RESUMO
BACKGROUND: This is the third update of the original Cochrane Review published in July 2005 and updated previously in 2012 and 2016. Cancer is a significant global health issue. Radiotherapy is a treatment modality for many malignancies, and about 50% of people having radiotherapy will be long-term survivors. Some will experience late radiation tissue injury (LRTI), developing months or years following radiotherapy. Hyperbaric oxygen therapy (HBOT) has been suggested as a treatment for LRTI based on 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 complications following surgery and radiotherapy. OBJECTIVES: To evaluate the benefits and harms of hyperbaric oxygen therapy (HBOT) for treating or preventing late radiation tissue injury (LRTI) compared to regimens that excluded HBOT. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was 24 January 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing the effect of HBOT versus no HBOT on LRTI prevention or healing. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. survival from time of randomisation to death from any cause; 2. complete or substantial resolution of clinical problem; 3. site-specific outcomes; and 4. ADVERSE EVENTS: Our secondary outcomes were 5. resolution of pain; 6. improvement in quality of life, function, or both; and 7. site-specific outcomes. We used GRADE to assess certainty of evidence. MAIN RESULTS: Eighteen studies contributed to this review (1071 participants) with publications ranging from 1985 to 2022. We added four new studies to this updated review and evidence for the treatment of radiation proctitis, radiation cystitis, and the prevention and treatment of osteoradionecrosis (ORN). HBOT may not prevent death at one year (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.47 to 1.83; I2 = 0%; 3 RCTs, 166 participants; low-certainty evidence). There is some evidence that HBOT may result in complete resolution or provide significant improvement of LRTI (RR 1.39, 95% CI 1.02 to 1.89; I2 = 64%; 5 RCTs, 468 participants; low-certainty evidence) and HBOT may result in a large reduction in wound dehiscence following head and neck soft tissue surgery (RR 0.24, 95% CI 0.06 to 0.94; I2 = 70%; 2 RCTs, 264 participants; low-certainty evidence). In addition, pain scores in ORN improve slightly after HBOT at 12 months (mean difference (MD) -10.72, 95% CI -18.97 to -2.47; I2 = 40%; 2 RCTs, 157 participants; moderate-certainty evidence). Regarding adverse events, HBOT results in a higher risk of a reduction in visual acuity (RR 4.03, 95% CI 1.65 to 9.84; 5 RCTs, 438 participants; high-certainty evidence). There was a risk of ear barotrauma in people receiving HBOT when no sham pressurisation was used for the control group (RR 9.08, 95% CI 2.21 to 37.26; I2 = 0%; 4 RCTs, 357 participants; high-certainty evidence), but no such increase when a sham pressurisation was employed (RR 1.07, 95% CI 0.52 to 2.21; I2 = 74%; 2 RCTs, 158 participants; high-certainty evidence). AUTHORS' CONCLUSIONS: These small studies suggest that for people with LRTI affecting tissues of the head, neck, bladder and rectum, HBOT may be associated with improved outcomes (low- to moderate-certainty evidence). HBOT may also result in a reduced risk of wound dehiscence and a modest reduction in pain following head and neck irradiation. However, HBOT is unlikely to influence the risk of death in the short term. HBOT also carries a risk of adverse events, including an increased risk of a reduction in visual acuity (usually temporary) and of ear barotrauma on compression. Hence, the application of HBOT to selected participants may be justified. The small number of studies and participants, and the methodological and reporting inadequacies of some of the primary studies included in this review demand a cautious interpretation. More information is required on the subset of disease severity and tissue type affected that is most likely to benefit from this therapy, the time for which we can expect any benefits to persist and the most appropriate oxygen dose. Further research is required to establish the optimum participant selection and timing of any therapy. An economic evaluation should also be undertaken.
