The
addition of hyperbaric oxygenation therapy to thermal burns patients did not
result in improved outcome.
Clinical Bottom Line:
1.
The addition of hyperbaric oxygen did not affect mortality, length of stay or
number of surgical procedures required. (LOS and mortality analysed by
logistic regression)
2.
No important benefit of HBO in thermal burns was identified.
Appraised
by: Mike Bennett, Dept. of Diving and
Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Friday, 04 December,
1998
Clinical
Scenario: A patient with thermal burns
presenting for early treatment in a specialist burns centre.
Three-part
Question: In patients with thermal burns,
does the addition of hyperbaric oxygen therapy to a standard care protocol
result in any improvement in the time taken to heal, or quality of scarring?
Search
Terms: Hyperbaric oxygenation,
burns/thermal.
The
Study:
Non-blinded randomised
controlled trial with intention-to-treat.
Adult patients with skin burns,
with or without airway /inhalation injury, referred to a tertiary care burns
centre in the first 24 hours.
Control group (N = 62; 62
analysed): Usual burn care.
Experimental group (N = 63; 63
analysed): Usual burn care plus oxygen at 2ATA for 90 minutes twice daily for a
minimum of 5 days and a maximum number of treatments equal to % burn area.
The
Evidence:
|
Outcome |
Time to
Outcome |
Normal care
rate |
Hyperbaric
care rate |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Death |
As required |
0.113 |
0.111 |
2% |
0.002 |
500 |
|
95% CI |
|
|
|
-96% to 100% |
-0.12 to 0.11 |
NNT=9 to INF
NNH=9 to INF |
Comments:
1. Potential for selection bias
as randomization depended on availability of HBO facility.
2. No attempt to blind patients
or staff.
3. No analysis of graft survival
or long-term outcome.
4. No analysis of the
modification of acute care that may have accompanied HBO treatment.
5. Most were quite small burn
areas and these results may not apply to larger burns.
Expiry date: September 2003
References:
1. Brannen AL, Still J, Haynes M, Orlet H, Rosenblum F, Law E,
Thompson W. A randomized prospective trial of hyperbaric oxygen in a referral
burn centre population. The American Surgeon 1997; 63:205-208.
