Hyperbare Zuurstoftherapie: Rapid Assessment - KCE
Hyperbare Zuurstoftherapie: Rapid Assessment - KCE
Hyperbare Zuurstoftherapie: Rapid Assessment - KCE
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8 Hyperbaric Oxygenation Therapy <strong>KCE</strong> Reports 74<br />
2 HYPERBARIC OXYGENATION THERAPY:<br />
HISTORY AND TECHNICAL DESCRIPTION<br />
2.1 BRIEF HISTORY<br />
Hyperbaric therapy refers to therapeutic conditions with ambient pressures higher than<br />
normal atmospheric pressure at sea level. This pressure can be expressed in relation to<br />
this sea level pressure as Atmosphere pressure absolute (ATA). Hyperbaric conditions<br />
thus correspond to pressures higher than 1 ATA and typically occur during underwater<br />
diving. At a depth of 10 meters pressure is approximately 2 ATA, and every additional<br />
10 meters of depth corresponds to about one extra ATA.<br />
As early as the 17 th century, strong airtight vessels combined with pumps capable of<br />
compressing air could be produced and where sporadically even used as treatments for<br />
various conditions. 1-3 Serious hyperbaric therapy, however, only began as a treatment of<br />
caisson disease, a disease occurring in engineering workers who had to labour in<br />
caissons under conditions of compressed air, mainly during the construction of tunnels<br />
and bridges in the late 19 th 2, 4<br />
century.<br />
The first reports of decompression sickness described this condition as ‘the bends’,<br />
since caisson workers assumed a bent posture to help relieve the pain caused by the<br />
nitrogen accrual in their joints. Although the physiology of the disease was only<br />
understood much later, recompression therapy at first with normal air, was proposed<br />
as early as 1854, 1, 2 and for a long time caisson disease, or decompression sickness<br />
(DCS) as it was later called, remained the main therapeutic indication for hyperbaric<br />
therapy. As a result of the introduction of a series of improvements of the working<br />
environment, including recompression therapy, mortality from this disease that ran as<br />
high as 25% originally, was dramatically reduced. 1, 4 Apart from this therapeutic use,<br />
however, all kinds of potential beneficial effects were ascribed to modest hyperbaric<br />
pressures and hyperbaric chambers were even introduced in health spas. In the<br />
nineteen twenties a 5-storey high hyperbaric building was built by O.J. Cunningham, the<br />
largest ever. 2, 3 Serious medical interest, however, quickly faded.<br />
With World War II interest in hyperbaric physiology and medicine re-emerged due to<br />
the increased demands not only on divers but also increasingly on aviators and later also<br />
astronauts who had to work in both hyperbaric and hypobaric conditions. By then also,<br />
the use of normal air in hyperbaric chambers had been replaced by that of 100% oxygen<br />
or by different mixtures of oxygen, air or helium.<br />
Early experiments in the 19 th and 20 th century had shown that breathing oxygen while<br />
raising the atmospheric pressure could lead to an increased amount of oxygen in the<br />
blood and tissues, but mainstream medical interest was only revived when the Dutch<br />
cardiac surgeon Ite Boerema reported in 1956 on the use of an operating room with<br />
raised atmospheric pressure to allow longer operating time during circulatory arrest in<br />
babies and young children with congenital heart defects. 2, 5, 6 His reports marked the<br />
beginning of a proliferation of hyperbaric chambers in hospitals around the world,<br />
although very soon they would become unnecessary for the original purpose due to the<br />
development of new operation methods and of new equipment to perform them. To<br />
use and justify the existing hyperbaric chambers new and sometimes bizarre indications<br />
were proposed. In 1987, Gabb and Robin published a manuscript entitled ‘Hyperbaric<br />
oxygen, a therapy in search of diseases’ in which they list over a hundred indications that<br />
had, by then, been suggested. 7 Those indications ranged from CO poisoning to senility,<br />
the preservation of youthfulness and the treatment of baldness. Many of the reported<br />
indications were based on very little or only anecdotic evidence.<br />
In an effort to respond to those shortcomings, medical societies such as the Undersea<br />
and Hyperbaric Medical Society (UHMS, www.uhms.org) 8 and the European Committee<br />
for Hyperbaric Medicine (ECHM, www.echm.org) 9 were established with the explicit<br />
aim to examine the indications for HBOT.