hboevidence wikis.unsw.edu.au - User contributions [en]

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'''The Database of Randomised Controlled Trials in Diving and Hyperbaric Medicine'''

[[File:Banner1.JPG|472x200px|center]]

'''Welcome to the HBO Evidence pages.''' '''Here you will find short critical appraisals of all (well, as many as we can find) randomised controlled trials and systematic reviews in both diving and hyperbaric medicine. These appraisals are classified into disease categories and present the evidence in a standard way to enable rapid and meaningful comparisons between trials.'''

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Pages written and maintained by The HBOE Working Group. This site is freely available to the public and professionals alike.If you want to become a member with access to editing rights for the site, please contact me personally at the e-mail below.


Professor Michael Bennett, Prince of Wales Clinical School, Sydney [[mailto:m.bennett@unsw.edu.au | m.bennett@unsw.edu.au]]



[[image:https:''pbs.twimg.com/profile_images/2996589453/459376cad105d55457d781a9237b47a9_400x400.jpeg width="144" height="144" align="center" caption="Mike Bennett" link="https:''twitter.com/gordoben"]]
Follow me on twitter

[[Global Clinical Trials Network | CLINICAL TRIALS NETWORK]]
[[Links | LINKS TO OTHER RELATED SITES]]


[[File:2x_ITU_pts.jpg|center|Two]]

We are always on the lookout for new trials or those we may have missed. If you know of any (human) RCTs in this area please contact us at [[mailto:m.bennett@unsw.edu.au | m.bennett@unsw.edu.au]]


Evidence link: to evidence-based review of many HBOT indications [http://unsworks.unsw.edu.au/vital/access/manager/Repository/unsworks:949 | (MD thesis of Mike Bennett)]

Latest CATS:
Just appraised: Who would have guessed section. Eating a dried salted plum during compression reduces ear pain ([[Meng | Meng 2017]]). Some experimental evidence that HBO hads a central anti-inflammatory effect, Belated appraisal! ([[Rasmussen | Rasmussen 2015]]). More evidence that HBOT improves outcome in diabetic ulcers ([[Perren | Perren 2018]]), while ([[Chiles | Chiles 2018]]) suggests HBO used routinely after robot-assisted prostatectomy did not improve erectile function. One small study suggests HBO will bring ulcerative colitis flares under remission in five days while another is not supportive ([[Dulai | Dulai 2018]]; [[Pagoldh | Pagoldh 2013]]). A planned study to tell us if HBOT is really effective for preventing ORN ([[Shaw | Shaw 2018]]).
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[[Studies in waiting | Papers awaiting appraisal]]: A list of published RCTs we have not got around to yet (take that as an invitation!).


Contributors to HBO Evidence appraisals in alphabetical order. Our thanks to all:

Mike Adams * Mike Bennett * Cecilia Bondjers * Alan Bourke * Kirsteen Brown * Tobias Cibis * Antonia Edge * Mark Fisher * Darran Foo * Abigail Fynn * Amy Gibbens * Glen Hawkins * Peter Hodkinson * Sean Hopson * James Hudgell * Brian Hui * Benjamin Kliot * Juliette Leverment * Shamani Singham * David Smart * Sven Todd * Annelies van der Hulst * Nick Titheridge * Michael Tom * Andre Venning * Craig Wilson * Katherine Witheridge * Danielle Wood * Vincenzo Zanon


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Whither 2019?


The South Pacific Underwater Medicine Society Annual Scientific Meeting will be held in Honiara. For all details go to [https://www.spums.org.au/content/2019-spums-48th-annual-scientific-meeting | www.spums.org.au] .

The UHMS ASM 2019 will be held in Puerto Rico from June 27th to 29th . But don't book yet - bets are hedged, get all details at [https://www.uhms.org/asm-new.html | UHMS web site]

The European Undersea and Baromedical Society ASM is in Israel





[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]] [[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]


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'''Original web authors: Dr. Dan Connor and A/Prof. Mike Bennett'''
'''For any technical queries or problems relating to this site, please contact the [[mailto:danthea@bigfoot.com;%20m.bennett@unsw.edu.au | web author]].'''

Studies in waiting

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Gordoben: Imported from Wikispaces

STUDIES AWAITING APPRAISAL


[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]]
[[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]


