Pengobatan Hiperbarik Pengobatan Hiperbarik
Oksigen dibidang klinikOksigen dibidang klinik
Suyanto SidikSuyanto Sidik
RSAL Dr.Mintohardjo JKTRSAL Dr.Mintohardjo JKTE-mail: [email protected]: [email protected]
Jabatan : Ka Kelompok Ahli RSAL Jabatan : Ka Kelompok Ahli RSAL Dr.Mintohardjo Dr.Mintohardjo
Pendidikan:Pendidikan:Dokter FK Gadjah Mada Yk 1979Dokter FK Gadjah Mada Yk 1979Hyperbaric and under sea Australia Hyperbaric and under sea Australia
19831983Ahli Peny dalam FK UNAIR Sby 1992Ahli Peny dalam FK UNAIR Sby 1992Endoscopy-Gastro intestinal FKUI 1996Endoscopy-Gastro intestinal FKUI 1996Doktor FKUI Jkt 2006Doktor FKUI Jkt 2006Konsultan Gastro-Hepatologi 2007Konsultan Gastro-Hepatologi 2007Spesiali Kedokteran Kelautan 2009Spesiali Kedokteran Kelautan 2009
Dr.dr.Suyanto Sidik SpPD KGEH Dr.dr.Suyanto Sidik SpPD KGEH SpKLSpKL
RSAL Dr.Mintohardjo RSAL Dr.Mintohardjo JakartaJakarta
HISTORY OF HISTORY OF HYPERBARIC MEDICINEHYPERBARIC MEDICINE 1900 Behnke US navy—DCS1900 Behnke US navy—DCS 1956 Dr I Boerma cardio pulm 1956 Dr I Boerma cardio pulm
surg.surg. 1963 Conggres I HBO Proef 1963 Conggres I HBO Proef BoeremaBoerema 2002 Conggres XIV Cramer & Shefield 2002 Conggres XIV Cramer & Shefield
Sanfransisco, USASanfransisco, USA 2005 Conggres XV Barcelona Jordi de 2005 Conggres XV Barcelona Jordi de
solasola 2008 Conggres XVI Becker & Cramer 2008 Conggres XVI Becker & Cramer
BeijingBeijing
11STST INTERNATIONAL CONGRESS ON INTERNATIONAL CONGRESS ON HYPERBARIC OXYGENATION, 1963HYPERBARIC OXYGENATION, 1963
Australia 9Australia 9thth 1987 1987Amsterdam 10Amsterdam 10thth 19901990CHINA 11, 16CHINA 11, 16thth 1993, 2008 1993, 2008Italy 12Italy 12thth 1996 1996Japan 13Japan 13thth 1999 1999America 8,14America 8,14thth 1984, 2002 1984, 2002Spanyol 15Spanyol 15thth 2005 2005Beijing 16Beijing 16thth 2008 2008
ContraindicationsContraindications
AbsoluteAbsolute
PneumothoraxPneumothorax
Relative:Relative:
Upper Resp InfUpper Resp Inf
Seizure disordersSeizure disorders
Malignant diseaseMalignant disease
PregnancyPregnancy
a.a. Paul Bert EffectPaul Bert Effect in CNS.in CNS. NauseaNausea Twitching Twitching ConvultionConvultion
b. Lorrain Smith Effect in pulmonal• Cough• Dyspnea• Substernal pain
6
I
Intermiten O2
Prev O2 toxcicity
INDICATION HBOT INDICATION HBOT UHMSUHMS1.1. Air or gas embolism 6Air or gas embolism 62.2. CO poisoning 5CO poisoning 53.3. Gas gangrene 8 Gas gangrene 8
4.4. Crush injury 3Crush injury 35.5. DCS 7DCS 76.6. Enhancement of healing 1Enhancement of healing 17.7. Anemia 12Anemia 128.8. Intracranial absces 13Intracranial absces 139.9. Necrotizing soft tissue infections 9Necrotizing soft tissue infections 910.10. Osteomyelitis 4 Osteomyelitis 4
11.11. Delayed radiation injury 2Delayed radiation injury 212.12. Skin grafts & flaps 10Skin grafts & flaps 1013.13. Thermal burns 11Thermal burns 11
Switzerland2%
Benelux8%
EasternEurope
6%
Spain5%
France17%
Italy33%
UK3%
Germany24%
Scandinavia2%
Japan10% Europe 10%
China37%Russia
26%
SouthKorea 8%
