M.bennett at 04:56, 30 August 2019

2019-08-30T04:56:12Z

Gordoben: Imported from Wikispaces

2018-04-27T07:35:32Z

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'''Hyperbaric oxygenation was associated with more rapid clinical recovery in non-comatose patients with carbon monoxide poisoning.''' 
'''Clinical Bottom Line:''' 
1. Early hyperbaric oxygen treatment results in a significant reduction in those with clinical impairment at 2 and 12 hours. 

'''Appraised by:''' Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Tuesday, 24 November, 1998 

'''Clinical Scenario:''' Non-comatose patient with carbon monoxide intoxication and presenting to hospital within 2 hours. 
'''Three-part Question:''' In non-comatose patients suffering with carbon monoxide intoxication, does the application of hyperbaric oxygen, compared to a normobaric oxygen regime, result in any improvement in neurological outcome? 
'''Search Terms:''' Hyperbaric oxygenation, carbon monoxide poisoning. 

'''The Study:''' 
Single-blinded randomised controlled trial with intention-to-treat. 
Presenting within 2 hours of exposure, less than 12 hours exposure, Glasgow Coma Score of 12 or more and not pregnant. 
Control group (N = 13; 13 analysed): Oxygen at 1ATA for 6 hours, then 0.5ATA for 6 hours in the ICU. 
Experimental group (N = 13; 13 analysed): Oxygen at 2.5ATA for 2 hours in a hyperbaric chamber, then at 1ATA for 4 hours and 0.5ATA for 6 hours. 

'''The Evidence:''' 

{|
| '''Outcome ''' || '''Time to Outcome ''' || '''NBO group ''' || '''HBO group ''' || '''Relative risk reduction ''' || '''Absolute risk reduction ''' || '''Number needed to treat '''
|-
| '''Clinical abnormalities ''' || 2 hours || 0.692 || 0.154 || 78% || 0.54 || 2 
|-
| '''95% CI ''' || || || || 32% to 100% || 0.22 to 0.86 || 1 to 5 
|-
| '''Clinical abnormalities ''' || 12 hours || 0.385 || 0 || 100% || 0.39 || 3 
|-
| '''95% CI ''' || || || || || 0.12 to 0.65 || 2 to 8 
|-
|}

'''Comments:'''
1. Patients and staff not blinded to treatment.
2. No information on longer-term outcomes. No apparent neurological differences.
3. Clinical abnormalities included headache, reflex impairment, asthenia and pulmonary oedema.

**Expiry date:''' April 2020
**References:'''
1. Ducasse JL, Cesis P, Marc-Vergnes JP. Non-comatose patients with acute carbon monoxide poisoning: hyperbaric or normobaric oxygenation? Undersea Hyperbaric Medicine 1995;22:9-15.
2. Ducasse JL, Izard PH, Celcis P, Leclercq Ch et al. Moderate carbon monoxide poisoning: hyperbaric or normobaric oxygenation? In: Bakker DJ, Schmutz J eds. Hyperbaric Medicine Proceedings, 2nd Swiss Symposium on Hyperbaric Medicine. Basel, Switzerland: Foundation for Hyperbaric Medicine 1990:289-297.

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==[[Carbon monoxide | BACK]]==

Ducasse - Revision history

M.bennett at 04:56, 30 August 2019

Gordoben: Imported from Wikispaces