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Hyperbaric oxygen therapy (HBOT) is the medical use of oxygen at a higher than atmospheric pressure. Image File history File links Information. ... Image File history File links Broom_icon. ... General Name, Symbol, Number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Standard atomic weight 15. ... Diurnal (daily) rhythm of air pressure in northern Germany (black curve is air pressure) Atmospheric pressure is the pressure at any point in the Earths atmosphere. ...

Uses

Several therapeutic principles are made use of in HBOT:

• The increased overall pressure is of therapeutic value when HBOT is used in the treatment of decompression sickness and air embolism.
• For many other conditions, the therapeutic principle of HBOT lies in a drastically increased partial pressure of oxygen in the tissues of the body. The oxygen partial pressures achievable under HBOT are much higher than those under breathing pure oxygen at normobaric conditions (i.e. at normal atmospheric pressure).
• A related effect is the increased oxygen transport capacity of the blood. Under atmospheric pressure, oxygen transport is limited by the oxygen binding capacity of hemoglobin in red blood cells and very little oxygen is transported by blood plasma. Because the hemoglobin of the red blood cells is almost saturated with oxygen under atmospheric pressure, this route of transport can not be exploited any further. Oxygen transport by plasma, however is significantly increased under HBOT.

The United States Food and Drug Administration-approved diagnoses for application of HBOT are: The use of water pressure - the Captain Cook Memorial Jet in Lake Burley Griffin in Canberra, Australia. ... Decompression sickness (DCS), the diver’s disease, the bends, or caisson disease is the name given to a variety of symptoms suffered by a person exposed to a reduction in the pressure surrounding their body. ... In a mixture of ideal gases, each gas has a partial pressure which is the pressure which the gas would have if it alone occupied the volume. ... Human red blood cells Red blood cells are the most common type of blood cell and the vertebrate bodys principal means of delivering oxygen from the lungs or gills to body tissues via the blood. ... Blood plasma is the liquid component of blood, in which the blood cells are suspended. ... Structure of hemoglobin. ... hi “FDA” redirects here. ...

• Certain non-healing wounds (post-surgical or diabetic)
• Radiation soft tissue necrosis and radiation osteonecrosis
• Necrotizing fasciitis (flesh eating bacteria)
• Carbon monoxide poisoning
• Decompression sickness
• Acute arterial ischemia (crush injury, compartment syndrome, etc.)
• Compromised skin grafts or flaps
• Severe infection by anaerobic bacteria (such as gas gangrene)
• Air or gas embolism
• Severe uncorrected anemia when blood transfusion is not available (e.g., in a Jehovah's Witness)
• Chronic refractory Osteomyelitis
• Some sports injuries

HBOT is recognized by Medicare in the United States as a reimbursable treatment for 14 conditions based primarily on double-blind controlled studies that have been published in peer-reviewed journals. However, HBOT has historically been associated with significant politics involved among physicians, insurance and pharmaceutical companies, primarily due to the fact that oxygen is not patentable and does not have the commercial or political advocacy of other therapies. Both sides of the controversy on the effectiveness of HBOT is available in the form of PUBMED and the Cochrane reviews (example: http://www.cochrane.org/reviews/en/ab004954.html) and a discussion of "Medical Polemics" http://www.drcranton.com/hbo/widelyaccepted.htm, a discussion of Multiple Sclerosis in particular http://drcranton.com/tmp/MS_and_Medical_Politics.htm Diabetic foot is an umbrella term for foot problems in patients with diabetes mellitus. ... Necrotizing fasciitis or fasciitis necroticans, commonly known as flesh-eating bacteria, is a rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue. ... Carbon monoxide poisoning occurs after the inhalation of carbon monoxide gas. ... Decompression sickness (DCS), the diver’s disease, the bends, or caisson disease is the name given to a variety of symptoms suffered by a person exposed to a reduction in the pressure surrounding their body. ... Aerobic and anaerobic bacteria can be identified by growning them in liquid culture: 1: Obligate aerobic bacteria gather at the top of the test tube in order to absorb maximal amount of oxygen. ... Gas gangrene is a bacterial infection that produces gas within tissues in gangrene. ... Description An air embolism, or more generally gas embolism, is a medical condition caused by gas bubbles in the bloodstream. ... Anemia (AmE) or anæmia (BrE), from the Greek () meaning without blood, is a deficiency of red blood cells (RBCs) and/or hemoglobin. ... Osteomyelitis is an infection of bone, usually caused by pyogenic bacteria or mycobacteria. ... President Johnson signing the Medicare amendment. ...