USA7%
Other2%
in the world
in Europe
HBO chambers in Japan, 2004 Hosps: 617 mono: 758 multi: 57
Textbook of HBO by Jain, 2004
Distribution of HBO chambers Distribution of HBO chambers in the worldin the world
Others3% Neurosurg
36%
Emerg18%
Surg15%
Int Med14%
Orthop3%Anesth
11%
172 HBO doctors172 HBO doctors
since 2000
Specialties of HBO doctor in JapanSpecialties of HBO doctor in Japan
Tre a tm ent Stra te g ie s
* Wo und b a se Prep a ra tion* Wo und Pro te c tio n* Dressing Se le c tion
O xyg ena tio n
Sp e c ia lC o nsid e ra tion
Tria l o f HBO
* 1-2-3 Pro to c o l* Re va sc ula riza tio n* Fa ile d Po st-up Wo und s
+ Pro g re ssive ne ec rotizing Soft Tissue Infe c tion+ C hronic Re fra c to ry O steo m ye litis+ Pre serva tio n o f C o m p ro m ised Skin G ra ft/Fla p+ C om b ined Synerg istic Infec tio n (M e le ney’s)+ Ac ute Pe rip hera l Arte ria l Insuffic ienc y+ De la ye d Ra d ia tion Injury (Bone /So ft Tissue)
+ O ne or m ore o f the 6 d ia g nose s (O n Le ft)+ In C o m b ina tion with O the r Sp e c ia l C onsid e ra tio n (Ab o ve )+ Pa tients with Hig h Sub sid ia ry (Ho st/Nutrition/G o a l) Sc o re s+ Am b ula tory a m p utee s with a thre a tene d d c o ntra la te ra l lim b+ Pa tients with c o lla g e n Va sc ula r Disea ses
Wo und G ra d ingWo undSc o re
Futile
Wound Sc ore(stra uss)
10 = Be st,0 = Wo rst
Ta b le 2
Sub sid ia ry info rm a tion
Ho st sc o re (Ta b le 5)
Nutrition sta tus
G o a l sc ore (Ta b le 6)
KISS p ro c ed ure s (Ta b le 4)Tre a tm e nt Stra te g ie s
(Wound M a na g e m ent)
@ Pre p a ra tion@ Pro te c tio n
@ Dre ssing s@ O xyg e na tion
Sp e c ia lC onsid e ra tion
@ Tria l o f HBO P O
@ 1 - 2 - 3 Pro to c o l *
@ Re va sc ula riza tio n
@ KISS Pro c e d ure
@ De la ye d He a ling * *
tc 2
Ma
na
ge
me
ntEv
alu
atio
n
P O Stud ytc 2
10 - 8 7 - 4 3 - 0
* Ba se line P O : The n Da y 1 = Nitro -o intm e nt/p a tc h a d ja c e nt to wo und a nd ne w a nd ne w
tc 2 P ODa y 2 = Nife d ip ine (Pro c a rd ia ) o ra lly P ODa y 3 = C o m b ina tio n o f 1 a nd 2 a nd ne w P O
tc 2
tc 2
tc 2
R
* * Initia l fa ile d , slo ug he d a nd /o r d e hisc e d wound (s) a fte r HBO tre a tm e nts a nd surg e ry; the n d e la ye d he a ling in fo r sta g e s (se e text)
Wo und Eva lua tio n a nd M a na g e m e nt
There are eight principal There are eight principal methods in which HBO is methods in which HBO is capable of affecting tissue:capable of affecting tissue:
Pressure effects of oxygen Pressure effects of oxygen Vasoconstrictive effects of oxygen. Vasoconstrictive effects of oxygen. 100% oxygen concentration effects 100% oxygen concentration effects on the diffusion gradient. on the diffusion gradient. Hyperoxygenation of ischemic Hyperoxygenation of ischemic tissue. tissue. Down regulation of inflammatory Down regulation of inflammatory cytokines. cytokines. Up-regulation of growth factors. Up-regulation of growth factors. Leukocyte effects. Leukocyte effects. Antibacterial effects.Antibacterial effects.
