UNDERSEA AND HYPERBARIC MEDICAL SOCIETY

Hyperbaric Oxygen Therapy

INDICATIONS
14TH EDITION

Richard E. Moon MD
Chair and Editor

Undersea and Hyperbaric Medical Society

631 US Highway 1, Suite 307
North Palm Beach, FL 33408
USA
No responsibility is assumed by the publisher or editor for any injury and or damage to persons or property as a matter
of product liability, negligence or otherwise, or from any use or operation of any methods, product, instructions, or
ideas contained in the material herein. No suggested test or procedure should be carried out unless, in the reader’s
judgment, its risk is justified. Because of rapid advances in the medical sciences, we recommend that the independent
verification of diagnoses and drug dosages be made.

All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form
or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the
publisher.

Copyright © 2019 Undersea and Hyperbaric Medical Society

ISBN: 978-1-947239-16-6

Library of Congress Catalog Number: 2019940027

Published by: Best Publishing Company

631 U.S. Highway 1, Suite 307
North Palm Beach, Florida 33408

Printed and bound in the United States of America

Table of Contents
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Members of the Hyperbaric Oxygen Therapy Committee. . . . . . . . . . . . . vii
I. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
II. Hyperbaric Oxygen: Definition . . . . . . . . . . . . . . . . . . . . . . . x
III. Utilization Review For Hyperbaric Oxygen Therapy . . . . . . . . . . . . . . xii
IV. Acceptance (Addition) of New Indications for Hyperbaric Oxygen Therapy . . . . . xii
V. List of Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
VI. Author Biographies . . . . . . . . . . . . . . . . . . . . . . . . . . xvi

PART I. Indications
1. Hyperbaric Treatment of Air or Gas Embolism: Current Recommendations . . . . . . . 1
2. Arterial Insufficiencies
A. Central Retinal Artery Occlusion . . . . . . . . . . . . . . . . . . . . . . 15
B. Hyperbaric Oxygen Therapy for Selected Problem Wounds . . . . . . . . . . . . 31
3. Carbon Monoxide Poisoning. . . . . . . . . . . . . . . . . . . . . . . . . 81
4. Clostridial Myonecrosis (Gas Gangrene) . . . . . . . . . . . . . . . . . . . . 105
5. The Effect of Hyperbaric Oxygen on Compromised Grafts and Flaps. . . . . . . . . 117
6. The Role of Hyperbaric Oxygen for Acute Traumatic Ischemias. . . . . . . . . . . 135
7. Decompression Sickness. . . . . . . . . . . . . . . . . . . . . . . . . . 153
8. Delayed Radiation Injuries (Soft Tissue and Bony Necrosis)
and Potential for Future Research. . . . . . . . . . . . . . . . . . . . . . 163
9. Sudden Sensorineural Hearing Loss. . . . . . . . . . . . . . . . . . . . . . 203
10. Intracranial Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
11. Necrotizing Soft Tissue Infections . . . . . . . . . . . . . . . . . . . . . . 239
12. Refractory Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . 263
13. Severe Anemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
14. Adjunctive Hyperbaric Oxygen Therapy in the Treatment of Thermal Burns. . . . . . 301

PART II. Additional Considerations

15. Mechanisms of Action of Hyperbaric Oxygen Therapy. . . . . . . . . . . . . . 325
16. Side Effects of Hyperbaric Oxygen Therapy. . . . . . . . . . . . . . . . . . . 335
17. Oxygen Pretreatment and Preconditioning. . . . . . . . . . . . . . . . . . . 343
18. Randomized Controlled Trials in Diving and Hyperbaric Medicine . . . . . . . . . 351
19. Hyperbaric Oxygen for Symptoms Following Mild Traumatic Brain Injury . . . . . . 379

Appendix A. Approved Indications for HBO2 Therapy. . . . . . . . . . . . . . . . 393

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Preface

The application of air under pressure (hyperbaric air) dates back to 1667, when Nathaniel Henshaw proposed a
hypo-hyperbaric room pressurized and depressurized with an organ bellows.1 In the nineteenth century, Simpson
wrote a treatise on the use of compressed air for certain respiratory diseases.2 The medicinal uses of oxygen were
first reported by Beddoes in 1794,3 while the first article describing adjunctive uses of hyperbaric oxygen therapy
(HBO2) was written by Fontaine in 1879,4 who constructed a mobile operating room which could be pressur-
ized. He observed that pressurized patients were not as cyanotic after the use of nitrous oxide during induction
of anesthesia as compared to patients anesthetized at atmospheric pressure. In addition, he noted that hernias
were much easier to reduce. Also around that time, the work of Paul Bert5 and J. Lorrain-Smith6 showed that oxy-
gen under pressure had potentially deleterious consequences on the human body with side effects that included
central nervous system and pulmonary toxicity. The efforts of Churchill-Davidson and Boerema in the 1950s and
1960s spurred the modern scientific use of clinical hyperbaric medicine.

In 1967, the Undersea Medical Society was founded by six United States Naval diving and submarine medical
officers with the explicit goal of promoting diving and undersea medicine. In short order, this society expanded
to include those interested in clinical hyperbaric medicine. In recognition of the dual interest by members in both
diving and clinical applications of compression therapy, the society was renamed The Undersea and Hyperbaric
Medical Society in 1986. It remains the leading not for profit organization dedicated to reporting scientifically
and medically efficacious and relevant information pertaining to hyperbaric and undersea medicine.

In 1972, an ad hoc Medicare committee was formed to evaluate the efficacy of hyperbaric oxygen therapy for
specified medical conditions. The focus was to determine if this treatment modality showed therapeutic benefit
and merited insurance coverage. The growth of the body of scientific evidence that had developed over the pre-
ceding years supported this endeavor and recognition for the field. In 1976, the Hyperbaric Oxygen Therapy
Committee became a standing committee of what was then the UMS. The first Hyperbaric Oxygen Committee
Report was published in 1977 and served as guidance for practitioners and scientists interested in HBO2. The
report is usually published every three to five years and was last published in 2014. Additionally, this document
continues to be used by the Centers for Medicare and Medicaid Services and other third party insurance carriers
in determining payment.

The report, currently in its 14th edition, has grown in size and depth to reflect the evolution of the literature. To
date, the committee recognizes 14 indications for which scientific and clinical evidence supports the use of HBO2.

The Undersea and Hyperbaric Medical Society continues to maintain its reputation for its expertise on hyper-
baric therapy. With leading experts authoring chapters in their respective fields, this publication continues to
provide the most current and up to date guidance and support for scientists and practitioners of hyperbaric
oxygen therapy.

