Yogaratnam - Revision history

M.bennett at 08:03, 22 August 2022

2022-08-22T08:03:54Z

M.bennett at 03:09, 16 September 2021

2021-09-16T03:09:51Z

M.bennett at 03:08, 16 September 2021

2021-09-16T03:08:31Z

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M.bennett at 03:07, 16 September 2021

2021-09-16T03:07:35Z

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M.bennett at 06:42, 7 April 2021

2021-04-07T06:42:15Z

M.bennett at 00:16, 6 May 2019

2019-05-06T00:16:32Z

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Gordoben: Imported from Wikispaces

2018-06-04T07:03:07Z

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=HBOT preconditioning prior to first time elective CABG improved intraoperative blood loss and reduced ICU stay.=
{|
| '''1. Pre-treating elective CBP CABG patients with HBO resulted in reduced intra-operative blood loss and ICU stay. ''' **2. Cardiac function post operatively may be improved.'''
|-
|}
**Citation:'''
1. Yogaratnam JZ, Laden G, Madden LA, Guvendik L, Cowen M, Greenman M, Seymour AM, Cale A, Griffin S. Hyperbaric oxygen preconditioning promotes cardioprotection following ischemic reperfusion injury by improving myocardial function, limiting necrosis and enhancing the induction of Hsp72. Undersea and Hyperbaric Medicine 2007; 34(4):301-302

2. Yogaratnam J, Laden G, Guvendik L, Cowen M, Cale A, Griffin S. Hyperbaric oxygen preconditioning improves myocardial function, reduces length of intensive care stay, and limits complications post coronary artery bypass graft surgery. Cardiovascular Revascularization Medicine: Including Molecular Interventions 2010;11(1):8-19.

 '''Lead author's name and contact:''' Jeysen Yogaratnam jeysenzy@msn.com
**Three-part Clinical Question:''' For patients about to undergo on-pump coronary artery bypass grafting, does pre-operative HBOT improve outcomes?

 '''Search Terms:''' Coronary artery bypass graft; cardiopulmonary bypass
**The Study:'''

 Single-blinded randomised controlled trial with intention-to-treat.

 '''The Study Patients:''' First time elective CABG using CPB and with an ejection fraction >30%.

 '''Control group''' (N = 40; 40 analysed): No specific intervention

 '''Experimental group''' (N = 41; 41 analysed): On the day of surgery, 100% oxygen at 2.4ATA for 60 minutes 4 hours prior to procedure.
**The Evidence:'''
{|
| '''Measure''' |||| '''Control Group''' |||| '''HBO Group''' || '''Difference''' || '''95% CI'''
|-
|^ || '''Mean''' || '''SD''' || '''Mean''' || '''SD''' ||^ ||^
|-
| '''Stroke Volume 24 hours postop. (mls)''' || 63.1 || 13.9 || 74.6 || 19.7 || 11.5 || -156 to 179
|-
|}

{|
| '''Non-Event Outcomes''' || '''Control group mean ''' || '''Experimental group mean''' || '''P-value'''
|-
| '''ICU stay in hours ''' || 1051 || 850 || 0.05
|-
| '''Intraoperative blood loss (mean in ml)''' || 309 || 133 || 0.02
|-
|}
**Comments:'''

 1. Other findings were not statistically significant but tended towards a more favourable outcome in the HBO group.

 2. Only 25 control and 22 intervention patients (58%) had haemodynamic studies due to lack of equipment. Bias may have been towards monitoring the more unwell patients in each group. 

3. The exclusion criteria removed the most at risk patients, so these results apply to low risk patients.

 4. Cost analysis conducted by the study found a saving of US $582.5 per HBOT patient in the intervention group based on a comparison of ICU bed cost and HBOT cost.

**Appraised by:''' Nicholas Titheridge HMAS PENGUIN, SUMU-E; Monday, 4 June 2018

 '''Email:''' ntitheridge@gmail.com

 '''Kill or Update By:''' June 2021



[[File:sumhorsa.gif|center]]

'''[[Acute ischaemia | BACK]]'''