HBOT is expensive, with a session costing anywhere from $100 to $200 in private clinics to over $2,000 in hospitals in the United States.

In the United Kingdom most chambers are financed by the National Health Service but there are non-profit HBOT chambers, such as those run by Multiple Sclerosis Therapy Centres. , the information in this article describes the current English public health service. ...

The traditional chamber

Recompression chamber

The traditional type of hyperbaric chamber used for HBOT is a hard shelled pressure vessel. Such chambers can be run at absolute pressures up to 600 kilopascals or 85 PSI (lbf/in²), nearly six atmospheres. Image File history File linksMetadata Download high-resolution version (3753x2601, 4778 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Hyperbaric oxygen therapy Metadata This file contains additional information, probably added from the digital camera or scanner used... Image File history File linksMetadata Download high-resolution version (3753x2601, 4778 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Hyperbaric oxygen therapy Metadata This file contains additional information, probably added from the digital camera or scanner used... Hyperbaric oxygen therapy (HBOT) is the medical use of oxygen at a higher than atmospheric pressure. ... Steel Pressure Vessel A pressure vessel is a closed, rigid container designed to hold gases or liquids at a pressure different from the ambient pressure. ... The pascal (symbol Pa) is the SI unit of pressure. ... A pressure gauge reading in PSI (red scale) and kPa (black scale) The pound-force per square inch (symbol: lbf/in²) is a non-SI unit of pressure based on avoirdupois units. ... Standard atmosphere (symbol: atm) is a unit of pressure. ...

Navies, diving organizations and hospitals typically operate these. They range in size from those which are portable and capable of transporting just one patient to those which are fixed, very heavy and capable of treating eight or more patients.

The chamber may consist of:

• a pressure vessel that is generally made of steel and aluminium with the view ports (windows) or hull made of acrylic.
• one or more human entry hatches—these could be small and circular or wheel-in type hatches for patients on trolleys
• an airlock allowing human entry—a separate chamber with two hatches, one to the outside world and one to the main chamber, which can be independently pressurized to allow patients to enter or exit the main chamber while it is still pressurized
• an airlock allowing medicines, instruments and food to enter the main chamber
• glass ports or closed-circuit television allowing the technicians and medical staff outside the chamber to monitor the inside of the chamber
• an intercom allowing two-way communications inside and outside the chamber
• a carbon dioxide scrubber—consisting of a fan that passes the gas inside the chamber through a soda lime canister
• a control panel outside the chamber is used to open and close valves allowing air to enter or leave the chamber and oxygen to be supplied to masks