Richard E. Moon MD
Editor, UHMS Committee Chair

Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.

References
1. Henshaw N. Aero-Chalinos or a register for the air for the better preservation of health and cure of diseases, after a
new method. London. 1677.
2. Simpson A. Compressed Air as a Therapeutic Agent in the Treatment of Consumption, Asthma, Chronic Bronchitis
and Other Diseases. Edinburgh: Sutherland and Knox; 1857.
3. Beddoes T, Watt J. Considerations of the Medicinal Use of Factitious Airs, and on the Manner of Obtaining Them
in Large Quantities, First Edition, part II. Bristol: Bulgin and Rossier; 1794.
4. Fontaine JA. Emploi chirurgical de l’air comprime. Union Med. 1879;28:445.
5. Bert P. Barometric Pressure [Hitchcock MS, Hitchcock FA, translation]. Bethesda, MD: Undersea Medical Society;
1978. P. 579.
6. Lorrain-Smith J. The pathological effects due to increase of oxygen tension in the air breathed. J Physiol. 1899;
24:19-35.

vi ~ Hyperbaric Oxygen Therapy Indications

Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.

Members of the Hyperbaric Oxygen Therapy Committee

Richard Moon MD (Chair)

Dirk Bakker MD
Robert Barnes MD
Michael Bennett MD
Enrico Camporesi MD
Paul Cianci MD
James Clark MD
William Dodson, MD
John Feldmeier DO
Laurie Gesell MD
Neil B. Hampson MD
Brett Hart MD
Enoch Huang MD
Irving Jacoby MD
Robert Marx DDS
Heather Murphy-Lavoie MD
Richard Roller MD
Ben Slade MD
Michael Strauss MD
Stephen Thom MD, PhD
Keith Van Meter MD
Lindell Weaver MD
Wilbur T. Workman MS

vii

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I. Background

The Undersea and Hyperbaric Medical Society (UHMS) is an international scientific organization which was
founded in 1967 to foster exchange of data on the physiology and medicine of commercial and military diving.
Over the intervening years, the interests of the Society have enlarged to include clinical hyperbaric oxygen therapy.
The society has grown to over 2,000 members and has established the largest repository of diving and hyperbaric
research collected in one place. Clinical information, an extensive bibliographic database of thousands of scientific
papers, as well as books, and technical reports which represent the results of over 100 years of research by military
and university laboratories around the world are contained in the UHMS Schilling Library, holdings are now part
of the Duke University Library, Durham, NC. The results of ongoing research and clinical aspects of undersea and
hyperbaric medicine are reported annually at scientific meetings and in Undersea and Hyperbaric Medicine published
bi-monthly. Previously the society supported two journals, Undersea Biomedical Research and the Journal of Hyper-
baric Medicine. These two journals were merged in 1993 into Undersea and Hyperbaric Medicine.

UHMS headquarters is located at:

631 US Highway 1, Suite 307

North Palm Beach, FL 33408
Phone: 561-776-6110 / 1-877-533-UHMS (8467)
FAX: 919-490-5149
Email: [email protected]
Internet: www.uhms.org

I. Background ~ ix

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II. Hyperbaric Oxygen: Definition

The UHMS defines hyperbaric oxygen (HBO2) as an intervention in which an individual breathes near 100%
oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure (1
atmosphere absolute [ATA]). For clinical purposes, the pressure must equal or exceed 1.4 ATA while breathing
near 100% oxygen. The United States Pharmacopoeia (USP) and Compressed Gas Association (CGA) Grade A
specify medical grade oxygen to be not less than 99.0% by volume, and the National Fire Protection Association
(NFPA) specifies USP medical grade oxygen.

In certain circumstances hyperbaric oxygen therapy rep-

resents the primary treatment modality while in others it Class A
is an adjunct to surgical or pharmacologic interventions.

The NFPA classifies chambers according to occupancy for

the purposes of establishing minimum construction and
operation requirements.1

1. Class A – Human, multiple occupancy

2. Class B – Human, single occupancy
3. Class C – Animal, no human occupancy

Clinical treatments can be carried out in either a Class A

(multi) or B (mono) chamber system. In a Class B sys- Figure 1. Multiplace Chamber
tem, the entire chamber is pressurized with near 100% Photograph courtesy of Lindell Weaver MD, of Intermountain
Medical Center, Murray, Utah. Fink DL8 multiplace chamber,
oxygen, and the patient breathes the ambient chamber Fink Engineering, Melbourne, Australia.
oxygen directly. A Class A system holds two or more peo-
ple (patients, observers, and/or support personnel); the chamber is pressurized with compressed air while the
patients breathe near 100% oxygen via masks, head hoods, or endotracheal tubes. It is important to note that
Class B systems can and are pressurized with compressed air while the patients breathe near 100% oxygen via
masks, head hoods, or endotracheal tubes.

According to the UHMS definition and the determination of The Centers for Medicare and Medicaid Services
(CMS) and other third-party carriers, breathing medical grade near-100% oxygen at 1 atmosphere of pressure or
exposing isolated parts of the body to 100% oxygen does not constitute HBO2 therapy. The patient must receive
the oxygen by inhalation within a pressurized chamber. Current information indicates that pressurization should
be to 1.4 ATA or higher.

The literature of HBO2 treatment began to appear during the 1930s as navies and universities around the world
began studies in oxygen breathing at elevated pressures as a way to more safely decompress divers and to treat
decompression sickness and arterial gas embolism. During the 1960s, HBO2 was incorporated in standard treat-
ment tables of the U.S. Navy. Extensive research on oxygen toxicity was undertaken to establish safe limits,
overall safety, and medical and physiologic aspects of the compressed gas environment. These efforts led to a vast
body of literature which underpins modern HBO2 therapy.

x ~ Hyperbaric Oxygen Therapy Indications

Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.

 Class B Class C

Figure 2. Monoplace Chamber Figure 3. Animal Chamber

Photograph courtesy of Sechrist Industries. Photograph courtesy of Reimers Systems.

In 1976, recognizing the need for meticulous scrutiny of emerging clinical applications of HBO2, the Executive
Committee of the UHMS established the Hyperbaric Oxygen Therapy Committee. The Committee was charged
with the responsibility of continuously reviewing research and clinical data and rendering recommendations
regarding clinical efficacy and safety of HBO2. To achieve this goal, the multispecialty committee is comprised
of practitioners and scientific investigators in the fields of internal medicine, infectious diseases, pharmacology,
emergency medicine, general surgery, orthopedic surgery, trauma surgery, thoracic surgery, otolaryngology, oral
and maxillofacial surgery, anesthesiology, pulmonology, critical care, radiation oncology and aerospace medicine.

