Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

Summary
separate and previously-studied series of patients undergoing treatment with 131 I-MIBG
alone. Patients in this series were recruited from an academic medical centre in the
Netherlands. The authors enrolled 51 but present results for the 35 (69%) who
completed more than one course of therapy. Overall, patients had a mean age of 6.8
years. There were 19 males and 19 females.
Patients were given 131 I-MIBG intravenously. Exposure to HBO was through a
multiplace chamber at 3 ATA for 75 minutes, once daily for four days. The primary end
point was survival.
Patients lived for a mean duration of 3 years following treatment. Kaplan-Meier plots
comparing survival distributions between those receiving HBOT and those treated with
131 I-MIBG alone showed better survival in the HBOT group. The results were
statistically significant (log rank test, p = 0.0326).
While this study provides some evidence of the effect of HBOT in the treatment of
neuroblastoma, until more rigorous evidence is collected, the use of this technology
cannot be supported.
Carbon monoxide poisoning
Several studies have been published examining the use of HBOT for acute carbon
monoxide poisoning. In 2000, Juurlink et al 122 published a systematic review of the
literature on this topic, focusing on the efficacy of the procedure on the development of
neurologic sequelae one month after treatment. The authors searched for relevant
publications from 1966 to 1999 using three electronic databases (Medline, Embase, and
the Cochrane Controlled Trials Register) supplemented by examination of reference lists
and contact with experts in the field. A search revealed no studies that met the inclusion
and exclusion criteria published subsequent to the release of this systematic review. The
following discussion is consequently limited to an assessment of the Juurlink et al review.
The review collected six reports of randomised controlled trials involving non-pregnant
adults acutely poisoned with carbon monoxide, regardless of severity. The authors
analysed the results of three studies 123,124,125 that scored three or more on the Jadad
quality scale.
The authors found that the severity of poisoning varied between trials. Each also
employed different doses of HBO. The results for a total of 455 patients were available
for analysis. Non-specific neurological symptoms (eg., headache, confusion, difficulty
concentrating, and disturbances with sleep) were present in 81 of 237 patients (34.1%) in
the intervention group compared to 81 of 218 patients (37.2%) in the comparison group
(OR = 0.82; 95% CI = 0.40, 1.66). Sensitivity analysis did not change the results.
Summary
This systematic review failed to demonstrate a significant reduction in neurologic
sequelae following HBOT for carbon monoxide poisoning. More methodologicallyrigorous
studies are required to examine the efficacy of HBOT on other outcomes and in
distinct patient subsets.
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