Hyperbaric oxygen therapy for vaso-occlusive crises in nine patients with sickle-cell disease.

INTRODUCTION Vaso-occlusive crisis (VOC) is the most frequent complication of sickle-cell disease and is associated with significant acute bone pain. OBJECTIVE To evaluate the feasibility and efficacy of hyperbaric oxygen therapy (HBOT) for severe VOC. METHODS We report our retrospective experience with HBOT in VOC in nine patients and 15 HBOT sessions. RESULTS All nine patients had received appropriate conventional treatment prior to HBOT. Pain scores using a Visual Analog Scale (0 to 10) determined whether HBOT was effective or not in improving symptoms. While no change in pain score occurred before the HBOT session, pain scores fell significantly from 3.3 prior to HBOT to 1.9 24 hours after HBOT (P = 0.002). While morphine dosage increased before HBOT (median morphine dose 23 mg per day and 35.95 mg per day respectively on Day -2 and Day -1, P = 0.04), the median morphine dose one day after HBOT (Day +1 23 mg per day) tended to be lower than Day -1 (P = 0.08), and decreased to zero 2 days after HBOT (P = 0.004). Two patients had ear pain during compression, requiring rapid interruption of the HBOT session, although neither patient had any sequelae. CONCLUSION HBOT is feasible in sickle cell disease and appears to be effective in reducing the pain of VOC rapidly.