Since 1976, the Committee has met annually to review research and clinical data. From the 28 indications for
which third-party reimbursement was recommended in the 1976 and 1979 reports, the number of recognized
indications has been refined to 14 in the current report. These indications are those for which in vitro and in
vivo pre-clinical research data as well as extensive positive clinical experience and study have become convincing.

Evidence considered by the Committee includes sound physiologic rationale; in vivo or in vitro studies that
demonstrate effectiveness; controlled animal studies, prospective controlled clinical studies; and extensive clinical
experience from multiple, recognized hyperbaric medicine centers.

The Committee requires that experimental and clinical evidence submitted for the efficacy of HBO2 treatment
for a disorder be at least as convincing as that for any other currently accepted treatment modality for that dis-
order. Studies in progress will continue to clarify mechanisms of action, optimal oxygen dosage, duration of
exposure times, frequency of treatments, and patient selection criteria. The Committee recommends third party
reimbursement of HBO2 therapy for the disorders included in the accepted conditions category. Currently, most
insurance carriers have established HBO2 reimbursement policies.

The Committee also reviews cost effectiveness and has established guidelines for each entity. Results show that, in
addition to its clinical efficacy, HBO2 therapy yields direct cost savings by successfully resolving a high percent-
age of difficult and expensive disorders, thereby minimizing prolonged hospitalization. However, the Committee
recommends that each individual hyperbaric facility, whether monoplace or multiplace, establish its own charges
consistent with the actual local costs of providing such service.

II. Hyperbaric Oxygen: Definition ~ xi

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III. Utilization Review for Hyperbaric Oxygen Therapy

A utilization review section is presented for each recognized HBO2 indication. It is recommended that utilization
review be obtained if the number of HBO2 treatments is to exceed the recommended number of treatments for
that indication. Such review should involve discussion of the clinical case with another qualified hyperbaric medi-
cine physician from an outside institution. If that individual agrees that additional HBO2 therapy is warranted,
treatment may exceed the usually prescribed number of treatments.

IV. Acceptance (Addition) of New Indications

for Hyperbaric Oxygen Therapy

New indications for HBO2 therapy are considered for acceptance at the meeting of the Hyperbaric Oxygen
Therapy Committee during the annual meeting of the Undersea and Hyperbaric Medical Society. This consid-
eration can be initiated from within the Committee itself or may result in response to a written request by a
non-Committee member. When a new indication is considered for acceptance, a position paper is written. The
information must summarize the in vitro, in vivo, and clinical aspects of the new indication for HBO2 therapy.
Two members of the Hyperbaric Oxygen Committee review the position paper and each writes a critique. The
position paper and critiques are presented to the Hyperbaric Oxygen Committee. A consensus of the Hyperbaric
Oxygen Committee is required for recommending the indication be moved into the recognized category. If the
Committee determines that a new condition merits acceptance, it makes this recommendation to the Executive
Committee of the Society, which ultimately votes whether or not to recognize the new indication.

xii ~ Hyperbaric Oxygen Therapy Indications

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Chapter 1: Hyperbaric Treatment of Air or Gas Embolism: Current Recommendations
Richard E. Moon MD
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Chapter 2A: Arterial Insufficiencies: Central Retinal Artery Occlusion
Heather Murphy-Lavoie MD, Frank Butler MD, Catherine Hagan MD
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56. Aten, LA; Stone, JA; Poli, (2011) T. Treatment of a patient with acute central retinal artery occlusion with
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Chapter 2B: Arterial Insufficiencies: Hyperbaric Oxygen Therapy for Selected Problem Wounds
Enoch T. Huang MD, MPH&TM, FUHM, FACEP, FACCWS,
Marvin Heyboer III MD, FUHM, FACEP, FACCWS, Davut J. Savaser MD, MPH, FAAEM, FACEP

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Chapter 3: Carbon Monoxide Poisoning
Lindell K. Weaver MD
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Chapter 4: Clostridial Myonecrosis (Gas Gangrene)
Robert A. van Hulst, MD, PhD, FUHM, Capt Navy (ret ), Dirk J. Bakker MD, PhD, FUHM,
Benjamin Cherng MD, C.R. Soh MD
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Infections Type Welchii. Ann N Y Acad Sci. 1965;117:688-99.

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58. Bakker DJ. The use of hyperbaric oxygen in the treatment of certain infectious diseases, especially gas gangrene and
acute dermal gangrene. Wageningen, Holland: Drukkerij Veenman BV; 1984.
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for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb
Med. 2017;47(1):24-32.

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Chapter 5: The Effect of Hyperbaric Oxygen on Compromised Grafts and Flaps
Shawna Kleban MD, Richard C. Baynosa MD (corresponding author)
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27. Selcuk CT, Kuvat SV, Bozkurt M, et al. The effect of hyperbaric oxygen therapy on the survival of random pattern
skin flaps in nicotine-treated rats. J Plast Reconstr Aesthet Surg. 2012;65:489-493.
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wounds in rats. Am Surg. 1986;52: 659-662.
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deficient patient. J Oral Maxillofac Surg. 1982;40: 412-420.
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composite skin grafts. Plast Reconstr Surg. 1966;37:422-430.
36. Jurell G, Kaijser L. The influence of varying pressure and duration of treatment with hyperbaric oxygen on the
survival of skin flaps: an experimental study. Scand J Plast Reconstr Surg. 1973;7:25-28.
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38. Ramon Y, Abramovich A, Shupak A, et al. Effect of hyperbaric oxygen on a rat transverse rectus abdominis
myocutaneous flap model. Plast Reconstr Surg. 1998:102;416-422.
39. Prada FS, Arrunategui G, Alves MC, et al. Effect of allopurinol, superoxide-dismutase, and hyperbaric oxygen on
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40. Nemiroff PM. Synergistic effects of pentoxifylline and hyperbaric oxygen on skin flaps. Arch Otolaryngol Head
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42. Lozano DD, Stephenson LL, Zamboni WA. Effect of hyperbaric oxygen and medicinal leeching on survival of axial
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43. Yucel A, Bayramicli. Effects of hyperbaric oxygen treatment and heparin on the survival of unipedicled venous flaps:
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1990;125:607-609.
48. Zamboni WA, Roth AC, Russell RC, et al. Morphological analysis of the microcirculation during reperfusion of
ischemic skeletal muscle and the effect of hyperbaric oxygen. Plast Reconstr Surg. 91. 1993;1110-1123.
49. Jones SR, Carpin KM, Woodward SM, et al. Hyperbaric oxygen inhibits ischemia-reperfusion-induced CD18
neutrophil polarization by a nitric oxide mechanism. Plast Reconstr Surg. 2010:126:403-411.
50. Baynosa RC, Naig AL, Murphy PS, et al. The effect of hyperbaric oxygen on nitric oxide synthase activity and
expression in ischemia-reperfusion injury. J Surg Res. Epub ahead of print. 2013 Feb 1.
51. Francis A, Kleban SR, Stephenson LL, et al. Hyperbaric Oxygen Inhibits Reperfusion-Induced Neutrophil
Polarization and Adhesion Via Plasmin-Mediated VEGF Release. Plast Reconstr Surg Glob Open. 2017 Sep
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52. Hong JP, Kwon H, Chung YK, et al. The effect of hyperbaric oxygen on ischemia-reperfusion injury: an
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53. Tomur A, Etlik O, Gundogan NU. Hyperbaric oxygenation and antioxidant vitamin combination reduces ischemia-
reperfusion injury in a rat epigastric island skin-flap model. J Basic Clin Physiol Pharmacol. 2005;16: 275-285.

