Gordoben: Imported from Wikispaces

2018-10-11T03:58:38Z

Imported from Wikispaces

New page

'''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

[[File:sumhorsa.gif|center]]

'''[[Stroke | BACK]]'''

Tang2 - Revision history

Gordoben: Imported from Wikispaces