HBOT should be used to HBOT should be used to compliment conventional compliment conventional therapies and treatmentstherapies and treatments..
HBOT is very cost effective. HBOT is very cost effective. HBOT is noninvasive. HBOT is noninvasive. HBOT is safe. HBOT is safe. HBOT works well with other HBOT works well with other
treatments.treatments.
HBOT has five actions which have HBOT has five actions which have been used to combat clinical been used to combat clinical
infection:infection:
1.Tissue rendered hypoxic by infection is 1.Tissue rendered hypoxic by infection is supported by oxygen. supported by oxygen.
2.Neutrophils are activated and rendered 2.Neutrophils are activated and rendered more efficient. more efficient.
3.Machrophage activity is enhanced. 3.Machrophage activity is enhanced.
4.Bacterial growth is inhibited. 4.Bacterial growth is inhibited.
5.The effect of antibiotics is potentiated.5.The effect of antibiotics is potentiated.
Prinsip Wound CarePrinsip Wound Care
OO2 2 NNutrisiutrisiEEdemadema
GGlucoselucoseLLipidipidIInfeksinfeksiTTraumaraumaCChronichronicHHematology Diseaseematology Disease
SSocial economyocial economyAAutoimmuneutoimmuneMMedicineedicinePPsychosocialsychosocialLLike a Like ike a Like
DiagnoseDiagnoseEEveryday Careveryday CareRRAA
HBO THERAPY
OXYGEN 100%, Pressure 2 – 3 ATA OXYGEN 100%, Pressure 2 – 3 ATA Hyperbaric ChamberHyperbaric Chamber
Decompresion sickness txDecompresion sickness tx Tissue damage: wound healing, hipoksia Tissue damage: wound healing, hipoksia Fibroblast, synthesis collagen, ratio Fibroblast, synthesis collagen, ratio
RNA/DNA, RNA/DNA, leucocyte killing, angiogenesis leucocyte killing, angiogenesis neovascularisation of the wound neovascularisation of the wound
& mikrovasc blood flow, dens cap & mikrovasc blood flow, dens cap iskhaemi – reperfussioniskhaemi – reperfussion
NO 4- 5 X NO 4- 5 X HBOT 2-3 ATA - 2 hours HBOT 2-3 ATA - 2 hours Healing of tissue damageHealing of tissue damage
HBO AND VASCULAR GROWTH
SMITH S. HYPERBARIC TEXT BOOK OF SURGERY PREOPERATIVE CARE, 2002
eNOSnNOS
iNOS
FAD + FMD L- ARGININE + n NADPH + O2 L - CITRULINE + NO + NADP+
BH4
O2 NO VASOKONSTRIKSICO2 NO VASODILATASI
24SMITH S. HYPERBARIC TEXT BOOK OF SURGERY PREOPERATIVE CARE, 2002
CONSTITUTIVE NOS
SMITH S. HYPERBARIC TEXT BOOK OF SURGERY PREOPERATIVE CARE, 2002
CD4+CD4+TCRTCR
Th1Th1CD4+CD4+TCRTCR
Th2Th2CD4+CD4+TCRTCR
SP SP
BB
STRESSORSTRESSOROHBOHB
CD8+CD8+TCRTCR
MHCMHCII
APCAPC
IFN Ƴ
IgGIgG
IL 10
+
+
+ +
+
-
-
APCAPC
MHCMHCIIII
OHB & IMMUNOHUMORALOHB & IMMUNOHUMORAL
CD4+CD4+TCRTCR
Th1Th1CD4+CD4+TCRTCR
Th2Th2CD4+CD4+TCRTCR
BB
STRESSORSTRESSOROHBOHB
IFN IFN ƳƳ
IgIgEE
IL 4IL 4
++
--
APCAPCMHCMHC
IIII
OHB & IMMUNOSUPRESIOHB & IMMUNOSUPRESI
IgIgGG
HBOT FOR ANTI-HBOT FOR ANTI-INFLAMATORYINFLAMATORY1.1. Sumen G, Cimsit M, Eroglu L. HBOT Sumen G, Cimsit M, Eroglu L. HBOT
reduces carrageenan-induced acute reduces carrageenan-induced acute inflammation in rats. Eur J inflammation in rats. Eur J Pharmacoln2001: 431; 265-8.Pharmacoln2001: 431; 265-8.