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# Chng J et al. A comparison of thermal stress in the submarine escape using immersion half- and full suit in tropical weather operations. UHM 2010;37(6):447-454.
# Senol MG et al. Efficacy of hyperbaric oxygen therapy in post-dural puncture headache. Turkiye Klinikleri J Med Sci 2009;29(6):1618-22.
# Steele J et al. Negative results of a phase II study of hyperbaric oxygen therapy for amyotrophic leteral sclerosis. Amyotrophic Lateral Sclerosis 2007;8:274-275.
# Yogaratnam J et al. Research Report: The effects of hyperbaric oxygen preconditioning on myocardial biomarkers of cardioprotection in patients having coronary artery bypass graft surgery. DHM 2011;38(3):175-185. 
# Churchill S, Weaver LK, Deru K, Russo AA, Handrahan D, Orrison Jr WW, Foley JF, Elwell HA. A prospective trial of hyperbaric oxygen for chronic sequelae after brain injury (HYBOBI). Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2012 Dec;40(2):165-93.
# Wang CJ, Kuo YR, Wu RW, Liu RT, Hsu CS, Wang FS, Yang KD. Extracorporeal shockwave treatment for chronic diabetic foot ulcers. J Surg Res. 2009 Mar;152(1):96-103. doi: 10.1016/j.jss.2008.01.026. Epub 2008 Mar7.
# Hammarlund C, Svedman C, Svedman P. Hyperbaric oxygen treatment of healthy volunteers with U.V.-irradiated blister wounds. Burns 1991;17(4):296-301.
# Sarno MT, Sarno JE, Diller L. The effect of hyperbaric oxygen on communication function in adults with aphasia secondary to stroke. Journal of Speech and Hearing Research 1972; 15:42-48.
# Boyle E, Aparico A, Canosa F, Owen D, Dash HH. Hyperbaric oxygen and acetazolamide in the treatment of senile cognitive functions. In: Trapp WG, Bannister EW, Davison AJ, Trapp PA, eds. Proceedings of the Fifth International Hyperbaric Conference. Burnaby, Canada: Simon Fraser University, 1974:432-438.
# Erwin CW, Massey EW, Brendle AC. Hyperbaric oxygen influences on the visual evoked potentials in multiple sclerosis patients. Neurology 1985; 35(suppl 1):104.
# Worthington JA, DeSouza LH, Forti A. A double-blind controlled cross-over trial investigating the efficacy of hyperbaric oxygen in patients with multiple sclerosis. In: Rose FS, Jones R, eds. Multiple Sclerosis: Immunological, Diagnostic and Therapeutic Aspects. London: John Libbey Publications, 1987.
# Williamson OD, Millar I, Venturoni C. Hyperbaric oxygen and the management of open tibial fractures. Journal of Bone and Joint Surgery – British Volume, Orthopaedic proceedings 2005; 88-B(Suppl II):323.
# Phillips JS, Jones SEM. Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004617.
# Eskes A, Vermeulen H, Lucas C, Ubbink DT. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD008059. DOI: 10.1002/14651858.CD008059.pub3.
# Levett D, Bennett MH, Millar I. Adjunctive hyperbaric oxygen for necrotizing fasciitis (Protocol). Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007937
# Denton AS, Maher J. Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003750.
# Svalestad J, Hellem S, Thorsen E, Johannessen AC. Effect of hyperbaric oxygen treatment on irradiated oral mucosa: microvessel density. International journal of oral and maxillofacial surgery. 2015 Mar 31;44(3):301-7.
# Miller RS, Weaver LK, Bahraini N, Churchill S, Price RC, Skiba V, Caviness J, Mooney S, Hetzell B, Liu J, Deru K. Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial. JAMA internal medicine. 2015 Jan 1;175(1):43-52.
# Chong SJ, Kwan TM, Weihao L, Joang KS, Rick SC.Maintenance of negative-pressure wound therapy while undergoing hyperbaric oxygentherapy.Diving Hyperb Med. 2011 Sep;41(3):147-50.
# Stoekenbroek RM, Santema TB, Koelemay MJ, Hulst RA, Legemate DA, Reekers JA, Ubbink DT. Is additional hyperbaric oxygen therapy cost‐effective for treating ischemic diabetic ulcers? Study protocol for the Dutch DAMOCLES multicenter randomized clinical trial Journal of diabetes. 2015 Jan 1;7(1):125-32.
# Møllerløkken A, Breskovic T, Palada I, Valic Z, Dujic Z, Brubakk AO. Observation of increased venous gas emboli after wet dives compared to dry dives. Diving Hyperb Med. 2011 Sep;41(3):124-8.
# Wu Z, Cai J, Chen J, Huang L, Wu W, Luo F, Wu C, Liao L, Tan J. Autologous bone marrow mononuclear cell infusion and hyperbaric oxygen therapy in type 2 diabetes mellitus: an open-label, randomized controlled clinical trial. Cytotherapy. 2014 Feb 28;16(2):258-65.
# Qu L, Ye Y, Gao G. Effect of Electroacupuncture on Transcutaneous Oxygen Partial Pressure During Hyperbaric Oxygen Therapy in Healthy Individuals. Alternative therapies in health and medicine. 2015 Sep 1;21(5):44. '''[Hard copy held]'''
# Boussi-Gross R, Golan H, Fishlev G, Bechor Y, Volkov O, Bergan J, Friedman M, Hoofien D, Shlamkovitch N, Ben-Jacob E, Efrati S. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury-randomized prospective trial. PloS one. 2013 Nov 15;8(11):e79995.
# Fagher K, Katzman P, Löndahl M. Hyperbaric oxygen therapy reduces the risk of QTc interval prolongation in patients with diabetes and hard-to-heal foot ulcers. Journal of Diabetes and its Complications. 2015 Dec 31;29(8):1198-202. J Cardiothorac Vasc Anesth. 2011 Dec;25(6):908-16. doi:10.1053/j.jvca.2011.06.017. Epub 2011 Aug 25.
# Jeysen ZY, Gerard L, Levant G, Cowen M, Cale A, Griffin S. Research report: the effects of hyperbaric oxygen preconditioning on myocardialbiomarkers of cardioprotection in patients having coronary artery bypass graftsurgery. Undersea Hyperb Med. 2011 May-Jun;38(3):175-85.
# Gasier HG, Fothergill DM. Oxidative stress, antioxidant defenses and nitric oxide production following hyperoxic exposures. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2012 Dec;40(2):125-34.
# Mutzbauer TS, Schneider M, Neubauer B, Weiss M, Tetzlaff K. Antioxidants may Attenuate Plasma Erythropoietin Decline after Hyperbaric Oxygen Diving. International journal of sports medicine. 2015 Nov;36(13):1035-40.
# Mao M, Rao P, Mou X, Guo L, Zhang L. [Clinical observation on delayed encephalopathy after carbon monoxide poisoning treated with acupuncture to restore consciousness combined with hyperbaric oxygen treatment]. Zhongguo zhen jiu= Chinese acupuncture & moxibustion. 2015 Mar;35(3):213-6.
# Yuan JB, Yang LY, Wang YH, Ding T, Chen TD, Lu Q. Hyperbaric oxygen therapy for recovery of erectile function after posteriorurethral reconstruction. Int Urol Nephrol. 2011 Sep;43(3):755-61. doi: 10.1007/s11255-010-9870-0.
# Ueno S, Sakoda M, Kurahara H, Iino S, Minami K, Ando K, Mataki Y, Maemura K,Ishigami S, Shinchi H, Natsugoe S. Safety and efficacy of early postoperative hyperbaric oxygen therapy withrestriction of transfusions in patients with HCC who have undergone partialhepatectomy. Langenbecks Arch Surg. 2011 Jan;396(1):99-106. doi: 10.1007/s00423-010-0725-z.Epub 2010 Nov 11.
# Shimoda M, Enomoto M, Horie M, Miyakawa S, Yagishita K. Effects of hyperbaric oxygen on muscle fatigue after maximal intermittent plantar flexion exercise. The Journal of Strength & Conditioning Research. 2015 Jun 1;29(6):1648-56.
# Blatteau JE, Pontier JM. Effect of in-water recompression with oxygen to 6 msw versus normobaric oxygenbreathing on bubble formation in divers. Eur J Appl Physiol. 2009 Jul;106(5):691-5. doi: 10.1007/s00421-009-1065-y. Epub2009 May 8.
# Efrati S, Gall N, Bergan J, Fishlev G, Bass A, Berman S, Hamad-Abu R, FeigenzonM, Weissgarten J. Hyperbaric oxygen, oxidative stress, NO bioavailability and ulcer oxygenation in diabetic patients. Undersea Hyperb Med. 2009 Jan-Feb;36(1):1-12.
# Alleva R, Tomasetti M, Sartini D, Emanuelli M, Nasole E, Di Donato F, Borghi B,Santarelli L, Neuzil J. Alpha-Lipoic acid modulates extracellular matrix and angiogenesis gene expressionin non-healing wounds treated with hyperbaric oxygen therapy. Mol Med. 2008 Mar-Apr;14(3-4):175-83.
# Stiegler P, Matzi V, Lipp C, Kontaxis A, Klemen H, Walch C, Smolle-Jüttner F. Hyperbaric oxygen (HBO2) in tinnitus: influence of psychological factors ontreatment results? Undersea Hyperb Med. 2006 Nov-Dec;33(6):429-37.
# Porubsky C, Stiegler P, Matzi V, Lipp C, Kontaxis A, Klemen H, Walch C,Smolle-Juttner F. Hyperbaric oxygen in tinnitus: influence of psychological factors on treatmentresults? ORL J Otorhinolaryngol Relat Spec. 2007;69(2):107-12.
# Muller-Bolla M, Collet JP, Ducruet T, Robinson A. Side effects of hyperbaric oxygen therapy in children with cerebral palsy.
> Undersea Hyperb Med. 2006 Jul-Aug;33(4):237-44.
# Schoen PJ, Raghoebar GM, Bouma J, Reintsema H, Vissink A, Sterk W, Roodenburg JL. Rehabilitation of oral function in head and neck cancer patients afterradiotherapy with implant-retained dentures: effects of hyperbaric oxygentherapy. Oral Oncol. 2007 Apr;43(4):379-88.
# Sun TB, Yang CC, Kuo TB. Effect of hyperbaric oxygen on cardiac neural regulation in diabetic individuals with foot complications. Diabet Med. 2006 Apr;23(4):360-6.
# Bader N, Bosy-Westphal A, Koch A, Mueller MJ. Influence of vitamin C and E supplementation on oxidative stress induced by hyperbaric oxygen in healthy men. Ann Nutr Metab. 2006;50(3):173-6.
# Muth CM, Glenz Y, Klaus M, Radermacher P, Speit G, Leverve X. Influence of an orally effective SOD on hyperbaric oxygen-related cell damage. Free Radic Res. 2004 Sep;38(9):927-32.
# Chen L, Li F, Gu D. Hyperbaric oxygen therapy for cerebral blood flow and electroencephalogram in patients with acute cerebral infarction: Choice for therapeutic occasion. Neural Regeneration Research 2007;2(3):171-4 
# Cvorovic L, Jovanovic MB, Milutinovic Z et al. Randomised prospective trial of hyperbaric oxygen therapy and intratympanic steroid injection as salvage treatment of sudden sensorineural hearing loss. Otology and Neurotology 2013;34(6):1021-1026.
# Hoggan, B. L., & Cameron, A. L. (2014). Systematic review of hyperbaric oxygen therapy for the treatment of non-neurological soft tissue radiation-related injuries. Supportive Care in Cancer, 22(6), 1715-26. doi:http://dx.doi.org/10.1007/s00520-014-2198-z
# Londahl, M ; Fagher, K ; Nilsson, AL ; Katzman, P. Diabetologia, Improved 6-year survival in patients with chronic diabetic foot ulcers afterhyperbaric oxygen therapy: outcome from a randomised double-blind study. 2015 Sep, Vol.58 Suppl 1, pp.S31-S31
# Svalestad J, Thorsen E, Vaagbø G, Hellem S. Effect of hyperbaric oxygen treatment on oxygen tension and vascular capacity in irradiated skin and mucosa. International journal of oral and maxillofacial surgery. 2014 Jan 31;43(1):107-12.
# Sanchez CO, Lugo YG, Sánchez LO, Varela LD, Calero JJ, Romero PP. Treatment of radiation-induced cervical fibrosis with pentoxifylline-tocoferol and hyperbaric oxygen. Reports of Practical Oncology & Radiotherapy. 2013(18):S111.
# Esposito M, Grusovin MG, Patel S, Worthington HV, Coulthard P. Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD003603
# Feng JJ, Li YH. Effects of hyperbaric oxygen therapy on depression and anxiety in the patients with incomplete spinal cord injury (a STROBE-compliant article). Medicine. 2017 Jul;96(29).
# Xiang W, Xue H, Wang B, Li Y, Zhang J, Jiang C, Pang J. Efficacy of N-Butylphthalide and hyperbaric oxygen therapy on cognitive dysfunction in patients with delayed encephalopathy after acute carbon monoxide poisoning. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2017;23:1501.
# Sevil E, Bercin S, Muderris T, Gul F, Kiris M. Comparison of two different steroid treatments with hyperbaric oxygen for idiopathic sudden sensorineural hearing loss. European Archives of Oto-Rhino-Laryngology. 2016 Sep 1;273(9):2419-26.
# QI Y, LIN SH, JIANG YH, ZHANG G. The effect of hyperbaric oxygen therapy in 36 cases of skin flap transplantation. Journal of Rare and Uncommon Diseases. 2009;3:014.
# Lacey DJ, Stolfi A, Pilati LE. Effects of hyperbaric oxygen on motor function in children with cerebral palsy. Annals of neurology. 2012 Nov 1;72(5):695-703.
# Santema KT, Stoekenbroek RM, Koelemay MJ, Reekers JA, van Dortmont LM, Oomen A, Smeets L, Wever JJ, Legemate DA, Ubbink DT. Hyperbaric Oxygen Therapy in the Treatment of Ischemic Lower Extremity Ulcers in Patients With Diabetes: Results of the DAMO2CLES Multicenter Randomized Clinical Trial. Diabetes Care. 2017 Oct 25:dc170654.
# Xu Q, Fan SB, Wan YL, Liu XL, Wang L. The potential long-term neurological improvement of early hyperbaric oxygen therapy on hemorrhagic stroke in the diabetics. Diabetes research and clinical practice. 2018 Apr 1;138:75-80.
# Qin L, Meihua C, Dadong G, Li W, Jinglin W, Xiaoyu D, Mingjun B, Yong Z. Efficacy of Combined XingZhi-YiNao Granules and Hyperbaric Oxygen Therapy for Cognition and Motor Dysfunction in Patients with Delayed Encephalopathy after Acute Carbon Monoxide Poisoning. Evidence-Based Complementary and Alternative Medicine. 2017;2017.
# Khandelwal S, Chaudhary P, Poddar DD, Saxena N, Singh RA, Biswal UC. Comparative study of different treatment options of grade III and IV diabetic foot ulcers to reduce the incidence of amputations. Clinics and practice. 2013 Jan 25;3(1).
# Zhao D, Luo S, Xu W, Hu J, Lin S, Wang N. Efficacy and Safety of Hyperbaric Oxygen Therapy Used in Patients With Diabetic Foot: A Meta-analysis of Randomized Clinical Trials. Clinical therapeutics. 2017 Oct 1;39(10):2088-94.
# Brebeck AK, Deussen A, Schmitz-Peiffer H, Range U, Balestra C, Cleveland S, Schipke JD. Effects of oxygen-enriched air on cognitive performance during SCUBA-diving–an open-water study. Research In Sports Medicine. 2017 Jul 3;25(3):345-56.
# Brebeck AK, Deussen A, Range U, Balestra C, Cleveland S, Schipke JD. Beneficial effect of enriched air nitrox on bubble formation during scuba diving. An open-water study. Journal of sports sciences. 2018 Mar 19;36(6):605-12.
# Chen CY, Wu RW, Hsu MC, Hsieh CJ, Chou MC. Adjunctive Hyperbaric Oxygen Therapy for Healing of Chronic Diabetic Foot Ulcers: A Randomized Controlled Trial. Journal of Wound Ostomy & Continence Nursing. 2017 Nov 1;44(6):536-45.
# Shandley S, Wolf EG, Schubert-Kappan CM, Baugh LM, Richards MF, Prye J, Arizpe HM, Kalns J. Increased circulating stem cells and better cognitive performance in traumatic brain injury subjects following hyperbaric oxygen therapy. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2017;44(3):257-69.
# Ng AW, Muller R, Orton J. Incidence of middle ear barotrauma in staged versus linear chamber compression during hyperbaric oxygen therapy: a double blinded, randomized controlled trial. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2017;44(2):101-7
# Germonpre P, Balestra C, Hemelryck W, Buzzacott P, Lafère P. Objective vs. subjective evaluation of cognitive performance during 0.4-MPa dives breathing air or nitrox. Aerospace medicine and human performance. 2017 May 1;88(5):469-75.
# Lambrechts K, Balestra C, Theron M, Henckes A, Galinat H, Mignant F, Belhomme M, Pontier JM, Guerrero F. Venous gas emboli are involved in post-dive macro, but not microvascular dysfunction. European journal of applied physiology. 2017 Feb 1;117(2):335-44
# Patrician A, Schagatay E. Dietary nitrate enhances arterial oxygen saturation after dynamic apnea. Scandinavian journal of medicine & science in sports. 2017 Jun 1;27(6):622-6.
# Bennett MH, Feldmeier J, Smee R, Milross C. Hyperbaric oxygenation for tumour sensitisation to radiotherapy. Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.: CD005007. DOI: 10.1002/14651858.CD005007.pub4.
# Ravaioli M, Baldassare M, Vasuri F, Pasquinelli G, Laggetta M, Valente S, De VP, Neri F, Siniscalchi A, Zanfi C, Bertuzzo VR. Strategies to Restore Adenosine Triphosphate (ATP) Level After More than 20 Hours of Cold Ischemia Time in Human Marginal Kidney Grafts. Annals of transplantation. 2018 Jan;23:34-44.
# Santema KT, Stoekenbroek RM, Koelemay MJ, Reekers JA, van Dortmont LM, Oomen A, Smeets L, Wever JJ, Legemate DA, Ubbink DT. Hyperbaric Oxygen Therapy in the Treatment of Ischemic Lower-Extremity Ulcers in Patients With Diabetes: Results of the DAMO2CLES Multicenter Randomized Clinical Trial. Diabetes care. 2018 Jan 1;41(1):112-9.
# Vadas D, Kalichman L, Hadanny A, Efrati S. Hyperbaric Oxygen Environment Can Enhance Brain Activity and Multitasking Performance. Frontiers in integrative neuroscience. 2017 Sep 27;11:25.
# Chen CY, Wu RW, Hsu MC, Hsieh CJ, Chou MC. Adjunctive Hyperbaric Oxygen Therapy for Healing of Chronic Diabetic Foot Ulcers: A Randomized Controlled Trial. Journal of Wound Ostomy & Continence Nursing. 2017 Nov 1;44(6):536-45.
# Zhao D, Luo S, Xu W, Hu J, Lin S, Wang N. Efficacy and Safety of Hyperbaric Oxygen Therapy Used in Patients With Diabetic Foot: A Meta-analysis of Randomized Clinical Trials. Clinical therapeutics. 2017 Oct 1;39(10):2088-94.
# Ng AW, Muller R, Orton J. Incidence of middle ear barotrauma in staged versus linear chamber compression during hyperbaric oxygen therapy: a double blinded, randomized controlled trial. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2017;44(2):101-7.
# Ersoz F, Arikan S, Sari S, Korpinar S, Ozcan O, Poyraz B, Purisa S, Toklu AS. Effect of hyperbaric oxygen treatment on pilonidal disease surgery. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2016 Nov 1;43(7):821-5.
# Weaver LK, Chhoeu A, Lindblad AS, Churchill S, Wilson SH. Hyperbaric oxygen for mild traumatic brain injury: Design and baseline summary. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2016;43(5):491-509.
# Feng JJ, Li YH. Effects of hyperbaric oxygen therapy on depression and anxiety in the patients with incomplete spinal cord injury (a STROBE-compliant article). Medicine. 2017 Jul;96(29).
# Li G, Hopkins RB, Levine MA, Jin X, Bowen JM, Thabane L, Goeree R, Fedorko L, O’Reilly DJ. Relationship between hyperbaric oxygen therapy and quality of life in participants with chronic diabetic foot ulcers: data from a randomized controlled trial. Acta diabetologica. 2017 Sep 1;54(9):823-31.
# Xiong T, Chen H, Luo R, Mu D. Hyperbaric oxygen therapy for people with autism spectrum disorder (ASD). Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD010922. DOI: 10.1002/14651858.CD010922.pub2
# Churchill S, Miller RS, Deru K, Wilson SH, Weaver LK. Simple and procedural reaction time for mild traumatic brain injury in a hyperbaric oxygen clinical trial. Military medicine. 2016 May 1;181(suppl_5):40-4.
# Souday V, Koning NJ, Perez B, Grelon F, Mercat A, Boer C, Seegers V, Radermacher P, Asfar P. Enriched air nitrox breathing reduces venous gas bubbles after simulated SCUBA diving: A double-blind cross-over randomized trial. PloS one. 2016 May 10;11(5):e0154761.
# Bennett MH, Feldmeier J, Hampson NB, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD005005. DOI: 10.1002/14651858.CD005005.pub4.
# Rollason V, Laverrière A, MacDonald LCI, Walsh T, Tramèr MR, Vogt-Ferrier NB. Interventions for treating bisphosphonate-related osteonecrosis of the jaw (BRONJ). Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD008455. DOI: 10.1002/14651858.CD008455.pub2.
# Bennett MH, French C, Schnabel A, Wasiak J, Kranke P, Weibel S. Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD005219. DOI: 10.1002/14651858.CD005219.pub3.
# Glover M, Smerdon GR, Andreyev HJ, Benton BE, Bothma P, Firth O, Gothard L, Harrison J, Ignatescu M, Laden G, Martin S. Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomised, double-blind, sham-controlled phase 3 trial. The Lancet Oncology. 2016 Feb 1;17(2):224-33.
# Bennett MH, Lehm JP, Jepson N. Hyperbaric oxygen therapy for acute coronary syndrome. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD004818. DOI: 10.1002/14651858.CD004818.pub4.
# Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD004123. DOI: 10.1002/14651858.CD004123.pub4.
# Wares JR, Cifu DX, Hoke KW, Wetzel PA, Gitchel G, Carne W. Effects of hyperbaric oxygen on eye tracking abnormalities in males after mild traumatic brain injury. Journal of rehabilitation research and development. 2014;51(7):1047.
# Miller RS, Weaver LK, Bahraini N, Churchill S, Price RC, Skiba V, Caviness J, Mooney S, Hetzell B, Liu J, Deru K. Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial. JAMA internal medicine. 2015 Jan 1;175(1):43-52.
# Bennett MH, Weibel S, Wasiak J, Schnabel A, French C, Kranke P. Hyperbaric oxygen therapy for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD004954. DOI: 10.1002/14651858.CD004954.pub3
# Walker WC, Franke LM, Cifu DX, Hart BB. Randomized, Sham-controlled, feasibility trial of hyperbaric oxygen for service members with postconcussion syndrome: cognitive and psychomotor outcomes 1 week postintervention. Neurorehabilitation and neural repair. 2014 Jun;28(5):420-32.
# Cifu DX, Walker WC, West SL, Hart BB, Franke LM, Sima A, Graham CW, Carne W. Hyperbaric oxygen for blast‐related postconcussion syndrome: Three‐month outcomes. Annals of neurology. 2014 Feb 1;75(2):277-86.
# Gallego-Vilar D, García-Fadrique G, Povo-Martin I, Salvador-Marin M, Gallego-Gomez J. Maintenance of the response to dimethyl sulfoxide treatment using hyperbaric oxygen in interstitial cystitis/painful bladder syndrome: a prospective, randomized, comparative study. Urologia internationalis. 2013;90(4):411-6.
# Krajcovicova Z, Melus V, Zigo R, Matisáková I, Vecera J, Kalíková K. Efficacy of hyperbaric oxygen therapy as a supplementary therapy of sudden sensorineural hearing loss in the Slovak Republic. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2018;45(3):363-70.
# Yuan Li, HuiPing Zhang, Ya-Feng Hao, Yi Liang, Ling-ge Wei, Tong-Shun Xu, Tao Wang Evaluation of hyperbaric oxygen effects on slow coronary flow patients using gated myocardial perfusion imaging tomography. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2018;45(4):403-09.
# Thistlethwaite KR, Finlayson KJ, Cooper PD, Brown B, Bennett MH, Kay G, O'Reilly MT, Edwards HE. The effectiveness of hyperbaric oxygen therapy for healing chronic venous leg ulcers: A randomised, double blind, placebo‐controlled trial. Wound Repair and Regeneration. 2018 Aug 21.
# Capt Vishvanath G. Hyperbaric oxygen therapy in free flap surgery: is it meaningful?. Medical Journal Armed Forces India. 2011 Jul 1;67(3):253-6.
# Sun Q, Bao JF, An YL, Lei H, Ma J. Hyperbaric oxygen therapy and comprehensive orthopedic treatment for incomplete traumatic spinal cord injury on the qinghai-tibet plateau: Study protocol for an open-label randomized controlled clinical trial. Asia Pacific Journal of Clinical Trials: Nervous System Diseases. 2017 Apr 1;2(2):50.
# Wolf EG, Prye P, Michaelson R, Brower G, Profenna L, Bonetta O. Hyperbaric side effects in a traumatic brain injury randomized clinical trial. Undersea Hyperb Med 2012; 39:1075-1082. [Hard copy in journals]
# Peng F, Wang S, Huang X, Xiao P. Effect of hyperbaric therapyon patients with herpes zoster. UHM 2012;39(6):1083-1087.
# Caspersen C, Stensrud T, Storebø ML, Thorsen E. Exhaled nitric oxide and lung function after moderate normobaric hyperoxic exposure. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2013;40(1):7-13.
# Tikkinen J, Parkkola K, Siimes MA. Reaction test revealed impaired performance at 6.0 atm abs but not at 1.9 atm abs in professional divers. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2013;40(1):33-9.

