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6 Hyperbaric Oxygenation Therapy KCE Reports 74 OPS Operationen- und Prozedurenschlüssel PCI Percutaneous Coronary Intervention PTA Pulse Tone Average PtcO2 Transcutaneous oxygen pressure measurement QALY Quality-Adjusted Life Year QoL Quality of Life RCT Randomised Controlled Trial RIZIV / INAMI Rijksinstituut voor Ziekte en Invaliditeits Verzekering / Institut National d'Assurance Maladie - Invalidité RNZN Royal New Zealand Navy RR Relative Risk RVU Relative Value Unit SD Standard Deviation SE Standard Error SF-36 Short-Form General Health Survey Sv Sievert (measure of effective radiation dose) TGR / CTM Technische Geneeskundige Raad / Conseil Technique Medical UHMS Undersea and Hyperbaric Medical Society UK United Kingdom (Great Britain) US United States of America VDD Verband Deutscher Druckkammerzentren VGE Venous Gas Embolism ZBC Zelfstandige Behandelcentra
KCE Reports 74 Hyperbaric Oxygenation Therapy 7 1 INTRODUCTION Hyperbaric Oxygen Therapy (HBOT) is the administration of oxygen at pressures greater than normal atmospheric pressure for therapeutic reasons. It is defined by the Undersea and Hyperbaric Medical Society (UHMS) as ‘a treatment in which a patient breathes 100% oxygen while inside a treatment chamber at a pressure higher than sea level pressure, i.e. more than 1 atmosphere absolute (ATA). Hyperbaric oxygenation can also be applied as a diagnostic procedure to decide on the appropriateness of HBOT. The treatment is performed in pressure chambers of various sizes, ranging from monoplace chambers for one patient only, to multiplace or multi-compartment treatment chambers in which several patients can sit and where hospital beds or even an entire intensive care setting can be installed and where health workers can attend to the patients. Recompression with normal air was initially intended as a treatment for decompression sickness (DCS). In the late 19 th century ‘caisson disease’ became a frequent illness in workers involved in large construction projects (bridges, tunnels) where they had to work in hyperbaric conditions while labouring in ‘caissons’. Mortality from this disease, also called bubble disease, was greatly reduced thanks to recompression therapy with normal air. Halfway the 20 th century, the use of normal air was replaced by the use of either pure oxygen or specific mixtures of gasses, and HBOT established itself as standard therapy for all types of decompression illness (DCI) caused by diving, aviation or of iatrogenic origin. Although it was known for a long time that breathing oxygen under increased ambient pressure could lead to an increased amount of oxygen in the blood, the medical use of HBOT for the treatment of conditions other than DCI only started about 50 years ago, when the Dutch cardiac surgeon Ite Boerema reported on the use of hyperbaric oxygen during paediatric cardiac surgery. This marked the beginning of a proliferation of hyperbaric chambers in hospitals around the world. During this era numerous new indications were proposed, from CO poisoning to the treatment of senility and the conservation of youthfulness. Many of the reported indications were based on little or no evidence and it was during this period that HBOT gained a reputation of quackery with many in the medical community. Recently, RCTs were performed for specific indications and evidence on certain indications has appeared. It is the aim of this report to bring together this evidence, to examine the health-economic aspects of HBOT, to describe current practice and organisation in Belgium and to make recommendations for the most appropriate use of this therapeutic technology in this country.
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KCE reports 33 Effects and costs of
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