Assuntos
Barotrauma , Oxigenoterapia Hiperbárica , Neoplasias , Osteorradionecrose , Lesões por Radiação , Humanos , Oxigenoterapia Hiperbárica/métodos , Lesões por Radiação/prevenção & controle , Neoplasias/terapia , Osteorradionecrose/prevenção & controle , Progressão da Doença , Dor , Barotrauma/terapiaRESUMO
BACKGROUND: The study was designed to evaluate the influence of hyperbaric oxygenation therapy (HBOT) on the parotid gland in patients following radiotherapy for head and neck tumours. PATIENTS AND METHODS: HBOT response was monitored by 3T magnetic resonance imaging (MRI) using T2 mapping and subsequent measurement of mean T2 and T2 variability as well as by salivary tests (salivary flow, buffer capacity, and pH). Eighteen patients previously treated with irradiation doses between 50 and 80 Gy as well as 18 healthy gender and age matched controls were enrolled. MRI was performed prior to HBOT (40.2 ± 20 months after radiotherapy) and after 20 daily HBOT at 2.5 ATA (absolute atmosphere). Each HBOT consisted of breathing 100% oxygen for 90 minutes. RESULTS: Significant differences in mean T2 prior to HBOT were observed between the ipsilateral irradiated (121 ± 20 ms), contralateral parotids (107 ± 21) and control group (96 ± 12 ms). A positive correlation in patients between T2 variability and irradiation dose was detected in contralateral parotids before HBOT (R = 0.489, p = 0.0287). In addition, negative correlations were observed between mean T2 in the ipsilateral as well as the contralateral gland and salivary flow before and after HBOT. Negative correlations between mean T2, T2 variability and pH of unstimulated saliva were also observed in the sides of parotid before and after HBOT. CONCLUSIONS: The study confirmed that T2 mapping had a potential for monitoring the differences between irradiated and normal parotid glands. It could also be useful in the assessment of the glandular tissue response to HBOT.
Assuntos
Neoplasias de Cabeça e Pescoço , Oxigenoterapia Hiperbárica , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Oxigenoterapia Hiperbárica/efeitos adversos , Oxigenoterapia Hiperbárica/métodos , Glândula Parótida/diagnóstico por imagem , SalivaRESUMO
The Sars-CoV-2 (COVID-19) pandemic has resulted in significant and unprecedented shifts in the delivery of health care services in the United States. Although wound care remains an essential service during the COVID-19 pandemic, the financial consequences and infectious disease ramifications of the pandemic have resulted in closure or limitation of hours in many outpatient wound and hyperbaric oxygen therapy (HBOT) centers. As HBOT patients often require daily treatment sessions for a period of months, it is necessary for facilities providing HBOT services to adjust to the COVID-19 pandemic while still maintaining availability of this important service. Modification of HBOT session timing and chamber decontamination procedures, utilisation of telehealth services for initial patient evaluations, and acceptance of novel patient populations and diagnoses are mechanisms by which HBOT centers can adapt to the evolving model of health care delivery throughout a pandemic. While COVID-19 is not a currently accepted indication for HBOT, patients may be referred for HBOT consultation due to the post-infectious sequelae of the virus, and thus HBOT facilities must be aware of the potential uses of this treatment for post-viral complications. By redefining paradigms for health care delivery during the COVID-19 pandemic, HBOT and wound centers can continue to provide high-quality and uninterrupted care to vulnerable patient populations.