2.2. Haapaniemi T, Nylander G, Sirsyo A et al. Haapaniemi T, Nylander G, Sirsyo A et al. Hyperbaric oxygen reduces ischemia-Hyperbaric oxygen reduces ischemia-induced skeletal muscle injury. Plast induced skeletal muscle injury. Plast Reconstr Surg 1996: 97: 602-7.Reconstr Surg 1996: 97: 602-7.
3.3. Waisman d, Brod V, Wolf R et al.Effects Waisman d, Brod V, Wolf R et al.Effects hyperoxia on local and remote circulatory hyperoxia on local and remote circulatory inflammatory response alter splanchnic inflammatory response alter splanchnic ischemia and reperfusion. Am J Physiol ischemia and reperfusion. Am J Physiol Heart Circ Physiol 2003:285: H 643-52.Heart Circ Physiol 2003:285: H 643-52.
1995 Proceding ICHM-111995 Proceding ICHM-11thth HBOT in treating RA in Europe and HBOT in treating RA in Europe and Asia Rui-ChangAsia Rui-Chang
Cured 24.4%Cured 24.4% Obvious effect 51.4%Obvious effect 51.4% Improvement 16.2%Improvement 16.2% No effect 8.1%No effect 8.1% Effective HBOT RA 91,9%Effective HBOT RA 91,9%1.The repercusision of the joint is fast, 1.The repercusision of the joint is fast,
the effect of analgesia is good.the effect of analgesia is good.2.The curative and obcious rate is 2.The curative and obcious rate is
high.high.
Mild poisoning 1 sesion
Moderate poisoning 2 sesion
ESA : 50 – 70 %ESA : 50 – 70 %
ESL : 2,5 – 25 %ESL : 2,5 – 25 %
LASHNERLASHNER
GILINSKYGILINSKY
TERGANTUNG :
DOSIS
FRAKSINASI
LUAS
TEKNIK RADIASI
GEJALA ESL :
~ ESA
+ LEBIH BERAT
DIARE LENDIR + DARAH
GEJALA ESA :
SAKIT PERUT
TENESMUS
HEMATOCHEZIA
33
Treatment of Radiation Proctitis and EnteritisTreatment of Radiation Proctitis and Enteritis
34
AuthorAuthor Type of ReportType of Report NCl GradeNCl Grade Clinical Clinical EvidenEviden
CommentsComments
Bouachour (1990)59
Charneau (1991)60
Nakada (1993)61
Feldmeier (1995)63
Feldmeier (1996)63
Woo (1997)64
Case Series-8 patients
Single case report
Single case report
Animal study
Case series-8 patients: 7 proctitis/colitis; 1 enteritis
Case series-18 patients
3ii
3ii
3ii
Not clinical
3ii
3ii
Likely to be Benefical
Positive Case
Unknown Effectiveness Single Positive Case
Not clinical but Positive Study
Likely to be Beneficial
Likely to be Beneficial
6 of 8 patients with hemorrhagic proctitis resolved
Single patient with succesful treatment of hemorrhagic proctitis
Single patient with succesful treatment of hemorrhagic proctitis
Reduced fibrosis and reduced gross appereance of enteritis in murine ileum
4 of 7 proctitis/colitis resolved; 1 enteritis did not resolve
2 patient had complete resolution; 8 partial and no change in 8
35
AuthorAuthor Type of ReportType of Report NCl NCl GradeGrade
Clinical Clinical EvidenEviden
CommentsComments
Warren (1997)65
Bredfelt (1998)66
Feldmeier (1998)67
Carl (1998)68
Gouello (1999)69
Bem (2000)70
Meyer (2001)52
Boyle (2002)71
Case series-14 patients
