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KCE Reports 74C Hyperbaric Oxygenation i
INTRODUCTION
Executive summary
Hyperbaric Oxygen Therapy (HBOT) is the administration of oxygen at pressures
greater than normal atmospheric pressure for therapeutic reasons. This 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.
This therapy has been available for several decades and is used for many indications.
Most of these reported indications were, however, based on little or no evidence. As a
result, HBOT has been called “a therapy in search of diseases”.
HBOT appears to be quite safe and the occasional adverse effects are mainly mild and
reversible although they could, potentially, be severe and life threatening. State of the
art installation and maintenance and adequate staffing is therefore of tantamount
importance. Furthermore, an adequate patient selection to avoid side-effect such as
barotraumas is necessary.
it is not entirely clear for which indications HBOT should be supported. The purpose of
this report is to gather evidence about clinical effectiveness, to examine the healtheconomic
aspects of HBOT, to describe current practice and organisation in Belgium
and to make recommendations for the most appropriate use of this therapy.
CLINICAL EFFECTIVENESS
HBOT has been used for many medical conditions. However, most of the randomised
clinical trials have been done in small groups and for many of the indications no proper
randomised trials have been performed. We therefore focussed our systematic
literature review on meta-analyses and systematic reviews of those indications accepted
by either the European or the North American Hyperbaric Medical Societies; the
European Committee for Hyperbaric Medicine (ECHM) and the Undersea and
Hyperbaric Society’ (UHMS). Other indications were only mentioned when summary
evidence was available.
We summarized evidence for the following categories: carbon monoxide (CO)
intoxication, decompression accidents, gas embolism, anaerobic or mixed anaerobicaerobic
bacterial infections, acute soft tissue ischemia, post radiotherapy tissue damage
(soft tissue and bones), delayed wound healing (such as diabetic foot ulcers), chronic
refractory osteomyelitis, post-anoxic encephalopathy, thermal burns, hearing disorders,
acute ophthalmological ischemia, neuroblastoma stage IV, pneumatosis cystoides
intestinalis, exceptional anaemia, and a residual category of miscellaneous indications.
HBOT has become accepted standard therapy in a few life threatening conditions i.e.
decompression illness and gas embolism, mainly based on historical empirical evidence.
For these indications it is unlikely that evidence from RCTs will become available
because such RCTs are considered unethical by many in the field.
There is low quality evidence from small RCTs on the clinical efficacy of HBOT for
three indications. In the treatment of diabetic ulcers adjuvant HBOT may help avoid
major amputations in the medium term compared to standard therapy without HBOT.
For acute deafness presenting early, a slightly better recovery was observed with
adjuvant HBOT, although the clinical relevance of this improvement is uncertain. Finally,
HBOT may improve healing in selected cases of post radiation therapy tissue damage. In
all of these three indications, however, future larger and well conducted RCTs should
enhance our evidence base.