Assuntos
COVID-19 , Atenção à Saúde/métodos , Oxigenoterapia Hiperbárica/métodos , Ferimentos e Lesões/terapia , Agendamento de Consultas , Desinfecção , Planejamento Ambiental , Acessibilidade aos Serviços de Saúde , Humanos , Controle de Infecções/métodos , SARS-CoV-2 , Telemedicina , Triagem/métodos , Estados UnidosAssuntos
Pé Diabético/terapia , Úlcera da Perna , Extremidade Inferior , Administração dos Cuidados ao Paciente , Úlcera Varicosa/terapia , Trombose Venosa/complicações , Amputação Cirúrgica/métodos , Humanos , Oxigenoterapia Hiperbárica/métodos , Úlcera da Perna/etiologia , Úlcera da Perna/fisiopatologia , Úlcera da Perna/terapia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Conduta do Tratamento Medicamentoso , Avaliação Nutricional , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/tendências , Procedimentos de Cirurgia Plástica , CicatrizaçãoRESUMO
INTRODUCTION: Delayed wound healing indicates wounds that have failed to respond to more than 4-6 weeks of comprehensive wound care. Wounds with delayed healing are a major source of morbidity and a major cost to hospital and community healthcare providers. Hyperbaric oxygen therapy (HBOT) is a treatment designed to increase the supply of oxygen to wounds and has been applied to a variety of wound types. This article reviews the place of HBOT in the treatment of non-healing vasculitic, calcific uremic arteriolopathy (CUA), livedoid vasculopathy (LV), pyoderma gangrenosum (PG) ulcers. METHODS: We searched electronic databases for research and review studies focused on HBOT for the treatment of delayed healing ulcers with rare etiologies. We excluded HBOT for ulcers reviewed elsewhere. RESULTS: We included a total of three case series and four case reports including 63 participants. Most were related to severe, non-healing ulcers in patients with vasculitis, CUA, LV, and PG. There was some evidence that HBOT may improve the healing rate of wounds by increasing nitric oxide (NO) levels and the number of endothelial progenitor cells in the wounds. HBOT may also improve pain in these ulcers. CONCLUSION: We recommend the establishment of comprehensive and detailed wound care registries to rapidly collect prospective data on the use of HBOT for these problem wounds. There is a strong case for appropriately powered, multi-centre randomized trials to establish the true efficacy and cost-effectiveness of HBOT especially for vasculitis ulcers that have not improved following immunosuppressive therapy.
Assuntos
Oxigenoterapia Hiperbárica , Cicatrização , Análise Custo-Benefício , Pé Diabético , Humanos , Oxigenoterapia Hiperbárica/métodos , Estudos ProspectivosAssuntos
Bronquiolite Viral/terapia , Oxigenoterapia Hiperbárica , Bronquiolite Viral/economia , Bronquiolite Viral/epidemiologia , Bronquiolite Viral/virologia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Humanos , Oxigenoterapia Hiperbárica/economia , Oxigenoterapia Hiperbárica/métodos , Lactente , Recém-Nascido , Irlanda , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Vírus Sinciciais RespiratóriosRESUMO
BACKGROUND: Carbon monoxide (CO) poisoning may result in acute neurological sequelae, cognitive sequelae, and delay neurological sequelae. The administration of hyperbaric oxygen (HBO) to prevent the development of delayed neurological sequelae in CO poisoning have extensively investigated but conflicting results have been reported. We performed a systematic literature review and meta-analysis of randomized controlled trials (RCTs) evaluating HBO treatment and its effect on neuropsychometric dysfunction after CO poisoning. METHODS: We searched Medline, Embase, Pubmed, and the Cochrane Register of Controlled Trials from inception to December 2017. Eligible studies compared HBO therapy with normobaric oxygen (NBO) in patients with CO poisoning. RESULTS: Six studies compared HBO with NBO in CO poisoning patients. Compared with patients treated with NBO, a lower percentage of patients treated with HBO reported headache (16.2% vs 16.5%, relative risk [RR]â=â0.83, 95% CIâ=â0.38-1.80), memory impairment (18.2% vs 23.8%, RRâ=â0.80, 95% CIâ=â0.43-1.49), difficulty concentrating (15.0% vs 18.4%, RRâ=â0.86, 95% CIâ=â0.55-1.34), and disturbed sleep (14.7% vs 16.2%, RRâ=â0.91, 95% CIâ=â0.59-1.39). Two sessions of HBO treatment exhibited no advantage over one session. CONCLUSIONS: The meta-analysis indicated that compared with CO poisoning patients treated with NBO, HBO treated patients have a lower incidence of neuropsychological sequelae, including headache, memory impairment, difficulty concentrating, disturbed sleep, and delayed neurological sequelae. Taking into consideration the cost-effectiveness of one session of HBO, one session of HBO treatment could be an economical option for patients with CO poisoning with high severity.