In larger "multiplace" chambers, both patients and medical staff inside the chamber breathe from individual oxygen masks, which supply pure oxygen and remove the exhaled gas from the chamber. During treatment patients breathe oxygen most of the time but have periodic air breaks to minimize the risk of oxygen toxicity. The exhaled gas must be removed from the chamber to prevent the build up of oxygen, which could provoke a fire. Medical staff may also breathe oxygen to reduce the risk of decompression sickness. The oxygen masks that are used may simply cover the mouth and nose or they may be a type of flexible, transparent helmet with a seal around the neck. The pressure inside the chamber is increased by opening valves allowing high-pressure air to enter from storage cylinders, similar to diving cylinders. A gas compressor is used to fill these cylinders. The steel cable of a colliery winding tower. ... General Name, Symbol, Number aluminium, Al, 13 Chemical series poor metals Group, Period, Block 13, 3, p Appearance silvery Standard atomic weight 26. ... Polymethyl methacrylate (PMMA) or poly (methyl 2-methylpropenoate) is the synthetic polymer of methyl methacrylate. ... An airlock is a device which permits the passage of objects, people, and the like, between a pressure vessel and its surrounding space while minimizing the change of pressure—and loss of air—in the vessel. ... Intercom system in the Pittock Mansion An intercom is an electronic communications system within a building or group of buildings. ... In order to meet Wikipedias quality standards, this article requires cleanup. ... // Soda lime is a mixture of chemicals, used in granular form in closed breathing environments, such as general anaesthesia, submarines, rebreathers and recompression chambers, to remove carbon dioxide from breathing gases to prevent CO2 retention and carbon dioxide poisoning. ... These water valves are regulated by handles. ... Look up air in Wiktionary, the free dictionary. ... Breathing 100% oxygen from a tight fitting pressure demand oxygen mask An oxygen mask provides a method to transfer breathing oxygen gas from a storage tank to the lungs. ... Oxygen toxicity or oxygen toxicity syndrome is severe hyperoxia caused by breathing oxygen at elevated partial pressures. ... 12 litre and 3 litre steel diving cylinders A diving cylinder, scuba tank or diving tank is used to store and transport high pressure breathing gas as a component of an Aqua-Lung. ... A gas compressor is a mechanical device that increases the pressure of a gas by reducing its volume. ...

A recompression chamber for a single diving casualty

Smaller "monoplace" chambers can only accommodate the patient. No medical staff can enter. The chamber is flooded with pure oxygen and the patient does not wear an oxygen mask or helmet. Sometimes, a mask or SCUBA-like apparatus is available to provide the patient with "air breaks," periods of breathing normal air, in order to reduce the risk of hyperoxic seizures. Hyperbaric Oxygen Therapy chamber for a single diving casualty I took this photo myself This image has been released into the public domain by the copyright holder, its copyright has expired, or it is ineligible for copyright. ... Hyperbaric Oxygen Therapy chamber for a single diving casualty I took this photo myself This image has been released into the public domain by the copyright holder, its copyright has expired, or it is ineligible for copyright. ...

Patients inside the chamber will notice discomfort inside their ears as a pressure difference develops between their middle ear and the chamber atmosphere. This can be relieved by the Valsalva maneuver or by "jaw wiggling". As the pressure increases further, mist may form in the air inside the chamber and the air may become warm. When the patient speaks, the pitch of the voice may increase to the level that they sound like cartoon characters. The ear is the sense organ that detects sounds. ... In medicine, the Valsalva maneuver is performed by forcibly exhaling against closed lips and pinched nose, forcing air into the middle ear if the Eustachian tube is open. ... Dramatic morning mist Mist is a phenomenon of a liquid in small droplets floating through air. ... Pitch is the perceived fundamental frequency of a sound. ... The human voice consists of sound made by a human using the vocal folds for talking, singing, laughing, crying and screaming. ... A cartoon is any of several forms of illustrations with varied meanings that evolved from its original meaning. ...

To reduce the pressure, a valve is opened to allow gas out of the chamber. As the pressure falls, the patient’s ears may "squeak" as the pressure inside the ear equalizes with the chamber. The temperature in the chamber will fall.

Chambers for home treatment

There are portable HBOT chambers, which are used for home treatment. These are usually referred to as "mild chambers", which is a reference to the lower pressure of soft-sided chambers. Those commercially available in the USA go up to 4.1 PSI (about 28.268 kPa) overpressure which is equivalent to a water depth of 11 ft. These chambers are operated with oxygen concentrators or with 100% oxygen as the breathing gas.

Historical link to diving

Initially, HBOT was developed as a treatment for diving disorders involving bubbles of gas in the tissues, such as decompression sickness and gas embolism. The chamber cures decompression sickness and gas embolism by increasing pressure, which reduces the size of the gas bubbles to improve the transport of blood to tissues downstream of the bubbles. Also, the high concentrations of oxygen breathed by the casualty are beneficial in keeping oxygen-starved tissues alive, and the high concentrations of oxygen in the tissues have the effect of removing the nitrogen from the bubble making it smaller until it consists only of oxygen which is re-absorbed into the body Divers face specific physical and health risks when they go underwater (e. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... General Name, Symbol, Number nitrogen, N, 7 Chemical series nonmetals Group, Period, Block 15, 2, p Appearance colorless gas Standard atomic weight 14. ...

