PMID- 25596836
OWN - NLM
STAT- MEDLINE
DCOM- 20150430
LR  - 20150119
IS  - 1833-3516 (Print)
IS  - 1833-3516 (Linking)
VI  - 44
IP  - 4
DP  - 2014 Dec
TI  - Unestablished indications for hyperbaric oxygen therapy.
PG  - 228-34
AB  - Unestablished indications are conditions in which systematic clinical use of 
      hyperbaric oxygen treatment (HBOT) is not supported by adequate proof of benefit. 
      HBOT is vulnerable to use in many such conditions for various reasons, perhaps 
      the most important being that a placebo or participation effect may create an 
      impression of efficacy. The systematic use of HBOT in unestablished indications 
      raises ethical concerns about provision of misleading information, giving false 
      hope, and taking payment for therapy of doubtful benefit. Any practice perceived 
      as unethical or unscientific has the potential to draw the wider field into 
      disrepute. Of substantial contemporary relevance is the use of HBOT in treatment 
      of various forms of chronic brain injury; in particular, cerebral palsy in 
      children and the sequelae of mild traumatic brain injury in adults. There are now 
      multiple, randomised, blinded, sham-controlled trials of HBOT in both 
      indications. None of these studies showed benefit of HBOT when compared to sham 
      control, though the sham and HBOT groups often both improved, indicating that a 
      placebo or participation effect influenced outcomes. These results almost 
      certainly explain those of open-label trials (lacking sham controls) in which 
      HBOT frequently seems beneficial. Advocates for HBOT in chronic brain injury 
      claim that the sham treatments (usually 1.3 ATA pressure exposure whilst air 
      breathing) in the blinded trials are actually active treatments; however, the 
      same dose of oxygen can be achieved at 1 ATA breathing 27% oxygen. To counter 
      this argument, advocates also claim that the extra 0.3 ATA of pressure is somehow 
      independently beneficial, but this notion has limited biological plausibility and 
      there is little supporting evidence. Chronic brain injuries remain unestablished 
      indications at this time and, in our opinion, should not be systematically 
      treated with HBOT.
FAU - Mitchell, Simon J
AU  - Mitchell SJ
AD  - Consultant anaesthetist and hyperbaric physician at Auckland City Hospital. He is 
      the Head of the Department of Anaesthesiology at the University of Auckland, 
      Department of Anaesthesiology, School of Medicine, University of Auckland Private 
      Bag 92019, Auckland, New Zealand, E-mail: sj.mitchell@auckland.ac.nz.
FAU - Bennett, Michael H
AU  - Bennett MH
AD  - Consultant anaesthetist and hyperbaric physician at Prince of Wales Hospital, 
      Sydney, Australia.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Australia
TA  - Diving Hyperb Med
JT  - Diving and hyperbaric medicine
JID - 101282742
SB  - IM
MH  - Adult
MH  - Brain Injuries/*therapy
MH  - Cerebral Palsy/*therapy
MH  - Child
MH  - Humans
MH  - *Hyperbaric Oxygenation
MH  - *Off-Label Use
OTO - NOTNLM
OT  - Hyperbaric oxygen therapy
OT  - central nervous system
OT  - children
OT  - ethics
OT  - evidence
OT  - hyperbaric research
OT  - review article
OT  - trauma and stress
EDAT- 2015/01/19 06:00
MHDA- 2015/05/01 06:00
CRDT- 2015/01/19 06:00
PHST- 2014/07/10 00:00 [received]
PHST- 2014/09/28 00:00 [accepted]
PHST- 2015/01/19 06:00 [entrez]
PHST- 2015/01/19 06:00 [pubmed]
PHST- 2015/05/01 06:00 [medline]
PST - ppublish
SO  - Diving Hyperb Med. 2014 Dec;44(4):228-34.