Diving Hyperb Med
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Unestablished indications are conditions in which systematic clinical use of hyperbaric oxygen treatment (HBOT) is not supported by adequate proof of benefit. HBOT is vulnerable to use in many such conditions for various reasons, perhaps the most important being that a placebo or participation effect may create an impression of efficacy. The systematic use of HBOT in unestablished indications raises ethical concerns about provision of misleading information, giving false hope, and taking payment for therapy of doubtful benefit. ⋯ Advocates for HBOT in chronic brain injury claim that the sham treatments (usually 1.3 ATA pressure exposure whilst air breathing) in the blinded trials are actually active treatments; however, the same dose of oxygen can be achieved at 1 ATA breathing 27% oxygen. To counter this argument, advocates also claim that the extra 0.3 ATA of pressure is somehow independently beneficial, but this notion has limited biological plausibility and there is little supporting evidence. Chronic brain injuries remain unestablished indications at this time and, in our opinion, should not be systematically treated with HBOT.