The predictive value of transcutaneous oxygen tension measurement in diabetic lower extremity ulcers treated with hyperbaric oxygen therapy: a retrospective analysis of 1144 patients

Abstract

The objective of this retrospective analysis was to determine the reliability of transcutaneous oxygen tension measurement (TcPO2) in predicting outcomes of diabetics who underwent hyperbaric oxygen therapy for lower extremity wounds. Six hyperbaric facilities provided TcPO2 data under several possible conditions: breathing air, breathing oxygen at sea level, and breathing oxygen in the chamber. Overall, 75.6% of the patients improved after hyperbaric oxygen therapy. Baseline sea-level air TcPO2 identified the degree of tissue hypoxia but had little statistical relationship with outcome prediction because some patients healed after hyperbaric oxygen therapy despite very low prehyperbaric TcPO2 values. Breathing oxygen at sea level was unreliable for predicting failure, but 68% reliable for predicting success after hyperbaric oxygen therapy. TcPO2 measured in chamber provides the best single discriminator between success and failure of hyperbaric oxygen therapy using a cutoff score of 200 mmHg. The reliability of in-chamber TcPO2 as an isolated measure was 74% with a positive predictive value of 58%. Better results can be obtained by combining information about sea-level air and in-chamber oxygen. A sea-level air TcPO2 < 15 mmHg combined with an in-chamber TcPO2 < 400 mmHg predicts failure of hyperbaric oxygen therapy with a reliability of 75.8% and a positive predictive value of 73.3%.

Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle–brachial index in patients with diabetes and chronic foot ulcers

“…Similar results have been reported by others. In a study by Fife et al, 629 patients with basal TcPO 2 below 25 mmHg were less likely to benefit from HBOT than those with higher TcPO 2 values [9]. Wattel et al reported a mean basal TcPO 2 of 32 mmHg in healers (n=15), compared with 12 mmHg in non-healers in a case-series of 20 patients (11 with diabetes and nine arterial insufficiency without diabetes) given adjunctive treatment with HBOT [10].…”

Clinical applications of EPR: overview and perspectives

“…The comparisons with transcutaneous oximetry (TcO 2 ) are important because, although it is currently widely used and accepted as useful by some clinicians, 115,116,117 even its most vocal proponents would welcome a more accurate technique. Despite several limitations, it is the current standard for evaluating capacity to heal in ischemic ulcers.…”

Impaired Lower Extremity Wound Healing Secondary to Sirolimus After Kidney Transplantation

“…However, the rise at 1.5 ATA was encouraging and suggestive of potential benefit of hyperbaric oxygen therapy. 7 Magnetic resonance angiogram showed the abdominal aorta, bilateral iliac, femoral, and popliteal arteries to be free of significant arterial disease. The trifurcation vessels were diseased, however, with extensive occlusion of the tibialis anterior and peroneal arteries without significant reconstitution ( Figure 3).…”