@@ Line 7: / Line 7: @@
 |-
+|
-<span style="font-size:medium;">1. Pre-treating elective CBP CABG patients with HBO resulted in reduced intra-operative blood loss and ICU stay.<br/> 2. Cardiac function post operatively may be improved and there may be improved cardioprotection from ischaemia- reperfusion injury</span>
+<span style="font-size:large;">1. Pre-treating elective CBP CABG patients with HBO resulted in reduced intra-operative blood loss and ICU stay.<br/> 2. Cardiac function post operatively may be improved and there may be improved cardioprotection from ischaemia- reperfusion injury</span>
 |}
-'''<span style="font-size: 11pt;">Citations:&nbsp;</span>'''<span style="font-size:small;">1. Yogaratnam JZ, Laden G, Madden LA, Guvendik L, Cowen M, Greenman M, Seymour AM, Cale A, Griffin S. Hyperbaric oxygen preconditioning promotes cardioprotection following ischemic reperfusion injury by improving myocardial function, limiting necrosis and enhancing the induction of Hsp72. Undersea and Hyperbaric Medicine 2007; 34(4):301-302</span>
+<span style="font-size:medium;">'''Citations:&nbsp;'''1. Yogaratnam JZ, Laden G, Madden LA, Guvendik L, Cowen M, Greenman M, Seymour AM, Cale A, Griffin S. Hyperbaric oxygen preconditioning promotes cardioprotection following ischemic reperfusion injury by improving myocardial function, limiting necrosis and enhancing the induction of Hsp72. Undersea and Hyperbaric Medicine 2007; 34(4):301-302</span>
-<span style="font-size:small;">2. Yogaratnam J, Laden G, Guvendik L, Cowen M, Cale A, Griffin S. Hyperbaric oxygen preconditioning improves myocardial function, reduces length of intensive care stay, and limits complications post coronary artery bypass graft surgery. Cardiovascular Revascularization Medicine: Including Molecular Interventions 2010;11(1):8-19.</span>
+<span style="font-size:medium;">2. Yogaratnam J, Laden G, Guvendik L, Cowen M, Cale A, Griffin S. Hyperbaric oxygen preconditioning improves myocardial function, reduces length of intensive care stay, and limits complications post coronary artery bypass graft surgery. Cardiovascular Revascularization Medicine: Including Molecular Interventions 2010;11(1):8-19.</span>
-<span style="font-size:small;">3.&nbsp;Jeysen ZY, Gerard L, Levant G, Cowen M, Cale A, Griffin S.&nbsp;</span>Research report: the effects of hyperbaric oxygen preconditioning on myocardialbiomarkers of cardioprotection in patients having coronary artery bypass graft surgery. Undersea Hyperb Med. 2011 May-Jun;38(3):175-85<span style="font-size:small;">&nbsp;</span>
+<span style="font-size:medium;">3.&nbsp;Jeysen ZY, Gerard L, Levant G, Cowen M, Cale A, Griffin S.&nbsp;Research report: the effects of hyperbaric oxygen preconditioning on myocardialbiomarkers of cardioprotection in patients having coronary artery bypass graft surgery. Undersea Hyperb Med. 2011 May-Jun;38(3):175-85&nbsp;</span>
-<span style="font-size: 11pt;">'''Lead author's name and contact:''' Jeysen Yogaratnam jeysenzy@msn.com</span>
+----
-'''<span style="font-size: 11pt;">Three-part Clinical Question:</span>'''<span style="font-size: 11pt;">For patients about to undergo on-pump coronary artery bypass grafting, does pre-operative HBOT improve outcomes?</span>
+<span style="font-size:medium;">'''Lead author's name and contact:''' Jeysen Yogaratnam jeysenzy@msn.com</span>
-<span style="font-size: 11pt;">'''Search Terms:''' Coronary artery bypass graft; cardiopulmonary bypass</span>
+<span style="font-size:medium;">'''Three-part Clinical Question:'''For patients about to undergo on-pump coronary artery bypass grafting, does pre-operative HBOT improve outcomes?</span>
-'''<span style="font-size: 11pt;">The Study:&nbsp;</span>'''<span style="font-size: 11pt;">Single-blinded randomised controlled trial with intention-to-treat.</span>
+<span style="font-size:medium;">'''Search Terms:''' Coronary artery bypass graft; cardiopulmonary bypass</span>
-<span style="font-size: 11pt;">'''The Study Patients:''' First time elective CABG using CPB and with an ejection fraction >30%.</span>
+<span style="font-size:medium;">'''The Study:&nbsp;'''Single-blinded randomised controlled trial with intention-to-treat.</span>
-<span style="font-size: 11pt;">'''Control group''' (N = 40; 40 analysed): No specific intervention</span>
+<span style="font-size:medium;">'''The Study Patients:''' First time elective CABG using CPB and with an ejection fraction >30%.</span>
-<span style="font-size: 11pt;">'''Experimental group''' (N = 41; 41 analysed): On the day of surgery, 100% oxygen at 2.4ATA for 60 minutes 4 hours prior to procedure.</span>
+<span style="font-size:medium;">'''Control group''' (N = 40; 40 analysed): No specific intervention</span>
-'''<span style="font-size: 11pt;">The Evidence:</span>'''
+<span style="font-size:medium;">'''Experimental group''' (N = 41; 41 analysed): On the day of surgery, 100% oxygen at 2.4ATA for 60 minutes 4 hours prior to procedure.</span>
-&nbsp;
+<span style="font-size:medium;">'''The Evidence:'''</span>
 {| class="Table" style="width:558.0pt; border:solid windowtext 1.0pt" width="0"
@@ Line 99: / Line 97: @@
 &nbsp;
-'''<span style="font-size: 11pt;">Comments:</span>'''
+<span style="font-size:medium;">'''Comments:'''</span>
-<span style="font-size: 11pt;">1. Other findings were not statistically significant but tended towards a more favourable outcome in the HBO group.</span>
+<span style="font-size:medium;">1. Other findings were not statistically significant but tended towards a more favourable outcome in the HBO group.</span>
-<span style="font-size: 11pt;">2. Only 25 control and 22 intervention patients (58%) had haemodynamic studies due to lack of equipment. Bias may have been towards monitoring the more unwell patients in each group.</span>
+<span style="font-size:medium;">2. Only 25 control and 22 intervention patients (58%) had haemodynamic studies due to lack of equipment. Bias may have been towards monitoring the more unwell patients in each group.</span>
-<span style="font-size: 11pt;">3. The exclusion criteria removed the most at risk patients, so these results apply to low risk patients.</span>
+<span style="font-size:medium;">3. The exclusion criteria removed the most at risk patients, so these results apply to low risk patients.</span>
-<span style="font-size: 11pt;">4. Cost analysis conducted by the study found a saving of US $582.5 per HBOT patient in the intervention group based on a comparison of ICU bed cost and HBOT cost.</span>
+<span style="font-size:medium;">4. Cost analysis conducted by the study found a saving of US $582.5 per HBOT patient in the intervention group based on a comparison of ICU bed cost and HBOT cost.</span>
-<span style="font-size: 11pt;">5. Third citation documented&nbsp;lower levels of eNOS and heat shock protein 72 (HSP72) within myocardial cells after induction and during CPB, but an increase after the period of ischaemia, This may imply an increase in endogenous myocardial protection.</span>
+<span style="font-size:medium;">5. Third citation documented&nbsp;lower levels of eNOS and heat shock protein 72 (HSP72) within myocardial cells after induction and during CPB, but an increase after the period of ischaemia, This may imply an increase in endogenous myocardial protection.</span>
-'''<span style="font-size: 11pt;">Appraised by:</span>'''<span style="font-size: 11pt;">Nicholas Titheridge HMAS PENGUIN, SUMU-E; Monday, 4 June 2018. Third citation by M Bennett May 2019.</span>
+<span style="font-size:medium;">'''Appraised by:'''Nicholas Titheridge HMAS PENGUIN, SUMU-E; Monday, 4 June 2018. Third citation by M Bennett May 2019.</span>
-<span style="font-size: 11pt;">'''Email:''' ntitheridge@gmail.com</span>
+<span style="font-size:medium;">'''Email:''' ntitheridge@gmail.com</span>
-<span style="font-size: 11pt;">'''Kill or Update By:''' June 2021</span>
+<span style="font-size:medium;">'''Kill or Update By:''' June 2024</span>
 &nbsp;