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54. Stevens DM, Weiss DD, Koller WA, et al. Survival of normothermic microvascular flaps after prolonged secondary
ischemia: Effects of hyperbaric oxygen. Otolaryngol Head Neck Surg. 115: 360-364, 1996.
55. Wong HP, Zamboni WA, Stephenson LL. Effect of hyperbaric oxygen on skeletal muscle necrosis following primary
and secondary ischemia in a rat model. Surg Forum. 1996;47:705-707.
56. Gampper TJ, Zhang F, Mofakhami NF, et al. Beneficial effect of hyperbaric oxygen on island flaps subjected to
secondary venous ischemia. Microsurg. 2002;22:49-52.
57. Perrins DJD. Hyperbaric oxygenation of skin flaps. Br J Plast Surg. 1966;19:110-112.
58. Perrins DJD, Cantab MB. Influence of hyperbaric oxygen on the survival of split skin grafts. Lancet. 1967;1: 868-
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59. Roje Z, Roje Z, Eterovic D et al. Influence of adjuvant hyperbaric oxygen therapy on short-term complications
during surgical reconstruction of upper and lower extremity war injuries: retrospective cohort study. Croat Med J.
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60. Gonnering RS, Kindwall EP, Goldmann RW. Adjunct hyperbaric oxygen therapy in periorbital reconstruction. Arch
Opthalmol. 1986;104: 439-443.
61. Bowersox JC, Strauss MB, Hart GB. Clinical experience with hyperbaric oxygen therapy in salvage of ischemic skin
flaps and grafts. J Hyperbaric Med. 1986; 141-149.
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63. Qing Y, Cen Y, Chen J, Ke S. Reconstruction of a large through-and-through defect of the nasal tip using a modified
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65. Assaad NN, Chong R, Tat LT, et al. Adjuvant hyperbaric oxygen therapy to support limbal conjunctival graft in the
management of recurrent pterygium. Cornea. 2011;30:7-10.
66. Ueda M, Kaneda T, Takahashi H, et al. Hyperbaric oxygen therapy of ischemic skin flaps: clinical and experimental
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by transcutaneous oxygen measurements in hyperbaric oxygen. Plast Reconstr Surg. 1993;91: 329-334.
68. Waterhouse MA, Zamboni WA, Brown RE, et al. The use of HBO in compromised free tissue transfer and
replantation, a clinical review. Undersea Hyperbaric Med.1993; 20(Suppl):64.
69. Larson JV, Steensma EA, Flikkema RM, Norman EM. The application of hyperbaric oxygen therapy in the
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70. Skeik N, Porten BR, Isaacson E, et al. Hyperbaric oxygen treatment outcome for different indications from a single
center. Ann Vasc Surg 2015; 29:206-214.
71. Nichter LS, Morwood DT, Williams GS, et al. Expanding the limits of composite grafting: a case report of
successful nose replantation assisted by hyperbaric oxygen therapy. Plast Reconstr Surg. 1991;87: 337-340.
72. Rapley JH, Lawrence WT, Witt PD. Composite grafting and hyperbaric oxygen therapy in pediatric nasal tip
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75. McCrary BF. Hyperbaric oxygen treatment for a failing facial flap. Postgrad Med J. 2007;83: e1-e3.
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77. Mermans JF, Tuinder S, von Meyenfeldt MF, et al. Hyperbaric oxygen treatment for skin flap necrosis after a
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78. Fredman R, Wise I, Friedman T, Heller L, Kami T. Skin-sparing mastectomy flap ischemia salvage using urgent
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treatments. Undersea Hyperb Med. 2018 Mar-Apr;45(2):157-164.

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Chapter 6: The Role of Hyperbaric Oxygen for Acute Traumatic Ischemias
Michael B. Strauss MD
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37. Slack WD, Thomas DA, De Jode LR. Hyperbaric oxygen in the treatment of trauma, ischemic disease of limbs
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42. Nylander G, Otamiri T, Lewis DH, Larsson J. Lipid peroxidation products in postischemic skeletal muscle and after
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46. Strauss MB, Hart GB. Hyperbaric oxygen and the skeletal muscle-compartment syndrome. Contemp Orthop.
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47. Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JA, Rader DJ, Rubin
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49. Strauss MB. The role of hyperbaric oxygen in the surgical management of chronic refractory osteomyelitis. In:
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50. Brighton CT. Hospital Tribune. May 9, 1977.
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54. Strauss MB. Why hyperbaric oxygen therapy may be useful in treating crush injuries and skeletal muscle-
compartment syndrome [Editorial]. Undersea Hyperb Med. 2012;39(4):799-800.

