Alex
Preoperative hyperbaric oxygenation reduced psychometric dysfunction and some systemic inflammatory markers following cardiac bypass and surgery
Clinical Bottom Line:
|
1.Pre-operative HBOT was associated with a reduced chance of neuropsychiatric deficit when defined as a reduction of >1 standard deviation in two of seven tests |
Citation:1. Alex J, Laden G, Cale A, Bennett S, Flowers K, Madden L, Gardiner E, McCollum T, Griffin S. Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass: A prospective randomised double-blind trial. Journal of Thoracic and Cardiovascular Surgery 2005;130(6):1623-30.
Lead author's name and fax:Joseph Alex mrjosephalex@yahoo.co.uk
Three-part Clinical Question:For patients having cardiac operations using cardiopulmonary bypass, does pre-treatment with hyperbaric oxygen versus a standard approach result in a reduction in neuropsychiatric deficit and/or systemic inflammatory response?
Search Terms:Cardiac surgical procedures, neuropsychology, inflammation mediators
The Study:Double-blinded randomised controlled trial with intention-to-treat.
The Study Patients:Adults without cerebrovascular disease or immunosuppresion having routine cardiac procedures using CPB
Control group(N = 31; 31 analysed): Sham procedure at 24, 12 and 4 hours before operation breathing air at 1.5 ATA for 60 minutes
Experimental group(N = 33; 33 analysed): 100% oxygen at 2.4 ATA on the same schedule
The Evidence:
Outcome |
Time to Outcome |
Sham group |
HBO group |
Relative risk reduction |
Absolute risk reduction |
NNT |
|
>1 SD deterioration in two or more NPTs |
4 months |
0.52 |
0.27 |
47% |
0.24 |
4 |
95% CIs: |
2% to 92% |
0.01 to 0.48 |
2 to 95 | |||
Comments:
1. Clinical significance of the effects demonstrated is not clear
2. There are logistic difficulties with three pre-operative hyperbaric sessions
3. The zero time for inflammatory mediators is after HBOT, making interpretation difficult
4. Those with previous myocardial infarction were over-represented in the HBOT group (31% versus 10%) which may bias outcome, direction unknown.
5. There is information in the abstract that does not appear in the main text and no units for the inflammatory markers
6. Overall good methodological study with a result that is difficult to interpret
Appraised by: Antonia Edge & Mike Bennett, Prince of Wales Hospital, Sydney ; Friday, 26 May 2006
Email:m.bennett@unsw.edu.au
Kill or Update By:June 2024
BACK