Assuntos
Intoxicação por Monóxido de Carbono/complicações , Oxigenoterapia Hiperbárica/efeitos adversos , Transtornos da Memória/prevenção & controle , Doenças do Sistema Nervoso/prevenção & controle , Transtornos do Sono-Vigília/prevenção & controle , Intoxicação por Monóxido de Carbono/terapia , Carboxihemoglobina/metabolismo , Progressão da Doença , Humanos , Oxigenoterapia Hiperbárica/economia , Oxigenoterapia Hiperbárica/métodos , Transtornos da Memória/etiologia , Transtornos da Memória/terapia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/terapia , Avaliação de Resultados em Cuidados de Saúde , Oxigenoterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/terapia , Resultado do TratamentoRESUMO
STUDY OBJECTIVE: In this exploratory, double-blind, longitudinal sham-controlled trial of hyperbaric oxygen (HBO2) for military personnel with post concussive mild traumatic brain injury (mTBI), self-reports and objective measures of sleep-wake disturbances were assessed and compared to normals. METHODS: Self-reports consisting of Pittsburg Sleep Quality Index (PSQI), sleep diary, screening for obstructive sleep apnea (OSA) risk, restless legs syndrome (RLS), cataplexy, and objective actigraphic measures of sleep-wake were obtained on 71 military personnel with mTBI [baseline, 13 weeks and six months post-randomization (post-intervention)], of which 35 met post-traumatic stress disorder (PTSD) criteria, and 75 healthy volunteers (baseline). Baseline between-group and follow-up changes from baseline overall and within subgroups were evaluated. Mild TBI was defined as consisting of head injury associated loss of consciousness (<24 h), post-traumatic amnesia, and neurological deficits. RESULTS: Sleep quality by self-reports was markedly degraded in the mTBI group at baseline compared to a normative cohort; insomnia 87.3 versus 2.8%, OSA risk 70% versus 1.3%, RLS 32.4% versus and 2.7%. (all p-values <0.001), but actigraphy measures did not differentiate between groups. HBO2 compared to sham treatment improved self-reports of PSQI sleep measures, reports (five out of eight at 13-weeks and two out of eight at six-months). However, other sleep-wake measures were not different. CONCLUSIONS: Perceived sleep quality was markedly disrupted in mTBI military personnel and sleep-wake disturbances were prevalent compared to a normative cohort. HBO2 relative to sham improved some measures of sleep quality on the PSQI, but other measures of sleep were not significantly different.
Assuntos
Lesões Encefálicas Traumáticas/complicações , Oxigenoterapia Hiperbárica/métodos , Militares/estatística & dados numéricos , Síndrome Pós-Concussão/etiologia , Transtornos do Sono-Vigília/etiologia , Adulto , Cataplexia/diagnóstico , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Síndrome das Pernas Inquietas/diagnóstico , Autorrelato , Apneia Obstrutiva do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologiaRESUMO
BACKGROUND: About 15% to 25% of people with diabetes will develop a foot ulcer. These wounds are often resistant to healing; therefore, people with diabetes experience lower limb amputation at about 20 times the rate of people without diabetes. If an ulcer does not heal with standard wound care, other therapeutic interventions are offered, one of which is hyperbaric oxygen therapy (HBOT). However, the effectiveness of this therapy is not clearly known. The objectives of this health technology assessment were to assess the safety, clinical effectiveness, and cost-effectiveness of standard wound care plus HBOT versus standard wound care alone for the treatment of diabetic foot ulcers. We also investigated the preferences and perspectives of people with diabetic