Benefits of hyperbaric oxygen therapy still doubtful.

Ruttermann et al. were able to determine “the efficacy” from whole-body hyperbaric oxygen therapy (HBOT) on the basis of “good evidence”, demanding an unequivocal recommendation (at least grade B) for its use. In support they cite a meta-analysis by Kranke et al. from 2004 (1). In 2012 however, Kranke et al. had updated their meta-analysis, reaching a notably different conclusion: “In people with foot ulcers due to diabetes, HBOT significantly improved the ulcers healed in the short term but not thelong term and the trials had various flaws in design and/or reporting that means we are not confident in the results” (2). While Ruttermann et al. refer to “valid data in support of hyperbaric oxygen,” Kranke et al. (2) felt compelled to comment that the relevance of hyperbaric oxygen therapy for persons with chronic wounds, after all, needs proper evaluation by studies adequately powered and designed to minimize all kinds of biases. In the US, hyperbaric oxygen therapy completely failed in 6259 diabetes patients with foot ulcers and sufficient arterial perfusion, as was shown in the most recent—and by far most comprehensive—publication on the subject (3).