Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

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Table 19 Therapeutic protocols used in intervention and comparison groups in included studies focusing on the use of HBOT in diabetic wounds.* First Author and Year of Publication Faglia 1998 48 Zamboni 1997 50 Faglia 1996 47 Doctor 1992 49 Baroni 1987 46 Intervention Group Comparison Group n=51 Comparison therapy plus treatment in a multiplace HBO chamber. Two phases: (1) first (antibacterial) phase uses 100% oxygen at 2.5 ATA for 90 minutes daily; (2) second (reparative) phase uses 100% oxygen at 2.2 – 2.4 ATA for 90 minutes, 5 days a week. n=5 Comparison therapy plus treatment in a monoplace HBO chamber with 100% oxygen at 2 ATA for 120 minutes, 30 sessions 5 days a week. n=35 Comparison therapy plus treatment in a multiplace HBO chamber. Two phases: (1) first (antibacterial) phase uses 100% oxygen at 2.5 ATA for 90 minutes daily; (2) second (reparative) phase uses 100% oxygen at 2.2 – 2.4 ATA for 90 minutes, 5 days a week. Mean (SD) number of sessions = 38 (8) n=? Comparison therapy plus treatment in a monoplace HBO chamber with 100% oxygen at 3 ATA for 45 minutes, 4 sittings over 3 weeks. n=18 Comparison therapy plus treatment in a multiplace HBO chamber. Two phases: (1) first (antibacterial) phase uses 100% oxygen at 2.8 ATA for 90 minutes daily; (2) second (reparative) phase uses 100% oxygen at 2.5 ATA for 90 minutes. Mean (SD) number of sessions = 34 (21.8) n=64 Debridement, topical antimicrobial agents, occlusive dressing. Empirical antibiotic therapy modified following sensitivity results. Diabetic control with insulin. PTCA or CABG, if needed. n=5 Debridement, silver sulfadiazine dressing twice a day for 5 days, and culture-specific antibiotics. n=33 Debridement, topical antimicrobial agents, occlusive dressing. Empirical antibiotic therapy modified following sensitivity results. Diabetic control with insulin. PTCA or CABG, if needed. n=? Regular surgical treatment, incision and drainage, debridement, local dressing with boric acid and bleaching powdered solution, or glycerine acriflavine. Amputation for gangrene or infection above the knee. Cephalosporins, aminoglycosides, and metronidazole with changes made following sensitivity patterns. Diabetic control with insulin n=10 Debridement. Diabetic control with insulin. * Abbreviations: ATA = atmosphere absolute, CABG = coronary artery bypass grafting, n = sample size, PTCA = percutaneous transluminal coronary angioplasty, SD = standard deviation 26 Hyperbaric oxygen therapy
Assessment of heterogeneity All the identified studies were sufficiently similar in clinical and epidemiological characteristics to allow statistical analysis of heterogeneity to proceed. The risk for major amputations was studied by all of the eligible reports. The Cochrane 2 Q statistic failed to detect the presence of heterogeneity ( χ df = 3 = 0. 87 , p = 0.833). A L’Abbé plot and Galbraith diagram (Figure 2) of the measures of effect supported this conclusion. Similarly sensitivity analyses performed across simple classifications of the identified studies demonstrated no statistically significant differences in effect sizes. This 2 was the case for sensitivity analyses based on study design (RCTs only: χ df = 1 = 0. 44 , p = 2 0.508), HBOT protocols used (two-phase protocol: χ df = 2 = 0. 68, p = 0.710), and recent 2 publication (post-1995: χ 0. 53 , p = 0.468). df = 1 = Similar results were seen for risk of minor amputations (p = 0.722) and wound healing (p = 0.462). In all analyses, the review made the assumption that the study by Doctor et al. 49 was successful in establishing balanced groups. HBOT Subjects z-score (b/se) .5 .4 .3 .2 .1 0 2.54705 2 0 -2 35 34 36 0 .1 .2 .3 .4 .5 Comparison Therapy Subjects . 0 .5 1 weighting factor (1/se) 1.5 2 Figure 2. L’Abbé plot (top) and Galbraith diagram (bottom) of subjects undergoing major amputation. Numerical symbols in each of the graphs refer to bibliographic citations found in the text. Sizes of studies in the L’Abbé plot are weighted using the Mantel- Haenszel method. Hyperbaric oxygen therapy 27 38 37 36 38 37 34
Page 1 and 2: Hyperbaric Oxygen Therapy November
Page 3 and 4: Contents Executive summary.........