Bubbles are eventually eliminated by long exposure to pressure and high oxygen concentrations, allowing a gradual reduction of pressure back to atmospheric levels.

Treatments

The slang term for a cycle of pressurization inside the HBOT chamber is "a dive". Slang is the use of highly informal words and expressions that are not considered standard in the speakers dialect or language. ...

Emergency HBOT for diving disorders typically follows one of two forms. For most cases, a shallow "dive" to a pressure the equivalent of 18 meters / 60 feet of water for 3 to 4.5 hours with the casualty breathing pure oxygen with air breaks every 20 minutes to reduce oxygen toxicity. For extremely serious cases, a deeper "dive" to a pressure the equivalent of 37 meters / 122 feet of water for 4.5 hours with the casualty breathing air.

In Canada and the United States, the U.S. Navy Dive Charts are used to determine the duration, pressure and breathing gas of the therapy. The most frequently used tables are Table 5 and Table 6. In the UK the Royal Navy 62 and 67 tables are used. USN redirects here. ... Air is the most common and only natural breathing gas. ... The Royal Navy of the United Kingdom is the oldest of the British armed services (and is therefore the Senior Service). ...

An HBOT treatment for longer-term conditions is often a series of 20 to 40 "dives".

The Undersea and Hyperbaric Medical Society (UHMS) publishes a "Committee Report" which compiles the latest research findings and contains information regarding the recommended duration and pressure of the longer-term conditions. Historically, the UHMS has been biased against using HBOT for treating brain injuries even though Decompression Sickness, Air Embolism, Cranioradionecrosis, Carbon Monoxide Poisoning and Intracranial Abscess are all brain injuries.

Complications

There are risks associated with HBOT, similar to some diving disorders.^{[citation needed]} Pressure changes can cause a "squeeze" or barotrauma in the tissues surrounding trapped air inside the body, such as the lungs, behind the eardrum, inside paranasal sinuses, or even trapped underneath dental fillings.^{[citation needed]} Also, breathing high-pressure oxygen for long periods can cause oxygen toxicity. One of the side effects of oxygen toxicity is a seizure. ^{[citation needed]}Vision changes (myopia or nearsightedness) caused by swelling of the lens, but this is more a temporary side-effect than a complication and usually resolves in two to four weeks following completion of HBOT.^{[citation needed]} Barotrauma is physical damage to body tissues caused by a difference in pressure between an air space inside or beside the body and the surrounding gas or liquid. ... Human respiratory system The lungs flank the heart and great vessels in the chest cavity. ... The tympanic membrane, colloquially known as the eardrum, is a thin membrane that separates the external ear from the middle ear. ... This article does not cite any references or sources. ... Dental fillings are inserted as restorations in the treatment of dental cavities, after drilling out the cavities. ... This article is about the medical term, epileptic seizure, as distinct from a non-epileptic seizure. ... Normal vision. ... Light from a single point of a distant object and light from a single point of a near object being brought to a focus by changing the curvature of the lens. ...

The only absolute contraindication to hyperbaric oxygen therapy is untreated pneumothorax.^{[citation needed]} Relative complications include grand mal seizure, fever, the inability to clear the ears or sinuses, and the use of certain chemotherapy agents.^{[citation needed]} In medicine, a contraindication is a condition or factor that increases the risk involved in using a particular drug, carrying out a medical procedure or engaging in a particular activity. ... Left-sided pneumothorax (on the right side of the image) on CT scan of the chest. ... This article is about the medical term, epileptic seizure, as distinct from psychogenic non-epileptic seizure. ... Chemotherapy is the use of chemical substances to treat disease. ...