@@ Line 95: / Line 95: @@
 | style="width:153.0pt; border:solid windowtext 1.0pt" width="206" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">133</span></span></span></p>
 | style="width:48.75pt; border:solid windowtext 1.0pt" width="68" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.02</span></span></span></p>
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@@ Line 15: / Line 15: @@
 <span style="font-size:small;">2. Yogaratnam J, Laden G, Guvendik L, Cowen M, Cale A, Griffin S. Hyperbaric oxygen preconditioning improves myocardial function, reduces length of intensive care stay, and limits complications post coronary artery bypass graft surgery. Cardiovascular Revascularization Medicine: Including Molecular Interventions 2010;11(1):8-19.</span>
-<span style="font-size:small;">3.&nbsp;Jeysen ZY, Gerard L, Levant G, Cowen M, Cale A, Griffin S. the effects of hyperbaric oxygen preconditioning on myocardial biomarkers of cardioprotection in patients having coronary artery bypass graft surgery.</span>
+<span style="font-size:small;">3.&nbsp;Jeysen ZY, Gerard L, Levant G, Cowen M, Cale A, Griffin S.&nbsp;</span>Research report: the effects of hyperbaric oxygen preconditioning on myocardialbiomarkers of cardioprotection in patients having coronary artery bypass graft surgery. Undersea Hyperb Med. 2011 May-Jun;38(3):175-85<span style="font-size:small;">&nbsp;</span>
 <span style="font-size: 11pt;">'''Lead author's name and contact:''' Jeysen Yogaratnam jeysenzy@msn.com</span>
@@ Line 31: / Line 31: @@
 <span style="font-size: 11pt;">'''Experimental group''' (N = 41; 41 analysed): On the day of surgery, 100% oxygen at 2.4ATA for 60 minutes 4 hours prior to procedure.</span>
 '''<span style="font-size: 11pt;">The Evidence:</span>'''
 {| class="Table" style="width: 744px;"