Hyperbaric oxygen therapy apparently highly effective for  'postbrain injury neural status'

 Clinical Bottom Line:

1. Significant resolution of post injury syndrome with hyperbaric oxygen

2.Study should be repeated with higher methodological rigour

 

Citation:

 1. Shi X, Tang Z, Xiong B, Bao J, Sun D, Zhang Y, Yao Y. Cerebral perfusion SPECT imaging for assessment of the effect of hyperbaric oxygen therapy on patients with postbrain injury neural status. Chinese Journal of Traumatology 2003;6(6):346-349.

 

Three-part Clinical Question:  For patients with 'postbrain injury neural status', does addition of hyperbaric oxygen therapy to cerebrolysin improve symptom resolution?

Search Terms:  Brain injuries, hyperbaric oxygenation, radiographic tomography

 

The Study:

Non-blinded randomised controlled trial without intention-to-treat.

The Study Patients:  Patients with history of head injury at least three months previously and symptoms of headache, dizziness, poor memory and/or epilepsy. No history of intracranial space occupying lesion, hypertension or cardiovascular disease.

Control group: (N = 125; 125 analysed): Daily treatment with cerebrolysin 20ml for 7-10 and oral vasodilating agent (nimodipine). Regimen repeated up to four times.

Experimental group: (N = 195; 195 analysed): As above with daily 96% oxygen at 2ATA

 

The Evidence:

Outcome

Time to Outcome

Control rate

HBOT rate

Relative risk reduction

Absolute risk reduction

NNT

symptom resolution

after treatment

0.28

0.92

-230%

-0.64

-2

95% CI:

 

 

 

-261% to -199%

-0.73 to -0.56

-2 to -1

improvement in cerebral blood flow (SPECT)

after treatment

0.11

0.81

-619%

-0.69

-1

95% CI:

 

 

 

-689% to -549%

-0.77 to -0.62

-2 to -1

resumed pre-trauma function

6-18 months

0.168

0.93

-454%

-0.76

-1

95% CI:

 

 

 

-498% to -409%

-0.84 to -0.67

-1 to -1

 

 Comments:

1. Exact nature of clinical problem is unclear.

2. Exceptional treatment effect of hyperbaric oxygen difficult to accept.

3. Method of randomisation not described and arms significantly imbalanced.

4. Potential confounding by injury and symptom types not explored.

5. 82 patients had intracranial haematoma despite the exclusion of intracranial space-occupying lesion

 

Appraised by: Jan Rigby and Mike Bennett; Friday, 30 April 2004

Email:  JR52@le.ac.uk

Kill or Update By:  May 2006