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Andy, I won't bite (too) hard and I am not a hyperbaric physician and hav=
e no vested interests, but this "treatment looking for a condition" comme=
nt is heard frequently and generally just reveals the ignorance of the pe=
rson making the comment.

1. There are some very well established conditions for HBOT, and diving i=
s less than 10% of the workload in most units, even in this country with =
more active divers per head population than anywhere else in the world.
Totally accepted indications include: radiation osteonecrosis, dysbaric o=
steonecrosis, clostridial myonecrosis and necrotising fasciitis (in each =
case as an adjunct to appropriate surgical debridement). The bread and bu=
tter workload of hyperbaric units is wound healing problems, especially i=
n diabetic vasculopaths and again I don't think anyone seriously question=
s the efficacy though the cost benefit may be debated.

2. The carbon monoxide question is the emotional one. Lots of poor qualit=
y little studies and case series, and only two well conducted PRCTs being=
=20(i) Carlos Scheinkestel's from Melbourne (Med J Aust 1999), showing no=
=20benefit from HBOT and possible harm, but using very high doses of oxyg=
en in the control group and with problems in followup, and (ii) Weaver's =
group from Salt Lake City published in last month's NEJM, which is the be=
st conducted and best followed up study in the literature and shows signi=
ficant benefits for the use of HBO to 12 months. The 'perspective' commen=
t in the NEJM suggests "HBO within 24 hours of acute CO poisoning should =
be the standard of care"

While not totally accepted I think a betting man would put money on the h=
yperbaric groups!

Cheers, Ian.

Ian Seppelt FJFICM FANZCA
Staff Specialist in Intensive Care Medicine
The Nepean Hospital, Sydney.


>>> mozza@doctors.org.uk 09/13/02 01:25am >>>

As to hyperbaric therapy- isn't this a treatment looking for a condition =

:-).(Ducks as dive medicine folk respond)

Andy Conway Morris
Med student
Glasgow, Scotland


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