Case series-19 patients
Animal study
Case Series-2 patients
Case series-36 patients
Case series-2 patients
Case series – 10patients
Case series- 19 patients
3ii
3ii
Not clinical
3ii
3ii
3ii
3ii
3ii
Likely to be Benefical
Likely to be Benefical
Not clinical but positive study
Likely to be Benefical
Likely to be Benefical
Likely to be Benefical
Likely to be Benefical
Likely to be Benefical
7 patients complete resolution; 2 improved 5 patient non-responder
Complete resolution in 47%; 37% improved 16% non-responder
Quantitative morphometry showed decreased Collagen in Bowel Wall
One patient completely rsolved;the other stopped at 38 treatments without improvement
2/3’s patients followed long term were improved or cured; 1/3 failed to improved
Both patients with anorectal ulcers resolved
5 of 5 with rectal bleeding resolved; Statistically significant decrease in late morbidity score
13 of 19 patients had major resolution of symptoms at completion of hyperbaric
KERANGKA TEORI
36
OHBT4
2 3
67 8
1
PENYEMBUHAN LUKA
PERBAIKAN STRUKTUR JARINGAN
AGREGASITROMBOSIT
EPITEL
SEL ENDOTEL
LISISKOLAGEN
SINTESISKOLAGEN
MAKROFAGGRANULOSIT
VASODILATASI
9
5 VASOKO
NTRI
KSI
1
Keterangan :- NOS = Nitric oxide syntethase- Lingkaran – lingkaran kuning menunjukan tempat-tempat kerja OHB
1.Vasokonstriksi.2. Peningkatan kemampuan sel endotel3. Peningkatan VEGF4. Peningkatan reseptor epitel vaskular
5. Pengurangan inflamasi6. Kolagen sintesis.7. Kolagen lisis8. Perbaikan struktur jaringan.9. Penyembuhan luka
METODE DAN ALUR PENELITIAN
03 y
P R S
Kontrol
Eksperimen Eksperimen
01 X 02
04
KeteranganKeterangan PP = Seleksi Pasien Penelitian= Seleksi Pasien Penelitian RR = Randominasi= Randominasi SS = Sampel Penelitian= Sampel Penelitian 0101 = Pretes pok pasien tanpa perlakuan sbg kontrol= Pretes pok pasien tanpa perlakuan sbg kontrol 0202 = Postes pok pasien tanpa perlakuan sbg kontrol= Postes pok pasien tanpa perlakuan sbg kontrol 0303 = Pretes pok pasien dgn perlakuan= Pretes pok pasien dgn perlakuan 0404 = Postes pok pasien dgn perlakuan= Postes pok pasien dgn perlakuan 37
Tabel 7. Variabel penelitian pada pemeriksaan pertama Tabel 7. Variabel penelitian pada pemeriksaan pertama
Data deskriptif variabel penelitian yg akan di analisis dpt dilihat Data deskriptif variabel penelitian yg akan di analisis dpt dilihat pada tabel 7.pada tabel 7.
38
VARIABEL
KELOMPOK
OHBT
RERATA + SD
KONTROL
RERATA + SD
K-1 73,8 ± 6,0 74,6 ± 8,3
Lent-1 7,7 ± 2,0 6,8 ± 2,3
MVD-1 7,8 ± 3,9 9,3 ± 3,4
Keterangan :K ; karnofskyLent : LENT-SOMAMVD : MICRO VASCULER DENSITY
Keterangan :K ; karnofskyLent : LENT-SOMAMVD : MICRO VASCULER DENSITY
Ratio beda pemeriksaan sebelum perlakuan s/d bulan ke-Ratio beda pemeriksaan sebelum perlakuan s/d bulan ke-6 setelah perlakuan yang dinyatakan dalam persen. 6 setelah perlakuan yang dinyatakan dalam persen. Tabel 8.Tabel 8.
