Controversial issues in hyperbaric oxygen therapy: A European Committee for Hyperbaric Medicine Workshop
Every few years, the European Committee for Hyperbaric Medicine (ECHM) publishes its recommendations concerning the clinical indications for hyperbaric oxygen therapy (HBOT). The last recommendations were issued during the 7th European Consensus Conference on Hyperbaric Medicine in 2004. Since then, several publications have reported on the use of HBOT in some indications in which it has not yet been recommended routinely, namely aseptic bone necrosis, global brain ischaemia and autism. Patients or their families push physicians and staff of hyperbaric facilities to use hyperbaric treatment regardless of the quality of the scientific evidence. Therefore, the ECHM Workshop "Controversial issues in hyperbaric oxygen therapy" was convened as a satellite meeting of the 2010 European Underwater and Baromedical Society Annual Scientific Meeting in Istanbul, Turkey in 2010. For each topic, a set procedure was used: first came a general report by specialists in the topic, incorporating a review of current pathophysiological, experimental and clinical evidence. Then, there were reports from hyperbaric facilities that had gained clinical experience in that condition, followed by a general discussion with specialists present in the audience. Finally, statements regarding each topic were proposed and voted on by the audience and these were presented to the ECHM Executive Board for consideration and possible approval. In conclusion, the use of HBOT in femoral head necrosis will be proposed during the next ECHM Consensus Conference to become an 'accepted' indication; whilst the use of HBOT in global brain ischaemia and autism should retain its current ECHM recommendations, that it should be 'optional' and 'non-accepted' respectively.
Available from: Daniel Dunleavy
- "The optimistic view of HBOT as a treatment for ASD is not shared by all hyperbarists. Some researchers (Yildiz, Aktas, & Uzun, 2008; Kot & Mathieu, 2011) are calling for more empirical evidence of HBOTs effectiveness, before establishing it as a viable treatment for ASDs. This is a necessary step before professional healthcare workers can ethically recommend HBOT as a treatment option for ASD. "
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Objectives: We review outcome studies regarding the effectiveness of hyperbaric oxygen
therapy (HBOT) for Autism Spectrum Disorders (ASD). Method: Studies were identified
through electronic bibliographic databases and manual searches of article reference lists.
Results: A total of 8 studies met eligibility criteria, consisting of three randomized controlled
trials (RCTs), one quasi-experimental study involving a comparison group, two pre-experimental
one-group pretest–posttest studies, and two single-system designs. Studies reviewed did not offer
credible evidence to suggest that HBOT is an effective treatment for autism. Conclusion: It is
premature to call HBOT an effective treatment for Autism and ASD. Individuals clinically
treated with HBOT outside the context of a RCT should have the effects of the therapy evaluated
using rigorous single-subject designs.
Available from: Elzbieta Salinska
- "Despite many reports on beneficial results of HBO in global cerebral ischemia/anoxia in animal models and human clinical studies (for review see Harch and Neubauer 2009), this therapy did not find the common use in neurological diseases treatment. Pressure-related complications of HBO and growing concern that HBO treatment may generate toxic free radicals, resulted in skepticism about the safety and efficacy of HBO in cerebral ischemia (Kot and Mathieu 2011). Nevertheless, HBO still remains the subject of interest of many scientists: moreover, the critical analysis of negative results and data from new animal studies renewed the interest in HBO therapy (Michalski et al. 2011). "
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ABSTRACT: Anoxic brain injury resulting from cardiac arrest is responsible for approximately two-thirds of deaths. Recent evidence suggests that increased oxygen delivered to the brain after cardiac arrest may be an important factor in preventing neuronal damage, resulting in an interest in hyperbaric oxygen (HBO) therapy. Interestingly, increased oxygen supply may be also reached by application of normobaric oxygen (NBO) or hyperbaric air (HBA). However, previous research also showed that the beneficial effect of hyperbaric treatment may not directly result from increased oxygen supply, leading to the conclusion that the mechanism of hyperbaric prevention of brain damage is not well understood. The aim of our study was to compare the effects of HBO, HBA and NBO treatment on gerbil brain condition after transient forebrain ischemia, serving as a model of cardiac arrest. Thereby, we investigated the effects of repetitive HBO, HBA and NBO treatment on hippocampal CA1 neuronal survival, brain temperature and gerbils behavior (the nest building), depending on the time of initiation of the therapy (1, 3 and 6 h after ischemia). HBO and HBA applied 1, 3 and 6 h after ischemia significantly increased neuronal survival and behavioral performance and abolished the ischemia-evoked brain temperature increase. NBO treatment was most effective when applied 1 h after ischemia; later application had a weak or no protective effect. The results show that HBO and HBA applied between 1 and 6 h after ischemia prevent ischemia-evoked neuronal damage, which may be due to the inhibition of brain temperature increase, as a result of the applied rise in ambient pressure, and just not due to the oxygen per se. This perspective is supported by the finding that NBO treatment was less effective than HBO or HBA therapy. The results presented in this paper may pave the way for future experimental studies dealing with pressure and temperature regulation.
Available from: Ahmad Ghanizadeh
- "The retrieved published documents (articles) included a hypothesis , 3 case series [14,24,25], and 3 commentaries [26-28]. In addition, 3 articles were not clinical trials [29-31], and 3 studies were open labeled without any control groups [15,17,23]. "
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ABSTRACT: There is a controversy about the efficacy of hyperbaric oxygen (HBO) therapy for the treatment of autism. This study systematically reviews the current evidences for treating of autism with HBO therapy. According to PRISMA guidelines for a systematic review, the databases of MEDLINE/Pubmed, Google Scholar, and Randomised Controlled Trials in Hyperbaric Medicine were electronically searched. In addition, medical subject heading terms and text words for hyperbaric oxygen therapy and autism were used. The main inclusion criteria were published studies which reported the original data from the trials conducted on the patients with autism and assessed outcomes with a valid and reliable instrument. A quality assessment was also conducted. The electronically search resulted in 18 title of publications. Two studies were randomized, double-blind, controlled-clinical trials. While some uncontrolled and controlled studies suggested that HBO therapy is effective for the treatment of autism, these promising effects are not replicated. Therefore, sham-controlled studies with rigorous methodology are required to be conducted in order to provide scientific evidence-based HBO therapy for autism treatment.
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