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A systematic review of the application of hyperbaric oxygen in the treatment of severe anemia: an evidence-based approach.

Van Meter KW.

Department of Medicine, Section of Emergency Medicine, Division of Hyperbaric Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.

The treatment of severe anemia with hyperbaric oxygen (HBO2) is one of thirteen indications approved by the Hyperbaric Oxygen Therapy Committee of the Undersea and Hyperbaric Medical Society for appropriate use of the therapy (1). This paper systematically reviews the literature reporting the use of HBO2 therapy in the treatment and management of severe anemia. Increasingly, a trend to use standards of evidence-based medicine to evaluate the effectiveness of therapeutic interventions in injury and illness is productively with us in medicine today. At issue is discovery and evaluation of the best evidence available in world medical literature for evaluation of current treatment of the individual patient. The best evidence is a published randomized controlled prospective human trial; at the other end of the spectrum, the least valued evidence is a published expert opinion. In this review thirty-five publications have been reviewed as representing published results of applying HBO2 in treatment of severe anemia. Each article underwent the evidence-based evaluative grading of the American Heart Association system (AHA), the National Cancer Institute Patient Data Query system (NCI-PDQ), and the British Medical Journal's (BMJ) Clinical Evidence system. Comparative results using the three systems of evaluation are presented in tabular form for the reader. All publications report a positive result when HBO2 is delivered as treatment for severe anemia. Other alternatives other than transfusion with autologous or heterologous matched blood products are helpful but most too have not been the subject of prospective human randomized controlled trials. HBO2 may be used adjunctively with hematinics, fluorocarbons, and cell wall free polymerized hemoglobin (currently fluorocarbons and cell wall free polymerized hemoglobin are not available for routine use in the United States, but both are undergoing advanced stage clinical trials at the time of this review).

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