Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

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Table 11 Minimum staffing levels by chamber type suggested by HOTFIG. 10 Staff Hyperbaric Physician Inside Attendant Outside Attendant† Patient Type* Monoplace Multiplace Single Lock Multilock All Consultant hyperbaric physician P1 Hyperbaric physician P1 or P2 Not required Patient attendant – fit for pressure P3 Not required Patient attendant – critical care trained and fit for pressure P1 Patient attendant Not required Patient attendant – fit for pressure P2 Patient attendant Patient attendant – fit for pressure P3 Patient attendant – critical care trained Patient attendant – fit for pressure Chamber Operator†‡ P1 or P2 Monoplace operator Hyperbaric Technical Officer P3 Hyperbaric Technical Officer * HOTFIG patient type classification: P1 = elective / non-medical intervention patients, P2 = patients requiring adjunctive medical intervention, P3 = critically ill patients. The medical director of the hyperbaric facility has responsibility for patient classification. † The outside attendant and chamber operator can be the same person. However, at least one other person needs to be in the area during treatments. ‡ During any monoplace therapy, a ratio of two chambers to one operator is the maximum allowed by HOTFIG. Undersea and Hyperbaric Medicine Society (UHMS) Guidelines for clinical hyperbaric facilities are available in the 1999 Committee Report of the Undersea and Hyperbaric Medicine Society. 1 The report was cited as informing the creation of HOTFIG. General guidelines appear as summaries of an earlier report by the UHMS Operations Committee. Clinical hyperbaric facility operations UHMS recommends that clinical departments be hospital-based with available 24-hour service. The Society recommends that treatment be limited to those indications approved by the Society. Quality improvement programs should include technical and nursing indicators and utilisation points. Education of clinical hyperbaric staff Practicing physicians should hold unrestricted licenses and be Board-eligible or Certified in a recognised medical or surgical specialty. Nursing staff should likewise be licensed to provide care. Technical staff are required to hold basic life support certification and possess advanced education and experience relative to their positions. The Society recommends that physicians, nurses, and technicians complete an approved course in introductory hyperbaric medicine. Staffing of clinical hyperbaric facilities UHMS recommends that a minimum of two hyperbaric physicians be on the staff of any full-time clinical hyperbaric medicine program, with one qualifying and assuming the duties of Medical Director. A minimum of one certified hyperbaric nurse or certified hyperbaric technician should be on duty in the clinical area at all times when a patient is receiving treatment. 18 Hyperbaric oxygen therapy
Is it effective? The review assessed the effectiveness of HBOT separately according to indication. Each assessment starts with a description of the included studies. Any subsequent statistical pooling of results occurred only when clinical, epidemiologic, and statistical evidence suggested no heterogeneity of treatment effects was present. Otherwise, a simple, descriptive explanation of results was performed. The pertinent characteristics of accepted studies are summarised in the evidence tables at Appendix C. Thermal burns Eight studies were retrieved from the published literature. A brief description of each study is given in Table 12. Table 12 Descriptive characteristics of included studies focusing on the use of HBOT in thermal burns.* First Author and Year of publication Brannen 1997 38 Niezgoda 1997 39 Hammarlund 1991 40 Cianci 1990 41 Gorman 1988 42 Niu 1987 43 Waisbren 1982 44 Hart 1974 45 NHMRC Level Study Design Location Dates of Enrolment Characteristics of Study Population † Hyperbaric oxygen therapy 19 Size II RCT USA ? ‡ 125 ? Age (years) Mean (SD) II RCT USA ? 12 ? 7:5 III-2 III-2 III-3 III-2 III-2 Comparative study Comparative study Comparative study with historical controls Comparative study Comparative study Sex Ratio (M:F) Sweden ? 9 26 (24-29) § 9:0 USA Australia II RCT USA Jan 1982 to Jul 1987 T=Jul 1986 to Jun 1988 C=Jan 1983 to Jun 1986 21 180 Taiwan After 1981 875 USA ? 72 Nov 1972 to Jan 1974 16 I=28 (9) C=29 (8.3) I=34.2 (14.9) C=38.6 (17.2) I=27 (2-82) § C=26 (7/12- 80) I=35.2 (15.0) # C=35.6 (14.8) I=21.62 C=21.31 I=50:12 C=44:19 * Abbreviations: C = comparison group, F = female, I = intervention group, M = male, RCT = randomised controlled trial, SD = standard deviation. † Information is given for intervention and comparison groups, if available. Otherwise, total study population values are stated. ‡ Unstated, unclear, or unknown. § Median of total population. Figures in parentheses are ranges. # Figures in parentheses are assumed to be standard deviations. Authors did not provide enough information for a definite conclusion. The studies were published over a period of 23 years and were conducted in four countries (with a majority conducted in the USA). The sample sizes ranged from as small as nine to as large as 875. Three of the studies were randomised controlled trials ? ? ? ? 14:2
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 and 16: No available evidence No evidence w
Page 17 and 18: Introduction The Medicare Services
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: Table 10 Minimum staff qualificatio
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 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 85 and 86:
Table 68 Therapeutic protocols used
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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
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need to insulate patients from outs
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Reactive effects A reactive effect
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Cost of major amputation The hospit
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Sensitivity analysis Table 79 shows
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Table 80 Estimation of incremental
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Sensitivity analysis Table 83 shows
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Conclusions Safety Potential risks
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Recommendations MSAC recommended th
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Appendix B Supporting committee Sup
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Appendix C Studies included in this
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Necrotising soft tissue infections:
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Soft tissue injuries: crush injurie
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Cancer: cervix First Author and Yea
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Appendix D Studies excluded in this
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2. Shandling AH, Ellestad MH, Hart
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5. Woo TCS, Joseph D, Oxer H. Hyper
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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
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Appendix G Reviews received from ot
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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
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117.Plenk HP. Hyperbaric radiation
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