RESUMO
The use of hyperbaric oxygen (HBO2) for the treatment of selected problem wounds has focused almost entirely on the diabetic foot ulcer (DFU) in recent years. The prevalence of DFUs in today's patient population and the reimbursement available for the treatment of DFUs have given it priority status in discussions about problem wounds, but there are sound fundamental reasons why additional oxygen may have benefits in the treatment of non-DFU wounds.
Assuntos
Oxigenoterapia Hiperbárica/métodos , Oxigênio/fisiologia , Úlcera Cutânea/terapia , Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Anemia Falciforme/complicações , Calciofilaxia/terapia , Pé Diabético/fisiopatologia , Pé Diabético/terapia , Doença Enxerto-Hospedeiro/terapia , Humanos , Salvamento de Membro , Metanálise como Assunto , Pressão Parcial , Seleção de Pacientes , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/terapia , Guias de Prática Clínica como Assunto , Pioderma Gangrenoso/fisiopatologia , Pioderma Gangrenoso/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Doença de Raynaud/fisiopatologia , Doença de Raynaud/terapia , Escleroderma Sistêmico/fisiopatologia , Escleroderma Sistêmico/terapia , Úlcera Cutânea/etiologia , Úlcera Cutânea/fisiopatologia , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Revisão da Utilização de Recursos de Saúde , Ferimentos e Lesões/complicaçõesRESUMO
INTRODUCTION: To determine if hyperbaric oxygen (HBO2) therapy has an effect on diabetic blood glucose levels (BGL) and, if so, the extent of this effect. Also, to examine factors that exacerbate any observed effect. METHODS: This was a retrospective review of prospectively collected quality data on diabetics undergoing HBO2. Pre- and post-treatment BGL were recorded. Pre-treatment BGL ⟨120 mg/dL received glucose supplementation. Hypoglycemia was defined as BGL ⟨70 mg/dL. BGL ⟨90 mg/dL was included as an elevated hypoglycemia threshold. RESULTS: 77 patients representing 1,825 treatments were included for analysis. No patient had deleterious side effects or required emergency care. BGL decreased in 75.4% of treatments in this group, with a median decrease of 25 mg/dL (IQR=54 mg/dL; range of decreased 374 mg/dL to increased 240 mg/dL). A statistically significant greater percentage of treatments of patients with type 2 diabetes resulted in a decrease in BGL (1598 or 77.5%) compared to treatments of patients with type 1 diabetes (169 or 51.5%) (χ2(1, N=1767) =55.37, p⟨0.001). 1.1% of treatments had post-HBO2 serum glucose ⟨90 mg/dL, and 0.2% of treatments had post-HBO2 serum glucose ⟨70 mg/dL. The majority (70%) of patients with post-HBO2 BGL ⟨90 mg/dL were maintained on insulin alone (χ2(2, N=20) =12.4, p=0.002). Well-controlled diabetics (i.e., those with all BGLs within 50 mg/dL over all pre-HBO2 treatments) had no post-HBO2 BGL ⟨70 mg/dL or ⟨90 mg/dL. CONCLUSION: Our results suggest that HBO2 does not cause a clinically significant decrease in diabetic patient BGL. No patient in our study had deleterious side effects or required emergency care. We found that glucose level of ⟨90 mg/dL occurred more often in those who use insulin. Hyperbaric patients who exhibit consistent BGL values may represent a group who could be managed similarly to the non-diabetic population.
Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Oxigenoterapia Hiperbárica , Idoso , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Oxigenoterapia Hiperbárica/efeitos adversos , Oxigenoterapia Hiperbárica/estatística & dados numéricos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Estudos Retrospectivos , Esteroides/efeitos adversosRESUMO
INTRODUCTION: Providers involved in treating patients who would benefit from HBOT need to be knowledgeable about the absolute and relative contraindications to HBOT. OBJECTIVE: This case series evaluates several challenging clinical scenarios in which HBOT was administered. Patients who may benefit from HBOT can present with relative contraindications, and it is the responsibility of the members of the health care team to know what additional information may be required to determine if the patient can safely undergo HBOT. However, such information is sparse in some cases. MATERIALS AND METHODS: Nine patients underwent HBOT to manage diverse presentations, some for which there was no or scant published information on the potential interaction between in situ devices and HBOT. RESULTS: All patients demonstrated clinical improvement, and there were no adverse events. CONCLUSION: Providers may encounter uncommon or unique situations when considering whether or not to administer HBOT, and it may be necessary to consult with others (eg, experts in other specialties, device manufacturers or vendors) to provide optimal patient care.