Ueno
Patients undergoing partial hepatectomy show modified neutrophil activity following post-operative hyperbaric oxygenation.
Clinical bottom line:
| 1. Clinical significance unclear. 2. HBOT in the acute post-operative period reduced neutrophil activation. |
'Citation':1. Ueno S, Tanabe G, Kihara K, Aoki D, Arikawa K, Dogomori H, Aikou T. Early postoperative hyperbaric oxygen therapy modifies neutrophile activation. Hepato-Gastroenterology 1999; 46:1798-1799. Lead author's name and fax: Shinichi Ueno, Fax: +81 992 65 7426
Three-part Clinical Question: In patients undergoing major surgery does hyperbaric oxygen therapy modify post-operative sinusoidal endothelial damage caused by activated neutrophils? Search Terms: hyperbaric oxygenation, endothelium, neutrophil
The Study:Non-blinded randomised controlled trial without intention-to-treat. Study Patients: Non-cirrhotic patients undergoing elective hepatectomy for liver cancer. Control group:(N = 12; 12 analysed): Standard post-operative care to maintain normal haemodynamic values. Experimental group: (N = 12; 12 analysed): Above, plus 2 sessions breathing 100% oxygen at 2ATA for 60 minutes at 3 hours and 24 hours post-operatively.
The Evidence:
| Outcome | Time to Outcome | Control group | HBO group | Relative risk reduction | Absolute risk reduction | NNT |
| serum total bilirubin >5mg/dl for 3 d | 3 days | 0.250 | 0 | 100% | 0.25 | 4 |
| ^ | 95% Confidence Intervals: | 0.01 to 0.50 | 2 to 200 | |||
| Hepatic failure | 3 days | 0 | 0 | 0.00 | ||
| ^ | 95% Confidence Intervals: | 0.00 to 0.00 | ||||
| Intraperitoneal infection | 3 days | 0.083 | 0 | |||
| ^ | 95% Confidence Intervals: |
| Non-Event Outcomes | Time to outcome | Control group | HBO group | P-value |
| PMNL elastase (mcg/L). | 12 hrs | 870 | 500 | <0.05 |
| Thrombomodulin (U/ml) | 12 hrs | 25 | 18 | <0.01 |
| Intensity of fluorescence in CD18 (nm) | 12 hrs | >10% increase | >10% decrease | 0.003 |
Comments: 1. Difficult to appraise, with minimal information/explanations throughout. 2. Findings poorly explained and discussed. 3. No apparent allowance for multiple testing of dependent data for non-event outcomes.
Appraised by: Peter Hodkinson. Edinburgh Medical School. UK. Mike Bennett Sydney, Australia; Wednesday, October 29, 2003Email: [| petehodkinson@hotmail.com] Kill or Update By: March 2013