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Meng

2019-01-24T01:35:02Z

Gordoben: Imported from Wikispaces

==Eating a dried salted plum during compression reduced the incidence of moderate to severe ear pain during compression==

==Clinical bottom line:==
{|
| '''1. The proportion of patients complaining of moderate to severe ear pain was reduced when compressed while eating a dried salted plum.''' ** 2. There was no reduction in otoscopic assessment of the severity of middle ear barotrauma '''
|-
|}

**Citation/s: '''
1. Meng FC, Shen CH, Wu D, Chu CM, Shih CP, Lin HC, Peng CK, Chang SC, Huang KL. Dried salted plum consumption ameliorates hyperbaric oxygen therapy-induced otalgia severity at the first chamber session: a prospective randomized controlled study. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2017;44(6):551-7.

'''Lead author's name and fax:''' Chih-Hao Shen, MD – potato652@yahoo.com.tw
'''Three-part Clinical Question:''' During an initial compression for hyperbaric oxygen delivery, does eating a dried salted plum versus doing nothing specific result in any reduction in otalgia from middle ear barotrauma?

'''Search Terms:''' Middle ear barotrauma; prevention; Valsalva

**The Study: '''Non-blinded randomised controlled trial with intention-to-treat. 
'''The Study Patients:''' Adult patients undergoing their first compression for the purpose of delivering hyperbaric oxygen therapy 
'''Control group''' (N = 37; 37 analysed): Patients underwent a 15 minute compression from 1 ATA to 2.5 ATA after instructions on clearing ears. 
'''Experimental group''' (N = 53; 53 analysed): As above but patients were also asked to eat a dried salted plum during compression

**The Evidence:'''
{|
| '''Outcome''' || '''Time to Outcome''' || '''Control Group''' || '''Plum Group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT'''
|-
| '''Otoscopic signs of severe (Grade 3 to 4) MEB (Teed score 0 to 5 worst) ''' || 30 mins || 0.19 || 0.19 || 0% || 0.0 || INF
|-
|^ |||||| 95% CIs: || -87% to 87% || -0.16 to 0.16 || NNT ''' 6 to INF; NNH ''' 6 to INF
|-
| '''Moderate to severe otalgia, VAS >3 (VAS 0 to 10 worst) ''' || 30 mins || 0.11 || 0 || 100% || 0.108 || 9
|-
|^ |||||| 95% CIs: || || 0.01 to 0.21 || 5 to 125
|-
|}
**Comments:'''

1. Not a surprising finding as the consumption of saliva-inducing food during compression has a long and venerable history of assisting ear clearing.

2. It is not quite clear what accounts for the difference in the number of patients allocated to each arm.

3. There seemed no close relationship between the Teed score and the degree of otalgia.

'''Appraised by:''' Mike Bennett; Monday, 21 January 2019

'''Email:''' m.bennett@unsw.edu.au

'''Kill or Update By''': June 2020

[[File:sumhorsa.gif|center|sumhorsa.gif]]

[[Audiovestibular | BACK]]

Audiovestibular

2019-01-24T01:34:25Z

Gordoben: Imported from Wikispaces

'''AUDIOVESTIBULAR'''

[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]][[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]

[[File:sumhorsa.gif|center]]

==Including both acute and chronic hearing loss and tinnitus.==



[[File:sumhorsa.gif|center]]


Subject last searched June 2015. Next search June 2020.
{|
| '''Author 1''' || '''Author 2''' || '''Author 3''' || '''Title''' || '''Citation''' || '''Search term 1''' || '''Search term 2''' || '''Search term 3'''
|-
| [[Pilgramm1 | Pilgramm M]] || Schumann K || || Hyperbaric oxygen therapy for acute acoustic trauma. || Archives of Otolaryngology 1985; 241:247-254. || Deafness || Tinnitus ||
|-
| [[Pilgramm2 | Pilgramm M]] || || || Clinical and animal experiment studies to optimise the therapy for acute acoustic trauma. || Scandinavian Audiology (Suppl) 1991; 34:103-122. || Deafness || Tinnitus ||
|-
| [[Carlson | Carlson S]] || Jones J || Brown M || Prevention of hyperbaric-associated middle ear barotrauma. || Annals of Emergency Medicine 1992; 21:1468-1471. || Barotrauma/ etiology/ *prevention & control || Nasal Decongest. || *Ear, Middle
|-
| [[Dauman | Dauman R]] || Poisot D || Cros AM || Sudden hearing loss: comparative randomized study of two modalities of hyperbaric oxygen therapy in association with naftidrofuryl. || Revue de Laryngologie 1993; 114:53-58. || Deafness, Sudden || Nafronyl || Hemodilution
|-
| [[Hoffman1 | Hoffmann G]] || Bohmer D || Desloovere C || Hyperbaric oxygenation as a treatment for sudden deafness and acute tinnitus || Proceedings of the Eleventh International Congress on Hyperbaric Medicine (Fuzhou, China). Best publishing, Flagstaff Arizona; 1993:146-152. || Deafness, Sudden || Tinnitus || Hemodilution
|-
||| [[Hoffman1 | Hoffmann G]] || || Hyperbaric oxygenation as a treatment for sudden deafness and acute tinnitus. (abstract) || In: Wen-ren Li, pres. Proceedings of the Eleventh International Congress on Hyperbaric Medicine (Fuzhou, China). Flagstaff, Arizona: Best Publishing 1993:26-27 || Deafness, Sudden || Tinnitus ||
|-
| [[Hoffman3 | Hoffmann G]] || Bohmer D || Desloovere C || Hyperbaric oxygenation as a treatment of chronic forms of inner ear hearing loss and tinnitus. || In: Wen-ren Li, Proceedings of the Eleventh International Congress on Hyperbaric Medicine, Fuzhou. Best Publishing, Flagstaff, Arizona 1993:141-145. || Deafness || Tinnitus ||
|-
| [[Cavalazzi | Cavallazzi G]] || Pignataro L || Capaccio P || Italian experience in hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss. || Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine. Marroni A, Oriani G, Wattel F, eds. Grafica Victoria, Bologna 1996:647-649. || Hearing Loss, Sensineuronal || Deafness, Sudden || Tinnitus
|-
| [[Schwab | Schwab B]] || Flunkert C || Heermann R || HBO in the therapy of cochlear dysfunctions - first results of a randomized study. || Collected manuscripts of XXIV Annual Scientific Meeting of the European Underwater and Baromedical Society || Deafness, sudden || Tinnitus ||
|-
| [[Mutzbauer | Mutzbauer T]] || Mueller P || Tetzlaff K || Is eustachian tube ventilatory function (ETVF) impairment after oxygen diving mediated by free radicals? || Undersea and Hyperbaric Medicine 2000; 27(suppl):16. || Eustachian tube || Middle ear || Oxygen diving
|-
| [[Fattori | Fattori B]] || || || Sudden hypoacusis treated with hyperbaric oxygen therapy: a controlled study. || Ear, Nose and Throat Journal 2001; 80(9):655-660. || Deafness, sudden || Hearing loss, sensorineural ||
|-
| [[Bennett2 | Bennett M]] || Kertesz T || Yeung P || Hyperbaric oxygen for idiopathic suddensensorineural hearing loss and tinnitus (Cochrane Review) || The Cochrane Library (Issue 1 2007). || Deafness, sudden || Hearing loss, sensorineural || Tinnitus
|-
| [[Topuz | Topuz E]] || Yigit O || Cinar U || Should hyperbaric oxygen be added to treatment in idiopathic sudden sensorineural hearing loss? || European Archives of Otorhinolaryngology 2004; 261:393-6. || Deafness, sudden || Hearing loss, sensorineural ||
|-
| [[Cekin | Çekin E]] || Cincik H || Ulubil SA || Effectiveness of hyperbaric oxygen therapy in management of sudden hearing loss. || The journal of laryngology and otology 2009; 123: 609-12 || Deafness, Sudden || Hearing loss, sensorineural ||
|-
| [[Naibogllu | Naibogllu B]] || Külekçi S || Sürmeli M || Efficacy of multimodality approach to sudden hearing loss. || The Turkish Journal of Ear, Nose and Throat. 2015; 25(2):77-81 || Deafness. sudden || Hearing loss,sensorineural || Steroids, intrtympanic
|-
| [[Meng | Meng FC]] || Shen CH || Wu D || Dried salted plum consumption ameliorates hyperbaric oxygen therapy-induced otalgia severity at the first chamber session: a prospective randomized controlled study. || Undersea & Hyperbaric Medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 2017;44(6):551-7. || Middle Ear Barotrauma || Prevention || Eustachian tubes
|-
|}




[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]][[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]

[[File:sumhorsa.gif|center]]


[[Category:Audiovestibular]]

Rasmussen

2019-01-18T06:29:21Z

Gordoben: Imported from Wikispaces

Evidence of a centrally mediated anti-inflammatory or direct anti-nociceptive effect of hyperbaric oxygen following a standard experimental thermal burn model

**Clinical Bottom Line:'''
1. HBO reduced the area of secondary hyperalgesic response in this burn model
2. There was no difference shown in the area of primary hyperalgesia
3. Combined, these findings suggest the action of HBO is centrally mediated and may be anti-nociceptive or anti-infammatory. 

'''Citation/s:''' 1. Rasmussen VM, Borgen AE, Jansen EC, Rotbøll Nielsen PH, Werner MU. Hyperbaric oxygen therapy attenuates central sensitization induced by a thermal injury in humans. Acta Anaesthesiologica Scandinavica. 2015 Jul 1;59(6):749-62 

'''Lead author's name:''' Per Rotboll Nielsen E-mail: per.rotboll.nielsen@regionh.dk 

'''Three-part Clinical Question:''' For volunteers subjected to a thermal injury model, does a hyperbaric oxygen exposure, compared to no specific intervention, result in any evidence of an anti-nociceptive action? 
Search Terms: Thermal burn; volunteer; nociception

'''The Study:''' Non-blinded randomised cross-over trial with intention-to-treat.
'''The Study Patients:''' Adult healthy male volunteers recruited from those previously volunteering for a thermal injury studies. 
Control group (N = 19; 17 analysed): Thermal injury to calf area by application of a probe at 47C, immediately followed by observation in a 1ATA air environment 
Experimental group (N = 19; 17 analysed): As above but injury followed immediately by one 90 minute session breathing 100% oxygen at 2.4 ATA 

**The Evidence:'''

{|
| '''Measure''' |||| '''Control Group''' |||| '''HBO Group''' || '''P-value'''
|-
|^ || '''Median''' || '''95% CI''' || '''Median''' || '''95%CI''' ||^
|-
| '''Area under curve of secondary hyperalgesia per min (cm2) over 237 minutes''' || 42 || 31.1 to 71.4 || 34.6 || 22.9 to 39.8 || 0.01
|-
| '''Area under curve of secondary hyperalgesia per min (mN) over 237 minutes''' || 124 || 55 to 209 || 155 || 101 to 226 || 0.01
|-
|}

**Comments:'''
1. Warm detection threshold, cool threshold and heat pain thresholds were not different between groups

2. There was a statistically evident reduction in secondary hyperalgesia in the control group who had previously had the HBO exposure. (A crossover effect).

3. There is a possibility of bias due to the lack of blinding.

'''Appraised by:''' Mike Bennett Friday, 18 January 2019

Email: [[mailto:m.bennett@unsw.edu.au | m.bennett@unsw.edu.au]] 

Kill or Update By: December 2024





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'''[[Burns | BACK]]'''

Chong

2019-01-18T06:28:39Z

Gordoben: Imported from Wikispaces

=Early HBOT did not influence burn depth or positive bacterial cultures in thermal burns=
{|
| 1. HBOT was of no clear benefit in thermal burns
|-
|}
'''Citation/s:''' Chong SJ, Kan EM, Song C, Soh CR, Lu J. Characterisation of early thermal burns and the effects of hyperbaric oxygen: a pilot study.
Diving and Hyperbaric Medicine 2013 Sep;43(3):157-61

 '''Lead author's name and fax:''' Si Jack Chong; Singapore General Hospital
'''Three-part Clinical Question:''' Does early adjunctive HBOT reduce conversion of thermal burns to deeper injury?

 '''Search Terms:''' Thermal burns; wound healing

**The Study:'''
Non-blinded randomised controlled trial with intention-to-treat.

 '''The Study Patients:''' All patients had suffered injury secondary to a burn (flame, flash, scald, contact and in one case chemical) <24 hours prior to admission, 
were aged 21-60 and had <40% total burn surface area with regions of deep dermal or full thickness burns. Notably, patients with ANY co-morbidities 
were excluded, as were those who required airway protection. 
'''Control group''' (N = 9; 6 analysed): Control group received 'standard' burns care at the Singapore General Hospital burns unit. 
 '''Experimental group''' (N = 8; 7 analysed): The above 'standard care' with the addition of HBOT - 2 sessions within 22 hours of admission - 90 minutes each at 
243kPa breathing 100% O2.

**The Evidence:'''
{|
| Outcome || Time to Outcome || Standard group || HBOT group || Relative risk reduction || Absolute risk reduction || NNT
|-
| '''Proportion of deep burns at 24 hrs that ''' **became superficial at 48 hrs''' || 48 hours || 0.11 || 0.25 || 125% || 0.14 || 7
|-
|^ |||||| 95% CI: || -45% to 100% || -0.23 to 0.5 || NNT ''' 2 to INF; NNH ''' 4 to INF
|-
| '''Proportion of superficial burns at 24 hours that ''' **became deep at 48 hours''' || 48 hours || 0.11 || 0.13 || 13% || 0.01 || 71
|-
|^ |||||| 95% CI: || -100% to 290% || -0.29 to 0.32 || NNT ''' 3 to INF; NNH ''' 3 to INF
|-
| '''Positive bacterial cultures''' || 48 hours || 0.44 || 0.25 || 44% || 0.194 || 5
|-
|^ |||||| 95% CI: || -56% to 100% || -0.25 to 0.64 || NNT ''' 2 to INF; NNH ''' 4 to INF
|-
|}

**Comments:'''
1. Very small study with low power to find important differences (planned 80 patients)
 2. A lot of incomplete data. 
3. White cell counts and cytokine levels were compared to averages from a non-burnt control population and found to be elevated at 48 hours, 
but with no significant difference between the HBOT and standard groups, the full data for this was not published. 
4. Once chemical burn included

'''Appraised by:''' Craig Wilson; Thursday, 26 January 2017
Email: c.c.wilson@live.co.uk

 '''Kill or Update By:'''December 2024




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'''[[Burns | BACK]]'''

Villanueva

2019-01-18T06:28:04Z

Gordoben: Imported from Wikispaces

'''Hyperbaric oxygen for thermal burns'''

**Citation:'''

Villanueva E, Bennett MH, Wasiak J, Lehm JP. Hyperbaric oxygen therapy for thermal burns. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004727.
.
Background
Hyperbaric oxygen therapy (HBOT) consists of intermittently administering 100% oxygen at pressures greater than 1 atmosphere in a pressure vessel. This technology has been used to treat a variety of disease states and has been described as helping patients who have sustained burns.