39
VARIABELKELOMPOK
OHBT KONTROL
Δ K 2-1 (%) 19,67 ± 9,64
4,53 + 10,74
Δ K 3-1 (%) 15,27 + 14,74 2,47 + 16,11
Δ Lent 1-2 (%) 44,12 + 28,22 0,71 + 30,16
Δ Lent 1-3 (%) 33,64 + 57,64 -19,69 + 69,44
Prevalensi proktitis
6 ( 13% ) 11 ( 23,9% )
Keterangan :ΔK 21 = Perbedaan kualitas hidup seblm perlakuan & segera setelah perlakuanΔK 31 = Perbedaan kualitas hidup seblm perlakuan & bulan ke-6 setelah perlakuanΔLent 12 = Perbedaan efek samping seblm perlakuan & segera setelah perlakuanΔLent 13 = Perbedaan efek samping seblm perlakuan & segera bulan ke-6 setelah
perlakuan)
Keterangan :ΔK 21 = Perbedaan kualitas hidup seblm perlakuan & segera setelah perlakuanΔK 31 = Perbedaan kualitas hidup seblm perlakuan & bulan ke-6 setelah perlakuanΔLent 12 = Perbedaan efek samping seblm perlakuan & segera setelah perlakuanΔLent 13 = Perbedaan efek samping seblm perlakuan & segera bulan ke-6 setelah
perlakuan)
PP
< 0,001< 0,001
0,0070,007
< 0,001< 0,001
0,0080,008
0,0260,026
HUBUNGAN OHBT DGN PREVALENSI PROKTITIS HUBUNGAN OHBT DGN PREVALENSI PROKTITIS RADIASIRADIASI
40
Tabel 9. Hasil analisis statistik chi-square untuk kejadian proktitis radiasi pada kelompok OHBT dan kontrol pada bulan ke-6 perlakuanTabel 9. Hasil analisis statistik chi-square untuk kejadian proktitis radiasi pada kelompok OHBT dan kontrol pada bulan ke-6 perlakuan
KelompokKelompok
Angka Kejadian Angka Kejadian
Proktitis (%)Proktitis (%) TotalTotal PP
YaYa TidakTidak
OHBT (%)OHBT (%)6 (13%)6 (13%) 20 (43,5%)20 (43,5%) 26 26
(56.5%)(56.5%)
0.0260.026Kontrol (%)Kontrol (%)
11 11
(23,9%)(23,9%)
9 (19,6%)9 (19,6%) 20 20
(43,5%)(43,5%)
Total (%)Total (%) 17 (37%)17 (37%) 29 (63%)29 (63%) 46 (100%)46 (100%)
Keterangan :
OHBT = Oksigen Hiperbarik Terapi
Keterangan :
OHBT = Oksigen Hiperbarik Terapi
Ratio beda pemeriksaan sebelum perlakuan dan setelah Ratio beda pemeriksaan sebelum perlakuan dan setelah perlakuan yang dinyatakan dalam prosen. perlakuan yang dinyatakan dalam prosen.
