Hyperbaric Oxygen Therapy and Wound Healing Rates Noah Yoskowitz1, Madeleine Burlingame1, Weiying Lu1, Amit Rao2, Christina Del Pin2, and Alisha Oropallo2 1Donald
2The
and Barbara Zucker School of Medicine at Hofstra/Northwell Comprehensive Wound Care Center at Northwell Health
Background Hyperbaric oxygen therapy (HBOT) is used as adjunctive therapy in the treatment of chronic wounds. HBOT involves placing a patient’s body in an increased pressure chamber where the patient inspires 100% oxygen for a specific period of time and number of treatments. The most common treatment regimen is 30 sessions for 90 minutes each.[1] There is a paucity of data on wound healing rates for patients undergoing HBOT. The Comprehensive Wound Center had the subject data on hand to examine and analyze healing rates of subjects who had undergone HBOT at the center.
Results 600 patients who had an initial HBOT evaluation session at the wound center met the inclusion criteria to undergo chart review. Of these patients, 225 had received at least one HBOT session for a diabetic foot ulcer. Formal statistical analysis has not yet been completed on the extracted data comparing it to the standard of care. Preliminary analysis shows that 114 patients completed at least 30 sessions of HBOT, 100 patients did not finish at least 30 sessions, and 11 patients’ data was missing regarding the number of sessions of HBOT (Figure 2).
Of the 100 patients that did not finish HBOT, 29 had wounds that fully healed before their 30th session, 31 did not have data on whether they continued with therapy or not, and the remaining 40 patients discontinued therapy due to a combination of nonadherence, hospitalization and amputations. (Figure 4).
Hypothesis Hyperbaric Oxygen Therapy (HBOT) will improve wound healing rates, defined as a reduction in surface area, over standard of care wound therapy in diabetic foot ulcers (DFU).
Figure 4. Reasons why the patients who did not complete 30 sessions of Hyperbaric Oxygen Therapy chose not to complete the therapy.
Methods A retrospective chart review was conducted on wound assessment data recorded from over 600 subjects with DFU who had undergone HBOT at the wound center. Study inclusion criteria consisted of all patients over 18 years old who had received at least one session of HBO treatment at a tertiary wound care center. Data was extracted from Touchworks Allscripts® EMR. Factors such as wound size and characteristics at the start of treatment, end of treatment and 30, 60 and 90 day follow ups were recorded. Comorbid risk factors, concomitant wound therapies (i.e., skin substitutes, specialized dressings), number of HBOT treatments, etc. were also recorded.
Conclusions and Future Direction Figure 2. Number of patients that completed, did not complete, or had no data on completion of Hyperbaric Oxygen Therapy.
Figure 3 illustrates that 67 of the patients’ wounds healed, 102 patients’ wounds did not heal, and 56 had no data on final healing status.
Figure 1. A patient in a Hyperbaric Oxygen Chamber receiving therapy.
A data set of 225 patients who received HBOT for DFUs was created out of 600 patients who met the initial inclusion criteria. Over half of the patients completed a full thirty sessions of HBOT. Of the patients who did not complete thirty sessions, 29 of them successfully healed their wounds. This data set will continue to be refined, and used to examine HBOT’s effect on reduction in wound size, time to complete healing, recurrence of wounds within 3 months, and wound complications of patients with DFUs. Assessment of differences between HBOT and standard of care will be done with comparison by t-test or Mann-Whitney test as well as multiple linear regression, logistic regression and/or Cox proportional hazards regression.
Resources Figure 3. Number of patients whose wounds fully healed, did not fully heal and did not have data on final healing status.
1. Kirby JP, Snyder J, Schuerer DJE, Peters JS, Bochicchio GV. Essentials of Hyperbaric Oxygen Therapy: 2019 Review. Mo Med. 2019;116(3):176-179. 2. Figure 1. image sourced from: https://www.inspirahealthnetwork.org/news/inspiraadds-new-state-art-technology-treat-patients-wounds