Objectives
The aim of this review was to assess the evidence for the benefit of hyperbaric oxygen treatment (HBOT) for the treatment of thermal burns.

Search strategy
We searched the Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2002), MEDLINE (Ovid 1966 to November Week 2, 2003), CINAHL (Ovid 1982 to December Week 2 2003), EMBASE (Ovid 1980 to September 2003) , DORCTHIM (The Database of Randomised Controlled Trials in Hyperbaric Medicine) from inception to 2003, and reference lists of articles.

Selection criteria
We included all randomised controlled trials that compared the effect of HBOT with no HBOT (no treatment or sham).

Data collection & analysis
Data from the studies were extracted independently by two authors and each trial was assessed for internal validity. All differences were resolved by discussion between the reviewers.

Main results
Four randomised controlled trials were identified, of which two satisfied inclusion criteria. The trials were of poor methodological quality. As a result, it was difficult to have confidence in either the individual results or any attempt to pool results across the studies. 
One trial reported no difference in length of stay, mortality, or number of surgeries between the control and HBO-treated groups once these variables were adjusted for the patient's condition. The second trial reported mean healing times that were shorter in patients exposed to HBOT (Mean: 19.7 days versus 43.8 days).

Reviewers' conclusions
This systematic review has not found sufficient evidence to support or refute the effectiveness of HBOT for the management of thermal burns. Evidence from the two randomised controlled trials is insufficient to provide clear guidelines for practice. Further research is needed to better define the role of HBOT in the treatment of thermal burns.

Update December 2024



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'''[[Burns | BACK]]'''

Xu

2019-01-18T06:27:22Z

Gordoben: Imported from Wikispaces

'''Hyperbaric oxygenation may have reduced the incidence of sepsis associated with thermal burns. '''

**Clinical Bottom Line:'''
1. Apparent reduction in the incidence of sepsis following thermal burns with the addition of hyperbaric oxygenation to a therapeutic regime.

**Citation:'''
Xu N, Li Z, Luo X. [Effects of hyperbaric oxygen therapy on the changes in serum sIL-2R and Fn in severe burn patients]. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1999; 15(3):220-223. 
Lead author's name and fax: 

**Three-part Clinical Question:''' For patients with thermal burns, does the addition of hyperbaric oxygenation to a standard therapeutic regimen reduce the incidence of burn infection?
Search Terms: Hyperbaric oxygenation, Burns thermal 

**The Study:'''
Non-blinded randomised controlled trial with intention-to-treat unknown.
The Study Patients: Patients with >30% body surface area burns (or 3rd degree >10%BSA).
Control group (N = 17): Not stated 
Experimental group (N = 25: HBO regimen not stated 

**The Evidence:'''

{|
| '''Non-Event Outcomes''' || '''Time to outcome''' || '''Control group''' || '''HBO group''' || '''P-value'''
|-
| '''Incidence of sepsis''' || 35 days || ? || Reduced || P <0.05
|-
| '''Serum soluble interleukin 2 receptor''' || 35 days || ? || Not increased || P <0.05
|-
| '''Plasma fibronectin''' || 35 days || ? || Not decreased || P < 0.01
|-
|}

**Comments:'''
1. Abstract only, little data given.
2. No details of randomization method, control therapy or hyperbaric schedule.
3. Clinical impact unknown.
4. Soluble interleukin 2 receptors in the serum are increased and plasma fibronectin is decreased in patients with burns and they are both apparently markers for burn infection. These markers were not significantly different in HBO treated subjects when compared to healthy, non-burned controls.
5. Article in Chinese, not yet available in translation. 

**Appraised by:''' Mike Bennett and Juliette Leverment, Hyperbaric Medicine, Prince of Wales Hospital, Sydney ; Monday, 9 December 2002
Email: m.bennett@unsw.edu.au 
Kill or Update By: December 2024





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'''[[Burns | BACK]]'''

Niezgoda

2019-01-18T06:26:51Z

Gordoben: Imported from Wikispaces

'''Hyperbaric oxygen may be associated with some reduction in wound size, exudate and hyperaemia following a standard injury model.'''

'''Clinical Bottom Line:'''
# The addition of hyperbaric oxygen treatment in this model of a burn injury was associated with a reduction of wound size, exudate and hyperaemia on day 2 only. 

**Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Thursday, 25 March 1999

**Clinical Scenario:''' A patient with thermal burns presented for treatment, we wondered if adding hyperbaric oxygen to the treatment would improve outcome. 
**Three-part Question:''' For patients with thermal burns, does the addition of hyperbaric oxygen to the standard treatment result in any improvement in the rate of healing?
**Search Terms:''' burns

**The Study:'''
Double-blinded concealed randomised controlled trial with intention-to-treat.
Healthy, non-smoking volunteers with a standard wound inflicted on the forearm.
'''Control group''' (N =6;6 analysed): Blister formed by suction, de-roofed and irradiated with UV light in a standard way. Wound then covered with hydrocolloid dressing renewed daily. Sham hyperbaric treatment started within 2 hours, twice daily for three days, at 2.4ATA on 8.75% oxygen for three thirty minute periods separated by 10 minute air breaks. 100% oxygen decompression.
'''Experimental group''' (N =6;6 analysed): As above, but hyperbaric sessions involved breathing of 100% oxygen for three thirty minute periods separated by 10 minute air breaks.

**The Evidence:'''
{|
| '''Non-event outcomes''' || '''Time to outcome''' || '''Control group''' || '''HBO group''' || '''P-value'''
|-
| '''Hyperaemia(perfusion units)''' || Day 2 || 25.0 || 14.4 || 0.05
|-
| '''exudate/day (g)''' || Day 2 || 0.30 || 0.19 || 0.03
|-
| '''Wound size (cm2)''' || Day 2 || 0.95 || 0.61 || 0.04
|-
|}

'''Comments:'''
1. Statistically significant differences on day two only.
2. Possibly inappropriate use of statistical analysis by use of multiple one-tail t-tests at times that may not have been a priori.
3. Clinical relevance unclear.

**Expiry date:''' December 2024
**References: '''
1. Niezgoda JA, Cianci P, Folden BW, Ortega RL, Slade JB, Storrow AB. The effect of hyperbaric oxygen therapy on a burn wound model in human volunteers. Plastic and Reconstructive Surgery 1997; 99:1620-1625.



[[File:sumhorsa.gif|center]]

'''[[Burns | BACK]]'''

Brannen

2019-01-18T06:26:12Z

Gordoben: Imported from Wikispaces

'''The addition of hyperbaric oxygenation therapy to thermal burns patients did not result in improved outcome.'''

'''Clinical Bottom Line:'''
1. The addition of hyperbaric oxygen did not affect mortality, length of stay or number of surgical procedures required. (LOS and mortality analysed by logistic regression)
2. No important benefit of HBO in thermal burns was identified. 

**Appraised by:''' Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Friday, 04 December, 1998

**Clinical Scenario:''' A patient with thermal burns presenting for early treatment in a specialist burns centre.
**Three-part Question:''' In patients with thermal burns, does the addition of hyperbaric oxygen therapy to a standard care protocol result in any improvement in the time taken to heal, or quality of scarring?
**Search Terms:''' Hyperbaric oxygenation, burns/thermal.

**The Study:'''
Non-blinded randomised controlled trial with intention-to-treat.
Adult patients with skin burns, with or without airway /inhalation injury, referred to a tertiary care burns centre in the first 24 hours.
'''Control group''' (N = 62; 62 analysed): Usual burn care.
'''Experimental group''' (N = 63; 63 analysed): Usual burn care plus oxygen at 2ATA for 90 minutes twice daily for a minimum of 5 days and a maximum number of treatments equal to % burn area.

**The Evidence:'''
{|
| '''Outcome''' || '''Time to Outcome''' || '''Normal care rate''' || '''Hyperbaric care rate''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT'''
|-
| '''Death''' || As required || 0.113 || 0.111 || 2% || 0.002 || 500
|-
| '''95% CI''' || || || || -96% to 100% || -0.12 to 0.11 || NNT'''9 to INF NNH=9 to INF
|-
|}

**Comments:'''
1. Potential for selection bias as randomization depended on availability of HBO facility.
2. No attempt to blind patients or staff.
3. No analysis of graft survival or long-term outcome.
4. No analysis of the modification of acute care that may have accompanied HBO treatment.
5. Most were quite small burn areas and these results may not apply to larger burns.

**Expiry date:''' December 2024
**References: '''
1. Brannen AL, Still J, Haynes M, Orlet H, Rosenblum F, Law E, Thompson W. A randomized prospective trial of hyperbaric oxygen in a referral burn centre population. The American Surgeon 1997; 63:205-208.



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'''[[Burns | BACK]]'''

Hart

2019-01-18T06:25:32Z

Gordoben: Imported from Wikispaces

'''The addition of hyperbaric oxygen to a burn care protocol resulted in a reduction in the time required for burn to heal.'''

'''Clinical Bottom Line:'''
1. The addition of hyperbaric oxygen to a burn care protocol resulted in a reduction in the time required to heal burns.
2. Any effect of the addition of hyperbaric oxygen on fluid requirements and graft success remains unclear.

**Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Thursday, 22 April 1999

**Clinical Scenario:''' A patient presented with thermal burns and we wondered if the addition of hyperbaric oxygen would improve healing time.
**Three-part Question:''' In patients with thermal burns, does the addition of hyperbaric oxygen to a standard burn care protocol result in any improvement in time required to heal, or the quality of healing?
**Search Terms:''' Thermal burns

**The Study:'''
Double-blinded concealed randomised controlled trial with intention-to-treat.
Patients with between 10 and 50% of body surface area thermal burns presenting to a burns centre within 24 hours of injury.
'''Control group''' (N = 16; 16 analysed): A standard burns protocol with fluid resuscitation, dressings and surgical procedures. Sham hyperbaric exposures in a chamber compressed to 1.3ATA and returned to 1ATA gradually at beginning and end of time period.
'''Experimental group''' (N = 16; 16 analysed): Protocol as above plus 100% oxygen breathing at 2ATA for 90 minutes every 8 hours in the first 24 hours, then 12 hourly until healed.

**The Evidence:'''
{|
| '''Non-event outcomes''' || '''Time to outcome''' || '''Air group''' || '''HBO group''' || '''P-value'''
|-
| '''Average volume of crystalloid required (mls/kg/%BSA)''' || 24 hours || 3.4 || 2.2 || Not tested
|-
| '''Mean healing time (days)''' || Healing || 43.8 || 19.7 || <0.005
|-
|}
**Comments:'''
1. Small study with paired stratification by surface area burnt.
2. Good randomisation and blinding.
3. Power to detect a significant improvement in fluid requirements or graft success unknown, but likely to be low.
4. Some suggestion of improvement in proportion of grafts taking in hyperbaric group (1/2 controls, 2/2 HBO).
4. Morbidity and mortality data in this paper do not relate to this RCT.

**Expiry date:''' December 2024
**References: '''
1. Hart GB, O'Reilly RR, Broussard ND, Goodman DB, Yanda RL. Treatment of burns with hyperbaric oxygen. Surgery, Gynaecology and Obstetrics 1974; 139:693-696.



[[File:sumhorsa.gif|center]]

'''[[Burns | BACK]]'''

Burns

2019-01-18T06:23:12Z

Gordoben: Imported from Wikispaces

'''BURNS'''

[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]][[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]

[[File:sumhorsa.gif|center]]


==Investigating the role of HBO in the acute treatment of thermal burns. Late healing issues are included in problem wounds.==



[[File:sumhorsa.gif|center]]

'''Last searched December 2019. Next search due December 2024.'''

{|
| [[Hart | Hart GB]] || O'Reilly RR || Broussard ND || Treatment of burns with hyperbaric oxygen. || Surgery, Gynaecology and Obstetrics 1974; 139:693-696. || Burns || Skin/ transplantation || Wound healing
|-
| [[Brannen | Brannen AL]] || Still J || Haynes M || A randomized prospective trial of hyperbaric oxygen in a referral burn centre population. || The American Surgeon 1997; 63:205-208. || Burns || ||
|-
| [[Niezgoda | Niezgoda JA]] || Cianci P || Folden BW || The effect of hyperbaric oxygen therapy on a burn wound model in human volunteers. || Plastic and Reconstructive Surgery 1997; 99:1620-1625. || Burns |||| Wound healing
|-
| [[Xu | Xu N]] || Li Z || Luo X || [Effects of hyperbaric oxygen therapy on the changes in serum sIL-2R and Fn in severe burn patients]. || Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1999; 15(3):220-223. || Burns |||| Wound healing
|-
| [[Villanueva | Villanueva E]] || Bennett MH || Wasiak J || Hyperbaric oxygen therapy for thermal burns (Cochrane Review). || In: The Cochrane Library// (Issue 3, 2004). || Burns |||| Wound healing
|-
| [[Chong | Chong SJ]] || Kan EM || Soh CR || Characterisation of early thermal burns and the effects of hyperbaric oxygen: a pilot study. || Diving and Hyperbaric Medicine 2013 Sep;43(3):157-61 || Burns || Thermal ||
|-
| [[Rasmussen | Rasmussen VM]] || Borgen AE || Jansen EC || Hyperbaric oxygen therapy attenuates central sensitization induced by a thermal injury in humans. || Acta Anaesthesiologica Scandinavica. 2015 Jul 1;59(6):749-62 || Burns || Thermal ||
|-
|}

[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]][[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]

[[File:sumhorsa.gif|center]]
[[Category:Burns]]

Efrati2

2019-01-10T05:57:03Z

Gordoben: Imported from Wikispaces

Unblinded hyperbaric oxygen therapy was associated with symptomatic improvement in fibromyalgia symptoms.

**Clinical Bottom Line:'''
1. Patients undergoing HBOT demonstrated improvements in symptomatology and quality of life,
2. A participation effect may explain these findings and a blinded random comparison is required to quantify any such effect. 

**Citation/s:''' 1. Efrati S, Golan H, Bechor Y, Faran Y, Daphna-Tekoah S, Sekler G, Fishlev G, Ablin JN, Bergan J, Volkov O, Friedman M. Hyperbaric oxygen therapy can diminish fibromyalgia syndrome–prospective clinical trial. PloS one. 2015 May 26;10(5):e0127012. 

**Lead author's name and email:''' Shai Efrati efratishai@013.net 

**Three-part Clinical Question:''' For adult patients diagnosed with fibromyalgia syndrome, does treatment with hyperbaric oxygen compared to no treatment, improve the symptoms? 

