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KCE Reports 74 Hyperbaric Oxygenation Therapy 1
Table of contents
Scientific Summary
ABBREVIATIONS............................................................................................................ 4
1 INTRODUCTION ................................................................................................... 7
2 HYPERBARIC OXYGENATION THERAPY: HISTORY AND TECHNICAL
DESCRIPTION....................................................................................................... 8
2.1 BRIEF HISTORY................................................................................................................................... 8
2.2 TECHNICAL DESCRIPTION................................................................................................................ 9
2.3 ACCEPTED INDICATIONS BY HYPERBARIC MEDICAL SOCIETIES................................................. 9
2.4 POTENTIAL HARMS, SAFETY AND PRECAUTIONS ........................................................................11
2.4.1 Barotrauma...............................................................................................................................11
2.4.2 Oxygen toxicity .......................................................................................................................11
2.4.3 Other hazards ..........................................................................................................................11
3 EVIDENCE FOR CLINICAL EFFECTIVENESS ......................................................... 13
3.1 INTRODUCTION ..............................................................................................................................13
3.2 LITERATURE SEARCHES ON CLINICAL EFFECTIVENESS................................................................14
3.3 DATA SOURCES ...............................................................................................................................14
3.4 EVIDENCE FOR SPECIFIC INDICATIONS.........................................................................................17
3.4.1 Carbon Monoxide (CO) intoxication .................................................................................17
3.4.2 Decompression accidents......................................................................................................19
3.4.3 Gas embolism...........................................................................................................................21
3.4.4 Anaerobic or mixed anaerobic-aerobic bacterial infections ..........................................22
3.4.5 Acute soft tissue ischemia .....................................................................................................23
3.4.6 Post-radiotherapy tissue damage (soft tissue and bones)...............................................24
3.4.7 Delayed wound healing ..........................................................................................................27
3.4.8 Chronic refractory osteomyelitis.........................................................................................30
3.4.9 Post-anoxic encephalopathy..................................................................................................30
3.4.10 Thermal burns..........................................................................................................................30
3.4.11 Hearing disorders....................................................................................................................31
3.4.12 Acute ophthalmological ischemia.........................................................................................35
3.4.13 Neuroblastoma stage IV.........................................................................................................35
3.4.14 Pneumatosis Cystoides Intestinalis......................................................................................35
3.4.15 Exceptional anaemia................................................................................................................36
3.4.16 Miscellaneous indications (not accepted by ECHM nor by UHMS) .............................36
3.5 GENERAL CONCLUSIONS...............................................................................................................38
4 REVIEW OF ECONOMIC STUDIES........................................................................ 40
4.1 INTRODUCTION ..............................................................................................................................40
4.2 METHODS .........................................................................................................................................40
4.2.1 Literature search strategy......................................................................................................40
4.2.2 Selection criteria......................................................................................................................40
4.3 RESULTS ............................................................................................................................................41
4.3.1 Diabetic foot ulcers ................................................................................................................43
4.3.2 Necrotising soft tissue infections.........................................................................................49
4.3.3 Osteoradionecrosis ................................................................................................................49
4.3.4 Non-diabetic chronic wounds ..............................................................................................51
4.4 DISCUSSION......................................................................................................................................51
4.4.1 Effectiveness .............................................................................................................................51
4.4.2 Costs..........................................................................................................................................52
4.4.3 Other aspects...........................................................................................................................53