Hyperbaric oxygen therapy
It is widely admitted, that its applications are extremely useful in treating difficult wounds and related traumas. However, recent research has revealed the lack of empirical evidence as for the real advantages and possible side effects of using HBOT. Moreover, there is serious lack of information on how diabetic foot should be treated with the help of HBOT. The article written by Wunderlich, Peters, and Lavery (2000) sheds the light onto the discussed problem. Systemic Hyperbaric Oxygen Therapy In their article, Wunderlich et al. (2000) aimed at clarifying the basic issues in applying HBOT to treating diabetic foot.
Their major concern was in the lack of empirical research in this area. They were very correct in stating that “although the clinical history of hyperbaric medicine dates back to the 17th century, reports of the beneficial effects of increased oxygen pressure on wound healing and infection did not appear in the medical literature until 1960s” (Wunderlich et al, 2000). The authors of the article have chosen a very correct approach in trying to find any relevant information on how HBOT worked in treating diabetic foot. They faced some difficulties in trying to find the required information.
In their search they used medical search databases. The need of search was primarily caused by an opinion, that “many clinicians routinely incorporate HBO sessions into their treatment protocols without full knowledge of the evidence-based data that support this therapy” (Wunderlich et al, 2000). The results of their research were rather surprising, and their implications are useful for the further research in the current nursing practice. Wunderlich et al. (2000) found a total of 76 articles related to the topic of HBO application in general. Those articles included the human research, the research on animals, and case reports.
It is interesting to note that only 21 out of the 76 articles found were directly connected with studying human objects and the impact of HBO sessions on them (Wunderlich et al. , 2000). Thus, the question appears, how have we come to using HBO in treating diabetic foot, without really knowing its effects. The researchers paid special attention to how diabetic foot could be treated with the help of NBO sessions. “Our literature search revealed only two reports of randomized controlled clinical trials that evaluated HBO therapy in the diabetic foot” (Wunderlich et al. , 2000).
Evidently, this small amount of empirical evidence is not sufficient to unilaterally admit the positive effect of HBO on treating diabetic foot. The authors have openly recognized urgent need of profound research in the area of HBO vs. diabetic foot, due to the substantial costs associated with this type of treatment. The small number of useful researches on diabetic foot was thoroughly examined by the Wunderlich et al (2000). They were trying to identify potential problems connected with previous researches, which could be avoided in future theoretical development. For example, Wunderlich et al.
(2000) mentioned the research conducted in 1996 by specialists from Milan University, in which they had performed a randomized clinical trial including 33 subjects in the control group, and 35 subjects in HBO group. Wunderlich et al. (2000) paid special attention to the fact that “the control group did not receive placebo sessions in a hyperbaric chamber at normal atmospheric pressure, so it is unknown whether a placebo effect exists for this treatment modality” (Wunderlich et al. , 2000). Another research mentioned by the authors of the article, was published in 1992 by Doctor et al.
and was devoted to investigating diabetic patients with chronic foot lesions. While the researchers did not identify any major differences among the diabetic patients participating in the research, they did not as well indicate, whether Doctor et al. (1992) had performed any extensive examination of the peripheral vascular disease (Wunderlich et al. , 2000). The authors of the article concluded that the existing amount of empirical evidence as for the treatment of diabetic foot with the help of HBO sessions was too scarce to assert its usefulness or its negative implications for the diabetic patients (Wunderlich et al., 2000).
Hyperbaric oxygen therapy and current nursing practice The research article has significantly impacted my knowledge of the nursing practice. While I was constantly relying on traditional knowledge of nursing practice gained from the textbooks, it appears that our learning should not be limited by books only. This does not mean that the authors of the books we use in studies are wrong or inconsistent. This only means that we have to be more objective when we strive for applying the newest medical solutions in practice.
It is difficult to argue with Neubauer and Walker (2001), who assert that “there is also a considerable amount of research that supports the use of HBOT”. Wunderlich et al. (2000) do not argue this position either. What they were trying to emphasize in their research was the lack of empirical evidence as for the use of HBO sessions in treating diabetic foot. Neubauer and Walker (2001) have created a significant work, devoted to practical application of HBO to various types of wounds and traumas.
