Methodology For Assessing Hyperbaric Oxygen Therapy In Clinical Practice

Francis Wattel, Daniel Mathieu

Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Calmette, Centre Hospitalier Régional Universitaire, Lille, France

Abstract: HBOT has to compete for credibility and financial support with a number of medical therapies that have already established themselves according to modern evidence-based scientific standards. In order to compete and survive in a climate of cost-containment as well as finding general acceptance and appropriate use in the clinical setting, HBO has to be held to the same standards. This section reviews the methods in which this can be achieved

Keywords: Evidence Based Medicine, Consensus Conference, guidelines, review, cost-effectiveness

In the past Hyperbaric Oxygen Therapy (HBO) has been called a "therapy in search of disease". To change this reputation and define accepted indications, its effectiveness has to be proved as compared with that of alternative procedures and it must be found technically feasible and safe, with the least possible adverse effects. One way of doing this and helping clinicians in treating patients is to consider the best available evidence from experimental and clinical studies based on Evidence based Medicine (EBM), a recent approach for teaching medical practice involving the application of formal rules for assessing medical literature.

In the United States the Undersea and Hyperbaric Medical Society (UHMS) have set up a committee of university experts from a number of medical or surgical fields, all recognized as specialists in hyperbaric or underwater medicine whose task it is to analyze in depth the available literature and draw from this a report on accepted indications for HBO. For each pathology, the indication has to be justified and treatment protocols,

assessment and cost-impact must be considered. The first list of HBO indications was published in 1977 by the UHMS in the form of a report to medical funders. Since then this report has been revised every 3 years - the length of time for which members are elected. The report summarises current scientific and medical progress and provides an analysis according to EBM criteria).

In Europe, the European Committee for Hyperbaric Medicine (ECHM) has chosen to hold international consensus conferences also following EBM methodology. The first took place in Lille, France in 1994. At that time, it was found that not many of the recommendations were supported by a high level of evidence according to the methodology of EBM, but as these recommendations were consensually agreed by a large number of experts, they were regarded as a good starting point for further research and experience. Since then a number of conferences have taken place (cf chapter 1), the last and 7th in Lille in December 2004.

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