Mathieu - Revision history

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'''Fewer patients with evidence of persistent neurological manifestations at 3 months following carbon monoxide intoxication following a single hyperbaric oxygen treatment.''' 
'''Clinical Bottom Line:''' 
1. Treatment with HBO resulted in fewer patients with persistent neurological manifestations at 3 months after exposure, but not 1 or 6 months. 

'''Appraised by:''' Mike Bennett Dept. of Diving and Hyperbaric Medicine 
Prince of Wales Hospital, Sydney; Thursday, 19 November, 1998 

'''Clinical Scenario:''' Non-comatose patient with carbon monoxide intoxication. 
'''Three-part Question:''' In non-comatose patients with CO poisoning, does the application of hyperbaric oxygen as compared to normobaric oxygen result in fewer patients with neurological manifestations? 
'''Search Terms:''' Hyperbaric oxygenation, carbon monoxide 

'''The Study:''' 
Non-blinded randomised controlled trial with intention-to-treat. 
Adult, non-comatose patients presenting within 12 hours and with a measured HbCO of greater than 10%. Excluded if there was mixed poisoning, pregnancy or specific contraindication. 
Control group (N = 276; 276 analysed): 100% oxygen for 12 hours at 1ATA. 
Experimental group (N = 299; 299 analysed): Hyperbaric oxygen at 2.5ATA for 90 minutes. 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''NBO''' || '''HBO''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Persistent neurological manifestations''' || 1 month || 0.26 || 0.23 || 12% || 0.030 || 33 
|-
| '''95% CI''' || || || || -16% to 39% || -0.04 to 0.10 || NNT'''10 to INF NNH'''25 to INF 
|-
| '''PNM''' || 3 months || 0.15 || 0.095 || 37% || 0.055 || 18 
|-
| '''95% CI''' || || || || 1% to 72% || 0.001 to 0.11 || 9 to 746 
|-
| '''PNM''' || 12 months || 0.05 || 0.043 || 16% || 0.007 || -143 
|-
| '''95% CI''' || || || || -64% to 96% || -0.03 to 0.04 || NNT'''37 to INF NNH'''24 to INF 
|-
|}

'''Comments:''' 
1. Interim report only with insufficient detail of outcome measures, randomisation, blinding or numbers of patients who reached final follow-up. 
3. There does not appear to have been any sham treatment. 
4. The effect shown is probably unreliable given nature of report. 

'''Expiry date:''' September 2004 
'''References:''' 1. Mathieu D, Wattel F, Mathieu-Nolf M, Durak C, Tempe JP, Bouachour G, Sainty JM. Randomized prospective study comparing the effect of HBO versus 12 hours NBO in non-comatose CO poisoned patients: results of the interim analysis. In: Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine, Marroni A, Oriani G, Wattel F eds. Grafica Victoria, Bolognia 1996; 331. 

[[File:http://www.hboevidence.com/_themes/copy-of-sumi-painting/sumhorsa.gif|center|external]]

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

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 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''References:''' 1. Mathieu D, Wattel F, Mathieu-Nolf M, Durak C, Tempe JP, Bouachour G, Sainty JM. Randomized prospective study comparing the effect of HBO versus 12 hours NBO in non-comatose CO poisoned patients: results of the interim analysis. In: Proceedings of the International Joint Meeting on Hyperbaric an&nbsp;d Underwater Medicine, Marroni A, Oriani G, Wattel F eds. Grafica Victoria, Bolognia 1996; 331.</span>
-<p style="text-align: center;">&nbsp;</p> <p style="text-align: center;">&nbsp;</p> <p style="text-align: center;">&nbsp;</p>
+<p style="text-align: center;">&nbsp;</p> <p style="text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</p> <p style="text-align: center;">&nbsp;</p>
 <span style="color: #7a00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 140%; text-align: center;"><span style="font-size:xx-large;">[[Carbon_monoxide|BACK]]</span></span>
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 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''References:''' 1. Mathieu D, Wattel F, Mathieu-Nolf M, Durak C, Tempe JP, Bouachour G, Sainty JM. Randomized prospective study comparing the effect of HBO versus 12 hours NBO in non-comatose CO poisoned patients: results of the interim analysis. In: Proceedings of the International Joint Meeting on Hyperbaric an&nbsp;d Underwater Medicine, Marroni A, Oriani G, Wattel F eds. Grafica Victoria, Bolognia 1996; 331.</span>
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 <span style="color: #7a00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 140%; text-align: center;"><span style="font-size:xx-large;">[[Carbon_monoxide|BACK]]</span></span>
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 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Expiry date:''' August 2022&nbsp;</span>
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''References:''' 1. Mathieu D, Wattel F, Mathieu-Nolf M, Durak C, Tempe JP, Bouachour G, Sainty JM. Randomized prospective study comparing the effect of HBO versus 12 hours NBO in non-comatose CO poisoned patients: results of the interim analysis. In: Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine, Marroni A, Oriani G, Wattel F eds. Grafica Victoria, Bolognia 1996; 331.</span>
+<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''References:''' 1. Mathieu D, Wattel F, Mathieu-Nolf M, Durak C, Tempe JP, Bouachour G, Sainty JM. Randomized prospective study comparing the effect of HBO versus 12 hours NBO in non-comatose CO poisoned patients: results of the interim analysis. In: Proceedings of the International Joint Meeting on Hyperbaric an&nbsp;d Underwater Medicine, Marroni A, Oriani G, Wattel F eds. Grafica Victoria, Bolognia 1996; 331.</span>
+<p style="text-align: center;">&nbsp;</p> <p style="text-align: center;"></p> <p style="text-align: center;">&nbsp;</p>
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+<span style="color: #7a00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 140%; text-align: center;"><span style="font-size:xx-large;">[[Carbon_monoxide|BACK]]</span></span>
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