Pengobatan Hiperbarik Oksigen dibidang klinik

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


SP SP

BB

STRESSORSTRESSOROHBOHB

CD8+CD8+TCRTCR

MHCMHCII

APCAPC

IFN Ƴ

IgGIgG

IL 10

+

+

+ +

+

-

-

APCAPC

MHCMHCIIII

OHB & IMMUNOHUMORALOHB & IMMUNOHUMORAL

CD4+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



Animal study

Case Series-2 patients



Case series – 10patients

Case series- 19 patients

3ii

3ii

Not clinical

3ii

3ii

3ii

3ii

3ii



Not clinical but positive study






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)


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


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)



20 of 29 patients 20 of 29 patients resolvedresolved

Maier Maier (2000)(2000)


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)



14 of 18 resolved14 of 18 resolved

David David (2001)(2001)



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


13 of 18 had major improvement

Nazrozny (2001)

Case Series-2 patients soft tissue necrosis including larynx and pharynx


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


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


Del Pizzo Del Pizzo (1998)(1998)

Case Series-Case Series-11 patients11 patients

55 3ii3ii Not Likely Not Likely to be to be BeneficialBeneficial


Weiss Weiss (1998)(1998)




Mathews Mathews (1999)(1999)




Mayer Mayer (2001)(2001)

Case Series-8 Case Series-8 patientspatients



Hendicks Hendicks (2000)(2000)




47


AHA AHA GradeGrade

NCI NCI GradeGrade


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


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


AHA AHA

GradeGrade

NCI NCI

GradeGrade


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)


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

Pengobatan Hiperbarik Oksigen dibidang klinik

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