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Hyperbaric Oxygen Therapy-Reply

Pam Grim, MD; Lawrence J. Gottlieb, MD
JAMA. 1990;264(14):1811. doi:10.1001/jama.1990.03450140031025.
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In Reply.—  We share the desire of Dr Ingle for a sober analysis of HBO therapy and cite the review by Gabb and Robin in our article. Oxygen is a toxic substance and its use within a pressurized chamber should not be undertaken lightly.Some indications for HBO therapy, such as that for problem wounds, are difficult to evaluate because little is known about the pathologenesis of specific wounds, because no good animal model exists, and because HBO therapy is recommended only in patients who have failed conventional therapy, a difficult group to study. However, osteoradionecrosis, a better-defined clinical problem, has been shown to respond to a carefully designed protocol that incorporates HBO.1Therapy for carbon monoxide poisoning is particularly difficult to evaluate. In the study by Raphael et al,2 which Dr Ingle cites, patients with carbon monoxide poisoning were stratified into two groups: those with and


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