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Chapter 7: Decompression Sickness
Richard E. Moon MD, Simon J. Mitchell MD, MBChB, PhD
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28. Mitchell SJ. Decompression sickness: manifestations. In: Edmonds C, Bennett MH, editors. Diving and Subaquatic
Medicine. 5 ed. Boca Raton, FL: Taylor and Francis; 2015. Pp. 141-51.
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sickness: rapid resolution following hyperbaric therapy. Radiology. 1987;163:81-2.
30. Trytko B, Mitchell SJ. Extreme survival: a deep technical diving accident. SPUMS J. 2005;35:23-7.
31. Warren LP, Djang WT, Moon RE, Camporesi EM, Sallee DS, Anthony DC. Neuroimaging of scuba diving injuries
to the CNS. AJNR Am J Neuroradiol. 1988;9:933-8.
32. Reuter M, Tetzlaff K, Hutzelmann A, Fritsch G, Steffens JC, Bettinghausen E, Heller M. MR imaging of the central
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33. Gempp E, Blatteau JE, Stephant E, Pontier JM, Constantin P, Peny C. MRI findings and clinical outcome in 45
divers with spinal cord decompression sickness. Aviat Space Environ Med. 2008;79(12):1112-6.
34. Chung JM, Ahn JY. Relationship between clinical and radiologic findings of spinal cord injury in decompression
sickness. Undersea Hyperb Med. 2017;44(1):57-62.
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36. Moir EW. Tunnelling by compressed air. J Soc Arts. 1896;44(May 15):567-85.
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39. Yarbrough OD, Behnke AR. The treatment of compressed air illness using oxygen. J Ind Hyg Toxicol. 1939;21:213-8.
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microcirculation during reperfusion of ischemic skeletal muscle and the effect of hyperbaric oxygen. Plast Reconstr
Surg. 1993;91:1110-23.
41. Martin JD, Thom SR. Vascular leukocyte sequestration in decompression sickness and prophylactic hyperbaric
oxygen therapy in rats. Aviat Space Environ Med. 2002;73(6):565-9.
42. Kindwall EP. Use of short versus long tables in the treatment of decompression sickness and arterial gas embolism.
In: Moon RE, Sheffield PJ, editors. Treatment of Decompression Illness. Kensington, MD: Undersea and
Hyperbaric Medical Society; 1996. Pp. 122-6.
43. Thalmann ED. Principles of US Navy recompression treatments for decompression sickness. In: Moon RE, Sheffield
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44. Moon RE, Sheffield PJ. Guidelines for treatment of decompression illness. Aviat Space Environ Med. 1997;68:234-43.
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& Elliott’s Physiology and Medicine of Diving. New York, NY: Elsevier Science; 2003. Pp. 600-50.
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of Hyperbaric Oxygen Therapy. Philadelphia, PA: Saunders Elsevier; 2008. Pp. 283-319.
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in Remote Locations. Durham, NC: Divers Alert Network; 2005.
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decompression illness: expert review of key principles and controversies. Diving Hyperb Med. 2018;48(1):45-55.
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Hyperbaric Technicians and Nurses Association 2011 Workshop. Diving Hyperb Med. 2012;42(3):171-80.

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56. Vann RD, Bute BP, Uguccioni DM, Smith LR. Prognostic factors in DCI in recreational divers. In: Moon RE,
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Medical Society; 2003.

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Chapter 8: Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) and Potential
for Future Research
John J. Feldmeier DO, FACRO, FUHM, Laurie B. Gesell MD, FACEP, FUHM
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Chapter 9: Sudden Sensorineural Hearing Loss
Tracy Leigh LeGros MD, PhD, and Heather Murphy-Lavoie MD
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Chapter 10: Intracranial Abscess
Edward O. Tomoye DO, Richard E. Moon MD
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Series-Based Review. World Neurosurg. 2017;107:124-9.
6. Gelfand MS, Stephens DS, Howell EI, Alford RH, Kaiser AB. Brain abscess: association with pulmonary arteriovenous
fistula and hereditary hemorrhagic telangiectasia: report of three cases. Am J Med. 1988;85(5):718-20.
7. Press OW, Ramsey PG. Central nervous system infections associated with hereditary hemorrhagic telangiectasia. Am
J Med. 1984;77(1):86-92.
8. Chang YT, Lu CH, Chuang MJ, Huang CR, Chuang YC, Tsai NW, et al. Supratentorial deep-seated bacterial brain
abscess in adults: clinical characteristics and therapeutic outcomes. Acta Neurol Taiwan. 2010;19(3):178-83.
9. Sukoff MH, Ragatz RE. Hyperbaric oxygenation for the treatment of acute cerebral edema. Neurosurgery.
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10. Mader JT, Brown GL, Guckian JC, Wells CH, Reinarz JA. A mechanism for the amelioration by hyperbaric oxygen
of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis. 1980;142:915-22.
11. Siddiqui A, Davidson JD, Mustoe TA. Ischemic tissue oxygen capacitance after hyperbaric oxygen therapy: a new
physiologic concept. Plast Reconstr Surg. 1997;99(1):148-55.
12. Price JC, Stevens DL. Hyperbaric oxygen in the treatment of rhinocerebral mucormycosis. Laryngoscope.
1980;90:737-47.
13. Ferguson BJ, Mitchell TG, Moon R, Camporesi EM, Farmer J. Adjunctive hyperbaric oxygen for treatment of
rhinocerebral mucormycosis. Rev Infect Dis. 1988;10(3):551-9.
14. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and
outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634-53.
15. Verklin RM, Jr., Mandell GL. Alteration of effectiveness of antibiotics by anaerobiosis. J Lab Clin Med.
1977;89(1):65-71.
16. Madsen ST. Sepsis, endocarditis, and brain abscess. Scand J Gastroenterol Suppl. 1983;85:48-54.
17. Kaide CG, Khandelwal S. Hyperbaric oxygen: applications in infectious disease. Emerg Med Clin North Am.
2008;26(2):571-95, xi.
18. Larsson A, Engstrom M, Uusijarvi J, Kihlstrom L, Lind F, Mathiesen T. Hyperbaric oxygen treatment of
postoperative neurosurgical infections. Neurosurgery. 2008;62 Suppl 2:652-71.
19. Bartek J, Jr., Jakola AS, Skyrman S, Forander P, Alpkvist P, Schechtmann G, et al. Hyperbaric oxygen therapy
in spontaneous brain abscess patients: a population-based comparative cohort study. Acta Neurochir (Wien).
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20. Kutlay M, Colak A, Yildiz S, Demircan N, Akin ON. Stereotactic aspiration and antibiotic treatment combined
with hyperbaric oxygen therapy in the management of bacterial brain abscesses. Neurosurgery. 2008;62 Suppl
2:540-6.
21. Lampl LA. Hyperbaric oxygen in intracranial abscess. In: Whelan HT, Kindwall EP, editors. Hyperbaric Medicine
Practice. 4th ed. North Palm Beach, FL: Best Publishing Company; 2017. p. 467-83.
22. Baechli H, Schmutz J, Mayr JM. Hyperbaric oxygen therapy (HBO) for the treatment of an epidural abscess in the
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23. Kohshi K, Abe H, Mizoguchi Y, Shimokobe M. Successful treatment of cervical spinal epidural abscess by combined
hyperbaric oxygenation. Mt Sinai J Med. 2005;72(6):381-4.
24. Kurschel S, Mohia A, Weigl V, Eder HG. Hyperbaric oxygen therapy for the treatment of brain abscess in children.
Childs Nerv Syst. 2006;22(1):38-42.
25. Nakahara K, Yamashita S, Ideo K, Shindo S, Suga T, Ueda A, et al. Drastic therapy for listerial brain abscess
involving combined hyperbaric oxygen therapy and antimicrobial agents. J Clin Neurol. 2014;10(4):358-62.

