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Treatable Conditions - Indications for Hyperbaric Oxygen Therapy

At the Toronto General Hospital Hyperbaric Chamber, we follow the guidelines established by the Undersea and Hyperbaric Medical Society (UHMS). For further information on each condition listed below, see www.uhms.org/Indications/indications.htm

• Air or Gas Embolism
• Carbon Monoxide Poisoning
• Carbon Monoxide Poisoning Complicated by Cyanide Poisoning
• Clostridal Myositis and Myonecrosis (Gas Gangrene)
• Crush Injury, Compartment Syndrome, and other Acute Traumatic Ischemias
• Decompression Sickness
• Enhancement of Healing in Selected Problem Wounds
• Exceptional Blood Loss (Anemia)
• Intracranial Abscess
• Necrotizing Soft Tissue Infections
• Osteomyelitis (Refractory)
• Delayed Radiation Injury (Soft Tissue and Bony Necrosis)
• Skin Grafts & Flaps (Compromised)
• Thermal Burns (includes frostbite)

Research at TGH's Hyperbaric Department

There are several research projects for which we would like to get funding. In order to provide a means of raising funds for research and other needs, we have established a Hyperbaric Teaching and Research Fund within the Toronto Western and Toronto General Hospital Foundation. Contributions can be made to the Foundation specifying they go to Hyperbaric purposes. Tax receipts for charitable donations are issued by the Foundation.

Here is a list of topics under current or potential exploration involving HBO at TGH:

• The Development of a Wound Management Expert System
• Early Hyperbaric Oxygenation Therapy Ameliorates Muscle Response Following Blunt Injury (Masters Thesis)
• Is Cognitive Dysfunction or Lipid Peroxidation Demonstrable in Mild (10%) Asymptomatic Carbon Monoxide Exposure
• The Use of Hyperbaric Oxygen in the Management of HIV Infection
• Hyperbaric Oxygen Therapy as an adjunct to healing following Ilizarov bone lengthening procedure
• A Randomized Controlled Trial To Study The Use Of Hyperbaric Oxygen Therapy In Treating Cerebrovascular Accident in Adults During the Acute Rehabilitation Phase
• Neuroprotection following focal ischemia
• Transient visual acuity changes in Adult associated with multiple clinical exposures to hyperbaric oxygen
• The Role of Hyperbaric Oxygen in the Management of Radiation Injuries
• Outcome of Mandibular Osteomyelitis managed with Adjunctive Hyperbaric Oxygen Therapy
• Role of hyperbaric oxygen therapy in extended use of bone morphogenic proteins (BMP) in oral surgical rehabilitation

Recent Developments

1. Radiation Injury Clinic: The efficacy of Hyperbaric Oxygen Therapy in cases of osteoradionecrosis of the mandible has previously been reported by members of this institution’s "Head and Neck" team. Surveillance of this continues. A recent series of five cases of soft tissue necrosis with favourable outcome from our unit is currently being reported.
2. Soft Tissue Sports Injuries: Recent media exposure linking Hyperbaric Oxygen Therapy to reduction in acute soft tissue injury time to healing in professional athletes has resulted in current research activity at this institution to explore the development of a tool to measure such insults quantitatively and assess the effect on the outcomes of Hyperbaric Oxygen Therapy. This tool may also permit quantitative evaluation of the performance of other "passive" therapeutic modalities often provided in musculoskeletal rehabilitation. This multidisciplinary Ph.D. project involves this institution’s Departments of Biochemistry and Orthopedics as well as the Department of Plastic Surgery and Exercise Physiology from the University of Toronto.
3. UHMS Ethics Task Force on Unconventional Uses of Hyperbaric Oxygenation: With the emergence of the internet, we are have recently experienced an escalation in interest by the general population in " fringe" uses of clinical hyperbaric oxygen therapy which has led to its provision for a multitude of unconventional health conditions. Often such service is provided in less controlled settings than the traditional hospital based or hospital associated hyperbaric facilities which must function in accordance with well established standards of quality assurance in both staff competence and equipment maintenance. Such non-hospital service provision has understandably raised concerns in the scientific community regarding facility and patient safety issues aside from the economic issue of costly treatments for conditions where evidence off efficacy is anecdotal or non-existent. Accordingly a process to evaluate the potential role of such services and establish guidelines for safety and information disclosure to fully inform patients as to the risk /reward issues is being developed. Amongst the potential new applications for HBO the single largest focus is in the field of neurological rehabilitation.
4. Canadian Council on Clinical Hyperbaric Oxygen Therapy: The public confusion and concerns regarding these recent events has resulted in hyperbaric clinicians from major Canadian Universities joining together to pursue large scale quality research in the use of hyperbaric oxygen with the formation of the Canadian Council on Clinical Hyperbaric Oxygen Therapy (www.ccchot.org).