There are reports that cataract may progress following HBOT.^{[citation needed]} Also a rare side effect has been blindness secondary to optic neuritis(inflammation of the optic nerve).^{[citation needed]}

Neuro-rehabilitation for Brain Injury, Cerebral Palsy & MS

The Collet (Quebec) trial [1] that was published in the Lancet in 2001, and was the largest randomized trial of Hyperbaric Oxygen Therapy (HBOT) for children with cerebral palsy (CP) and it followed the McGill pilot study on the same subject [2].

The evidence showed that both groups of children treated with two very different hyperbaric treatment dosages improved significantly. The motor improvements that were seen and measured with the G.M.F.M.[3] were greater; more generalized, and were obtained in a shorter period of time than most of the changes found in any other studies of recognized conventional therapies in the treatment of children with cerebral palsy [4-17]. The children in both groups improved an average of ten times more during the two months of HBO (whilst all other therapies and medication were stopped) than during the three months follow-up (when medication and all the ancillary treatments were restarted). This impressive change in the rate of improvements clearly indicates the probable effectiveness of hyperbaric treatment. The Lancet commentary [19] and even the flawed tech report by the Agency for Healthcare Research and Quality (AHRQ) [20] concluded that the hypothesis of both treatments being equally effective should be retained, possibly as the main hypothesis.

As an aside, the 2003 AHRQ report, guided by its UHMS handlers, attempted to put their stamp of disapproval on using hyperbaric oxygen for neuro-rehabilitation in children, but their methodology was widely criticized. The Oregon Health Sciences Center for Evidence Based Medicine ended up reviewing the literature with a rigid and unorthodox scoring system on a 3 point scale: good, fair, poor, a methodology so simplistically and unusual that when one of their own consultants sent them a random sampling of all of the controlled studies from three of the latest issues of each of the New England Journal of Medicine, JAMA, and the British Medical Journal, 14 of the 22 articles completely failed their criteria.

Since the Quebec study of HBOT for children with CP, many reports [21-22] have been made on the possible efficacy of a low pressure hyperbaric treatment and all the trials [23-31] conducted with HBOT in CP have demonstrated positive results.

The below references are a reflection of some of the literature in this area:

• Hardy P, Johnston KM, Beaumont LD, Montgomery DL, Lecomte JM, Soucy JP, Bourbonnais D, Lassonde M. Pilot case study of the therapeutic potential of hyperbaric oxygen therapy on chronic brain injury. J Neurol Sci 2007;253(1-2):94-105.

• Holbach K. H., Wassmann H., Kolberg T. Improved reversibility of the traumatic midbrain syndrome using hyperbaric oxygen. Acta Neurochir (Wien) 1974; 30(3-4): 247-256.

• Neubauer R. A., Gottlieb S. F., Miale A. Identification of hypometabolic areas in the brain using brain imaging and hyperbaric oxygen. Clin Nucl Med 1992; 17(6): 477-481.

• Neubauer R. A., James P. Cerebral oxygenation and the recoverable brain. Neurol Res 1998; 20 Suppl 1: S33-S36.

• Rockswold G. L., Ford S. E., Anderson D. C., Bergman T. A., Sherman R. E. Results of a prospective randomized trial for the treatment of severely brain-injured patients with hyperbaric oxygen. J Neurosurg 1992; 76(6): 929-934.

• Sheffield PJ, Davis JC. Application of hyperbaric oxygen therapy in a case of prolonged cerebral hypoxia following rapid decompression. Aviat Space Environ Med 1976;47(7):759-62.

• Vlodavsky E, Palzur E, Soustiel JF. Hyperbaric oxygen therapy reduces neuroinflammation and expression of matrix meralloproteinase-9 in the rat model of traumatic brain injury. Neuropathol Appl Neurobiol 2006;32(1):40-50.

• Waalkes P, Fitzpatrick DT, Stankus S, Topolski R. Adjunctive HBO treatment of children with cerebral anoxic injury. Army Medical Department Journal 2002;April-June:13-21.

• Lou M, Chen Y, Ding M, Eschenfelder CC, Deuschl G. Involvement of the mitochondrial ATP-sensitive potassium channel in the neuroprotective effect of hyperbaric oxygenation after cerebral ischemia. Brain Res Bull 2006;69(2):109-16.