41
VARIABELKELOMPOK
Sebelum OHB
Sesudah OHB
CD 31( 30pasien )
7,83±3,91 10,03±5,29
Keterangan :CD31 =Cluster define 31OHB = Oksigen hiperbarik
Keterangan :CD31 =Cluster define 31OHB = Oksigen hiperbarik
PP
< 0,001< 0,001
Hubungan korelasi efek samping dengan Hubungan korelasi efek samping dengan MVD pada OHBMVD pada OHB
42
Keterangan :
ESA Lent21 = Efek samping akut menurut LENT SOMAsegera setelah perlakuan dibanding sebelum perlakuan
MVD21 = Densitas vaskuler segera setelah perlakuan dibandingsebelum perlakuan
Keterangan :
ESA Lent21 = Efek samping akut menurut LENT SOMAsegera setelah perlakuan dibanding sebelum perlakuan
MVD21 = Densitas vaskuler segera setelah perlakuan dibandingsebelum perlakuan
MeanMean Standar Standar DeviasiDeviasi NN
Korelasi Korelasi PearsonPearson PP
ESAESALent21Lent21
3,53,5 1,81,8 3232
0,550**0,550** 0,0020,002MVD21MVD21 3,53,5 7,37,3 2929
Tabel Korelasi ESA radiasi dengan MVD 12 pada OHBTabel Korelasi ESA radiasi dengan MVD 12 pada OHB
AuthorAuthor Type of Type of ReportReport
AHA AHA GraGradede
NCI NCI GraGradede
Clinical Clinical EvidenEviden
cece
CommentsComments
Marx Marx (1985)(1985)
RCT-74 RCT-74 patientpatient
1B1B 1ii1ii BeneficiBeneficialal
5.4% ORN 5.4% ORN in HBO in HBO GroupGroup
29.9% in 29.9% in non-HBO non-HBO GroupGroup
VudiniabVudiniabola ola (1999)(1999)
Case Case Series-37 Series-37 patientspatients
44 3ii3ii Likely Likely to be to be beneficibeneficialal
1 of 29 HBO 1 of 29 HBO and 7 of 8 and 7 of 8 non-HBO non-HBO developed developed ORNORN
David David (2001)(2001)
Case Case Series-24 Series-24 patientspatients
55 3ii3ii Likely Likely to be to be beneficibeneficialal
1 of 24 1 of 24 developed developed ORNORN
Published Report of Hyperbaric Oxygen for Prevention of Mandibular Necrosis
43
AuthorAuthor Type of Type of ReportReport
AHA AHA GradGrad
ee
NCI NCI GradGrad
ee
Clinical Clinical EvidencEvidenc
ee
CommentsComments
Mounsey Mounsey (1993)(1993)
Case Case Series-Series-41 41 patientspatients
55 3ii3ii Likely to Likely to be be BeneficiaBeneficiall
34 of 41 had 34 of 41 had significant significant improvementimprovement
Van Van MerkesteMerkestey (1995)y (1995)
Case Case Series-Series-29 29 patientspatients
55 3ii3ii Likely to Likely to be be BeneficiaBeneficiall
20 of 29 patients 20 of 29 patients resolvedresolved
Maier Maier (2000)(2000)
Case Case Series-Series-41 41 patientspatients
33 22 NotNot BeneficiaBeneficiall
A negative trial of A negative trial of hyperbaric hyperbaric compared o compared o historic historic controls;13 of 20 controls;13 of 20 HBO resolvedHBO resolved
Curi Curi (2000)(2000)
Case Case Series-Series-18 18 patientspatients
55 3ii3ii Likely to Likely to be be BeneficiaBeneficiall
14 of 18 resolved14 of 18 resolved
David David (2001)(2001)
Case Case Series-Series-51 51 patientspatients
55 3ii3ii Likely to Likely to be be BeneficiaBeneficiall
48 of 51 showed 48 of 51 showed improvementimprovement
Published Report of Hyperbaric Oxygen as Treatment for Mandibular Necrosis
44
Author Type of Report AHA Grad
e
NCI Grad
e
Clinical Evidence
Comments
Neovius (1997)
Case Series-15 patients compared to historical control group
4 3ii Likely to be Beneficial
Healing in 12 of 15 patients; 2 improved; 1 non-healing; compared to 7 of 5 healed in the control group with 1 fatal bleed
Marx (1999)
Prospective controlled but not randomized study of 160 patients
3 2 Likely to be Beneficial
Stat signfcnt reduct in wound infection, dehiscience & delayed healing in HBO group
Filintisis (2000)
Case Series-18 patients with laryngeal necrosis