foot ulcers through lived experience. METHODS: We performed a review of the clinical and economic literature for the effectiveness and cost-effectiveness of hyperbaric oxygen therapy, as well as the budget impact of HBOT from the perspective of the Ministry of Health and Long-Term Care. We assessed the quality of the body of clinical evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. To better understand the preferences, perspectives, and values of patients with diabetic foot ulcers and their experience with HBOT, we conducted interviews and administered an online survey. RESULTS: Seven randomized controlled trials and one nonrandomized controlled trial met the inclusion criteria. Comparing standard wound care plus HBOT with standard wound care alone, we found mixed results for major amputation rates (GRADE quality of evidence: low), a significant difference in favour of standard wound care plus HBOT on ulcers healed (GRADE quality of evidence: low), and no difference in terms of adverse events (GRADE quality of evidence: moderate). There is a large degree of uncertainty associated with the evaluation of the cost-effectiveness of standard wound care plus HBOT. However, results appear to suggest that this treatment results in lower costs and better outcomes than standard wound care alone. Funding HBOT will result in a budget impact of $4 million per year in immediate treatment costs for the Ontario Ministry of Health and Long-Term Care. This cost decreases to $0.5 million per year when downstream costs are considered. There is a substantial daily burden of care and emotional weight associated with living with diabetic foot ulcers, both of which are compounded by concern regarding possible amputation. Patients feel that HBOT is an effective treatment and reported that they were satisfied with how their ulcers healed and that this improved their quality of life. CONCLUSIONS: The evidence makes it difficult to draw any definitive conclusions on the clinical and cost effectiveness of standard wound care plus HBOT versus standard wound care alone for the treatment of diabetic foot ulcers.
Assuntos
Pé Diabético/terapia , Oxigenoterapia Hiperbárica/economia , Oxigenoterapia Hiperbárica/métodos , Ensaios Clínicos como Assunto , Análise Custo-Benefício , Humanos , Ontário , Qualidade de Vida , Avaliação da Tecnologia Biomédica , CicatrizaçãoRESUMO
OBJECTIVE: This systematic review examines the efficacy of hyperbaric oxygen (HBO2) for traumatic brain injury (TBI) to make evidence-based recommendations for its application and future research. METHODS: A comprehensive search was conducted to identify studies through 2014. Methodological quality was assessed and synthesis and interpretation of relevant data was performed. RESULTS: Twelve randomized trials were included. All mild TBI studies demonstrated minimal bias and no statistically significant differences between HBO2 and sham arms. Statistically significant improvement occurred over time within both groups. Moderate-to-severe TBI studies were of mixed quality, with majority of results favoring HBO2 compared with "standard care." The placebo analysis conducted was limited by lack of details. CONCLUSIONS: For mild TBI, results indicate HBO2 is no better than sham treatment. Improvements within both HBO2 and sham groups cannot be ignored. For acute treatment of moderate-to-severe TBI, although methodology appears flawed across some studies, because of the complexity of brain injury, HBO2 may be beneficial as a relatively safe adjunctive therapy if feasible. Further research should be considered to resolve the controversy surrounding this field, but only if methodological flaws are avoided and bias minimized.
