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20 Hyperbaric Oxygenation Therapy KCE Reports 74
After the introduction of recompression therapy with air, symptoms dramatically
improved. In combination with other improvements at the worksite mortality fell to less
than 2% annually. 4 More recent studies in workers with caisson disease also show the
high effectiveness of recompression therapy. 44
Therefore, most current recommendations and recent RCTs deal mainly with different
therapy schedules and adjuvant therapies. Besides, specific guidelines for the prevention
of DCS in divers, both professional and recreational, and in professionals working in
hyperbaric conductions have been elaborated. Details of these are outside the scope of
1, 8, 9
this report but can be found in the relevant publications.
Several hyperbaric schedules have been described and tested, differing in pressure, time,
frequency and number of sessions, and although there are no human RCTs available
comparing HBOT to no HBOT it is generally agreed that early hyperbaric treatment is
most likely to lead to complete recovery in mild or moderate DCS. 8 Conducting RCTs
of HBOT versus a sham alternative is considered by many in the field as unethical, but
they agree that there is definitely a need for rigorous RCTs to define optimal treatment
schedules, adjuvant therapy and potentially the use of gas mixtures other than 100%
oxygen. 45
A Cochrane review by Bennett et al. from 2007 identified two RCTs. 20 It showed that
the addition of an NSAID (Figure 3) may reduce the number or recompressions
required due to adequate pain relief.
With the use of heliox, a helium/oxygen mixture (Figure 4) the difference was at the
limit of statistical significance. Both alternatives did not improve recovery. Neither the
37, 38
HAS nor the IECS assessments added additional information on this indication.
Figure 3. More than two recompressions administered, tenoxicam vs. no
tenoxicam
Source: Bennett et al. 20