Tang2
Hyperbaric oxygen postoperatively improved outcomes following anterior cerebral artery clipping.
| Clinical bottom line: 1. HBOT improved clinical outcome as estimated by GOS at six months and KPS at 21 days 2. HBOT also resulted in lower volume of abnormal brain on C/T and lower MCA blood flow at days 7 and 21. |
- Citation:
1. Tang X-P, Tan M. Zhang T, Peng H, Duan J-W. Effects of early hyperbaric oxygen therapy on clinical outcome in postoperative patients with intracranial aneurysm. Undersea and Hyperbaric Medicine 2011;38(6):493-501
- Lead author's name and email: Xiao-Ping Tang Tangxiaoping1971@126.com
- Three-part Clinical Question: For patients requiring clipping of anterior circulation aneurysm, does the postoperative addition of hyperbaric oxygen result in improved clinical outcomes?
Search Terms: Neurosurgery, postoperative, Glasgow outcome score The Study: Non-blinded randomised controlled trial without intention-to-treat.
The Study Patients: Adult patients following clipping of anterior circulation aneurysm and in whom there was no re-operation, postoperative bleeding or severe systemic disease.
Control group (N = 60; 60 analysed): Aneurysm clipping, 20mg nimodipine iv daily for 7-10 days, papaverine 30mg IM daily tds for 3 days. Cerebral vasospasm treated with 'triple -H' therapy using AHA guideline (hypertension/hypovoaemia/haemodilution).
- Experimental group (N = 60; 60 analysed): As above plus HBOT starting one to three days postoperatively when deemed stable. Monoplace treatment at 2ATA for 60 minutes (20 compression, 20 at depth, 20 on ascent) daily to a minimum of 20 sessions and up to 50 sessions.
- The Evidence:
| Outcome | Time to Outcome | Control group | HBO group | Relative risk reduction | Absolute risk reduction | NNT |
| Glasgow outcome score 4 or 5 (good) | Six months | 0.77 | 0.90 | 17% | 0.13 | 8 |
| ^ | 95% CIs: | 0% to 34% | 0.00264 to 0.26 | 4 to 545 | ||
| Cerebral vasospasm | Day 14 | 0.22 | 0.08 | 62% | 0.13 | 7 |
| ^ | 95% CIs: | 4% to 100% | 0.008 to 0.26 | 4 to 118 |
| Measure | Control Group | Experimental Group | Difference | 95% CI | ||
| ^ | Mean | SD | Mean | SD | ^ | ^ |
| Mean flow velocity in middle cerebral artery Day 14 (cm/s) | 120 | 50 | 95 | 35 | 25 | 9.456 to 40.544 |
| Volume of brain with abnormal density at 21 days (ml) | 19.5 | 5.5 | 9.5 | 4.5 | 10.000 | 8.184 to 11.816 |
| Karnofsky performance scale at 21 days (score) | 73 | 13 | 86 | 14 | -13 | -17.699 to -8.301 |
- Comments:
1. 15 cases in each group were excluded after randomisation because of death or need for re-operation. 2. It is unclear how the decision was made to stop HBOT 3. Lower flows in MCA suggests better metabolic state. Flows were lower at both 7 and 14 days with HBOT.
Appraised by: Mike Bennett, POWH; Monday, 30 October 2017
Email: m.bennett@unsw.edu.au
Kill or Update By: July 2022
