Validation of sham treatment in hyperbaric medicine: a randomised trial

Introduction: This study aimed to determine the lowest possible atmospheric pressure in the 111−152 kPa (1.1−1.5 atmospheres absolute [atm abs]) range that would require the patients to equalise their ears, allowing an effective sham for a 203 kPa (2.0 atm abs) hyperbaric exposure. Methods: We performed a randomised controlled study on 60 volunteers divided into 3 groups (compression to 111, 132 and 152 kPa (1.1, 1.3, 1.5 atm abs) to determine the minimum pressure to obtain blinding. Secondly, we applied additional blinding strategies (faster compression with ventilation during the fictitious compression time, heating at compression, cooling at decompression) on 25 new volunteers in order to enhance blinding. Results: The number of participants who did not believe they had been compressed to 203 kPa was significantly higher in the 111 kPa compressed arm than in the other two arms (11/18 vs 5/19 and 4/18 respectively; P = 0.049 and P = 0.041, Fisher’s exact test). There was no difference between compressions to 132 and 152 kPa. By applying additional blinding strategies, the number of participants who believed they had been compressed to 203 kPa increased to 86.5 %. Conclusions: A compression to 132 kPa, (1.3 atm abs, 3 metres of seawater equivalent) combined with the additional blinding strategies of forced ventilation, enclosure heating and compression in five minutes, simulates a therapeutic compression table and can be used as a hyperbaric placebo.