References
Guidelines for the use of topical oxygen therapy in the treatment of hard-to-heal wounds based on a Delphi consensus
Abstract
A growing body of evidence supports the use of topical oxygen therapy (TOT) in the treatment of diabetic foot ulcers (DFUs). In addition, anecdotal evidence suggests that topical oxygen may be effective in the treatment of other wound types. In May 2021, experts in the field of wound healing from across the US assembled in New Orleans for the inaugural Leaders in Wound Healing conference. In an interactive session dedicated to TOT, several physicians presented and debated the evidence for TOT. Experts in the audience also shared their experiences in treating patients with TOT. The consensus of the experts recommended the use of TOT in DFUs and supported payer reimbursement for the modality. However, they stressed the need for a guidance document on the use of TOT in patients with hard-to-heal wounds. Following the conference, a Delphi method was employed to establish consensus guidelines for prescribing TOT. A multidisciplinary panel of 24 wound experts (15 wound specialists, six vascular surgeons, one plastic surgeon, one critical care provider and one PhD researcher) participated in two rounds of questionnaires. The Delphi survey questions focused on the indications for topical oxygen, when to prescribe the therapy, pretreatment work-up, visit frequency and length of therapy. A clinical workflow algorithm was also included as part of the Delphi. After two rounds, the Delphi participants were able to reach consensus of >77% on when to prescribe topical oxygen, the wound types that may benefit from the therapy, pretreatment wound preparation and work-up and length of therapy. The goal of the guidelines is to standardise the use of topical oxygen and inform further research efforts.
Millions of people worldwide suffer for weeks, months or years with hard-to-heal wounds that fail to heal despite advances in wound care.1 The US Wound Registry reports that fewer than 50% of wounds are healed at 12 weeks.2 The annual cost of caring for the rising numbers of patients afflicted with wounds approaches US$100 billion in the US.3 The search for technology that promotes wound healing continues.
In the last 4 years, three randomised controlled clinical trials (RCTs) have demonstrated the efficacy of topical oxygen therapy (TOT) in promoting wound healing in hard-to-heal diabetic foot ulcers (DFUs).4,5,6 In addition, a 2021 systemic review and meta-analysis of these RCTs, involving 530 participants, concluded that ‘TOT significantly increased the likelihood of ulcer healing compared to controls’.7 This evidence was discussed and debated at a recent Leadership in Wound Healing conference held in May 2021. The experts in wound care recommended that clinicians consider this technology in the treatment of DFUs. Anticipating the increased interest in the use of TOT, it was suggested that a group of experts draft a consensus document to guide its use, including an algorithm for clinicians to follow when prescribing TOT (Fig 1).
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