**Search Terms:''' Fibromyalgia Syndrome; placebo; SPECT 

'''The Study:''' Non-blinded randomised controlled trial with intention-to-treat.
'''The Study Patients:''' Female adult patients with a two year history of established FMS symptoms and diagnosed by pain above and below the waist and at least 11 of 18 tender points. 
'''Control group''' (N = 30; 26 analysed): No treatment
'''Experimental group''' (N = 30; 24 analysed): 100% oxygen breathing at 2 ATA for 90 minutes daily (Monday to Friday) to a total of 40 treatments 

**The Evidence:'''

{|
| '''Measure''' |||| '''Control Group''' |||| '''HBOT Group''' || '''Difference''' || '''95% CI'''
|-
|^ || '''Mean''' || '''SD''' || '''Mean''' || '''SD''' ||^ ||^
|-
| '''Dolorimeter threshold (kg) after 40 treatment period''' || 0.58 || 0.46 || 1.65 || 0.81 || 1.07 || -0.70 to 1.44
|-
| '''Tender points after 40 treatment period''' || 17.2 || 1.2 || 8.9 || 6.0 || 8.4 || 5.9 to 10.80
|-
| '''Fibromyalgia Impact Questionnaire (0 worst to 10) ''' || 3.7 || 1.15 || 2.51 || 1.14 || 1.19 || 0.54 to 1.84
|-
|}

**Comments:'''

1. In summary, the outcome measures in the control group did not change, while the same measures improved over the period of the HBOT in the active group. The same improvements were evident after the control group was treated. No change in the control group is unsurising and it is not clear what this group achieves versus treating everyone.

2. Because of the unblinded nature of this trial, the question of any changes being due to a participation effect cannot be answered. This trial is a cohort study of two different groups treated with HBOT at different times rather than a true RCT as commonly understood. 

3. Rheumatologist assessing tender point count and pain was blinded to allocation but could easily be aware of that allocation if the individual mentioned the chamber or lack of it.

4. SPECT scanning suggested symptom improvements were accompanied by changes in brain activity. It remains unclear if this is cause or effect and does not preclude a participation effect.

'''Appraised by:''' Mike Bennett m.bennett@unsw.edu.au; Thursday, 10 January 2019
'''Kill or Update By:''' June 2020

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[[Neuro - miscellaneous | BACK]]

Neuro - miscellaneous

2019-01-10T05:56:21Z

Gordoben: Imported from Wikispaces

'''NEUROLOGICAL - MISCELLANEOUS CONDITIONS'''
[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]][[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]

[[File:sumhorsa.gif|center]]

==Including pain syndromes Bell's palsy and autism.==

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Subject last searched June 2018. Next search June 2020

{|
| [[Raskin | Raskin A]] || Gershon S || Crook T || The effects of hyperbaric and normobaric oxygen on cognitive impairment in the elderly. || Archives of General Psychiatry 1978; 35:50-56. || Cognitive disorders/therapy |||| Mental disorders/psychology
|-
| [[Racic | Racic G]] || Denoble PJ || Sprem N || Hyperbaric oxygen as a therapy of Bell's palsy. || Undersea and Hyperbaric Medicine 1997; 24:35-38. || Facial paralysis || Anti-Infalmmatory Agents, Steroidal || Bell's Palsy
|-
| [[Kiralp | Kiralp MZ]] || Yildiz S || Vural D || Effectiveness of hyperbaric oxygen therapy in the treatment of complex regional pain syndrome. || The Journal of International Medical Research 2004; 32:258-262 || Chronic regional pain syndrome || Reflex sympathetic dystrophy || Trauma
|-
| [[Alex | Alex J]] || Laden G || Cale C || Preoperative hyperbaric oxygenation reduced psychometric dysfunction and some systemic inflammatory markers following cardiac bypass and surgery || Journal of Thoracic and Cardiovascular Surgery 2005;130(6):1623-30. || Cardiac surgical procedures || Neuropsychology || Inflammation markers
|-
| [[Yildiz | Yildiz S]] || Kiralp MZ || Akin A || A new treatment modality for fibromyalgia syndrome: hyperbaric oxygen therapy. || Journal of International Medical Research 2004; 32:263-267 || Fibromyalgia || Pain || Algomitry
|-
| [[Rossignol | Rossignol D]] || Rossignol L || Smith S || Hyperbaric treatment for children with autism: a multicenter, randomised, double blind, controlled trial || BMC Paediatrics 2009;9:21 || Autism || Mild HBOT ||
|-
| [[Tang | Tang X]] || Yin X || Peng H || Postoperative hyperbaric oxygen reduced neurological deficit, brain oedema and abnormal brain density on C/T imaging following resection of meningiomas with associated brain oedema. || Undersea and Hyperbaric Medicine 2011;38(2):109-115 || Meningioma || Neurosurgery || Karnofsky
|-
| [[Granpeesheh | Granpeesheh D]] || Tarbox J || Dixon D || Randomized trial of hyperbaric oxygen therapy for children. || Research in Autism Spectrum Disorders 2010;4:268-275 || Autism || Mild HBO ||
|-
| [[Holland]] NJ || Bernstein JM || Hamilton JW || Hyperbaric oxygen therapy for Bell's palsy. || Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD007288. || Facial Paralysis || Bell' Palsy || Systematic review
|-
| [[Xiao | Xiao Y]] || Wang J || Jiang S || Hyperbaric oxygen therapy for vascular dementia. Cochrane Dementia and Cognitive Improvement Group, editor. || Cochrane Database of Systematic Reviews. 2012 Jul 11;31(7):478–23. || Vascular dementia || Cognition || Mental disorders
|-
| [[Sampanthavivat | Sampanthavivat M]] || Singkhwa W || Chaiyakul T || Hyperbaric oxygen in the treatment of childhood autism: a randomised controlled trial. || Diving Hyperb Med. 2012 Sep 1;42(3):128-33. || Autism || Mental disorders ||
|-
| [[Efrati2 | Efrati S]] || Golan H || Bechor Y || Hyperbaric oxygen therapy can diminish fibromyalgia syndrome–prospective clinical trial. || PloS one. 2015 May 26;10(5):e0127012 || Fibromyalgia || Placebo || SPECT
|-
|}


[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]][[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]

[[File:sumhorsa.gif|center]]
[[Category:Neurological]]

Shaw

2018-12-28T04:12:14Z

Gordoben: Imported from Wikispaces

==Does hyperbaric oxygen reduce the chance of the development of osteoradionecrosis following surgery in an irradiated mandible? A study protocol. ==
{|
| '''1. Study protocol only and so no results at this time.'''
|-
|}

'''Citation/s:''' Shaw R, Butterworth C, Tesfaye B, Bickerstaff M, Dodd S, Smerdon G, Chauhan S, Brennan P, Webster K, McCaul J, Nixon P. HOPON (Hyperbaric Oxygen for the Prevention of Osteoradionecrosis): a randomised controlled trial of hyperbaric oxygen to prevent osteoradionecrosis of the irradiated mandible: study protocol for a randomised controlled trial. Trials. 2018 Dec;19(1):22-32.

'''Lead author's name and email''': Richard Shaw rjshaw@liv.ac.uk
'''Three-part Clinical Question:''' For patients at risk of developing osteoradionecrosis of the mandible, does a course of hyperbaric oxygen, compared to normal care alone, result in a lower rate of development of this complication?

'''Search Terms:''' Osteoradionecrosis, preventative, radiotherapy

**The Study:'''
Single-blinded concealed randomised controlled trial with intention-to-treat.

'''The Study Patients''': Adult patients with a history of radiotherapy to the mandible (>50Gy) needing either dental extractions or implants.

'''Control group''' (N = 110): Standard treatment including clorhexidine mouthwashes for five days postoperatively and amoxicillin immediately pre-op and for five days postoperatively

'''Experimental group''' (N = 111): As above plus 100% oxygen breathing at 2.4 ATA between 80 and 90 minutes daily. 20 sesssions pre-op and 10 post-op.

**The Evidence:'''
{|
| '''Outcome''' || '''Time to Outcome''' || '''Control''' '''Event Rate''' || '''HBOT''' '''Event Rate''' || '''Relative''' '''Risk Reduction''' || '''Absolute''' '''Risk Reduction''' || '''NNT'''
|-
| '''Diagnosis of ORN''' || Six months || || || || ||
|-
|^ |||||| 95% CIs: || || ||
|-
| '''Diagnosis of ORN''' || 12 months || || || || ||
|-
|^ |||||| 95% CIs: || || ||
|-
|}

**Comments:'''

1. Stratified randomisation by centre and in randomly-sized blocks.

2. The primary outcome will be assessed by blinded investigators

3. Patients are eligible if >50Gy was administered even though the authors suggested the group who received >60Gy have been shown to be at high risk.

4. Secondary outcomes include QoL by head and neck questionnaire, pain, acute postoperative symptoms and adverse effects.

5. Study is powered (80%) to find a difference between groups if the rate of ORN is 5% with HBO and 18.5% in the control arm. This seems a very high rate in the control arm and may well be above the minimum clinically important difference. (221 patients planned in total).

6. Interim analyses planned by an independent monitoring committee.

7. Authors considered a sham control but decided against this because of financial pressure as well as doubts about the feasibility of the patents remaining blinded (despite evidence to the contrary in the literature). The primary outcome is, however, a hard outcome made by blinded experts.

8. A potential bias is identified due to earlier surgery after randomisation to the control group.

'''Appraised by''': Michael Bennett m.bennett@unsw.edu.au; Friday, 28 December 2018

'''Kill or Update By:''' December 2019

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'''[[Radiation tissue injury | BACK]]'''

Denton

2018-12-28T04:11:24Z

Gordoben: Imported from Wikispaces

'''No high quality evidence for the application of any non-surgical treatment for late radiation cystitis'''
'''Citation:''' Denton AS, Clarke N, Maher J. Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD001773. DOI: 10.1002/14651858.CD001773.

'''Background: '''Chronic radiation cystitis occurs a minimum of three months after completion of pelvic radiotherapy and represents a range of clinical symptoms for which there is as yet no recommended standard management.
Objectives: The aim of this review was to identify the various non-surgical treatment options for the management of late chronic radiation cystitis and evaluate the evidence.

'''Search methods: '''Synonyms for radiation therapy and for the spectrum of radiation toxicity to the bladder in both text and MeSH terms were combined and applied to a range of databases - Cochrane Central Register of Controlled Trials (CENTRAL), Register 2001; MEDLINE 1966 to 2001; EMBASE 1980 to 2001; CANCERCD 1980 to 2001; Science Citation Index 1991 to 2001; CINAHL 1982 to 2001,and sources of grey literature. We also hand searched textbooks and contacted experts in the field. In the current update the search was updated to April 2007.
Selection criteria: Randomised controlled trials (RCTs), studies of interventions for the non-surgical management of all grades of late radiation cystitis.

'''Data collection and analysis: '''Out of 85 relevant studies, there was one RCT that met the inclusion criteria and a prospective series (phase II study), both of these used the same intervention. In addition, there were three prospective case series and two non-RCTs which assessed different interventions and were not comparable.

'''Main results: '''Sixty-five reports met the stated inclusion criteria. The majority were predominantly retrospective case series with the exception of one RCT which used an agent called WF 10 (Veerasaran 2004), there were also two unrandomised and unblinded studies with a control group for comparison of effect, (Micic 1988), (intravesical placental extract) and (Milani 1988), (flavoxate). There is also a phase II series using WF 10 therapy.

'''Authors' conclusions: '''Late radiation cystitis is a relatively uncommon treatment complication and there are obvious difficulties in identifying sufficient patients to participate in a RCT. The number of published reports is a reflection of the degree of medical interest that exists in providing therapeutic solutions for late radiation cystitis. However, in spite of the two studies of level IIA evidence and the solitary RCT it is difficult to draw any firm conclusions.

'''Comments: '''
# Ageing review – now 15 years old. Search updated 2007.
# HBOT was included. 19 studies, 18 case series and one prospective study of 40 patients. Minimum reported response rate of 60%
# No conclusions made concerning HBOT

'''Update:''' December 2019

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'''[[Radiation tissue injury | BACK]]'''

Esposito

2018-12-28T04:10:52Z

Gordoben: Imported from Wikispaces

=Little evidence available to assess the effect of hyperbaric oxygen therapy for dental implants into irradiated tissue=
{|
| '''Clinical bottom line:''' **1. Only one small study found, so no meta-analysis possible. ''' ** 2. HBOT may not offer any appreciable clinical benefits.'''
|-
|}

**Citation/s: '''Esposito M, Worthington HV. Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants. Cochrane Database of Systematic Reviews 2013, Issue 9. Art No.: CD003603. DOI: 10.1002/14651858.CD003603.pub3

 '''Lead author's name and fax:''' Marco Esposito, Cochrane Oral Health Group, espositomarco@hotmail.com
**Three-part Clinical Question:''' For previously irradiated patients requiring dental implants, does HBOT therapy around the time of implant, compared to no specific intervention, result in an increase in successful implantation rate or a reduction in adverse outcomes?

 '''Search Terms:''' Radiotherapy; dental implants

**The Review:'''
 '''Data Sources''': : Cochrane Library, Medline, Embase, Authors of the review also wrote to RCT author, oral implant manufacturers, personal contacts and an internet discussion group (implantology@yahoogroups.com)

 '''Study Selection''': All RCTs enrolling patients having osseointegrated dental implants into an irradiated area and which compare HBOT to no HBOT. 

 '''Data Extraction''': Data independently extracted by two reviewers. Any dispute adjudicated by third reviewer. Extracted patient details, type of intervention and outcomes of interest.

**The Evidence:'''
{|
| '''Outcome''' || '''Time to Outcome''' || '''Typical Control Event Rate''' || '''Typical Odds Ratio''' || '''Relative Risk Reduction''' || '''NNT'''
|-
| '''Prosthetic failure''' || 1 year || 0 || 3.00 || ||
|-
|^ || 95% CI: |||| 0.13 to 67.06 || ||
|-
| '''Implant failures''' || 1 year || 0.167 || 2.50 || -100% || -6
|-
|^ || 95% CIs: |||| 0.60 to 10.46 || || 17 to -2
|-
| '''Postimplantation complications ''' || 1 year || 0 || 5.0 || ||
|-
|^ || 95% CIs: |||| 0.27 to 94.34 || ||
|-
|}

**Comments:'''

 1. Only 24 randomized patients contributed to this review from a single small study.

 2. The outcome assessors were not blinded so this domain was assessed as high risk of bias

 3. One patient who lost all implants was excluded from the analysis so this domain was assessed as at unclear risk of bias.

 4. This SR has added little information but helps to define a more definitive study.

 5. This is one of a series of systematic reviews of interventions for these patients

**Appraised by''': Vincenzo Zanon c/o Servizio OTI - Istituto Clinico Città di Brescia degli Istituti Ospedalieri Bresciani, SpA - GSD 15, Via Gualla -- 25128 Brescia ITALY Fax: +39-030-37.10.357; Sat, July 09th 2016

 '''Email:''' vincenzo.zanon@gmail.com

 '''Kill or Update By''': December 2019


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=[[Radiation tissue injury | BACK]]=

Shao

2018-12-28T04:09:49Z

Gordoben: Imported from Wikispaces

==Intravesical instillation of hyaluronic acid as effective as hyperbaric oxygen for radiation-induced haemorrhagic cystitis ==
{|
| '''1. Both treatments were equally effective in improving symptoms of haematuria, dysuria and pelvic pain in patients with radiation-induced hemorrhagic cystitis.''' **2. No improvements in frequency was noted in patients of either group at 18 months ''' **post-treatment'''
|-
|}
'''Citation:''' 
1.Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU Int. 2012 Mar; 109(5):691-4. doi: 10.1111/j.1464-410X.2011.10550.x. Epub 2011 Sep 2.
2.Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation‐induced hemorrhagic cystitis. BJU international. 2012 Mar 1;109(5):691-4.

