Sun
The addition of hyperbaric oxygen to management of acute spinal cord injured patients resulted in improved functional ability and reduced signs of neuro-inflammation
|
1. The addition of hyperbaric oxygen improved motor scores and an impairment scale in acute spinal injury |
Citation/s:1.Sun L, Zhao L, Li P, Liu X, Liang F, Jiang Y, Kang N, Gao C, Yang J. Effect of hyperbaric oxygen therapy on HMGB/NF-kB expression and prognosis of acute spinal cord injury: a randomized clinical trial. Neuroscience Letters 2019, Jan23;692:47-52.
Lead author's name and fax: Lei Sun: leisun-neurology@foxmail.com
Three-part Clinical Question:For patients with acute spinal injury, does the administration of hyperbaric oxygen along with usual standard measures, compared to standard measures alone, lead to any effects on secondary inflammatory responses and electromyographic changes?
Search Terms: Spinal cord injury; inflammatory markers, DNA binding protein
The Study:Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Adult patients with traumatic spinal cord injury and admitted to the relevant hospital within 72 hours.
Control group (N = 38; 38 analysed): Conventional medical and surgical management with mannitol, methylprednisolone, ganglioside and vitamin B12.
Experimental group (N = 41; 41 analysed): As above plus 100% oxygen breathing at 1 ATA for 60 minutes daily for 30 days.
The Evidence:
Outcome |
Time to Outcome |
Control group |
Hyperbaric group |
Relative risk reduction |
Absolute risk reduction |
NNT |
Improved at least one level in American Spinal Injury Impairment Scale |
30 days |
.71 |
.93 |
30% |
0.22 |
5 |
95% CIs: |
7% to 54% |
0.05 to 0.38 |
3 to 19 | |||
Measure |
Control Group |
Experimental Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
High mobility group box 1 (HMGB1) in plasma at 30 days (ng/ml) |
4.48 |
2.08 |
3.65 |
1.30 |
0.83 |
0.06 to 1.60 |
|
F-wave persistence (% of discernible F-waves) at 30 days |
0.52 |
0.24 |
0.73 |
0.15 |
0.21 |
0.12 to 0.30 |
|
Mean American Spinal Injury Motor Score at 30 days |
53 |
20 |
77 |
10 |
24 |
16.8 to 31.2 |
Comments:
1. A ganglioside is a glycoshpingolipid derived from a cell plasma membrane and has immunological activity . Has been used in neurodegenerative disorders.
2. HMGB1 is a DNA binding protein that is a pro-inflammatory marker.
3. Poor methodological reporting. Method of randomization and any blinding unclear.
4. Clinical outcomes are poorly presented. ASIA scores read from graph.
Appraised by:Mike Bennett m.bennett@unsw.edu.au; Tuesday, 30 June 2020
Kill or Update By: June 2024
