Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...
Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...
Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...
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Summary<br />
separate and previously-studied series of patients undergoing treatment with 131 I-MIBG<br />
alone. Patients in this series were recruited from an academic medical centre in the<br />
Netherlands. The authors enrolled 51 but present results for the 35 (69%) who<br />
completed more than one course of therapy. Overall, patients had a mean age of 6.8<br />
years. There were 19 males and 19 females.<br />
Patients were given 131 I-MIBG intravenously. Exposure to HBO was through a<br />
multiplace chamber at 3 ATA for 75 minutes, once daily for four days. The primary end<br />
point was survival.<br />
Patients lived for a mean duration of 3 years following treatment. Kaplan-Meier plots<br />
comparing survival distributions between those receiving HBOT and those treated with<br />
131 I-MIBG alone showed better survival in the HBOT group. The results were<br />
statistically significant (log rank test, p = 0.0326).<br />
While this study provides some evidence of the effect of HBOT in the treatment of<br />
neuroblastoma, until more rigorous evidence is collected, the use of this technology<br />
cannot be supported.<br />
Carbon monoxide poisoning<br />
Several studies have been published examining the use of HBOT for acute carbon<br />
monoxide poisoning. In 2000, Juurlink et al 122 published a systematic review of the<br />
literature on this topic, focusing on the efficacy of the procedure on the development of<br />
neurologic sequelae one month after treatment. The authors searched for relevant<br />
publications from 1966 to 1999 using three electronic databases (Medline, Embase, and<br />
the Cochrane Controlled Trials Register) supplemented by examination of reference lists<br />
and contact with experts in the field. A search revealed no studies that met the inclusion<br />
and exclusion criteria published subsequent to the release of this systematic review. The<br />
following discussion is consequently limited to an assessment of the Juurlink et al review.<br />
The review collected six reports of randomised controlled trials involving non-pregnant<br />
adults acutely poisoned with carbon monoxide, regardless of severity. The authors<br />
analysed the results of three studies 123,124,125 that scored three or more on the Jadad<br />
quality scale.<br />
The authors found that the severity of poisoning varied between trials. Each also<br />
employed different doses of HBO. The results for a total of 455 patients were available<br />
for analysis. Non-specific neurological symptoms (eg., headache, confusion, difficulty<br />
concentrating, and disturbances with sleep) were present in 81 of 237 patients (34.1%) in<br />
the intervention group compared to 81 of 218 patients (37.2%) in the comparison group<br />
(OR = 0.82; 95% CI = 0.40, 1.66). Sensitivity analysis did not change the results.<br />
Summary<br />
This systematic review failed to demonstrate a significant reduction in neurologic<br />
sequelae following HBOT for carbon monoxide poisoning. More methodologicallyrigorous<br />
studies are required to examine the efficacy of HBOT on other outcomes and in<br />
distinct patient subsets.<br />
<strong>Hyperbaric</strong> oxygen therapy 77