Holbach
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: November 2021 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.
