Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

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osteoradionecrosis avoided does take into account the cost offsets associated with prevention of osteoradionecrosis (eg avoidance of a mandibular resection). 92 <strong>Hyperbaric</strong> oxygen therapy
Recommendations MSAC recommended that public funding should be supported for hyperbaric oxygen therapy (HBOT) administered in either a multiplace or monoplace chamber, as appropriate, for the following indications: • decompression illness, gas gangrene, air or gas embolism. HBOT is widely accepted as standard clinical care in the management of these life-threatening conditions for which there are limited alternative treatment options; • diabetic wounds including diabetic gangrene and diabetic foot ulcers. There is evidence that HBOT is effective in promoting wound healing, and reducing the length of hospital stays and the likelihood of major amputations in patients with diabetic wounds. There may also be cost savings associated with these treatment benefits; and, • necrotising soft tissue infections including necrotising fasciitis and Fournier’s gangrene and the prevention and treatment of osteoradionecrosis. These are serious conditions in which HBOT provides a non-invasive treatment option which may have a beneficial effect and offer cost-savings. Further studies are required to provide more conclusive evidence of an effect but are difficult to undertake due to the ethical and practical constraints of conducting trials in these conditions. Public funding should be continued for HBOT use in these conditions until conclusive evidence becomes available that indicates it is not effective or that other treatments are preferable and more cost-effective. Since there is currently insufficient evidence pertaining to HBOT use in the following indications, MSAC recommended that public funding should not be supported for HBOT administered in either a multiplace or monoplace chamber, for: • thermal burns, non-diabetic wounds and decubitus (or pressure) ulcers, necrotising arachnidism, actinomycosis, soft tissue radionecrosis, osteomyelitis, skin graft survival, multiple sclerosis and cerebral palsy, cardiovascular conditions including acute myocardial infarctions, cerebrovascular disease, and peripheral obstructive arterial disease (POAD), soft tissue injuries including acute ankle sprains and crush injuries, facial paralysis (Bell’s palsy), cluster and migraine headaches, Legg-Calve-Perthes disease (necrosis of the femoral head, especially prevalent in children), sudden deafness and acoustic trauma, Crohn’s disease, osteoporosis, cancer, carbon monoxide poisoning, cyanide poisoning, head trauma, cerebral oedema, acquired brain injury, cognitive impairment, senile dementia, glaucoma, keratoendotheliosis, HIV infection, anaemia from exceptional blood loss, insulin-dependent diabetes mellitus, facial neuritis, arthritis, spinal injuries and non-union of fractures. MSAC has not considered safety standards for HBOT services administered in either multiplace or monoplace chambers, in detail, but endorses a standard for facilities, staffing and training which meets that in development by Standards Australia. - The Minister for Health and Aged Care accepted this recommendation on 9 February 2001 - <strong>Hyperbaric</strong> oxygen therapy 93
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Hyperbaric Oxygen Therapy November
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Contents Executive summary.........
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Tables Table 1 Measures of disease
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Table 45 Functional neurologic scor
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Figures Figure 1. Outline of search
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Effectiveness Published guidelines
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evidence that exposure to HBO may b
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No available evidence No evidence w
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Introduction The Medicare Services
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Multiplace chambers can accommodate
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Marketing status of the device The
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Table 3 1998 - 1999 self-reported d
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Table 6 retrieval. Indication-speci
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Phase of Search Initial Search Ful
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Conduct of meta-analysis When the d
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early as 1995. The guidelines - kno
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Table 10 Minimum staff qualificatio
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Is it effective? The review assesse
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Table 14 Patient criteria of includ
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offered ample details. The remainin
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characteristics compared to the tre
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Assessment of heterogeneity All the
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Odds ratio 10 1 0.1 0.01 A sensitiv
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Wound healing Two of the five ident
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Studies of necrotising soft tissue
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Summary Table 25 Survival in patien
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Table 29 Therapeutic protocols used
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Osteomyelitis The study by Esterhai
Page 57 and 58: Summary The HBO group showed a stat
Page 59 and 60: Summary These results are difficult
Page 61 and 62: outcomes or that decreased the risk
Page 63 and 64: Anderson et al 80 recruited non-pre
Page 65 and 66: Summary The collected evidence exam
Page 67 and 68: Table 46 Major outcomes following t
Page 69 and 70: Table 50 Therapeutic protocols used
Page 71 and 72: Table 53 Patient criteria of includ
Page 73 and 74: Thirty-seven subjects (comparison g
Page 75 and 76: whose hearing loss was not secondar
Page 77 and 78: tinnitus (6 versus 3 subjects). Non
Page 79 and 80: assume that all participants knew o
Page 83 and 84: Table 65 Descriptive characteristic
Page 87 and 88: These contrasted with the conclusio
Page 89 and 90: Table 73 Patient criteria of includ
Page 91 and 92: Summary There are conflicting resul
Page 93 and 94: Summary separate and previously-stu
Page 95 and 96: need to insulate patients from outs
Page 97 and 98: Reactive effects A reactive effect
Page 99 and 100: Cost of major amputation The hospit
Page 101 and 102: Sensitivity analysis Table 79 shows
Page 103 and 104: Table 80 Estimation of incremental
Page 105 and 106: Sensitivity analysis Table 83 shows
Page 107: Conclusions Safety Potential risks
Page 111 and 112: Appendix B Supporting committee Sup
Page 113 and 114: Appendix C Studies included in this
Page 115 and 116: Necrotising soft tissue infections:
Page 117 and 118: Soft tissue injuries: crush injurie
Page 119 and 120: Cancer: cervix First Author and Yea
Page 121 and 122: Appendix D Studies excluded in this
Page 123 and 124: 2. Shandling AH, Ellestad MH, Hart
Page 125 and 126: 5. Woo TCS, Joseph D, Oxer H. Hyper
Page 127 and 128: 22. Kunkler PB, Boulis-Wassif S, Sh
Page 129 and 130: 45. Wiernik G, Perrins D. The radio
Page 131 and 132: Appendix E Calculation of monoplace
Page 133 and 134: Hence, the total operating costs of
Page 135 and 136: Appendix G Reviews received from ot
Page 137 and 138: Sechrist Industries -- Hyperbaric O
Page 139 and 140: References 1. Hampson N. Hyperbaric
Page 141 and 142: 31. L'Abbe K, Detsky A, O'Rourke K.
Page 143 and 144: 61. Perrins DJ. Influence of hyperb
Page 145 and 146: 89. DiSabato F, Giacovazzo M, Crist
Page 147: 117.Plenk HP. Hyperbaric radiation
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