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Chapter 11: Necrotizing Soft Tissue Infections
Caesar A. Anderson MD, MPH, Irving Jacoby MD, FACP, FACEP, FAAEM, FUHM
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Infect Dis. 2007;45:450.

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32. Goodell J, Jordan M, et al. Rapidly advancing necrotizing fasciitis caused by Phytobacterium (Vibrio) damsel: a
hyperagressive variant. Crit Care Med. 2004;32(1):278-281.
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41. Sawin RS, Schaller RT, Tapper D, Morgan A, Cahill J. Early recognition of neonatal abdominal wall necrotizing
fasciitis. Am J Surg. 1994;167:481-484.
42. Wang TL, Hung CR. Role of tissue oxygen saturation monitoring in diagnosing necrotizing fasciitis of the lower
limbs. Ann Emerg Med. 2004;44:222-228.
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newborn. Ann Surg. 1984;199:101-103.
44. Sawin RS, Schaller RT, Tapper D, Morgan A, Cahill J. Early recognition of neonatal abdominal wall necrotizing
fasciitis. Am J Surg. 1994;167:481-484.
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59. Bilbault P, Castelain V, et al. Life threatening cervical necrotizing fasciitis after a common dental extraction. Am J
Emerg Med. 2008;26:5-7

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60. Soh CR, Pietroban R, Freiberger JJ, et al. Hyperbaric Oxygen therapy in necrotizing soft tissue infections:a study of
patients in the US Nationwide Inpatient sample. Intensive Care Med. 2012;38:1143.
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Surg. 2004;139:1339-1345.
62. Escobar SJ, Slade JB, Hunt TK, Cianci P. Adjuvant hyperbaric oxygen therapy (HBO2) for treatment of necrotizing
fasciitis reduces mortality and amputation rate. Undersea Hyperb Med. 2006;32(6):437-443.
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Am J Surg. 2005;189(4):462-466.

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Chapter 12: Refractory Osteomyelitis
Brett B. Hart MD
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Chapter 13: Severe Anemia
Keith W. Van Meter MD
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Chapter 14: Adjunctive Hyperbaric Oxygen Therapy in the Treatment of Thermal Burns
Paul Cianci MD, FAC, FUHM (Corresponding Author), Ronald M. Sato MD, Julia Faulkner
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110. Ray CS, Green G, Cianci P. Hyperbaric oxygen therapy in burn patients: Cost effective adjuvant therapy (abstract).
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Chapter 15: Mechanisms of Action of Hyperbaric Oxygen Therapy
Gerardo Bosco MD, PhD (corresponding author), Alex Rizzato MSc., Enrico M. Camporesi MD
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in rats and idiopathic trigeminal neuralgia in patients. Eur J Pain. 2012 Sep;16(8):1094–105.

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58. Inamoto Y, Okuno F, Saito K, Tanaka Y, Watanabe K, Morimoto I, et al. Effect of hyperbaric oxygenation on
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Chapter 16: Side Effects of Hyperbaric Oxygen Therapy
Matteo Paganini MD, Enrico M. Camporesi MD
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Appl Physiol. 1971;30:739–752.

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27. Thorsen E, Aanderud L, Aasen TB. Effects of a standard hyperbaric oxygen treatment protocol on pulmonary
function. Eur Respir J. 1998;12:1442-1445.
28. Weaver LK, Howe S. Normobaric measurement of O2 tension of blood in subjects exposed to hyperbaric oxygen.
Chest. 1992;102:1175-1181.
29. Weaver LK, Howe S. Arterial oxygen tension of patients with abnormal lungs treated with hyperbaric oxygen is
greater than predicted. Chest. 1994;106:1134-1139.
30. Bond GF. Arterial gas embolism. In: Davis JC, Hunt TK, eds. Hyperbaric oxygen therapy. Bethesda, MD: Undersea
Medical Society;1977. Pp:141-152.
31. Wolf HK, Moon RE, Mitchell PR, Burger PC. Barotrauma and air embolism in hyperbaric oxygen therapy. Am J
Forensic Med Pathol. 1990;11:149-153.
32. Sloan EP, Murphy DG, Hart R, Cooper MA, Turnbull T, Barreca RS, Ellerson B. Complication and protocol
considerations in carbon monoxide-poisoned patients who require hyperbaric oxygen therapy: report from a ten-year
experience. Ann Emerg Med. 1989;18:629-634.
33. K.W. Donald: Oxygen poisoning in man. I. Br Med J.1:667-672. 1947.
34. K.W. Donald: Oxygen poisoning in man. II. Br Med J.1:712-717. 1947.
35. Hart GB, Strauss MB. Central nervous system oxygen toxicity in a clinical setting. In: Bove AA, Bachrach AJ,
Greenbaum LJ, eds. Undersea and hyperbaric physiology IX. Proceedings of the ninth international symposium on
underwater and hyperbaric physiology. Bethesda, MD: Undersea and Hyperbaric Medical Society; 1987. Pp:695-699.
36. Sherlock S, Way M, Tabah A. Audit of practice in Australasian hyperbaric units on the incidence of central nervous
system oxygen toxicity. Diving Hyperb Med. 2018;48(2):73-78.
37. Keenan HT, Bratton SL, Norkool DM, Brogan TV, Hampson NB. Delivery of hyperbaric oxygen therapy to
critically ill, mechanically ventilated children. J Crit Care. 1998;13:7-12.
38. Patz A. Effect of oxygen on immature retinal vessels. Invest Ophthalmol. 1965;4:988-999.
39. Sola A, Chow L, Rogido M. [Retinopathy of prematurity and oxygen therapy: a changing relationship]. An Pediatr
(Barc). 2005;62(1):48-63.
40. Lind F. A pro/con review comparing the use of mono- and multiplace hyperbaric chambers for critical care. Diving
Hyperb Med. 2015;45(1):56-60.
41. Beard T, Watson B, Barry R, Stewart D, Warriner R: Analysis of adverse events occurring in patients undergoing
adjunctive hyperbaric oxygen treatment: 2009-2010 (Abstract) UHM Vol. 38-5 - section G, p. 455. 2011.
42. Zadik Y, Drucker S. Diving dentistry: a review of the dental implications of scuba diving. Australian Dent J.
2011;56:265–271.

Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.

Chapter 17: Oxygen Pretreatment and Preconditioning
Enrico M. Camporesi MD, Matteo Paganini MD, Gerardo Bosco MD, PhD
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open-sea air dive. Appl Physiol Nutr Metab. 2012;37(5):888-92.
23. Morabito C, Bosco G, Pilla R, Corona C, Mancinelli R, Yang Z, Camporesi EM, Fano G, Mariggio MA. Effect
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alterations of the cell membrane in the skeletal muscle of rats submitted to ischemia and reperfusion. J Surg Res.
2000;92:1-6.

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27. YangZJ, Bosco G, Montante A, Ou XI, Camporesi EM. Hyperbaric O2 reduces intestinal ischemia-reperfusion-
induced TNF-alpha production and lung neutrophil sequestration. Eur J Appl Physiol. 2001;85(1-2):96-103.
28. Bosco G, Yang ZJ, Nandi J, Wang J, Chen C, Camporesi EM. Effects of hyperbaric oxygen on glucose, lactate,
glycerol and anti-oxidant enzymes in the skeletal muscle of rats during ischaemia and reperfusion. Clin Exp
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injury and reduces hydroxyl radical formation and glutamate release. Eur J Appl Physiol. 2010;108(3):513-22.
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ischemia in rats. J Neurotrauma. 2009;26(1):55-66.
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involves upregulation of hypoxia-inducible factor-1alpha and erythropoietin in rats. J Appl Physiol.
2008;104(4):1185-91.
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ER, Weder W, Follath F. Clinical review: practical recommendations on the management of perioperative heart
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39. Wu ZK, Iivainen T, Pehkonen E, Laurikka J, Tarkka MR. Arrhythmias in off-pump coronary artery bypass grafting
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40. Yellon DM, Alkhulaifi AM, Pugsley WB. Preconditioning the human myocardium. Lancet. 1993;342:276-277.
41. Berger MM, Macholz F, Mairbäurl H, Bärtsch P. Remote ischemic preconditioning for prevention of high-altitude
diseases: fact or fiction?. J Appl Physiol. 2015;119(10):1143-51.
42. Yogaratnam JZ, Laden G, Guvendik L, Cowen M, Cale A, Griffin S. Hyperbaric oxygen preconditioning improves
myocardial function, reduces length of intensive care stay, and limits complications post coronary artery bypass graft
surgery. Cardiovasc Revasc Med. 2010;11:8-19.
43. Li Y, Dong H, Chen M, Liu J, Yang L, Chen S, Xiong L. Preconditioning with repeated hyperbaric oxygen induces
myocardial and cerebral protection in patients undergoing coronary artery bypass graft surgery: a prospective,
randomized, controlled clinical trial. J Cardiothorac Vasc Anesth. 2011 Dec;25(6):908-916.
44. Alex J, Laden G, Cale A, Bennett S, Flowers K, Madden L, Gardiner E, McCollum T, Griffin S. Pretreatment
with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response
after cardiopulmonary bypass: A prospective randomised double-blind trial. J Thorac Cardiovasc Surg.
2005;130(6):1623-1630.
45. Jeysen ZY, Gerard L, Levant G, Cowen M, Cale A, Griffin S. Research report: the effects of hyperbaric oxygen
preconditioning on myocardial biomarkers of cardioprotection in patients having coronary artery bypass graft
surgery. Undersea Hyperb Med. 2011;38(3):175-85.
46. Li Q, Li J, Zhang L, Wang B, Xiong L. Preconditioning with hyperbaric oxygen induces tolerance against
oxidative injury via increased expression of heme oxygenase-1 in primary cultured spinal cord neurons. Life Sci.
2007;80:1087-1093.
47. Sterling DL, Thornton JD, Swafford A, Gottlieb SF, Bishop SP, Stanley AW, Downey JM. Hyperbaric oxygen limits
infarct size in ischemic rabbit myocardium in vivo. Circulation. 1993 Oct;88(4 Pt 1):1931-1936.
48. Wada K, Ito M, Miyazawa T, Katoh H, Nawashiro H, Shima K, Chigasaki H. Repeated hyperbaric oxygen induces
ischemic tolerance in gerbil hippocampus. Brain Res. 1996;740:15-20.

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49. Liska GM, Lippert T, Russo E, Nieves N, Borlongan CV. A dual role for hyperbaric oxygen in stroke
neuroprotection: preconditioning of the brain and stem cells. Cond Med. 2018;1(4):151-166.
50. Gao L, Taha R, Gauvin D, Othmen LB, Wang Y, Blaise G. Postoperative cognitive dysfunction after cardiac surgery.
Chest. 2005;128:3664-3670.
51. Sato Y, Laskowitz DT, Bennett ER, Newman MF, Warner DS, Grocott HP. Differential cerebral gene expression
during cardiopulmonary bypass in the rat: evidence for apoptosis? Anesth Analg. 2002;94:1389-1394, table of
contents.
52. Gao ZX, Rao J, Li YH (2017) Hyperbaric oxygen preconditioning improves postoperative cognitive dysfunction by
reducing oxidant stress and inflammation. Neural Regen Res 12(2):329-336.
53. Liu Y, Sun XJ, Liu J, Kang ZM, Deng XM. Heme- oxygenase-1 could mediate the protective effects of hyperbaric
oxygen preconditioning against hepatic ischemia-reperfusion injury in rats. Clin Exp Pharmacol Physiol.
2011;38:675-682.
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randomized double-blind pilot study. Anticancer Res. 2014;34(6):2899-906.
55. Sharifi M, Fares W, Abdel-Karim I, Koch JM, Sopko J, Adler D; Hyperbaric Oxygen Therapy in Percutaneous
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57. Yang Z, Nandi J, Wang J, et al. Hyperbaric oxygenation ameliorates indomethacin-induced enteropathy in rats by
modulating TNF-alpha and IL-1beta production. Dig Dis Sci. 2006;51(8):1426-33.

Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.

Chapter 18: Randomized Controlled Trials in Diving and Hyperbaric Medicine
Michael H. Bennett
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of chronic refractory radiation proctitis: a randomised and controlled double-blind crossover trial with long-term
follow-up. International Journal of Radiation Oncology, Biology, Physics. 2008;72:134-143.

