Utilization Review

As in other life-threatening conditions such as e.g. gas gangrene, it is mandatory in intracranial abscesses to apply HBO only in combination with currently accepted standard procedures57'58. Above all, treatment must include appropriate neuro-surgical management (e.g. puncture, drainage, or even resection of the abscess, depending on the individual situation) as well as antibiotics and steroids, and - if needed - standard intensive care treatment in order to stabilize endangered or disturbed vital functions. It has to be emphasized that HBO must not interrupt these intensive care measures, and full intensive care treatment must be continued inside the hyperbaric chamber.

The early administration of HBO is of utmost importance, however. To delay the onset of HBO or to start it as a last-ditch attempt when everything else has failed obscures its true benefit and run the risk of otherwise avoidable and perhaps irreversible secondary brain damage.

Since we consider the infectious component of intracranial abscesses to be of primary importance, we recommend a treatment pressure of 2.5ata, 60 - 90 minutes on oxygen, repeated one or twice daily, depending on the urgency of the situation given. The total number of treatments has to be assessed on an individual basis in accordance to the patient's clinical response and the radiological findings.

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