• Nighoghossian N., Trouillas P., Adeleine P., Salord F. Hyperbaric oxygen in the treatment of acute ischemic stroke. Stroke 1995; 26: 1369-1372.

• SHI Xiao-yan, TANG Zhong-quan, SUN Da and HE Xiao-jun. Evaluation of hyperbaric oxygen treatment of neuropsychiatric disorders following traumatic brain injury. Chin Med J 2006;119(23):1978-1982.

Middle ear barotrauma (MEBT) is always a consideration in treating both children and adults in a hyperbaric environment, but most children currently being treated with HBOT for autism are being pressurized to 1.3 ATA which greatly reduces the risks of potential side effects of any kind.

The senior clinicians who ran the Quebec/McGill trials (co-authors on the Collet’s Lancet article), Pierre Marois, MD., FRCP, a physiatrist, and Michel Vanasse, MD., FRCP, a neurologist, were responsible for more than 4,500 pressurizations during the course of these studies and have followed 40,000 other HBO treatments given to children with CP that they follow regularly. Only a few children have been referred for myringotomy because of a MEBT, and no complication or permanent injury has ever been observed.

These clinicians have always stated that in the vast majority of cases, children with CP can undertake HBOT without significant complications and in most cases it will improve their quality of life and that of their families.

Even the misleading article of Muller-Bolla [32] states that: “This study shows that exposure to low hyperbaric pressure is associated with minor signs of barotrauma compared to very low exposure. All other side effects were rare and similar in both groups” (referring to the children who participated in the Quebec study)

Several studies in the literature show that markers of hypoxia in the autistic brain are higher than in control brains:

• Fatemi, S.H., A.R. Halt, 2001. Altered levels of Bcl2 and p53 proteins in parietal cortex reflect deranged apoptotic regulation in autism. Synapse, 42:281-284.

• Araghi-Niknam, M., S.H Fatemi, 2003. Levels of Bcl-2 and P53 are altered in superior frontal and cerebellar cortices of autistic subjects. Cell Mol. Neurobiol., 23:945-952.

• Fatemi SH, Stary JM, Halt AR, Realmuto GR. Dysregulation of Reelin and Bcl-2 proteins in autistic cerebellum. J Autism Dev Disord. 2001 Dec;31(6):529-35.

• Fatemi SH, Halt AR, Stary JM, Realmuto GM, Jalali-Mousavi M. Reduction in anti-apoptotic protein Bcl-2 in autistic cerebellum. Neuroreport. 2001 Apr 17;12(5):929-33.

This is important because one of the most important mechanisms of HBO protection is the inhibition of apoptosis in hypoxia-ischemia. Inhibition of apoptosis by HBO translates into brain tissue preservation. HBO decreases the activity and expression of capase-3, reduces PARP cleavage, and abolishes DNA fragmentation.HBO causes the up-regulation of pro-survival Bc1-2 genes, protects the blood brain barrier, and improves Metabolism of Glutamate, Glucose, and Pyruvate. HBO decreases hypoxia-inducible factor-1a (hip-1a) & multiple genes related to apoptosis. In fact, HBO reduces all pathological events consequent to hypoxia.

It is regrettable that there has been so much politics in this new and emerging specialty, but that is the sad fact. The abhorrence of using HBOT to treat neurological conditions has become institutionalized at the UHMS. Even the funding for research is subject to this political pressure and hyperbaric medicine has had its share of that. This whole area has truly been a black spot on modern medicine because the reality is HBOT is a relatively risk-free, humanitarian, and non-invasive therapy that has such great promise for improving patient functionality across so many neurological indications.

