Bosco
A single hyperbaric oxygen exposure preoperatively may modulate inflammatory markers and clinical complications following pancreatodudenectomy
Clinical Bottom Line:
1. Some evidence that HBO exposure modulates the level IL-6 (down) and IL-10 (up)
2. Fewer pulmonary complications with HBO exposure but not fistula development, bleeding or fever.
Citation/s: 1. Bosco G, Casarotto A, Nasole E, Camporesi E, Salvia R, Giovinazzo F, Zanini S, Malleo G, Di Tano A, Rubini A, Zanon V, Mangar D, Bassi C. Preconditioning with hyperbaric oxygen in pancreatodudenectomy: a randomised double-blind pilot study.
Lead author's name and email: Bosco G:gerardo.bosco@unipd.it
Three-part Clinical Question:'Does preoperative hyperbaric oxygen exposure before pancreatoduodenectomy reduce the rate of postoperative complications?
Search Terms: Preconditioning; pancreatectomy; surgery
The Study: Double-blinded concealed randomised controlled trial with intention-to-treat.
The Study Patients: Adult patients scheduled for pancreatoduodenectomy for pancreatic ductal carcinoma.
Control group:(N = 11; 11 analysed): A single sham exposure breathing air at 1.15 ATA on a schedule lasting 116 minutes on the day prior to surgery.
Experimental group:(N = 10; 10 analysed): A single exposure to 2.5 ATA breathing 100% oxygen for a total of 116 minutes on the day prior to surgery.
The Evidence:
|
Outcome |
Time to Outcome |
Control group |
HBO group |
Relative Risk Reduction |
Absolute risk reduction |
NNT |
|
Pulmonary complications |
?Discharge |
0.55 |
0 |
100% |
0.55 |
2 |
95%CI: |
|
0.25 to 0.84 |
1 to 4 | |||
|
Postop bleeding |
?Discharge |
0.18 |
0.30 |
-65% |
-0.12 |
-8 |
95%CI: |
|
-265% to 100% |
-0.48 to 0.25 |
NNT 4 to INF; NNH 2 to INF | ||
|
Postop fistula |
?Discharge |
0.27 |
0.33 |
-22% |
-0.06 |
-17 |
95%CI: |
|
-166% to 100% |
-0.45 to 0.33 |
NNT 3 to INF; NNH 2 to INF | ||
|
|
|
|
|
|
|
|
|
Non-Event Outcomes |
Time to outcome/s |
Control group |
Experimental group |
P-value |
|
Serum cytokine IL-6 (no units given) |
Pre-HBO/ Post-HBO/ Day 1 Postop/ Day 7 Postop |
5.97/ 24.06/ 179.54 /24.5 |
5.06/ 5.81/ 141.23/ 21.76 |
0.009 |
|
'Serum cytokine IL'10 (no units given) |
Pre-HBO/ Post-HBO/ Day 1 Postop/ Day 7 Postop |
4.04/ 4.43/ 7.76/ 4.14 |
2.01/ 2.41/ 5.6/ 3.34 |
0.034 |
Comments:
1. Small study underpowered for some outcomes.
2. There was a statistically significant relationship between IL-6 and post-operative fistula. Not clear if there is a causal relationship between serum IL-6 reduction and HBO, or between the development of fistula and serum IL-6 increase.
3. Reduction in post-operative pneumonia in HBO patients should be confirmed in larger studies
Appraised by:M. Bennett, POWH, m.bennett@unsw.edu.au; Friday, 2 January 2015
Kill or Update By:01/2022