5 3ii Likely to be Beneficial
13 of 18 had major improvement
Nazrozny (2001)
Case Series-2 patients soft tissue necrosis including larynx and pharynx
5 3ii Likely to be Beneficial
Resolution in both patients
Hyperbaric Oxygen as Treatment for Soft Tissue Radiation Injury of the Head and Neck
45
46
Hyperbaric Oxygen as Treatment Hyperbaric Oxygen as Treatment for Radiation Cystitisfor Radiation Cystitis
AuthorAuthor Type of Type of ReportReport
AHA AHA GradeGrade
NCI NCI GradeGrade
Clinical Clinical EvidenceEvidence
CommentsComments
Bevers Bevers (1995)(1995)
Prspctive Prspctive non-rndmized non-rndmized trial of 40 trial of 40 patientspatients
55 3ii3ii Likely to be Likely to be BeneficialBeneficial
37 of 40 resolved37 of 40 resolved
Del Pizzo Del Pizzo (1998)(1998)
Case Series-Case Series-11 patients11 patients
55 3ii3ii Not Likely Not Likely to be to be BeneficialBeneficial
3 of 11 resolved3 of 11 resolved
Weiss Weiss (1998)(1998)
Case Series-Case Series-29 patients29 patients
55 3ii3ii Likely to be Likely to be BeneficialBeneficial
7 of 10 resolved7 of 10 resolved
Mathews Mathews (1999)(1999)
Case Series-Case Series-17 patients17 patients
55 3ii3ii Likely to be Likely to be BeneficialBeneficial
11 of 17 resolved11 of 17 resolved
Mayer Mayer (2001)(2001)
Case Series-8 Case Series-8 patientspatients
55 3ii3ii Likely to be Likely to be BeneficialBeneficial
6 of 8 resolved6 of 8 resolved
Hendicks Hendicks (2000)(2000)
Case Series-Case Series-20 patients20 patients
55 3ii3ii Likely to be Likely to be BeneficialBeneficial
14 of 20 resolved14 of 20 resolved
47
AuthorAuthor Type of Type of ReportReport
AHA AHA GradeGrade
NCI NCI GradeGrade
Clinical Clinical EvidenceEvidence
CommentsComments
Feldmeier Feldmeier (1995)(1995)
Case Series-23 Case Series-23 patients patients softtissue-15 softtissue-15 bone+soft bone+soft tissue necrosis tissue necrosis of chest wallof chest wall
55 3ii3ii Likely to be Likely to be BeneficialBeneficial
6 of 8 soft tissue 6 of 8 soft tissue resolvedresolved
8 of resolved 15 8 of resolved 15 tissue+bone tissue+bone resolvedresolved
Carl Carl (1998)(1998)
Case Report Case Report Single Positive Single Positive casecase
55 3ii3ii No category No category for single for single case reportcase report
Resolution of breast Resolution of breast edema and painedema and pain
Carl Carl (2001)(2001)
Case Series-44 Case Series-44 patients 32 patients 32 received HBO; received HBO; 12 control12 control
44 22 Likely to be Likely to be BeneficialBeneficial
Statistically significant Statistically significant improvement in pain, improvement in pain, erythema and edema of erythema and edema of breast in HBO group breast in HBO group compared to controlcompared to control
Hyperbaric Oxygen as Treatment for Radiation Injury of the Chest Wall and Breast
48
AuthorAuthor Type of Type of ReportReport
AHA AHA
GradeGrade
NCI NCI
GradeGrade
Clinical Clinical EvidenceEvidence
CommentsComments
Farmer Farmer (1978)(1978)
Single Case Single Case ReportReport
55 3ii3ii UnknownUnknown 1 of 1 failed to 1 of 1 failed to respondrespondEffectivenEffectiven
ess Single ess Single Negative Negative CaseCase
FeldmeiFeldmeier er (2000)(2000)
Case Case Series-17 Series-17 patientspatients
55 3ii3ii Likely to Likely to be be BeneficialBeneficial
11 of 17 11 of 17 resolved; 11 of resolved; 11 of 13 if those lost 13 if those lost to follow up or to follow up or with active with active cancer are cancer are excludedexcluded
Hyperbaric Oxygen as Treatment
for Radiation Injuries of the Extremities