They have profoundly researched all aspects of HBO use towards stroke, central nervous system, difficult wounds, infections, and burns, but they have also omitted the issues of diabetic foot, and remembering the growing number of diabetic patients, and as a result, the number of complications, this is a significant gap in current nursing research. Of course, we can use indirect evidence provided by Neubauer and Walker (2001) on treating difficult wounds with HBOT, but it remains indirect in terms of treating diabetic foot, and we urgently require real evidence as for how diabetic foot should be properly treated.
“For years, conventional medicine thought of HBOT only as a treatment for decompression sickness and air embolism. However, the use of HBOT is becoming increasingly common in general medical practice as more doctors become acquainted with its applications. Doctors now realize there are other issues for HBOT, including treatment of nonhealing wounds, carbon monoxide poisoning, various infections, damage caused by radiation treatments, and all typed of diving accidents” (Neubauer and Walker, 2001).
However, current nursing practice also proves an urgent need of researching the possibilities of treating diabetic foot with the use of HBO sessions. Having read the research article (Wunderlich et al. , 2000), I have come to conclusion that we face a serious problem, which we hardly realize in our routine nursing practice: we use to apply the notions and skills which have not been thoroughly researched. Does this mean that we put the lives of our patients under risk?
This probably does not, but we have to remember that in treating diabetic foot treatment, we can only use indirect evidence and the results of researches towards difficult wounds, for example. In everything else we seem more to rely on our intuition and our practical knowledge. Wunderlich et al. (2000) recognize the difficulties in researching the problems of difficult wounds through the prism of HBO treatment. They understand that difficult wounds’ issues in nursing are connected with the numerous variables, which should be accounted in the research.
“The most convincing work in the medical literature to date demonstrates that HBO therapy can reduce the number of major amputations in patients with Wagner grade IV wounds” (Wunderlich et al. , 2000). It is an important implication for treating diabetic foot with the help of HBO, but this also implies, and it has already been mentioned, that what we currently have is only indirect research which can only partially be applied to diabetic foot treatment. For me personally the analyzed research article has become the source of critical information within the nursing practice area.
It has attracted my attention to the problems, which were not also discussed by Ignatavicius and Workman (2005): the authors have devoted the whole chapter to Interventions for Clients with Diabetic Mellitus, yet they have not provided any consistent research results as for possible application of HBO in these interventions. Contemporary nursing practice is a rapidly developing area of medical studies, yet there is still high probability that we miss or omit something important in our research.
Wunderlich et al and practical application The article and the research performed by Wunderlich et al. (2000), is interesting and useful, but to be objective, it could hardly be applied in practice. Its importance for the nursing practice is undeniable, but it is also indirect. This indirect character is viewed through the fact that the authors have not performed their own empirical research. They have supplied us with the critical evaluation of the primary medical sources.
As a result, their research is secondary and is only the means of attracting our attention to the issues of diabetic foot and its HBO treatment. As a result, I have several questions which are yet to be answered: how should we properly design our future research to fill the existing theoretical gap? What variables should we account, and what variables should we neglect in order to provide nursing practitioners with consistent proofs of usefulness or drawbacks of applying HBO to diabetic foot treatment? Wunderlich et al.
(2000) have performed a large theoretical analysis, and their results can also be used by us in identifying future problems in the discussed research. However, the discussed article’s value is limited by its theoretical and not practical direction, which seriously decreases its applicability in contemporary nursing practice. Conclusion The theoretical research performed by Wundelich et al has shed the light onto the theoretical (and as a result, practical) gap, which currently exists in the nursing practice.
The issues of applying HBO to treating diabetic foot were not empirically researched. As a result, we do not possess sufficient and objective information on the topic. The scarce information gained from previous studies is either inconsistent or can be used only indirectly, being gained from the generalized studies of difficult wounds and related complications. Nursing practitioners require exact data in order to fully understand the implications of HBO treatment among diabetic foot patients.
References Doctor, N., Pandya, S. , Super, A. (1992). Hyperbaric oxygen therapy in diabetic foot. J Postgrad Med 38, p. 112-114. Ignatavicius, D. D. & Workman, L. M. (2005). Medical-surgical nursing: Critical thinking for collaborative care. 5th edition. W. B. Saunders Company. Neubauer, R. A. & Walker, D. M. (2001). Hyperbaric Oxygen Therapy. Avery. Wunderlich, R. P. , Peters, E. J. & Lavery, L. A. (2000). Systemic hyperbaric oxygen therapy. Lower-extremity wound healing and the diabetic foot. Diabetic Care 23, no. 10, 1551-1555.