'''Lead author's name and fax:''' Yuan Shao: shenzhoujun@hotmail.com

'''Three-part Clinical Question:''' For patients with radiation-induced haemorrhagic cystitis (HC), does treatment with intravesicular hyaluronic acid (HA), compared with HBOT, reduce the symptoms of HC?Search Terms: Intravesical hyaluronic acid instillation, hematuria, radiation-induced hemorrhagic cystitis

'''The Study:''' Non-blinded randomised controlled trial without intention-to-treat.The Study Patients: Patients who developed HC after radiotherapy for pelvic malignancies
'''Control group''' (N = 20; 20 analysed): 30 daily sessions at 2.5ATA breathing 100% oxygen for 60 minutes
'''Experimental group''' (N = 16; 16 analysed): Intravesicular instillation of 40mg of HA weekly in the first month and subsequently monthly in the following 2 months.

**The Evidence:'''
{|
| '''Outcome''' || '''Time to Outcome''' || '''Control group''' || '''HA group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT'''
|-
| '''Complete response''' || 18 months || 0.45 || 0.5 || 11% || 0.05 || 20
|-
|^ |||||| 95% CI: || -62% to 84% || -0.28 to 0.38 || NNT ''' 3 to INF; NNH ''' 4 to INF
|-
| '''No clots, but macroscopic haematuria persisting''' || 18 months || 0.30 || 0.25 || 17% || 0.05 || 20
|-
|^ |||||| 95% CI: || -81% to 100% || -0.24 to 0.34 || NNT ''' 3 to INF; NNH ''' 4 to INF
|-
|}

{|
| '''Outcome''' |||| '''HBOT Group''' |||| '''HA Group''' || '''Difference''' || '''95% CI'''
|-
|^ || '''Mean''' || '''SD''' || '''Mean''' || '''SD''' ||^ ||^
|-
| '''Visual analogue scale (pelvic pain) at 18 months''' **(0 to 10)''' || 1.35 || 1.69 || 1.25 || 1.53 || 0.10 || -1.01 to 1.21
|-
| '''Urinary Frequency at 18 months (Voids per day)''' || 10.0 || 1.97 || 10.3 || 1.5 || -0.30 || -1.51 to 0.91
|-
|}

**Comments:'''
1. The exclusion criteria of this study (if any) were not mentioned in the report
2. 25% of patients did not benefit in either group with respect to haematuria symptoms 
3. Decrease in frequency was significant in both groups 6 months after treatment, but was only significant in the HA group 12 months after therapy

'''Appraised by:''' Bryan Hui; Tuesday, 30 April 2013
'''Email:''' bryan.hui@student.unsw.edu.au
'''Kill or Update By:''' December 2019

[[File:sumhorsa.gif|center]]

'''[[Radiation tissue injury | BACK]]'''

Bennett10

2018-12-28T04:08:18Z

Gordoben: Imported from Wikispaces

'''Hyperbaric oxygen therapy for the treatment of late radiation tissue injury'''

**Background'''
Cancer is a significant global health problem. Radiotherapy is a treatment for many cancers and about 50% of patients having radiotherapy with be long-term survivors. Some will experience LRTI developing months or years later. HBOT has been suggested for LRTI based upon the ability to improve the blood supply to these tissues. It is postulated that HBOT may result in both healing of tissues and the prevention of problems following surgery.

**Objectives'''
To assess the benefits and harms of HBOT for treating or preventing LRTI.

**Search strategy'''
We searched The Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2004, MEDLINE, EMBASE, CINAHL and DORCTHIM (hyperbaric RCT register) in September 2004.

**Selection criteria'''
Randomised controlled trials (RCTs) comparing the effect of HBOT versus no HBOT on LRTI prevention or healing.

**Data collection and analysis'''
Three reviewers independently evaluated the quality of the relevant trials using the guidelines of the Cochrane Handbook [http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005005/bibliography.html#CD005005-bbs2-0018 | Clarke 2003]) and extracted the data from the included trials.

**Main results'''
Six trials contributed to this review (447 participants). For pooled analyses, investigation of heterogeneity suggested important variability between trials. From single studies there was a significantly improved chance of healing following HBOT for radiation proctitis (relative risk (RR) 2.7, 95% confidence Interval (CI) 1.2 to 6.0, P = 0.02, numbers needed to treat (NNT) = 3), and following both surgical flaps (RR 8.7, 95% CI 2.7 to 27.5, P = 0.0002, NNT = 4) and hemimandibulectomy (RR 1.4, 95% CI 1.1 to 1.8, P = 0.001, NNT = 5). There was also a significantly improved probability of healing irradiated tooth sockets following dental extraction (RR 1.4, 95% CI 1.1 to 1.7, P = 0.009, NNT = 4).

There was no evidence of benefit in clinical outcomes with established radiation injury to neural tissue, and no data reported on the use of HBOT to treat other manifestations of LRTI. These trials did not report adverse effects.

**Authors' conclusions'''
These small trials suggest that for people with LRTI affecting tissues of the head, neck, anus and rectum, HBOT is associated with improved outcome. HBOT also appears to reduce the chance of osteoradionecrosis following tooth extraction in an irradiated field. There was no such evidence of any important clinical effect on neurological tissues. The application of HBOT to selected patients and tissues may be justified. Further research is required to estabish the optimum patient selection and timing of any therapy. An economic evaluation should be also be undertaken. There is no useful information from this review regarding the efficacy or effectiveness of HBOT for other tissues.

'''Citation:'''
Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD005005.

'''Kill or update:''' December 2019

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'''[[Radiation tissue injury | BACK]]'''

Annane

2018-12-28T04:07:48Z

Gordoben: Imported from Wikispaces

='''Hyperbaric oxygenation alone did not improve recovery rate with osteoradionecrosis of the mandible. '''=

{|
| '''Clinical Bottom Line:''' 1. No indication of benefit from hyperbaric oxygen, a trend to better outcome with sham. 2. Success rate probably high in both arms (?74% versus ?86%). 3. Did not test the combination of HBOT and surgery, but rather of HBT alone
|-
|}

'''Citation/s:'''
1. Annane D, Depondt J, Aubert P, Villart M, Gehanno P, Gajdos P, Chevret S. Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomised, placebo-controlled, double-blind trial from the ORN96 study group. Journal of Clinical Oncology 2004; 22(24):1-8.
'''Lead author's name and fax:''' Djillal Annane [[mailto:djillal.annane@rpc.ap-hop-paris.fr | djillal.annane@rpc.ap-hop-paris.fr]]

'''Three-part Clinical Question:''' For patients with established osteoradionecrosis of the mandible, does the hyperbaric oxygenation without surgery result in any improvement in satisfactory outcomes?
'''Search Terms:''' Hyperbaric oxygenation, osteoradionecrosis, radiation tissue injury

'''The Study:'''Double-blinded concealed randomised controlled trial with intention-to-treat.
'''The Study Patients:''' Adults with established osteoradionecrosis but excluded if pathological fracture, bone loss to inferior border or active cancer. Stratified randomisation: Group A - exposed bone <20mm diameter, no fistula and no clear need for surgery, Group B – exposed bone >20mm, fistula or clear need for surgery.
'''Control group''' (N = 31; 31 analysed): Conservative treatment involving analgesia, antibiotics, debridement/curettage/irrigation plus daily sessions for 90 minutes breathing 9% oxygen at 2.4ATA to a total of 30. 10 further sessions post-operatively if surgery required.
'''Experimental group''' (N = 37; 37 analysed): As above, but sessions involved breathing 100% oxygen at 2.4ATA.

'''The Evidence:'''

{|
| '''Outcome''' || '''Time to Outcome''' || '''Control event rate''' || '''HBOT''' '''Event rate''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Recovered''' || '''1 year''' || 0.32 || 0.19 || -67% || -0.13 || -8
|-
|^ |||||| 95% Confidence Intervals: || -173% to 39% || -0.34 to 0.08 || NNT ''' 13 to INFNNH ''' 3 to INF
|-
| '''Recovered as above or cured following surgery''' || '''1 year''' || 0.87 || 0.74 || -17% || -0.12 || -8
|-
|^ |||||| 95% Confidence Intervals: || -42% to 9% || -0.31 to 0.07 || NNT ''' 15 to INFNNH ''' 3 to INF
|-
| '''Persistent ulceration''' || '''1 year''' || 0.41 || 0.42 || 3% || 0.01 || 71
|-
|^ |||||| 95% Confidence Intervals: || -53% to 59% || -0.22 to 0.25 || NNT ''' 4 to INFNNH ''' 5 to INF
|-
|}
'''Comments:'''
1. Trend to poor outcomes with HBO lead to termination of the trial (blinded and predetermined).
2. Unusual definition of 'recovered' as opposed to ‘failure of therapy’ did not allow good outcome if an individual moved from A to B, but was later cured. It is not clear how many ‘recovered’ are from each of strata A and B
3. Some outcomes are data collected after the one year follow-up, but it is not clear which. Two individuals were operated on in the control group after one year (personal communication).

'''Appraised by:''' Mike Bennett +61 2 9382 3882 ; Tuesday, 21 December 2004
Email: [[mailto:m.bennett@unsw.edu.au | m.bennett@unsw.edu.au]]
'''Kill or Update By:''' December 2019

[[File:sumhorsa.gif|center]]

'''[[Radiation tissue injury | BACK]]'''

Clarke

2018-12-28T04:07:20Z

Gordoben: Imported from Wikispaces

'''Hyperbaric oxygen therapy resulted in improved outcomes for radiation proctitis patients '''
{|
| '''Clinical Bottom Line:''' '''1. Significantly greater chance of a good outcome from radiation proctitis with the application of HBOT, with an NNT of 5.'''
|-
|}

'''Citation/s:'''1. Clarke R, Tenorio C, Dominguez L, Toklu A, Hussey J. Treatment of radiation necrosis with hyperbaric oxygen: a randomized, double-blind, placebo controlled trial. Proceedings of the Undersea and Hyperbaric Medical Society Annual Scientific Meeting 2004; abstract F202.
2. Clarke RE, Tenorio C, Hussey JR, Toklu AS, Cone L, Hinojosa JG, Desai SP, Parra LD, Rodrigues SD, Long RJ, Walker MB. Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow up. Int. J. Radiation Oncology Biol. Phys 2008; Sep 1;72(1):134-43.

'''Three-part Clinical Question:''' For patients with soft tissue radiation injury, does the application of hyperbaric oxygen therapy, compared to a sham treatment, result in any improvement in mortality, symptoms or function?
'''Search Terms:''' Radiation injury, proctitis, cystitis

'''The Study:'''Double-blinded concealed randomised controlled trial without intention-to-treat.
'''The Study Patients:''' Patients with a history of tumour requiring irradiation and with later onset of radiation injury to the anus or rectum.
'''Control group''' (N = 75; 59 analysed): Sham treatment breathing air at 1ATA, with a brief excursion to trivial pressure, once daily for 2 hours to a total of 30 to 40 treatments over 6 to 8 weeks.
'''Experimental group''' (N = 75; 63 analysed): As above, but breathing 100% oxygen at 2ATA.

'''The Evidence:'''

{|
| '''Outcome''' || '''Time to Outcome''' || '''Sham group''' || '''Hyperbaric group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Significant improvement or healed''' || 8 weeks || 0.20 || 0.39 || 94% || 0.19 || 5
|-
|^ |||||| 95% Confidence Intervals: || 22% to 165% || 0.04 to 0.33 || 3 to 25
|-
|}

{|
| '''Measure''' |||| '''Sham Group''' |||| '''HBOT Group''' || '''Difference''' || '''P value '''
|-
|^ || Mean || SD || Mean || SD ||^ ||^
|-
| '''LENT-SOMA Score at''' '''8 weeks''' || 10.23 || || 7.48 || || 3.75 || 0.002
|-
|}
'''Comments:'''
1. This was the first full report of what was an eight-armed study to examine a range of tissus being treated with HBOT.
2. Numbers presented here are by intention to treat, the report quotes figures excluding patients who did not complete the protocol (30 of 150 enrolled - 20% - did not reach analysis). None of the sham patients healed completely at eight weeks versus five of the HBOT arm..
3. Logistic regression to adjust for confounders supports significant effect of HBOT (LENT-SOMA 5.93 less with HBOT at eight weeks (95% confidence interval 2.04–17.24)
4. The evidence is compelling for short-term benefit of HBOT. After eight weeks, sham group was crossed to received HBOT and subsequently benefited as did the original HBOT group. At five year follow-up there was no important difference between groups in LENT-SOMA score (12.8 down to 4.3 in the initial sham group versus 12.6 down to 3.7 in the original HBOT group). The suggestion is that improvement continues over time after HBOT administration, but this is not a randomised comparison.

'''Appraised by''': Mike Bennett POWH, Sydney ; Tuesday, 13th March 2018
Email: [[mailto:m.bennett@unsw.edu.au | m.bennett@unsw.edu.au]] 
'''Kill or Update By:''' December 2019

[[File:sumhorsa.gif|center]]

'''[[Radiation tissue injury | BACK]]'''

Marx1

2018-12-28T04:06:26Z

Gordoben: Imported from Wikispaces

'''Hyperbaric oxygen improved wound healing and infection rates in previously irradiated patients requiring major soft-tissue procedures.''' 

'''Clinical Bottom Line:''' 
1. The application of a 20/10 protocol of hyperbaric oxygen treatment before and after major soft-tissue repair into an irradiated area resulted in improved wound healing and lower infection rates. 

'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Thursday, 15 April 1999 

'''Clinical Scenario:''' A patient presented requiring a myocutaneous flap to cover a previously irradiated area. We wondered if hyperbaric oxygen would improve healing. 
'''Three-part Question:''' In patients requiring soft tissue flaps into an area previously irradiated with at least 6,400 cGy, does the peri-operative administration of hyperbaric oxygen result in improved wound healing and successful grafting? 
'''Search Terms:''' radiotherapy, soft-tissue grafts 

'''The Study:''' 
Randomised controlled trial, no detail. 
Patients requiring major soft tissue surgery or flap introduction into a previously irradiated area. 
Control group (N = 80; 80 analysed): Usual peri-operative program with surgery as planned. 
Experimental group (N = 80; 80 analysed): As above, but given 20 treatments breathing 100% oxygen at (?2.4ATA) before surgery and 10 similar treatments following surgery 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Control group''' || '''HBO group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Major wound breakdown''' || unknown || 0.325 || 0.038 || 88% || 0.287 || 3 
|-
| '''95% CI:''' || || || || 54% to 100% || 0.176 to 0.398 || 3 to 6 
|-
| '''Wound infection''' || unknown || 0.237 || 0.063 || 73% || 0.174 || 6 
|-
| '''95% CI:''' || || || || 28% to 100% || 0.067 to 0.281 || 4 to 15 
|-
| '''Extended hospital stay to heal''' || unknown || 0.55 || 0.113 || 79% || 0.437 || 2 
|-
| '''95% CI:''' || || || || 56% to 100% || 0.308 to 0.566 || 2 to 3 
|-
|}

'''Comments:''' 
1. Brief report in a textbook only. No peer review or methodology details. 
2. The author used hyperbaric oxygen as part of the protocol to heal wounds with delayed healing or dehiscence in both groups in this study. The numbers of wounds ultimately healed is not given. 

