M.bennett at 05:00, 30 August 2019

2019-08-30T05:00:40Z

Gordoben: Imported from Wikispaces

2018-04-27T07:36:59Z

Imported from Wikispaces

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'''Hyperbaric oxygenation prevents the development of delayed neuropsychological sequelae in mild/moderately severe carbon monoxide poisoning. '''
'''Clinical Bottom Line:''' 
1. HBO decreased the incidence of delayed neuropsychological sequelae. 
2. The entry level of COHb was not predictive of DNS. 
3. All patients with DNS recovered to base-line scores during further follow-up. 

'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine 
Prince of Wales Hospital Sydney; Friday 2nd October 1998 

'''Clinical Scenario:''' Adult with mild to moderate carbon monoxide poisoning. 
'''Three-part Question:''' In patients with carbon monoxide poisoning, does treatment with HBO in contrast to treatment with NBO, result in a reduction in the incidence of delayed neurological sequelae? 
'''Search Terms:''' Carbon monoxide poisoning/therapy, hyperbaric oxygenation 

'''The Study:''' 
Non-blinded randomised controlled trial with intention-to-treat. 
Exposure to products of combustion and/or high COHb level and/or symptoms and signs suggestive of CO poisoning. Excluded if unconscious at any time or evidence of myocardial compromise. 
Control group (N = 32; 30 analysed): 100% oxygen via face mask until symptoms resolved, (ave 4.2 hours). 
Experimental group (N = 33; 30 analysed): 100% oxygen as above until HBO instituted at 2.8ATA for 30 mins, then 2.0ATA for 90 mins, (ave total time 2.1 hours). 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Control Group Rate''' || '''HBO Group Rate''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''Number Needed to Treat''' 
|-
| '''Diagnosis of DNS''' || 4 weeks || 0.233 || 0 || 100% || 0.233 || 4 
|-
| '''95% Confidence Intervals:''' || || || || || 0.082 to 0.384 || 3 to 12 
|-
|}

'''Comments: '''
1. HBO given early (<6 hours from exposure in all cases). 
2. All DNS patients eventually recovered. 
3. Greatest flaw of the study is that it was not blinded. 

'''Expiry date:''' April 2020

'''References: '''
1. Thom SR, Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB. Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen.Ann Emerg Med. 1995 Apr;25(4):474-80. 

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Thom - Revision history

M.bennett at 05:00, 30 August 2019

Gordoben: Imported from Wikispaces