A clinical practice guideline for the use of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers

The Undersea and Hyperbaric Medical Society (UHMS), following the methodology of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group, undertook a systematic review of the HBO2 literature in order to rate the quality of evidence and generate practice recommendations for the treatment of DFU. The major recommendations are as follows

Recommendations

1. In patients with Wagner Grade 2 or lower diabetic foot ulcers (DFUs), the committee suggests against using hyperbaric oxygen (HBO₂) therapy (very low-level evidence in support of HBO₂, conditional recommendation).


2. In patients with Wagner Grade 3 or DFUs that have not shown significant improvement after 30 days of treatment, the committee suggests adding HBO₂ to the standard of care to reduce the risk of major amputation and incomplete healing (moderate-level evidence, conditional recommendation).


3. In patients with Wagner Grade 3 or higher DFUs who have just had a surgical debridement of an infected foot (e.g., partial toe or ray amputation; debridement of ulcer with underlying bursa, cicatrix or bone; foot amputation; incision and drainage [I&D] of deep space abscess; or necrotizing soft tissue infection), the committee suggests adding acute post-operative HBO₂ to the standard of care to reduce the risk of major amputation and incomplete healing (moderate-level evidence, conditional recommendation).