Serious, life-threatening events are probably rare, but not well quantified. Some centers routinely insert tympanostomy tubes prophylactically. Patients with barotraumatic otitis may require the placement of tympanostomy tubes. Most adverse events are self-limiting and resolve after termination of therapy. Some patients may experience claustrophobia due to the confined space of the treatment chambers. Potential risks for patients undergoing therapy with HBO include pressure related traumas (e.g., barotraumatic otitis, pneumothorax) and adverse effects due to oxygen toxicity (e.g., myopia, seizures). In either case, the arterial partial pressure of oxygen will approach 1,500 mmHg. The chamber is compressed with air to 2 to 2.5 ATA while the patient breathes 100% oxygen via head tent, face mask, or endotracheal tube. A multiplace chamber can accommodate several patients and/or health care personnel.
A monoplace chamber accommodates only a single patient, the chamber is pressurized to about 2 to 2.5 ATA with 100% oxygen. HBO is administered either in a monoplace or a multiplace chamber. Adjunctive HBO therapy is used in the management of a variety of disorders such as refractory wounds, gas gangrene, necrotizing infections, radiation injuries and chronic osteomyelitis. The benefit of HBO is based on the premise that raising tissue oxygen levels will enhance wound healing ability. Wounds often have reduced oxygen supply (hypoxia) which impairs leukocyte bacteriocidal activities and wound healing. In hyperbaric oxygen.(HBO)therapy, patients breathe 100% oxygen at elevated pressure, typically at 2 to 2.5 atmospheric absolute (ATA). The shortened duration necessitate tradeoffs for the amount of literature that can be assessed and synthesized in the timeframe. While a conventional evidence report takes about one year to complete, the turnaround time for an average RRR is about 6 to 8 weeks. Users of these reports may utilize additional information in the decision making process. Most importantly, evidence reports do not make specific recommendations on the use of diagnostic tests or treatments. Detailed evaluation of the pathophysiology and mechanism of action of treatments is beyond the scope of RRRs. Evidence reports, RRRs in particular, focus on data from clinical studies on human subjects who have the condition of interest. The scope of an evidence report generally covers prevalence, diagnosis and management of important or common clinical problems. The purpose of evidence reports produced under the Agency for Healthcare Research and Quality (AHRQ)'s Evidence-based Practice Center (EPC) program is to summarize information from relevant studies addressing several well-defined key questions. "Rapid Response Reports (RRR)" are abbreviated evidence reports conducted to meet the quick turnaround needs of the Centers for Medicare and Medicaid Services (CMS) in their evaluation of requests for coverage NCDs.
Hyperbaric Oxygen Therapy in Treatment of Hypoxic WoundsĪgency for Healthcare Research and Quality
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