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Hyperbaric oxygen therapy, which involves people breathing pure oxygen in a specially designed chamber, for the treatment of multiple sclerosis

Multiple sclerosis (MS) is a chronic disease of the nervous system which affects young and middle‐aged adults. Repeated damage to parts of the nerves leads to progressive weakness and disability. Hyperbaric oxygen therapy (HBOT) involves people breathing pure oxygen in a specially designed chamber (such as used for deep sea divers suffering pressure problems after resurfacing). HBOT is sometimes used for MS in case a lack of oxygen to the affected nerves may be making MS worse, but this theory is unproven. The review of nine trials found no consistent evidence that HOBT can improve disability or modify the progression of MS. There is little need for further research.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Normal pressure oxygen therapy and hyperbaric oxygen therapy for migraine and cluster headaches

Migraine and cluster headaches are severe and disabling. Both hyperbaric oxygen therapy (HBOT) and normal pressure oxygen therapy (NBOT) have been suggested as effective treatments to end acute attacks and prevent future attacks. HBOT involves people breathing pure oxygen in a specially designed chamber. In our review, we found some weak evidence to suggest that HBOT helps people with acute migraine headaches and possibly cluster headaches, and that NBOT may help people with cluster headache. We found no evidence that either can prevent future attacks. Because many migraines can be treated simply with appropriate drug therapy, further research is needed to help choose the most appropriate patients (if any) to receive HBOT.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Little evidence that burns patients benefit from hyperbaric oxygen therapy

Burns are very common, sometimes fatal, and have a high impact on the wellbeing of those affected. Recovery is often slow and complicated by infection and scarring. Hyperbaric oxygen therapy (HBOT) is a treatment designed to increase the supply of oxygen to the burnt area and improve healing. HBOT involves people breathing pure oxygen in a specially designed chamber (such as those used for deep sea divers suffering pressure problems after resurfacing). The review found only two randomised trials, with only a limited number of patients. There was no consistent benefit from HBOT, but one trial did suggest an improvement in healing time. Overall, there is little evidence to support or refute the use of HBOT for burns patients. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Hyperbaric oxygen therapy for vascular dementia

Hyperbaric oxygen therapy (HBOT) has been used to treat a variety of conditions and has shown possible efficacy for treating vascular dementia (VaD) in experimental and preliminary clinical studies. This review included one randomised controlled trial of poor methodological quality involving 64 patients with VaD who were also taking donepezil. Safety assessment was not mentioned at all. Although the authors reported cognitive benefit, this trial alone cannot be taken as evidence of efficacy. Further well‐designed randomised controlled trials are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury

Soft tissue injuries are very common. Hyperbaric oxygen therapy (HBOT) involves people breathing pure oxygen in a specially designed chamber. It is sometimes used to increase the supply of oxygen to the injured area in an attempt to speed recovery. Our review included nine small trials, involving a total of 219 participants. Two trials compared HBOT versus sham therapy on ankle sprain and knee sprain respectively. Neither trial provided sufficient evidence to determine if HBOT helped people with these injuries. The other seven trials examined the effect of HBOT on muscle injury following unaccustomed exercise. There was no evidence that HBOT helped people with muscle injury following unaccustomed exercise, but some evidence that people given HBOT had slightly more pain. Further research on HBOT is not a high priority given the variety of other treatment interventions available.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Hyperbaric oxygen therapy for acute surgical and traumatic wounds

Acute surgical and traumatic wounds occur as a result of a trauma or surgical procedures and whilst many heal uneventfully, sometimes poor local blood supply, infection, damage to the blood vessels, or a combination of factors result in these acute wounds taking longer to heal. Hyperbaric oxygen therapy (HBOT), which involves placing the person in an airtight chamber and administering 100% oxygen at a pressure greater than 1 atmosphere, is sometimes used with the aim of speeding wound healing. The aim is to bathe all fluids, tissues and cells of the body in a high concentration of oxygen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Hyperbaric oxygen therapy (HBOT) for the treatment of the late effects of radiotherapy

There is a risk of serious complications developing after radiation treatment for cancer (late radiation tissue injury (LRTI). HBOT involves breathing oxygen in a specially designed chamber. It is used as a treatment to improve oxygen supply to damaged tissue and stimulate healing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