Fischer et al. [33] in New York University performed the first randomized, placebo-controlled, double-blind trial on MS patients treated with HBOT. Improvements in balance and bladder function were found in 12 of 17 patients (P < 0.0001). Those patients with a less severe form of the disease had a more favorable and long lasting response. After a year with no further treatment, the treated group showed a positive change (P < 0.0008). Barnes et al. [34] found overall benefit in their treated group (P < 0.03) and a year later there was less deterioration in cerebellar function (P < 0.03). They called for further studies. Two other controlled studies have reported sustained benefit with follow-up. Oriani et al. [35] used patients with a low Kurtzke [36] disability score 7 and compared 22 controls with 22 patients treated each week for a year. They detected an appreciable difference in outcome ( P < 0.01). Pallotta et al [37] followed 22 patients for 8 years.

A logical and thoughtful analysis of HBOT reveals that it is a therapy that helps a great many indications, beyond the narrow number on some chamber’s FDA labels. In fact treating off-label is an established and important part of the practice of medicine in the USA, won three decades ago in United States v. Evers, 453 F. Supp. 1141, 1149 (M.D. Ala. 1978).

The off-label uses of medical devices and drugs perform an important therapeutic role in many, if not most, areas of medical practice. Prescriptions for off-label uses of drug products may account for more than 25% of the approximately 1.6 billion prescriptions written each year, with some recent estimates running as high as 60%. Pediatric uses also are mostly off-label. It should not be a requirement to have IRB supervision just to treat off-label. In fact, in some cases, if certain drugs weren’t used in the off-label way, one would be guilty of malpractice (Beck, James and Elizabeth Azari. FDA, Off-Label Use, and Informed Consent: Debunking Myths and Misconceptions.. Food and Drug Law Journal, 53 [1998]: 71 . 104 page 80)

HBOT for brain injuries, for example, is simply the off-label use of a FDA approved drug and device. HBOT for brain injuries, multiple sclerosis, and cerebral palsy, to just name three, are acceptable off-label uses, and treating off-label is an important legal and accepted part of the practice of medicine.

See also

• Hyperbaric chamber
• Undersea and Hyperbaric Medical Society

Hyperbaric oxygen therapy (HBOT) is the medical use of oxygen at a higher than atmospheric pressure. ... The Undersea and Hyperbaric Medical Society (UHMS) is the primary source of information for diving and hyperbaric medicine physiology worldwide. ...

References

1-Collet, J.P., Vanasse, M., Marois, P., Amar, M., Goldberg, J., Lambert, J. et al. (2001) Hyperbaric oxygen for children with cerebral palsy: A randomized multicentre trial. The Lancet, 357, 582-586.

2-Montgomery, D., Goldberg, J., Amar, M., Lacroix, V., Lecomte, J., Lambert, J., Vanasse, M., & Marois, P. (1999). Effects of hyperbaric oxygen therapy on children with spastic diplegic cerebral palsy: A pilot project. Undersea and Hyperbaric Medicine, 26(4), 235-242.

3-Russell, D.J., Rosenbaum, P.L., Cadman, D.T., Gowland, C., Hardy, S., & Jarvis, S. (1989). The gross motor function measure: A means to evaluate the effects of physical therapy. Developmental Medicine & Child Neurology, 31(3), 341-352.

4-Almeida, G.L., Campbell, S.K., Girolami, G.L., Penn, R.D., & Corcos, D.M. (1997). Multidimensional assessment of motor function in a child with cerebral palsy following intrathecal administration of baclofen. Physical Therapy, 77 (7), 751-764.

5-Damiano, D.L. & Abel, M.F. (1998). Functional outcomes of strength training in spastic cerebral palsy. Archives of Physical Medicine and Rehabilitation, 79 (2), 119-125.

6-Electrophysioligical monitoring during selective dorsal rhizotomy, and spasticity and GMFM performance. Developmental Medicine & Child Neurology, 40 (4), 233-238.

7-Knox, V., & Evans, A.L. (2002). Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: A preliminary study. Developmental Medicine & Child Neurology, (44), 447-460.

8-Law, M., Russell, D., Pollock, N., Rosenbaum, P., Walter, S., & King, G. (1997). A comparison of intensive neurodevelopmental therapy plus casting and a regular occupational therapy program for children with cerebral palsy. Developmental Medicine & Child Neurology 39, 664-670.