'''Expiry date:''' December 2019

'''References:''' 
1. Marx RE. Clinical applications of hyperbaric oxygen. In: Hyperbaric Medicine Practice, 2nd edition,Kindwall EP (ed). Best Publishing, Arizona 1999:681-682. 

[[File:sumhorsa.gif|center]]

'''[[Radiation tissue injury | BACK]]'''

Marx2

2018-12-28T04:05:51Z

Gordoben: Imported from Wikispaces

'''A peri-operative regime of hyperbaric oxygenation significantly reduced the incidence of osteoradionecrosis in tooth sockets following dental extractions in a previously irradiated field.''' 

'''Clinical Bottom Line:''' 
The number of patients developing osteoradionecrosis in at least one socket was significantly reduced by the application of hyperbaric oxygenation. 
'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, Sunday, 15 November, 1998 

'''Clinical Scenario''': A patient with a history of therapeutic irradiation to the head and neck and requiring dental extractions. 
'''Three-part Question''': In irradiated patients requiring dental extractions, does the prophylactic application of hyperbaric oxygenation as opposed to standard care, result in any reduction in the rate of osteoradionecrosis in the teeth sockets? 
'''Search Terms:''' hyperbaric oxygenation, osteoradionecrosis. 

'''The Study:''' 
Non-blinded randomised controlled trial with intention-to-treat. 
Patients requiring at least one tooth extraction in a section of mandible previously irradiated with at least 6,000 rads of absorbed radiation, 6 or more months previously and who showed no evidence of tumour persistence or recurrence. 
'''Control group''' (N = 37; 37 analysed): General or local anaesthesia as indicated, standard method of tooth extraction and penicillin 1 gram pre-op and 500mg sixth hourly for 10 days post-op. 
'''Experimental group''' (N = 37; 37 analysed): As above but no penicillin and received 20 sessions of hyperbaric oxygen at 2.4 ATA for 90 minutes pre-op and 10 further sessions post-op. 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Penicillin rate''' || '''HBO rate''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| ORN in at least one socket || 6 months || 0.297 || 0.054 || 82% || 0.243 || 4 
|-
| 95% CI || || || || 27% to 100% || .41 to 0.08 || 2 to 13 
|-
|}

'''Comments:''' 
1. Not blinded, but a hard endpoint after six months. 
2. In terms of sockets, 23% in penicillin arm versus 3% in HBO arm, developed ORN. 
3. May have implications for the prevention of spontaneous ORN. 
4. Suggests that penicillin may not have a role in prevention of ORN. 

'''Expiry date''': December 2019

'''References:''' 
1. Marx RE, Johnson RP, Kline SN. Prevention of osteoradionecrosis: a randomised prospective clinical trial of hyperbaric oxygen versus penicillin. Journal of American Dental Association 1985; 111: 49-54. 

[[File:sumhorsa.gif|center]]

'''[[Radiation tissue injury | BACK]]'''

Tobey

2018-12-28T04:05:24Z

Gordoben: Imported from Wikispaces

'''Hyperbaric oxygen may improve healing following surgical treatment for osteoradionecrosis of the mandible.''' 

'''Clinical Bottom Line:''' 
1. No quantifiable evidence of improvement in osteoradionecrosis after the addition of hyperbaric oxygen to the treatment protocol. 

'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Friday, 11 June 1999 

'''Clinical Scenario:''' A patient with osteoradionecrosis of the mandible presented for surgical debridement. 
'''Three-part Question:''' In patients with established osteoradionecrosis, does the addition of hyperbaric oxygen to antibiotic and surgical measures to the treatment protocol result in improved resolution of the necrosis and improved wound healing? 
'''Search Terms''': osteoradionecrosis 

'''The Study:''' 
Double-blinded concealed randomised controlled trial intention-to-treat unknown. 
Patients with osteoradionecrosis of the mandible. No further details. 
'''Control group''' (N = 6; 0 analysed): Usual treatment protocol involving antibiotics, analgesics, wound irrigation, teeth extraction and sequestrectomies, plus 100% oxygen at 1.2ATA for 2 hours daily, five days each week for eight weeks. 
'''Experimental group''' (N = 6; 0 analysed): As above, but 100% oxygen exposure was at 2.0ATA on the same schedule 

'''The Evidence:''' 
"Healing process was better according to x-ray interpretation, clinical signs and symptoms, and soft tissue lesions." 

'''Comments:''' 
1. No statistical analysis of outcomes. The analysis was heralded but does not appear to have been published. 
2. Small study would have low power. 

'''Expiry date:''' December 2019
**References: '''
1. Tobey RE, Kelly JF. Osteoradionecrosis of the jaws. Otolaryngologic Clinics of North America 1979; 12:183-186 

[[File:sumhorsa.gif|center]]

'''[[Radiation tissue injury | BACK]]'''

Marx3

2018-12-28T04:05:01Z

Gordoben: Imported from Wikispaces

'''The addition of hyperbaric oxygen therapy bracketed around hemi-mandibular reconstruction in an irradiated field improved the success rate of surgery.''' 

'''Clinical Bottom Line:''' 
1. The addition of hyperbaric oxygen to the surgical management of jaw reconstruction improved the success rate of the operation as defined by continuity, alveolar bone height, osseous bulk, facial form and elimination of soft tissue deficiency. 
2. There was a trend to lower complication rates that did not reach statistical significance. 

'''Appraised by:''' Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Tuesday, 13 April 1999 

'''Clinical Scenario:''' A patient presented for a hemi-mandibular jaw reconstruction following radiotherapy and surgery. We wondered if the addition of hyperbaric oxygen would improve outcome. 
'''Three-part Question:''' In patients requiring reconstructive surgery to the mandible in a field with previous surgery and radiotherapy for carcinoma of the oropharynx, does the addition of hyperbaric oxygen before and after reconstruction result in any improvement in outcome or complication rate. 
'''Search Terms:''' Oropharynx carcinoma, reconstructive surgery. 

'''The Study:''' 
Non-blinded randomised controlled trial without intention-to-treat. Little detail given. Patients requiring hemi-mandibular jaw reconstruction in a tissue bed previously irradiated with at least 6,400 cGy. 
'''Control group''' (N = 52; 52 analysed): Standard surgical technique 
'''Experimental group''' (N = 52; 52 analysed): As above but 20 hyperbaric treatments before and 10 after surgery (dose not stated in report). 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Control group''' || '''HBO group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Success''' || unknown || 0.654 || 0.923 || -41% || -0.27 || -4 
|-
| '''95% CI:''' || || || || -64% to -18% || -0.42 to -0.12 || -8 to -2 
|-
| '''Complication''' || unknown || 0.212 || 0.096 || 55% || 0.12 || 9 
|-
| '''95% CI:''' || || || || -10% to 100% || -0.02 to 0.25 || NNT'''4 to INF NNH'''48 to INF 
|-
|}

'''Comments:''' 
1. Very brief report in a textbook. No details of methods employed. 
2. Other work from this author strongly suggests a regime of oxygen at 2.4ATA daily five times each week for 20 treatments pre-op and ten post-operatively. 

'''Expiry date:''' December 2019

'''References:''' 
1. Marx RE. Clinical applications of hyperbaric oxygen. In: Hyperbaric Medicine Practice, 2nd edition, Kindwall EP (ed).Best, Arizona 1999; 683-687. 

[[File:sumhorsa.gif|center]]

'''[[Radiation tissue injury | BACK]]'''

Pitkin

2018-12-28T04:04:05Z

Gordoben: Imported from Wikispaces

'''Hyperbaric oxygen did not reverse the changes of radiation-induced brachial plexopathy following irradiation of early breast cancer.''' 

'''Clinical Bottom Line:''' 
1. No evidence of improvement in brachial plexus function with HBOT. 

'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Tuesday, 19 September 2000 

'''Clinical Scenario:''' A patient with pain and weakness in the arm following irradiation to the breast. 
'''Three-part Question:''' For patients with brachial plexus damage following irradiation, does the administration of hyperbaric oxygen, compared to 100% oxygen at 1ATA, result in any improvement in pain or function? 
'''Search Terms:''' Radiation tissue damage, breast cancer 

'''The Study:''' 
Double-blinded concealed randomised controlled trial with intention-to-treat. 
Patients with moderate radiation- induced brachial plexopathy following irradiation for breast cancer. 
'''Control group''' (N = 17; 17 analysed): 41% oxygen at 2.4ATA for 90 minutes (equivalent to 100% at 1ATA) daily for 30 treatments. 
'''Experimental group''' (N = 18; 17 analysed): 100% oxygen at 2.4ATA on the same schedule as above. 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Control group''' || '''HBO Group''' || '''Relative Risk Reduction''' || '''Absolute Risk Reduction''' || '''NNT''' 
|-
| '''Warm sensory threshold normalised''' || 12 months || 0 || 0.18 || --- || 0.18 || 6 
|-
| '''95% CI''' || || || || || -0.01 to 0.36 || NNT 3 to INF NNH 199 to INF 
|-
|}

No clinically significant differences for McGill pain questionnaire or MOS SF-36 general health questionnaire. 

'''Comments:''' 
1. Cases were of relatively long-standing (median 11 yrs, range 1-29) 
2. Very high compliance rate with follow-up. 
3. Authors comment on two cases of marked improvement in lymphoedema 
4. Some evidence of minor improvements on multiple comparisons with self-assessment questionnaires, but authors agree they are difficult to interpret. 
5. A follow-up at 6 to 7 years examined McGill pain and MOS SF-16 general health questionnaires and again reported no differences between the groups. 

'''Expiry date:''' December 2019

'''References:''' 
# Pitkin A, Pritchard J, Anand P et al. Double-blind randomised controlled trial of hyperbaric oxygen (HBO) therapy for treatment of radiation-induced brachial plexopathy (RIBP). Undersea and Hyperbaric Medicine 2000; 27(suppl):39. 
# Pritchard J, Anand P, Broome J, Davis C, Gothard L, Hall E, Maher J, McKinna F, Millington J, Misra VP, Pitkin A, Yarnold JR. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiother Oncol 2001 Mar;58(3):279-86. 
# Yarnold J. Double-blind randomised phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiotherapy and Oncology 2005; 77:327.
# Gothard J, Haviland J, Bryson P. Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema after radiotherapy for cancer Radiotherapy and Oncology 2010; 97:101-107

[[File:sumhorsa.gif|center]]

'''[[Radiation tissue injury | BACK]]'''

Radiation tissue injury

2018-12-28T04:01:11Z

Gordoben: Imported from Wikispaces

'''TREATING RADIATION TISSUE INJURY'''

[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]][[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]

[[File:sumhorsa.gif|center]]

'''Includes both ORN and STRI'''
[[File:sumhorsa.gif|center]]


Subject last searched December 2018. Next search December 2019


{|
| Author 1 || Author 2 || Author 3 || Title || Citation || Keyword 1 || Keyword 2 || Keyword 3
|-
|''' [[Tobey | Tobey RE]] || Kelly JF || || Osteoradionecrosis of the jaws. || Otolaryngologic Clinics of North America 1979; 12:183-186 || Mandible || Osteoradionecrosis || Radiation Injuries
|-
| [[Marx2 | Marx RE]] || Johnson RP || Kline SN || Prevention of osteoradionecrosis: a randomised prospective clinical trial of hyperbaric oxygen versus penicillin. || Journal of American Dental Association 1985; 111: 49-54. |||| Osteoradionecrosis ||
|-
| [[Marx3 | Marx RE]] || || || Clinical applications of hyperbaric oxygen. || Hyperbaric Medicine Practice, 2nd edition, Kindwall EP (ed).Best, Arizona 1999; 681-682. || Reconstructive surgery |||| Oropharynx carcinoma
|-
| [[Marx1 | Marx RE]] || || || Clinical applications of hyperbaric oxygen || Hyperbaric Medicine Practice, 2nd edition, Kindwall EP (ed). Best Publishing, Arizona 1999:683-687. || Radiotherapy |||| Soft-tissue grafts
|-
| [[Pitkin | Pitkin A]] || Pritchard J || Anand P || Double-blind randomised controlled trial of hyperbaric oxygen (HBO) therapy for treatment of radiation-induced brachial plexopathy (RIBP). || Undersea and Hyperbaric Medicine 2000; 27(suppl):39. || Radiation injury || Brachial plexus || Lymphoedema
|-
| [[Pitkin | Pritchard J]] || Anand D || Broome J || Double-blind randomised phase II study of hyperbaric oxygen for patients with radiation-induced brachial plexopathy. || Radiotherapy and Oncology 2001; 58(3):279-286 || Radiation injury || Brachial plexus || Lymphoedema
|-
| [[Clarke | Clarke D]] || Tenorio C || Dominguez L || Treatment of radiation necrosis with hyperbaric oxygen: a randomised double-blind placebo controlled trial || Undersea and Hyperbaric Medicine || Radiation injury || Proctitis ||
|-
| [[Annane | Annane D]] || Depondt J || Aubert P || Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomised, placebo-controlled, double-blind trial from the ORN96 study group. || Journal of Clinical Oncology || Radiation injuries || Osteoradionecrosis || Mandible
|-
| [[Bennett10 | Bennett M]] || Feldmeier J || Hampson N || Hyperbaric oxygen therapy for late radiation tissue injury || Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD005005. || Radiation injuries || Soft-tissue radiation || Osteoradionecrosis
|-
| [[Hulshof | Hulshof M]] || Stark N || Van der Kleij A || Hyperbaric oxygen therapy for cognitive disorders after irradiation of the brain || Strahlentherapie und Onkol 2001;177:192-8 || Radiation injuries || Brain injury || Cognition
|-
| [[Gesell | Gesell LB]] || Warnick RE || Brenerman JC || A randomized, controlled trial of hyperbaric oxygen therapy for brain radionecrosis. || Undersea and Hyperbaric Medicine, 2005. 32(4): 235-236 || Radiation injuries || Brain injury || Neuropsychiatric testing
|-
| [[Lewis | Lewis AL]] || Hardy KR || Huang ET || Hyperbaric oxygen therapy decreases gross haematuria and improves quality of life in patients with radiation cystitis. || Undersea and Hyperbaric Medicine 2005; 32(4)236 || Radiation injuries || Cystitis || Haematuria
|-
| [[Pitkin | Gothard L]] || Haviland J || Bryson P || Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema after radiotherapy for cancer || Radiotherapy and Oncology 2010; 97:101-107 || Radiation injuries || Lymphoedema || Brachial plexus
|-
| [[Sidik | Sidik S]] || Daldiyono H || Setiabudy R || Oxygen hyperbaric therapy in patients with radiation proctitis. || The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy 2007;8(1):1-4. || Radiation proctitis || Cervical cancer || Quality of life
|-
| [[Sidik | Sidik S]] || Hardjodisastro D || Setiabudy R || Does hyperbaric oxygen administration decrease side effect and improve quality of life after pelvic radiation? || Acta Med Indones 2007;39(4):169-173. || Radiation procitis || Cervical cancer || Quality of Life
|-
| [[Shao | Shao Y]] || Lu GL || Shen ZJ || Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. || BJU Int. 2012 Mar; 109(5):691-4. || Radiation cystitis || Hyaluronic acid || Haematuria
|-
| [[Teguh | Teguh DN]] || Levendag PC || Noever I || Early hyperbaric oxygen therapy for reducing radiotherapy side effects: early results of a randomised trial in oropharyngeal and nasopharyngeal cancer. || Int J Radiation Oncology 2009; 75(3):711-716 || Radiation injuries || Prevention || Head and Neck cancer
|-
| [[Esposito | Esposito M]] || Worthington HV || || Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants. || Cochrane Database of Systematic Reviews 2013, Issue 9. Art No.: CD003603. DOI: 10.1002/14651858.CD003603.pub3 || Radiation injuries || Osseointegration || Head and Neck cancer
|-
| [[Denton | Denton AS]] || Clarke N || Maher J || Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis. || Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD001773. DOI: 10.1002/14651858.CD001773. || Radiatiom cystitis || Soft-tissue radiation injury || pevic tumours
|-
| [[Clarke | Clarke RE]] || Tenorio C || Hussey JR || Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow up. || Int. J. Radiation Oncology Biol. Phys 2008; Sep 1;72(1):134-43. || Radiation injury || Proctitis || Pelvic tumours
|-
| [[Shaw | Shaw R]] || Butterworth C || Tesfaye B || HOPON (Hyperbaric Oxygen for the Prevention of Osteoradionecrosis): a randomised controlled trial of hyperbaric oxygen to prevent osteoradionecrosis of the irradiated mandible: study protocol for a randomised controlled trial. || Trials. 2018 Dec;19(1):22-32 || Radiation injury || Osteoradionecrosis || Prevention
|-
|}