Page 5 and 6: Tables Table 1 Measures of disease
Page 7 and 8: Table 45 Functional neurologic scor
Page 9 and 10: Figures Figure 1. Outline of search
Page 11 and 12: Effectiveness Published guidelines
Page 13 and 14: evidence that exposure to HBO may b
Page 15 and 16: No available evidence No evidence w
Page 17 and 18: Introduction The Medicare Services
Page 19 and 20: Multiplace chambers can accommodate
Page 21 and 22: Marketing status of the device The
Page 23 and 24: Table 3 1998 - 1999 self-reported d
Page 25 and 26: Table 6 retrieval. Indication-speci
Page 27 and 28: Phase of Search Initial Search Ful
Page 29 and 30: Conduct of meta-analysis When the d
Page 31 and 32: early as 1995. The guidelines - kno
Page 33 and 34: Table 10 Minimum staff qualificatio
Page 35 and 36: Is it effective? The review assesse
Page 37 and 38: Table 14 Patient criteria of includ
Page 39 and 40: offered ample details. The remainin
Page 41: characteristics compared to the tre
Page 45 and 46: Odds ratio 10 1 0.1 0.01 A sensitiv
Page 47 and 48: Wound healing Two of the five ident
Page 49 and 50: Studies of necrotising soft tissue
Page 51 and 52: Summary Table 25 Survival in patien
Page 53 and 54: Table 29 Therapeutic protocols used
Page 55 and 56: Osteomyelitis The study by Esterhai
Page 57 and 58: Summary The HBO group showed a stat
Page 59 and 60: Summary These results are difficult
Page 61 and 62: outcomes or that decreased the risk
Page 63 and 64: Anderson et al 80 recruited non-pre
Page 65 and 66: Summary The collected evidence exam
Page 67 and 68: Table 46 Major outcomes following t
Page 73 and 74: Thirty-seven subjects (comparison g
Page 75 and 76: whose hearing loss was not secondar
Page 77 and 78: tinnitus (6 versus 3 subjects). Non
Page 79 and 80: assume that all participants knew o
Page 83 and 84: Table 65 Descriptive characteristic
Page 87 and 88: These contrasted with the conclusio
Page 91 and 92: Summary There are conflicting resul
Page 93 and 94:
Summary separate and previously-stu
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need to insulate patients from outs
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Reactive effects A reactive effect
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Cost of major amputation The hospit
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Sensitivity analysis Table 79 shows
Page 103 and 104:
Table 80 Estimation of incremental
Page 105 and 106:
Sensitivity analysis Table 83 shows
Page 107 and 108:
Conclusions Safety Potential risks
Page 109 and 110:
Recommendations MSAC recommended th
Page 111 and 112:
Appendix B Supporting committee Sup
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Appendix C Studies included in this
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Necrotising soft tissue infections:
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Soft tissue injuries: crush injurie
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Cancer: cervix First Author and Yea
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Appendix D Studies excluded in this
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2. Shandling AH, Ellestad MH, Hart
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5. Woo TCS, Joseph D, Oxer H. Hyper
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22. Kunkler PB, Boulis-Wassif S, Sh
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45. Wiernik G, Perrins D. The radio
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Appendix E Calculation of monoplace
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Hence, the total operating costs of
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Appendix G Reviews received from ot
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Sechrist Industries -- Hyperbaric O
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References 1. Hampson N. Hyperbaric
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31. L'Abbe K, Detsky A, O'Rourke K.
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61. Perrins DJ. Influence of hyperb
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89. DiSabato F, Giacovazzo M, Crist
Page 147:
117.Plenk HP. Hyperbaric radiation
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