High pressure (hyperbaric) oxygen therapy for Bell's palsy

Bell's palsy is a weakness of one side of the face that is diagnosed after other causes of facial weakness have been ruled out. It is a 'diagnosis of exclusion'. Bell's palsy may be caused by a virus affecting the facial nerve. Standard treatment includes steroids to help settle swelling of the facial nerve, whereas antiviral treatment does not appear to help. In hyperbaric oxygen therapy, the person undergoing treatment breathes 100% oxygen in a pressurised chamber for about one hour (called a 'dive'). This may produce more dissolved oxygen in the facial nerve and might reduce nerve damage in Bell's palsy. We searched for evidence from randomised controlled trials on hyperbaric oxygen therapy in adults with moderate to severe Bell's palsy. Our searches revealed no trials that met the inclusion criteria for the review. We found very low quality evidence from one trial to suggest that hyperbaric oxygen therapy might be beneficial for moderate to severe Bell's palsy. The trial involved 79 participants and compared hyperbaric oxygen therapy to prednisone, a corticosteroid, which is a proven active treatment. The participants did not know which treatment they were being given. Those treated with hyperbaric oxygen recovered more quickly and recovered normal facial movement more often (95% versus 76%). All participants tolerated the treatment well, and there were no major complications. The quality of evidence from this trial was very low because the assessors of facial function were aware of which treatment each participant had been given, which introduces a high risk of bias. There is therefore no high quality evidence on which to base conclusions about the efficacy of hyperbaric oxygen therapy in Bell's palsy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants

This review, carried out by authors of the Cochrane Oral Health Group, was produced to compare the success of dental implant treatment carried out with and without hyperbaric oxygen therapy (HBO) in patients who had previously had radiation treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Hyperbaric oxygen therapy for treating people with acute ischaemic stroke

We wanted to compare the safety and effectiveness of hyperbaric oxygen therapy (HBOT) versus no HBOT (either no treatment or an ineffective intervention designed to mimic the true treatment) for treating people who had suffered an acute ischaemic stroke.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Hyperbaric oxygen therapy for treating chronic wounds

Chronic wounds are wounds that take a long time to heal, do not heal, or recur; these wounds are often ulcers associated with diabetes or arterial or venous disease (poor blood circulation). One characteristic of chronic wounds is that the wound tissues are hypoxic (have low oxygen levels). Chronic wounds are commonly occurring and reduce the quality of life of those affected.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Does hyperbaric oxygen therapy improve the survival and quality of life in patients with traumatic brain injury?

Traumatic brain injury is a major cause of death and disability. Not all damage to the brain occurs at the moment of injury; a reduction of the blood flow and oxygen supply to the brain can occur afterwards and cause further secondary brain damage that is itself an important cause of avoidable death and disability. In the early stages after injury, it is therefore important that efforts are made to minimise secondary brain damage to provide the best chances of recovery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Hyperbaric oxygen as an additional treatment for malignant otitis externa

Malignant otitis externa is an uncommon, although potentially fatal, infection of the external ear canal including the surrounding soft tissue and bone. It is mainly found in the elderly or diabetics. Treatments include antibiotics, stringent diabetes control, the repeated removal of dead tissue and surgical management. Hyperbaric oxygen therapy is increasingly being used in addition to these treatments where facilities exist. Hyperbaric oxygen treatment involves placing the patient in a compression chamber, increasing the environmental pressure within the chamber and administering 100% oxygen for respiration.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Hyperbaric oxygen may reduce the risk of dying, the time to pain relief and the chance of adverse heart events in people with heart attack and unstable angina

Acute heart attacks associated with coronary artery disease are collectively referred to as 'acute coronary syndrome' (ACS). ACS is very common and may lead to severe complications including death. Hyperbaric oxygen therapy (HBOT) involves people breathing pure oxygen at high pressures in a specially designed chamber. It is sometimes used as a treatment to increase the supply of oxygen to the damaged heart in an attempt to reduce the area of the heart that is at risk of dying. We first searched the literature in 2004 and most recently in June 2010, finding one further study. Overall,we found some evidence that people with ACS are less likely to die or to have major adverse cardiac events, and to have more rapid relief from their pain, if they receive hyperbaric oxygen therapy as part of their treatment. However, our conclusions are based on six relatively small randomised trials (five of which included only patients with confirmed heart muscle death). While HBOT may therefore reduce the risk of dying, time to pain relief and the chance of adverse heart events in people with heart attack and unstable angina, more work is still needed to be sure that HBOT should be recommended.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Hyperbaric oxygen for sudden hearing loss and tinnitus (ringing in the ears) of unknown cause