Assuntos
Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Oxigenoterapia Hiperbárica/métodos , Guias de Prática Clínica como Assunto , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
BACKGROUND: Cancer is a significant global health problem. Radiotherapy is a treatment for many cancers and about 50% of people having radiotherapy will be long-term survivors. Some will experience late radiation tissue injury (LRTI) developing months or years later. Hyperbaric oxygen therapy (HBOT) has been suggested as a treatment 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 METHODS: We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 11), MEDLINE, EMBASE, DORCTIHM and reference lists of articles in December 2015. We also searched for ongoing trials at clinicaltrials.gov. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the effect of HBOT versus no HBOT on LRTI prevention or healing. DATA COLLECTION AND ANALYSIS: Three review authors independently evaluated the quality of the relevant trials using the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and extracted the data from the included trials. MAIN RESULTS: Fourteen trials contributed to this review (753 participants). There was some moderate quality evidence that HBOT was more likely to achieve mucosal coverage with osteoradionecrosis (ORN) (risk ratio (RR) 1.3; 95% confidence interval (CI) 1.1 to 1.6, P value = 0.003, number needed to treat for an additional beneficial outcome (NNTB) 5; 246 participants, 3 studies). There was also moderate quality evidence of a significantly improved chance of wound breakdown without HBOT following operative treatment for ORN (RR 4.2; 95% CI 1.1 to 16.8, P value = 0.04, NNTB 4; 264 participants, 2 studies). From single studies there was a significantly increased chance of improvement or cure following HBOT for radiation proctitis (RR 1.72; 95% CI 1.0 to 2.9, P value = 0.04, NNTB 5), and following both surgical flaps (RR 8.7; 95% CI 2.7 to 27.5, P value = 0.0002, NNTB 4) and hemimandibulectomy (RR 1.4; 95% CI 1.1 to 1.8, P value = 0.001, NNTB 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 value = 0.009, NNTB 4).There was no evidence of benefit in clinical outcomes with established radiation injury to neural tissue, and no randomised data reported on the use of HBOT to treat other manifestations of LRTI. These trials did not report adverse events. 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 ORN 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 participants and tissues may be justified. Further research is required to establish the optimum participant selection and timing of any therapy. An economic evaluation should be undertaken.
Assuntos
Oxigenoterapia Hiperbárica/métodos , Neoplasias/radioterapia , Lesões por Radiação/terapia , Neoplasias do Ânus/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Órgãos em Risco/efeitos da radiação , Osteorradionecrose/prevenção & controle , Lesões por Radiação/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Retais/radioterapiaRESUMO
Hyperbaric oxygen therapy (HBOT) is a scientifically justified and internationally established therapy, which is however not well-known thus rarely used in Germany. During a HBOT, the ambient pressure is raised while the patient breathes 100% O2, causing tissue partial oxygen pressure (ptO2) to increase distinctly. Through that, various pressure- and O2-associated processes are initiated. Herein 3 case studies are described that illustrate the mechanism of action and the range of applications of HBOT.
Assuntos
Doença da Descompressão/terapia , Mergulho/lesões , Oxigenoterapia Hiperbárica/instrumentação , Medicina Esportiva/instrumentação , Doença da Descompressão/diagnóstico , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Oxigenoterapia Hiperbárica/métodos , Masculino , Pessoa de Meia-Idade , Avaliação da Tecnologia Biomédica , Resultado do Tratamento , Adulto JovemRESUMO
There is some evidence for the benefit of hyperbaric oxygen therapy in late radiation tissue injury (LRTI) affecting the head, neck and lower bowel, but there is little evidence for or against the benefit in other tissues (e.g. the breast) affected by LRTI. There is a need for large prospective trials including quality-of-life and cost-effectiveness studies, because hyperbaric oxygen therapy is becoming more popular.
