Research

During recent decades, many studies have been carried out both on professional and recreational diving medicine. Oil exploitation in the North Sea has provided a stimulus to teams working in Aberdeen, NUTEC scientists in Trondheim and COMEX in Marseille. The world-wide development of recreational diving has generated an increase in the number of studies on diving capacities and therapy procedures for decompression accidents. In the meantime, there has been an increase in the number of fundamental and clinical studies, wherever possible prospective, controlled and multi-centre.

In 2001, updating the report J. Schmutz presented at the First Consensus Conference in Lille in 1994, D. Mathieu drew up a status report of research, by analyzing the Medline database for the years between 1996 and 2000. He reported that the mean annual number of publications remained constant, research teams were few, but their number remained the same; that there was a large proportion of experimental studies, but this was decreasing; and that there was a great increase in clinical research. He also noted the appearance of prospective, randomized, controlled and in some cases double-blind studies.

Comparing the type of publications referenced in the Medline database between 1996 and 2000 in the fields of Hyperbaric Medicine, Intensive Care and Surgery produced the following results: the number of publications varied between 1 and 20 with regard to Intensive Care, and between 1 and 300 with regard to Surgery. Clinical studies were about the same in the three fields; but the proportion of prospective randomized controlled studies, equal in Hyperbaric Medicine and Intensive Care, was half that amount in Surgery.

This leads us to the conclusion that hyperbaric physicians are developing high quality and pertinent clinical research.

As for research networks, it is to be noted that many studies are carried out by local teams in temporary collaboration with local laboratories. This explains why experimental studies are a majority; but it is in itself a handicap for clinical research because each centre will have only a few cases of the rarer diseases. The answer to this problem is the development of multi-centre research networks.

Still, the experimental research performed in the last few years has provided an understanding of the mechanical effects of HBO, offering new perspectives. These concern the ischemia-reperfusion phenomenon, and the effects of HBO on the leukocyte/endothelium interaction, inflammatory reactions, defence mechanisms against oxidization and apoptosis, as well as the impact of HBO on auto-immune diseases.

The Action B14 of the COST programme is an appropriate vehicle to promote clinical research in Hyperbaric Medicine. Launched in 1998, it involves 18 European countries. Its activities are based on working groups guided by a steering committee, led by D. Mathieu. Among other projects, methodology guidelines for research and a code of good practice for Hyperbaric Medicine have been developed. Various clinical research protocols involving multiple centres have been defined and initiated: sudden deafness, femoral head necrosis, diabetic foot lesions, glioblastoma radiosensitivity, bone regeneration in irradiated bones. A website "Oxynet" ensures coordination (www.oxynet.org).

3. CONCLUSION

On June 19th, 1997 a first careful attempt was done to compare the European Committee indications with those of the HBO Committee of the UHMS. Not only indications were discussed but also recommended protocols, pressures and threshold treatment levels. The conclusion was that similarities were far greater than differences, and that in the future the two tables should be harmonized. Conditions not on both lists were to be evaluated to resolve differences as soon as possible. It was also planned to include the levels of recommendation for the ECHM indications as in the HBO Therapy UHMS Committee Report. A joint meeting took place during the Annual Meeting of the UHMS in Sydney in 2004; but a lot more work is required, involving both the UHMS Committee and the ECHM .

At the beginning of the 3rd millennium, Hyperbaric Medicine appears to be a grown-up field of medicine world-wide with its own approved and accepted methods of evaluation of the efficacy and cost-effectiveness of therapy following EBM methods. For Hyperbaric Medicine to gain complete recognition as such, ethical and ecological considerations must be paramount in clinical practice, research and training. For this, imagination and creativity are more than ever a necessity.

PART I

PHYSICAL AND PATHOPHYSIOLOGICAL BASES OF HYPERBARIC OXYGEN THERAPY

Editors: B. Ratzenhofer-Komenda, J. Niinikoski, M. Hamilton-Farell

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