The addition of hyperbaric
oxygenation to the care of severely brain injured patients was associated with
improved morbidity at six months.
Clinical Bottom Line:
1. The addition of HBO improved
outcome GCS, GOS and an assessment of brain electric activity in this group of
severe brain injury patients compared to the standard therapy approach practiced
in this institution.
2. This result excluded any
deaths during the period of randomised treatment (no details given).
Citation:
1. Ren H, Wang W, Ge Z. Glasgow
coma scale, brain electrical activity mapping and Glasgow outcome scale after
hyperbaric oxygen treatment of severe brain injury. Chinese Journal of
Traumatology 2001; 4(4):239-241.
2. Ren H, Wang W, Ge Z. Clinical, brain electric earth map, endothelin and transcranial ultrasonic doppler findings after hyperbaric oxygen treatment for severe brain injury. Chinese Medical Journal (Engl) 2001; 114(4):387-390.
Three-part Clinical Question:
For patients with severe closed head injury, does the concurrent administration
of hyperbaric oxygen, compared to a standard treatment regimen, result in any
reduction in mortality or morbidity?
Search Terms:
Hyperbaric Oxygenation, Head Injuries, closed, Brain Injuries
The Study:
Non-blinded randomised controlled
trial without intention-to-treat. Patients admitted with isolated closed head
injury with GCS of <9 in a stable condition on day 3 of admission.
Control group (N = 20; 20
analysed): Usual intensive management of severe brain injury with dehydration,
corticosteroids and antibiotics (no details).
Experimental group (N = 35; 35
analysed): As above plus the addition of 100% oxygen breathing at 2.5ATA for 10
periods of 40 - 60 minutes broken by 10 minutes air breathing at 2.5ATA (total
oxygen time 400 - 600 minutes). This exposure was then repeated every 4 days to
a total of 3 or 4 cycles.
The
Evidence:
|
Outcome |
Time
to Outcome |
Control
group |
HBO
group |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Brain Electrical Activity
Mapping failed to normalize |
After
3 treatments |
0.800 |
0.371 |
54% |
0.43 |
2 |
|
95% CI: |
|
|
|
24%
to 83% |
0.19
to 0.67 |
2
to 5 |
|
Glasgow Outcome Scale
moderately severe disability |
6
months |
0.650 |
0.171 |
74% |
0.48 |
2 |
|
95% CI: |
|
|
|
36%
to 100% |
0.24
to 0.72 |
1
to 4 |
|
Glasgow Outcome Scale failed to
achieve good recovery or mild disability |
6
months |
0.700 |
0.171 |
76% |
0.53 |
2 |
|
95% CI: |
|
|
|
42%
to 100% |
0.29
to 0.77 |
1
to 3 |
Non-Event Outcomes
Time to outcome
Control group
HBO group P-value
Mean Glasgow Coma Score
After 3 treatments
9.5
14.6
P<0.01
Comments:
1. Generally poorly reported with
loss of intention to treat by exclusion of deaths from analysis.
2. Why the two groups are so
uneven in numbers is not addressed.
3. Very unusual HBO treatment
course was employed.
4. No difference in treatment
until day 3 following admission, so this treatment is not delivered in the acute
situation.
5. The results of this trial are
difficult to reconcile with other studies.
Appraised by: Mike Bennett and
Juliette Leverment Email: m.bennett@unsw.edu.au
Prince of Wales Hospital, Sydney.
Thursday, 5 December 2002
Kill or Update By:
September
2005