Assuntos
Oxigenoterapia Hiperbárica/tendências , Lesões por Radiação/terapia , Análise Custo-Benefício , Humanos , Oxigenoterapia Hiperbárica/economia , Oxigenoterapia Hiperbárica/métodos , Estudos Prospectivos , Qualidade de VidaAssuntos
Amputação Cirúrgica , Pé Diabético/terapia , Hemoglobinas Glicadas , Oxigenoterapia Hiperbárica , Amputação Cirúrgica/economia , Amputação Cirúrgica/estatística & dados numéricos , Biomarcadores/sangue , Pé Diabético/sangue , Fidelidade a Diretrizes , Humanos , Oxigenoterapia Hiperbárica/economia , Oxigenoterapia Hiperbárica/métodos , Oxigenoterapia Hiperbárica/tendências , CicatrizaçãoRESUMO
We review and report on accumulated data showing the benefits offered by hyperbaric oxygen (HBO2) therapy as an adjunct in the treatment of coronary artery bypass graft (CABG) patients. It has been shown that ischemia-reperfusion injury is deleterious to the myocardium, causing left ventricular dysfunction, structural damage to the myocytes and endothelial cells, myocardial stunning, reperfusion arrhythmias and potentially irreversible injury. There is a substantial body of evidence pointing to the role of HBO2 in mitigating the harmful effects of ischemia-reperfusion injury. Specifically, we review evidence from a number of studies which clearly point to both clinical and cost benefits HBO2 offers when used to precondition non-emergent patients having on-pump coronary arterial bypass graft surgery. Study data show that adding adjunctive HBO2 into the plan of care leads to improved myocardial function, reduces length of stay in the ICU, and limits post-surgical complications. Further, it has only minimal impact on the presurgical preparation, i.e., time must be allowed for the hyperbaric treatment(s), and no role in the surgery or post-surgical care of the patient. The studies pointing to clinical and cost benefit of preconditioning have been conducted outside the United States. Given the pressure on costs in all areas of health care, it seems that a therapeutic approach, which has been shown to be of benefit in both animal and human trials over the course of many years, should attract funding for a properly structured study designed to test whether significant and simultaneous improvements in clinical outcomes and cost reductions can be achieved within the framework of a U.S. healthcare facility.
Assuntos
Ponte de Artéria Coronária , Oxigenoterapia Hiperbárica/métodos , Precondicionamento Isquêmico Miocárdico/métodos , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Animais , Custos e Análise de Custo , Procedimentos Cirúrgicos Eletivos , Humanos , Precondicionamento Isquêmico Miocárdico/economia , Tempo de Internação , Isquemia Miocárdica/terapia , Traumatismo por Reperfusão Miocárdica/etiologia , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/prevenção & controleRESUMO
BACKGROUND: The utility of hyperbaric oxygen therapy (HBOT) in the treatment of necrotizing soft tissue infections (NSTIs) has not been proved. Previous studies have been subject to substantial selection bias because HBOT is not available universally at all medical centers, and there is often considerable delay associated with its initiation. We examined the utility of HBOT for the treatment of NSTI in the modern era by isolating centers that have their own HBOT facilities. METHODS: We queried all centers in the University Health Consortium (UHC) database from 2008 to 2010 that have their own HBOT facilities (n=14). Cases of NSTI were identified by International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, which included Fournier gangrene (608.83), necrotizing fasciitis (728.86), and gas gangrene (040.0). Status of HBOT was identified by the presence (HBOT) or absence (control) of ICD-9 procedure code 93.95. Our cohort was risk-stratified and matched by UHC's validated severity of illness (SOI) score. Comparisons were then made using univariate tests of association and multivariable logistic regression. RESULTS: There were 1,583 NSTI cases at the 14 HBOT-capable centers. 117 (7%) cases were treated with HBOT. Univariate analysis showed that there was no difference between HBOT and control groups in hospital length of stay, direct cost, complications, and mortality across the three less severe SOI classes (minor, moderate, and major). However, for extreme SOI the HBOT group had fewer complications (45% vs. 66%; p<0.01) and fewer deaths (4% vs. 23%; p<0.01). Multivariable analysis showed that patients who did not receive HBOT were less likely to survive their index hospitalization (odds ratio, 10.6; 95% CI 5.2-25.1). CONCLUSION: At HBOT-capable centers, receiving HBOT was associated with a significant survival benefit. Use of HBOT in conjunction with current practices for the treatment of NSTI can be both a cost-effective and life-saving therapy, in particular for the sickest patients.