9-McGibbon, N.H., Andrade, C.K., Widener, G., & Cintas, H.L. (1998). Effect of an equine-movement therapy program on gait, energy expenditure, and motor function in children with spastic cerebral palsy: A pilot study. Developmental Medicine & Child Neurology, 40 (11), 754-762.

10-McLaughlin, J.F., Bjornson, K.F., Astley, S.J., Hays, R.M., Hoffinger, S.A., Armantrout, E.A., & Roberts, T.S. (1994). The role of selective dorsal rhizotomy in cerebral palsy: critical evaluation of a prospective clinical series. Developmental Medicine & Child Neurology, 36 (9), 755-769.

11-McLaughlin, J.F., Bjornson, K.F., Astley, S.J., Graubert, C., Hays, R.M., Roberts, T.S., Price, R., & Temkin, N. (1998). Selective dorsal rhizotomy: Efficacy and safety in an investigator-maked randomized clinical trial. Developmental Medicine & Child Neurology, 40 (4), 220-232.

12-Nordmark, E., Jarnlo, G.B., Hagglund, G. (2000). Comparison of the Gross Motor Function Measure and Paediatric Evaluation of Disability Inventory in assessing motor function in children undergoing selective dorsal rhizotomy. Developmental Medicine & Child Neurology, 42 (4), 245-252.

13-Steinbok, P., Reiner, A., & Kestle, J.R. (1997). Therapeutic electrical stimulation following selective posterior rhizotomy in children with spastic diplegic cerebral palsy: A randomized clinical trial. Developmental Medicine & Child Neurology, 39 (8), 515-520.

14-Sterba, J.A., Rogers, B.T., France, A.P., & Vokes, D., A.(2002). Horse back riding in children with cerebral palsy: Effect on gross motor function. Developmental Medicine & Child Neurology, 44, 301-308.

15-Trahan, J., & Malouin, F. (1999). Changes in the Gross Motor Function Measure in children with different types of cerebral palsy : An eight-month follow-up study. Pediatric Physical Therapy, 11, 12-17.

16-Tsorlakis, N., Evaggelinou, C., Grouios, G., & Tsorbatzoudis, C. (2004). Effect of intensive neurodevelopmental treatment in gross motor function of children with cerebral palsy. Developmental Medicine & Child Neurology, 46, 740-745.

17-Wright, F.V., Sheil, E.M., Drake, J.M., Wedge, J.H., Naumann, S. (1998). Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled tria. Developmental Medicine & Child Neurology, 40 (4), 239-247.

19-Talking Points, Hyperbaric oxygen: Hype or hope? Lancet 2001;357

20-Agency for Healthcare US Department. (2003). Web page : http://www.ahrq.gov/clinic/epcsums/hypoxsum.htm

21-Chang CF, Niu KC, Hoffer BJ, Wang Y, Borlongan CV. Hyperbaric oxygen therapy for treatment of post ischemic stroke in adult rats. Exp Neurol 2002; 166: 298-306.

22-Heuser G, Heuser SA, Rodelander D, Aguilera O, Uszler M. Treatment of neurologically impaired adults and children with "mild" hyperbaric oxygenation (1.3 ATA and 24% Oxygen). In Joiner JT, ed. Hyperbaric Oxygenation for Cerebral Palsy and the Brain-Injured Child. Best Publications, Flagstaff Arizona 2002;109-15

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External links

• Hyperbaric Therapy Center
• HyperbaricMedicine.ca
• Canadian Association of Hyperbarics
• International Hyperbaric Medical Association
• Undersea and Hyperbaric Medical Society
• Diving Diseases Research Centre
• Diving Medicine Online
• HBO evidence
• Hyperbaric Oxygen Therapy
• International Hyperbaric Association
• Oxygen Centre ZOL Belgium
• Indian Hyperbaric Chamber
• MeSH Hyperbaric+oxygenation
• Joey's Breath of Life

www.ichm.net International Congress on Hyperbaric Medicine www.sfhbo.com San Francisco Institute for Hyperbaric Medicine www.hyperbaricmedicalassociation.org International Hyperbaric Medical Association Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ...