may be expected to improve healing rates. As well as improving tissue oxygenation, Hyperbaric oxygen therapy is thought to increase fibroblast proliferation and white blood cell killing capacity during periods of hyperoxia, while stimulating angiogenesis during periods of relative hypoxia. [1]

HBOT Theory

However, while the theory of hyberbaric oxygen therapy sounds plausible, clinicians have known for some time that the therapy is controversial and that further evidence for the effectiveness of this intervention is urgently required. [2]

The Cochrane Review

Although no new randomized clinical trials of HBOT have been reported for some time, the therapy has recently been the subject of a systematic Cochrane Review involving a full search of the Cochrane, Medline, Embase and EBSCO CINAHL databases.3 Cochrane reviews are some of the best regarded publications in medical sciences. The lack of published evidence for the effectiveness of HBOT is exposed by the fact that this fully comprehensive review identified only three relevant trials, involving a total of 219 participants. Of the three studies included, two suggested some benefits with hyberbaric oxygen therapy, but were of poor quality. A third trial reported no benefits associated with HBOT for skin grafts. There were insufficient similarities between these trials to allow a meta-analysis.

The authors of the Cochrane review concluded that there is currently a lack of high-quality research evidence showing that HBOT is beneficial for wound healing and that further better quality research is needed to address this issue. The authors’ conclusion only serves to further emphasize the inconclusive nature of current evidence available for the effectiveness of this therapy. While such evidence is gathered, individual clinicians will undoubtedly base their use of HBOT on their own previous experiences with the therapy.

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References

1. Guo S, Counte MA, Schmitz H, Wu HS. Physician adoption of hyperbaric oxygen therapy in the treatment of chronic wounds. Ostomy Wound Management. 2005;51(10):46.
2. Rodriguez PG, Felix FN, Woodley DT, Shim EK. The role of oxygen in wound healing: a review of the literature. Dermatol Surg. 2008;34(9):1159.
3. Eskes A, Ubbink DT, Lubbers M, Lucas C, Vermeulen H. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. Cochrane Database Syst Rev. 2010;10:CD008059.