The
addition of hyperbaric oxygen to an intensive care treatment regime for comatose
patients with traumatic mid-brain syndromes resulted in improved survival and
complete recovery rates.
Clinical Bottom Line:
1.
The addition of hyperbaric oxygen resulted in a significant improvement in
survival rate for patients with a mid-brain injury syndrome.
2.
There was also a significant improvement in the proportion of patients with
full recovery from injury when hyperbaric oxygen was administered.
Appraised
by: Mike Bennett, Dept of Diving and
Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Thursday, 2 September
1999
Clinical
Scenario: A patient presented comatose
following a traumatic head injury. We wondered if the addition of hyperbaric
oxygen to the treatment regime would improve outcome.
Three-part
Question: For patients with acute
traumatic mid-brain syndromes, does the addition of hyperbaric oxygen therapy to
usual intensive therapy result in any improvement in morbidity or mortality?
Search
Terms: Head injury
The
Study:
Non-blinded ?randomised trial
without intention-to-treat.
Acute traumatic mid-brain
syndrome patients- exact entry criteria not given.
Control group (N = 50; 50
analysed): Usual intensive care regime- no details.
Experimental group (N = 49; 49
analysed): As above but with addition of daily treatments at 2 ATA breathing
100% oxygen, total dose not given.
The
Evidence:
|
Outcome |
Time
to Outcome |
CER |
EER |
Relative
Risk Reduction |
Absolute
Risk Reduction |
NNT |
|
Death |
unknown |
0.74 |
0.53 |
28% |
0.210 |
5 |
|
95%
CIs: |
|
|
|
3%
to 53% |
0.025
to 0.395 |
3
to 40 |
|
Complete
recovery |
unknown |
0.06 |
0.33 |
-450% |
-0.270 |
-4 |
|
95%
CIs: |
|
|
|
-100%
to -205% |
-0.417
to -0.123 |
-8
to -2 |
Comments:
1. Abstract only- full text
awaits translation.
2. It is not clear if allocation
was sequential or random.
3. Entry criteria and length of
follow-up remains unclear.
Expiry
date:
Sept 2005
References:
1. Holbach KH, Wassman H,
Kolberg T. Improved reversibility of the traumatic mid-brain syndrome following
the use of hyperbaric oxygen. Acta Neurochirurgica 1974; 30:247-256.