Idiopathic sudden sensorineural hearing loss (ISSHL) is common and often results in permanent hearing loss. It therefore has a high impact on the well‐being of those affected. Tinnitus (abnormal persistent noises or ringing in the ear) is similarly common and often accompanies the hearing loss. Although the cause of these complaints is not clear, they may be related to a lack of oxygen secondary to a vascular problem not yet identified. Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a specially designed chamber and it is sometimes used as a treatment to increase the supply of oxygen to the ear and brain in an attempt to reduce the severity of hearing loss and tinnitus.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Using oxygen at high pressure (in a compression chamber) for the treatment of broken bones

Broken bones (fractures) are very common and sometimes may take a long time to heal or in some cases may fail to heal. The resulting non‐union can result in long‐term pain and loss of function. The use of hyperbaric oxygen therapy (HBOT) has been suggested as a way to enhance healing and treat non‐union. Hyperbaric oxygen therapy involves the delivery of oxygen at high pressure to patients in a specially designed chamber (like those used for deep sea divers suffering pressure problems after resurfacing). The aim is to increase the supply of oxygen to the fracture site, which theoretically should improve healing. It should be noted that hyperbaric oxygen therapy may, albeit rarely, result in serious long‐term adverse effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

High pressure oxygen breathing during radiotherapy for cancer treatment

Breathing oxygen while at raised pressure in a closed chamber (hyperbaric oxygen or HBO) may increase the effectiveness of radiotherapy and thus improve mortality and reduce tumour regrowth. We found some evidence that people with head and neck cancer are less likely to die within five years if they are treated this way, and evidence that regrowth of tumour at the original site is less likely for head and neck, and cervical cancer. However, Hyperbaric oxygen therapy (HBOT) may only be effective when radiotherapy is given in an unusually small number of sessions, each with a relatively high dose. HBOT does not appear to work for other cancers studied. Our conclusions are based on 19 randomised trials with over 2000 patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

There is insufficient evidence to support the use of hyperbaric oxygen for treatment of patients with carbon monoxide poisoning

Many people are poisoned by carbon monoxide gas each year, either intentionally (e.g. in suicide attempts) or by accident. Carbon monoxide interferes with oxygen transport in the body, and can also directly damage a variety of organs including the brain. The usual treatment involves removing the affected person from the source of the gas, general supportive care, and administering oxygen which hastens the elimination of carbon monoxide from the body. High pressure oxygen (hyperbaric oxygen) is only available at a few hospitals, and it is sometimes used to speed this process even further. However, the review of published trials found conflicting, potentially biased, and generally weak evidence regarding the usefulness of hyperbaric oxygen for the prevention of neurological injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Recompression therapy and adjunctive drug therapy for decompression illness (the bends)

Decompression illness (DCI) is due to the presence of bubbles in the tissues or blood vessels following the reduction of surrounding pressure (decompression). It is most commonly associated with breathing compressed gas while diving underwater. The effects of DCI may vary from the trivial to life‐threatening and treatment is usually administered urgently. Recompression is applied while breathing 100% oxygen or a mixture of oxygen and helium (heliox), based on the reduction in bubble size with pressure and more rapid elimination of nitrogen from the bubbles when breathing nitrogen poor mixtures. Recovery without recompression can be slow and incomplete and DCI is responsible for significant health problems in geographical areas where recompression is unavailable. Recompression with 100% oxygen has become universally accepted as the appropriate therapy despite the lack of high quality clinical evidence of effectiveness. This review found only two randomized trials enrolling a total of 268 patients. One trial compared standard oxygen recompression to helium and oxygen recompression, while the other compared oxygen recompression alone to recompression and an adjunctive non‐steroidal anti‐inflammatory drug (NSAID). Both trials suggested that these additional interventions may shorten the course of recompression required. For example, the use of an NSAID reduced the median number of recompression sessions required from three to two. We conclude that there is little evidence for using one recompression strategy over another in the treatment of decompression illness and that the addition of an anti‐inflammatory drug may shorten the course of recompression required. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Chronic radiation proctitis (rectal inflammation) affects a small but notable proportion of patients who undergo pelvic radiotherapy

The aim of this review was to identify the interventions used in the treatment of late radiation proctitis and evaluate the evidence. We have demonstrated that although there are a number of randomised controlled trials (RCTs) in this field, they address quite diverse interventions. Although these studies can be assessed individually, this data cannot be used to compare the efficacy of different treatments.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

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