Assuntos
Fasciite Necrosante/terapia , Gangrena de Fournier/terapia , Gangrena Gasosa/terapia , Oxigenoterapia Hiperbárica/métodos , Oxigenoterapia Hiperbárica/estatística & dados numéricos , Infecções dos Tecidos Moles/terapia , Adulto , Feminino , Custos de Cuidados de Saúde , Hospitais Universitários , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Resultado do TratamentoRESUMO
We report on two cases of idiopathic sensorineural sudden hearing loss (ISSHL) successfully treated at our center. The patients were referred to us by a neurotologist for adjunctive hyperbaric oxygen therapy and were treated using a standard 2.4 atmospheres absolute (atm abs) 90-minute protocol with two five- minute air breaks. During this period the referring physician administered injections of steroids at his offices. The outcome in both cases was positive and produced significantly improved scores in both speech reception and speech discrimination. In October 2011, the UHMS added ISSHL to its list of approved indications. Despite this and an increasing body of literature that supports the use of hyperbaric oxygen therapy as an adjunct in the treatment of ISSHL, it has not yet been accepted for reimbursement by CMS and, in our experience, commercial carriers. We believe it would be beneficial in developing the case for reimbursement in this indication if all facilities record and submit their results to a national database perhaps organized and managed by the UHMS.
Assuntos
Perda Auditiva Neurossensorial/terapia , Perda Auditiva Súbita/terapia , Oxigenoterapia Hiperbárica/métodos , Pressão Atmosférica , Terapia Combinada , Dexametasona/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Oxigenoterapia Hiperbárica/estatística & dados numéricos , Injeções/métodos , Reembolso de Seguro de Saúde , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUÇÃO: As queimaduras estão entre as principais causas externas de morte no Brasil, geram enormes gastos financeiros e são responsáveis por sequelas físicas, psicológicas e sociais. O Objetivo deste estudo foi comparar os dois grupos de pacientes queimados com e sem tratamento coadjuvante com Oxigenoterapia Hiperbárica, assim como, realizar uma análise dos custos. MÉTODOS: Foi realizado estudo retrospectivo, período de 2011 a 2013, selecionando, 20 pacientes com queimaduras moderadas e graves, internados na Santa Casa de Misericórdia de Campo Grande, tratados com auxílio de OHB (grupo I) e 22 pacientes sem auxílio de OHB (grupo II). RESULTADOS: A maioria dos pacientes pertencia ao sexo masculino, 24 pacientes (57,1%). O agente etiológico mais frequente nos dois grupos foi produtos inflamáveis com 56,6% dos casos. A idade média do grupo I foi de 26,6 e a do grupo II 23,3, predominando a faixa etária entre 13 e 35 anos 50,4% dos pacientes. Custo médio final por paciente do Grupo I foi R$17.292,00, e grupo II R$25.360 (p=0,028). CONCLUSÃO: Concluímos que, no nosso serviço, o grupo de pacientes com queimaduras moderadas e graves tratados com auxílio da Oxigenioterapia Hiperbárica teve um menor número de procedimentos cirúrgicos, como enxertos e desbridamento, e menor tempo de internação, levando a uma economia importante dos gastos hospitalares.
INTRODUCTION: Burns are among the leading external causes of death in Brazil, generating huge costs and having physical, psychological, and social consequences. The objective of this study was to compare two groups of burn patients, i.e., those with and those without adjuvant treatment with hyperbaric oxygen (HBO) therapy and to perform a cost analysis. METHODS: A retrospective study was carried out between 2011 and 2013, comparing 20 patients with moderate to severe burns who were hospitalized at the Santa Casa de Misericórdia de Campo Grande and treated with HBO (group I) and 22 patients treated without HBO (group II). RESULTS: Most of the patients, i.e., 24 (57.1%), were male. Flammable product was the most frequent etiologic agent in both groups, accounting for 56.6% of the burn cases. The average age of group I patients was of 26.6 years and that of group II was of 23.3 years, with a prevalence (50.4%) of those aged between 13 and 35 years. The average final cost per patient was R$17,292.00 for group I and R$25,360 for group II (p = 0.028). CONCLUSION: We conclude that, in our service, patients presenting moderate and severe burns and treated with HBO therapy underwent a lower number of surgical procedures, e.g., grafts and debridement that allowed reduced hospitalization time and led to significant savings in hospital costs.