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28. Weaver LK, Hopkins RO, Churchill S, Haberstock D. Double-blinding is possible in hyperbaric oxygen (HBO2)
randomized clinical trials (RCT) using a minimal chamber pressurization as control (abstract). Undersea and
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individuals can determine chamber pressure. Undersea and Hyperbaric Medicine. 2012;39:801-5.
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31. Wolf G, Cifu D, Baugh L, Carne W, Profenna L. The effect of hyperbaric oxygen on symptoms after mild traumatic
brain injury. Journal of Neurotrauma. 2012. Pp:2606-2612.
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33. Mitchell SJ, Bennett MH. Unestablished indications for hyperbaric oxygen therapy. Diving Hyperb Med. 2014 Dec
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35. Fedorko L, Bowen JM, Jones W, Oreopoulos G, Goeree R, Hopkins RB, O’Reilly DJ. Hyperbaric oxygen therapy
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36. Santema KT, Stoekenbroek RM, Koelemay MJ, Reekers JA, van Dortmont LM, Oomen A, Smeets L, Wever JJ,
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with meta-analysis. http://trove.nla.gov.au/.
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other meta-analyses of the same drugs: systematic review. BMJ 2006;333:782.

Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.

Appendix 1: Randomized Clinical Trials in Hyperbaric Medicine
This list includes abstracts when there has been no more complete report.

Acute Thermal Burns

1. Hart GB, O’Reily RR, Broussard N, Cave RH, Goodman DB, Yanda RL. Treatment of burns with hyperbaric
oxygen. Surg Gynecol Obstet. 1974;139:693-696.
2. Hammarlund C, Svedman C, Svedman P. Hyperbaric oxygen treatment of healthy volunteers with U.V.-irradiated
blister wounds. Burns. 1991;17(4):296-301.
3. Brannen AL, Still J, Haynes M, Orlet H, Rosenblum F, Law E, Thompson WO. A randomized prospective trial of
hyperbaric oxygen in a referral burn center population. Am Surgeon. 1997;63(3):205-208.
4. Niezgoda JA, Cianci P, Folden BW, Ortega RL, Slade JB, Storrow AB. The effect of hyperbaric oxygen therapy on a
burn wound model in human volunteers. Plastic and Reconstructive Surgery. 1997;99:1620-1625.
5. Xu N, Li Z, Luo X. [Effects of hyperbaric oxygen therapy on the changes in serum sIL-2R and Fn in severe burn
patients]. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi. 1999; 15(3):220-223.
6. Villanueva E, Bennett MH, Wasiak J, Lehm JP. Hyperbaric oxygen therapy for thermal burns (Cochrane Review).
In: The Cochrane Library (Issue 3, 2004). Chichester, UK: John Wiley & Sons, Ltd.
7. Ma L, Li P, Shi Z, Hou T, Chen X, Du J. A prospective, randomized, controlled study of hyperbaric oxygen therapy:
effects on healing and oxidative stress of ulcer tissue in patients with a diabetic foot ulcer. Ostomy Wound Manage.
2013 Mar 1;59(3):18-24.
8. Rasmussen VM, Borgen AE, Jansen EC, Rotbøll Nielsen PH, Werner MU. Hyperbaric oxygen therapy attenuates
central sensitization induced by a thermal injury in humans. Acta Anaesthesiologica Scandinavica. 2015 Jul
1;59(6):749-62.
Acute Myocardial Ischemia and Cardiac Surgery
9. Cameron AJV, Gibb BH, Ledingham IMcA. A controlled clinical trial of hyperbaric oxygen in the treatment of
acute myocardial infarction. Proceedings of the Second International Congress. London: ES Livingston; 1965.
P:277.
10. Thurston JGB, Greenwood TW, Bending MR, Connor H, Curwen MP. A controlled investigation into the effects of
hyperbaric oxygen on mortality following acute myocardial infarction. Q J Med, New Series, XLII. 1973;168:751-
770.
11. Swift PC, Turner JH, Oxer HF, O’Shea JP, Lane GK. Myocardial hibernation identified by hyperbaric oxygen
treatment and echocardiography in postinfarction. Am Heart J. 1992;124:1151-1158.
12. Dekleva MN, Ostojic M, Vujnovic D. Hyperbaric oxygen and thrombolysis in acute myocardial infarction: a
preliminary report. In: Sitinen SA, Leinio M, eds. Proceedings of the Twenty-first Annual Meeting of the European
Underwater and Baromedical Society (EUBS), Helsinki, Finland; 1995. Pp:9-13.
13. Shandling AH, Ellestad MH, Hart GB, Crump R, Marlow D, Van Natta B, Messenger JC, Strauss M, Stavitsky Y.
Hyperbaric oxygen and thrombolysis in myocardial infarction: The “Hot MI” Study. Am Heart J. 1997;143(3):544-
550.
14. Stavitsky Y, Shandling AH, Ellestad MH, Hart GB, Van Natta B, Messenger JC, Strauss M, Dekleva MN,
Alexander JM, Mattice M, Clarke D. Hyperbaric oxygen and thrombolysis in myocardial infarction: the ‘HOT MI’
randomised multicenter study. Cardiology. 1998; 90:131-136.
15. Vlahovic A, Neskovic AN, Dekleva M, Putnikovic B, Popovic ZB, Otasevic P, Ostojic M. Hyperbaric oxygen
treatment does not affect left ventricular chamber stiffness after myocardial infarction treated with thrombolysis.
American Heart Journal. 2004;148:J1-J7.
16. Sharifi M, Fares W, Abdel-Karim I, Koch MJ, Sopdo J, Adler D. Usefulness of hyperbaric oxygen therapy to inhibit
restenosis after percutaneous coronary intervention for acute myocardial infarction or unstable angina pectoris. Am J
Cardiol. 2004;93:1533-1535.
17. Dekleva M, Neskovic A, Vlahovic A, Putnikovic B, Beleslin B, Ostojic M. Adjunctive effect of hyperbaric oxygen
treatment after thrombolysis on left ventricular function in patients with acute myocardial infarction. Am Heart J.
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Wound Healing
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272. Fedorko L, Bowen JM, Jones W, Oreopoulos G, Goeree R, Hopkins RB, O’Reilly DJ. Hyperbaric oxygen therapy
does not reduce indications for amputation in patients with diabetes with nonhealing ulcers of the lower limb: a
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Chapter 19: Hyperbaric Oxygen for Symptoms Following Mild Traumatic Brain Injury
Lindell K. Weaver MD
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