Fukami

 

Hyperbaric oxygen did not improve the outcome from postoperative adhesive small bowel obstruction

Clinical Bottom Line:

1.Hyperbaric oxygen made no difference to the outcome

 

Citation/s: 1. Fukami Y, Kobayashi S, Sekoguchi E, Kurumiya Y. Randomized controlled trial of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction. Langenbeck's archives of surgery. 2018 Aug 1;403(5):555-9.

Lead author's name and fax:Y Fukami yasuyuki490225@yahoo.co.jp

 

Three-part Clinical Question:For patients with postoperative small bowel obstruction, does the addition of a course of hyperbaric oxygen to the usual care, result in a reduction in the time to recovery or need for operation?

Search Terms:Small bowel obstruction., postoperative compliations

 

The Study: Non-blinded concealed randomised controlled trial with intention-to-treat.

The Study Patients:Adult patients with a history of abdominal surgery more than four weeks previously and clinical signs and symptoms of mechanical obstruction, with dilated loops of small intestine of CT scan.

Control group(N = 40; 40 analysed): No oral intake, IV fluids and insertion of nasograstric tube.

Experimental group(N = 33; 33 analysed): As above plus 100% osygen breathing at 2 ATA for 90 minutes daily up to seven times or until improvement in symptoms.

 

The Evidence:

Outcome

Time to Outcome

Standard group

Hyperbaric group

Relative risk reduction

Absolute risk reduction

NNT

Need for operation

no defined period

0.10

0.18

-82%

-0.08

12

95% CIs:

-243% to 79%

-0.24 to 0.08

NNT = 4 to INF; NNH = 13 to INF

Successful medical treatment

No defined period

0.73

0.79

-9%

-0.06

16

95% CIs:

-36% to 18%

-0.259 to 0.133

NNT = 4 to INF; NNH = 7 to INF

 

Measure

Standard Group

Hyperbaric group

Difference

95% CI

Mean

SD

Mean

SD

Time to oral intake (days)

4.2

3.7

4.2

3.3

0.0

-5.8 to 5.8

Length of hospital stay (days)

11.5

7.0

14.2

10.0

-2.7

-36.4 to 31.0

 

Comments:

1. Small trial, somewhat underpowered (original target 100 individuals randomised), but no indication of likely benefit.

2. Bias remains possible due to unbiased nature of trial, but this seems unlikely to be large given the nature of the endpoints.

 

Appraised by:Michael Bennett, POWH m.bennett@unsw.edu.au; Monday, 22 July 2019

 

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