[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]][[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]

[[File:sumhorsa.gif|center]]

[[Category:Radiation tissue injury]]

Hsu

2018-12-17T02:23:23Z

Gordoben: Imported from Wikispaces

==A cocktail treatment including hyperbaric oxygen and alendronate was not more effective than extracorporeal shockwave treatment alone for the treatment of femoral head necrosis. ==
{|
| '''1. The addition of hyperbaric oxygen and alendronate did not improve outcome over EWST alone. '''
|-
|}

**Citation/s: '''
 1. Hsu SL, Wang CJ, Lee MS, Chan YS, Huang CC, Yang KD. Cocktail therapy for femoral head necrosis of the hip.Arch Orthop Trauma Surg. 2010 Jan;130(1):23-9. 
**Lead author's name and fax: '''Shan-Ling Hsu w281211@adm.cgmh.org.tw

**Three-part Clinical Question:''' For patient with femoral head necrosis, does the addition of hyperbaric oxygen and alendronate to treatment with extracorporeal shockwave treatment (ESWT), result in any improvement in outcome? 

 '''Search Terms:''' ESWT, alendronate, femoral necrosis

**The Study: '''Non-blinded pseudo-randomised trial without intention-to-treat.

 '''The Study Patients:''' Adult patients with stage I, II or III femoral hip necrosis according to the ARCO classification 

 '''Control group''' (N = 48; 48 analysed): Patients received a session of ESWT under general anaesthesia with the target area identified by mobile X-Ray fluorosopy. 6,000 shocks in total at 28kV.

 '''Experimental group''' (N = 50; 50 analysed): As above plus 100% oxygen at 2.5 ATA for 50 minutes daily to a total of 20 treatments, and 70mg alendronate weekly for 12 months

**The Evidence:'''
{|
| '''Outcome''' || '''Time to Outcome''' || '''ESWT group''' || '''Cocktail group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT'''
|-
| '''Total hip replacement ''' || 24 months || 0.104 || 0.100 || 4% || 0.004 || 250
|-
|^ |||||| 95% CIs: || -111% to 100% || -0.116 to 0.124 || NNT ''' 8 to INF; NNH ''' 9 to INF
|-
| '''Improved symptoms ''' || 24 months || 0.792 || 0.740 || 7% || 0.052 || 19
|-
|^ |||||| 95% CIs: || -15% to 28% || -0.115 to 0.219 || NNT ''' 5 to INF; NNH ''' 9 to INF
|-
| '''Decrease in size of MRI lesion ''' || after treatment || 0.208 || 0.22 || -6% || -0.012 || -83
|-
|^ |||||| 95% CIs: || -84% to 72% || -0.174 to 0.150 || NNT ''' 7 to INF; NNH ''' 6 to INF
|-
|}

{|
| '''Measure''' |||| '''ESWT Group''' |||| '''Cocktail Group''' || '''Difference''' || '''95% CI'''
|-
|^ || '''Mean''' || '''SD''' || '''Mean''' || '''SD''' ||^ ||^
|-
| '''Activities of daily living (SF12) after treatment ''' || 47.6 || 7.1 || 44.3 || 6.9 || 3.35 || 0.53 to 6.17
|-
| '''Pain score at end of treatment ''' || 1.1 || 1.5 || 1.5 || 1.3 || -0.40 || -0.96 to 0.16
|-
|}

**Comments:'''
 1. This was a pseudorandomised, unblinded trial that was not analysed by intention to treat. Allocation was by record number and there were a total seven hips replaced (5 in cocktal group and 2 in ESWT group) that were excluded. 

 2. The stated primary outcome was total hip replacement, but this is not prominently presented in results.

 3. The authors’ note that more success was obtained for those with lower grade lesions as would be expected.

 4. Many of the outcomes measures are not explained in this paper.

 5. All analyses are made by hip rather than patient (50 hips in 28 patients in cocktail group and 48 hips in 35 patients in ESWT group). This might favour the EWST group as more patients had single side disease. 

'''Appraised by''': Mike Bennett; Monday, 12 February 2018
Email: m.bennett@unsw.edu.au

 '''Kill or Update By:''' December 2022

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Camporesi

2018-12-17T02:21:26Z

Gordoben: Imported from Wikispaces

=Hyperbaric oxygen therapy improved pain and range of motion for patients with Ficat stage II idiopathic femoral head necrosis=
{|
| '''1. Pain was significantly reduced following 20 and 30 treatments with HBOT''' **2. The range of movement was improved following HBOT'''
|-
|}
**Citation/s:'''1. Camporesi E, Vezzani G, Bosco G, Mangar D, Bernasek T. Hyperbaric oxygen therapy in femoral head necrosis. Journal of Arthroplasty 2010;25(6):118-123.
2. Vezzani G, Caberti L, Cantadori L, Mordacci M, Nicolopolou A, Pizzola A, Valesi M. Hyperbaric oxygen therapy (HBO2) for idiopathic avascular femoral head necrosis (IAFHN): a prospective double-blind randomized trial. Undersea and Hyperbaric Medicine 2005; 32(4):272-273.

**Three-part Clinical Question:''' For patients with Ficat stage II idiopathic femoral head necrosis, does the administration of hyperbaric oxygen result in any improvement in range of motion or pain?
**Search Terms:''' femoral head necrosis, arthroplasty
**The Study:'''Double-blinded randomised controlled trial with intention-to-treat.
**The Study Patients:''' Adult patients with a diagnosis of idiopathic FHN staged at Ficat II after plain X-Ray and MRI confirmation. No specific therapy.
**Control group''' (N = 10; 9 analysed): Air breathing at 2.5ATA, 30 sessions over six weeks for 80 minutes daily.
**Experimental group''' (N = 10; 10 analysed): 100% oxygen breathing on the same schedule
**The Evidence:'''
{|
| '''Outcome''' |||| '''Air Group''' |||| '''Oxygen Group''' || '''Difference''' || '''95% CI'''
|-
|^ || '''Mean''' || '''SD''' || '''Mean''' || '''SD''' ||^ ||^
|-
| '''Pain''' (VAS 0 to 10) || 5.3 || 0.6 || 1.4 || 0.3 || 3.9 || 3.69 to 4.11
|-
| '''Non-Event Outcomes''' || '''Time to outcome''' || '''Air group ''' || '''Oxygen group''' || '''P-value'''
|-
| '''ROM in flexion (degrees - median and range)''' || 30 treatments || 76 (50 - 120) || 112 (92 - 120) || 0.2
|-
| '''ROM Extension (degrees - median and range)''' || 30 treatments || 3.0 (0 - 5.0) || 20 (15 - 20) || < 0.001
|-
| '''ROM abduction (degrees - median and range)''' || 30 treatments || 7.0 (0 -10.0) || 35.5 (26.0 - 45.0) || <0.001
|-
| '''Standing load on affected leg (% difference good/affected leg – median and range)''' || 30 treatments || 18 (10 - 42) || 12 (6 - 22) || 0.06
|-
|}
**Comments:'''
1. The RCT was completed immediately following 30 treatments because all control patients were crossed over to receive HBOT. Not clear how that decsion was reached.
2. Cohort follow-up for seven years suggests gains are maintained and no patient required joint replacement during that time.
3. Clinical significance is unclear, but probable true functional improvement for this group.

**Appraised by''': Mike Bennett [[mailto:m.bennett@unsw.edu.au | m.bennett@unsw.edu.au]] ;Monday 9th October 2017
**Kill or Update By:''' December 2022

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Fractures

2018-12-17T02:17:17Z

Gordoben: Imported from Wikispaces

'''BONES - FRACTURES AND NECROSIS (NOT DUE TO RADIOTHERAPY)'''

[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]][[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]

[[File:sumhorsa.gif|center]]

The use of HBOT for the treatment of bone injuries and necrosis not due to radiation therapy.


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Subject last searched June 2011. Next search December 2022


{|
| '''Author 1''' || '''Author 2''' || '''Author 3''' || '''Title''' || '''Citation''' || '''Keyword 1''' || '''Keyword 2'''
|-
| [[Bennett5 | Bennett MH]] || Stanford R || Turner R || Hyperbaric oxygen therapy for promoting fracture healing and treating fracture non-union. || Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD004712. || Fracture || Non-union
|-
| [[Freiberger | Freiberger JJ]] || Padilla-Burgos R. || || Update on the Duke randomised controlled trial of hyperbaric oxygen for osteonecrosis of the jaw in patients who have taken bisphosphonates. || Undersea and Hyperbaric Medicine 2007;34(4):241 || Bisphosphonate || osteonecrosis
|-
| [[Camporesi | Vezzani G]] || Caberti L || Cantadori L || Hyperbaric oxygen therapy (HBO2) for idiopathic avascular femoral head necrosis (IAFHN): a prospective double-blind randomized trial. || Undersea and Hyperbaric Medicine 2005; 32(4):272-273. || Avascular necrosis || Idiopathic
|-
| [[Camporesi | Camporesi E]] || Vezzani G || Bosco G || Hyperbaric oxygen therapy in femoral head necrosis. || Journal of Arthroplasty 2010;25(6):118-123 || Avascular necrosis || Idiopathic
|-
| [[Hsu | Hsu SL]] || Wang CJ || Lee MS || Cocktail therapy for femoral head necrosis of the hip. || Arch Orthop Trauma Surg. 2010 Jan;130(1):23-9 || Avascular necrosis || Idiopathic
|-
| [[Freiberger | Freiberger JJ]] || Padilla-Burgos R || McGraw T || What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics. || J Oral Maxillofac Surg. 2012 Jul;70(7):1573-83. || Bisphosphonate || Osteonecrosis
|-
|}


[[home | HOME]] [[Index page | INDEX]] [[Search Database | SEARCH DATABASE]] [[What is a CAT? | WHAT IS A CAT?]][[What can I do? | WHAT CAN YOU DO?]] [[Introduction | INTRODUCTION]] [[What is hyperbaric medicine? | HBO EXPLAINED]]

[[File:sumhorsa.gif|center]]
[[Category:Fractures]]

Freiberger

2018-12-17T02:12:07Z

Gordoben: Imported from Wikispaces

Some evidence that HBOT improves healing of lesions associated with bisphosphonate-related osteonecrosis

**Clinical Bottom Line:'''

1.Those receiving HBOT had a higher proportion of oral lesions graded as healed or improved.

2. Lesions improved more rapidly with HBOT.

3. Pain settled more rapidly in those who received HBOT.

'''Citation/s:''' 1. Freiberger JJ, Padilla-Burgos R. Update on the Duke randomised controlled trial of hyperbaric oxygen for osteonecrosis of the jaw in patients who have taken bisphosphonates. Undersea and Hyperbaric Medicine 2007;34(4):241
2. Freiberger JJ, Padilla-Burgos R, McGraw T, Suliman HB, Kraft KH, Stolp BW, Moon RE, Piantadosi C. What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics. J Oral Maxillofac Surg. 2012 Jul;70(7):1573-83.

Lead author's name and fax: Jake Freiberger: john.freiberger@duke.edu

'''Three-part Clinical Question:''' For patients with bisphosphonate =related osteonecrosis of the jaw (BROJ), does the adjunctive use hyperbaric oxygen, compared to standard treatment alone, result in any improvement in healing or quality of life?

'''Search Terms:''' bisphosphonate; osteonecrosis

'''The Study:''' Non-blinded concealed randomised controlled trial without intention-to-treat.

'''The Study Patients:''' Patients with an established diagnosis of BRONJ in the absence of radiation exposure, metastatic disease or recurrent malignancy in the head and neck region.

Control group (N = 21; 21 analysed): Continued standard oral care including surgery and antibiotics as necessary. Debridement at surgeon discretion.

Experimental group (N = 25; 25 analysed): As above plus 100% oxygen breathing at 2.0 ATA for two hours twice each day for four weeks.

**The Evidence:'''

{|
| '''Outcome''' || '''Time to Outcome''' || '''Standard Group''' || '''HBOT Group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT'''
|-
| '''Lesions healed or improved''' || Final follow-up || 0.38 || 0.68 || 78% || 0.3 || 3
|-
|^ |||||| 95% CI: || 6% to 151% || 0.02 to 0.58 || 2 to 45
|-
|}

{|
| '''Non-Event Outcomes''' || '''Time to outcome/s''' || '''Control group ''' || '''Experimental group''' || '''P-value'''
|-
| '''Mean time to lesion improvement (weeks)''' || Up to two years || 67.9 (95%CI 48.4 to 87.5) || 39.7 (95%CI 22.4 to 57.0) || 0.03
|-
| '''Mean time to gingival healing (weeks)''' || Up to two years || 70 (52.2 to 88.4) || 59 (42.8 to 75.8) || 0.32
|-
|}

**Comments:'''

1. Original study planned for 35 patients per group after power calculation. 

2. As received analysis was done in view of the number of dropouts and crossovers for various reasons.

3. The result for proportion of lesions healed/improved is for the latest follow-up across all patients analysed - however actual analysis of time points after 3 months does not show any statistically significant differences.

4. Regression also suggested a more rapid relief of pain in the HBOT group.

5. No significant differences in quality of life measures reported between groups

'''Appraised by:''' Mike Bennett: m.bennett@unsw.edul.au; Monday, 17 December 2018

'''Kill or Update By:''' December 2022

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