Adjunctive
hyperbaric oxygen improved the rate of healing and reduced requirements for
re-operation in crush injuries of the limbs.
Clinical Bottom Line:
1.
Hyperbaric oxygen administration was associated with improved rate of healing
following a crush injury.
2.
Fewer patients required re-operation when hyperbaric oxygen was used.
Appraised
by: Abigail Fynn, Mike Bennett, Dept. of
Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Tuesday, 30
March 1999
Clinical
Scenario: 40
year old patient presented with a crush injury to the leg following a motor bike
crash. We wondered if hyperbaric oxygen would be of benefit.
Three-part
Question: In patients with crush injuries
of the limbs, does the adjunctive use of hyperbaric oxygen compared with
standard treatment alone, result in any important improvements in healing or
lower rates of re-operation?
Search
Terms: Crush syndrome,
extremities/*injuries
The
Study:
Double-blinded concealed
randomised controlled trial with intention-to-treat.
Moderate or severe crush injury
to one or more limbs and no contraindication to hyperbaric therapy.
Control group (N = 18; 18
analysed): Standard care plus sham hyperbaric oxygen twice daily for 6 days as
for HBO group.
Experimental group (N = 18; 18
analysed): As above, plus 100% oxygen at 2.4ATA for 90 minutes twice daily for 6
days.
The
Evidence:
|
Outcome |
Time to
Outcome |
Air group |
HBO group |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Wound not healed |
60 days |
0.444 |
0.06 |
86% |
0.384 |
3 |
|
95% CI: |
|
|
|
29% to 100% |
0.130 to 0.638 |
2 to 8 |
|
Repeat
surgical procedure |
60 days |
0.333 |
0.06 |
82% |
0.273 |
4 |
|
95% CI: |
|
|
|
9% to 100% |
0.029 to 0.517 |
2 to 34 |
Comments:
1.
Well organised and methodologically sound trial.
2.
Reductions in morbidity appear clinically important
Expiry
date:
October 2004
References:
1. Bouachour G, Cronier P, Gouello J, Toulemonde J, Talha A,
Alquier P. Hyperbaric oxygen therapy in the management of crush injuries: a
randomised double-blind placebo-controlled clinical trial. The Journal of
Trauma, Injury, Infection and Critical Care 1996; 41:333-339.
