Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

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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. xvi Hyperbaric oxygen therapy
Introduction The Medicare Services Advisory Committee (MSAC) evaluates new and existing health technologies and procedures for which funding is sought under the Medicare Benefits Scheme in terms of their safety, effectiveness and cost-effectiveness, while taking into account other issues such as access and equity. MSAC adopts an evidence-based approach to its assessments, based on reviews of the scientific literature and other information sources, including clinical expertise. MSAC’s terms of reference and membership are at Appendix A. MSAC is a multidisciplinary expert body, comprising members drawn from such disciplines as diagnostic imaging, pathology, surgery, internal medicine and general practice, clinical epidemiology, health economics, consumer affairs and health administration. The Hyperbaric Oxygen Therapy (HBOT) Supporting Committee of MSAC (membership at Appendix B) has supervised a systematic review of the use of hyperbaric oxygen therapy for the following indications: thermal burns; diabetic wounds; nondiabetic wounds; nectrotising soft tissue infections including necrotising fasciitis, Fournier’s gangrene, and necrotising arachnidism; osteomyelitis; osteoradionecrosis and soft tissue radionecrosis; survival of skin grafts and flaps; multiple sclerosis; cardiovascular conditions including acute myocardial infarctions, cerebrovascular disease, and peripheral obstructive arterial disease; soft tissue injuries including acute ankle sprains and crush injuries; cluster and migraine headaches; facial paralysis; sudden deafness and acoustic trauma; neoplastic conditions including cancers of the head and neck, cervic, bladder, lung, and lymphomas and neuroblastomas; carbon monoxide poisoning; actinomycosis; Crohn’s disease; Legg-Calve-Perthes disease; and osteoporosis. This report summarises the assessment of current evidence for the use of hyperbaric oxygen therapy in these indications. Hyperbaric oxygen therapy 1
Page 1 and 2: Hyperbaric Oxygen Therapy November
Page 3 and 4: Contents Executive summary.........
Page 5 and 6: Tables Table 1 Measures of disease
Page 7 and 8: Table 45 Functional neurologic scor
Page 9 and 10: Figures Figure 1. Outline of search
Page 11 and 12: Effectiveness Published guidelines
Page 13 and 14: evidence that exposure to HBO may b
Page 15: No available evidence No evidence w
Page 19 and 20: Multiplace chambers can accommodate
Page 21 and 22: Marketing status of the device The
Page 23 and 24: Table 3 1998 - 1999 self-reported d
Page 25 and 26: Table 6 retrieval. Indication-speci
Page 27 and 28: Phase of Search Initial Search Ful
Page 29 and 30: Conduct of meta-analysis When the d
Page 31 and 32: early as 1995. The guidelines - kno
Page 33 and 34: Table 10 Minimum staff qualificatio
Page 35 and 36: Is it effective? The review assesse
Page 37 and 38: Table 14 Patient criteria of includ
Page 39 and 40: offered ample details. The remainin
Page 41 and 42: characteristics compared to the tre
Page 43 and 44: Assessment of heterogeneity All the
Page 45 and 46: Odds ratio 10 1 0.1 0.01 A sensitiv
Page 47 and 48: Wound healing Two of the five ident
Page 49 and 50: Studies of necrotising soft tissue
Page 51 and 52: Summary Table 25 Survival in patien
Page 53 and 54: Table 29 Therapeutic protocols used
Page 55 and 56: 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
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Thirty-seven subjects (comparison g
Page 75 and 76:
whose hearing loss was not secondar
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tinnitus (6 versus 3 subjects). Non
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assume that all participants knew o
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Page 83 and 84:
Table 65 Descriptive characteristic
Page 85 and 86:
Page 87 and 88:
These contrasted with the conclusio
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Table 73 Patient criteria of includ
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Summary There are conflicting resul
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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 and 108:
Conclusions Safety Potential risks
Page 109 and 110:
Recommendations MSAC recommended th
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:
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Soft tissue injuries: crush injurie
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Cancer: cervix First Author and Yea
Page 121 and 122:
Appendix D Studies excluded in this
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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
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45. Wiernik G, Perrins D. The radio
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Appendix E Calculation of monoplace
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Hence, the total operating costs of
Page 135 and 136:
Appendix G Reviews received from ot
Page 137 and 138:
Sechrist Industries -- Hyperbaric O
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References 1. Hampson N. Hyperbaric
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31. L'Abbe K, Detsky A, O'Rourke K.
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61. Perrins DJ. Influence of hyperb
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89. DiSabato F, Giacovazzo M, Crist
Page 147:
117.Plenk HP. Hyperbaric radiation
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