The
addition of hyperbaric oxygen to a burn care protocol resulted in a reduction in
the time required for burn to heal.
Clinical Bottom Line:
1.
The addition of hyperbaric oxygen to a burn care protocol resulted in a
reduction in the time required to heal burns.
2.
Any effect of the addition of hyperbaric oxygen on fluid requirements and
graft success remains unclear.
Appraised
by: Mike Bennett, Dept of Diving and
Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Thursday, 22 April 1999
Clinical
Scenario: A patient presented with
thermal burns and we wondered if the addition of hyperbaric oxygen would improve
healing time.
Three-part
Question: In patients with thermal burns,
does the addition of hyperbaric oxygen to a standard burn care protocol result
in any improvement in time required to heal, or the quality of healing?
Search
Terms: Thermal burns
The
Study:
Double-blinded concealed
randomised controlled trial with intention-to-treat.
Patients with between 10 and 50%
of body surface area thermal burns presenting to a burns centre within 24 hours
of injury.
Control group (N = 16; 16
analysed): A standard burns protocol with fluid resuscitation, dressings and
surgical procedures. Sham hyperbaric exposures in a chamber compressed to 1.3ATA
and returned to 1ATA gradually at beginning and end of time period.
Experimental group (N = 16; 16
analysed): Protocol as above plus 100% oxygen breathing at 2ATA for 90 minutes
every 8 hours in the first 24 hours, then 12 hourly until healed.
The
Evidence:
Non-Event Outcomes
Time to outcome Air
group
HBO group
P-value
Average
volume of
crystalloid
required
24 hours
3.4
2.2
not
tested
(mls/kg/%BSA)
Mean
healing time
(days)
Healing
43.8
19.7
<0.005
Comments:
1. Small study with paired
stratification by surface area burnt.
2. Good randomisation and
blinding.
3. Power to detect a significant
improvement in fluid requirements or graft success unknown, but likely to be
low.
4. Some suggestion of
improvement in proportion of grafts taking in hyperbaric group (1/2 controls,
2/2 HBO).
4. Morbidity and mortality data
in this paper do not relate to this RCT.
Expiry
date:
September 2003
References:
1. Hart GB, O'Reilly RR, Broussard ND, Goodman DB, Yanda RL.
Treatment of burns with hyperbaric oxygen. Surgery, Gynaecology and Obstetrics
1974; 139:693-696.
