Difference between revisions of "Alex"
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<span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" arial",sans-serif"="">Preoperative hyperbaric oxygenation reduced psychometric dysfunction and some systemic inflammatory markers following cardiac bypass and surgery</span></span>'''</span>
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<span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:">Preoperative hyperbaric oxygenation reduced psychometric dysfunction and some systemic inflammatory markers following cardiac bypass and surgery</span></span>'''</span>
  
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<span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:" arial",sans-serif"="">Clinical Bottom Line:</span></span>'''</span>
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<span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:">Clinical Bottom Line:</span></span>'''</span>
  
 
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<span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" arial",sans-serif"="">1.</span></span><span style="font-size:14.0pt"><span style="font-family:" arial",sans-serif"="">Pre-operative HBOT was associated with a reduced chance of neuropsychiatric deficit when defined as a reduction of >1 standard deviation in two of seven tests<br/> 2. HBOT reduced the increase in some markers of systemic inflammation, including ICAM-1, CD-18 and heat shock protein 70, but not others.</span></span></span>
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<span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:">1.</span></span><span style="font-size:14.0pt"><span style="font-family:">Pre-operative HBOT was associated with a reduced chance of neuropsychiatric deficit when defined as a reduction of >1 standard deviation in two of seven tests<br/> 2. HBOT reduced the increase in some markers of systemic inflammation, including ICAM-1, CD-18 and heat shock protein 70, but not others.</span></span></span>
  
 
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Citation:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">1. Alex J, Laden G, Cale A, Bennett S, Flowers K, Madden L, Gardiner E, McCollum T, Griffin S. Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass: A prospective randomised double-blind trial. Journal of Thoracic and Cardiovascular Surgery 2005;130(6):1623-30.</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Citation:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">1. Alex J, Laden G, Cale A, Bennett S, Flowers K, Madden L, Gardiner E, McCollum T, Griffin S. Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass: A prospective randomised double-blind trial. Journal of Thoracic and Cardiovascular Surgery 2005;130(6):1623-30.</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Lead author's name and fax:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Joseph Alex [mailto:mrjosephalex@yahoo.co.uk| <span style="color:blue">mrjosephalex@yahoo.co.uk</span>]</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Lead author's name and fax:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Joseph Alex [mailto:mrjosephalex@yahoo.co.uk| <span style="color:blue">mrjosephalex@yahoo.co.uk</span>]</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Three-part Clinical Question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">For patients having cardiac operations using cardiopulmonary bypass, does pre-treatment with hyperbaric oxygen versus a standard approach result in a reduction in neuropsychiatric deficit and/or systemic inflammatory response?</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Three-part Clinical Question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">For patients having cardiac operations using cardiopulmonary bypass, does pre-treatment with hyperbaric oxygen versus a standard approach result in a reduction in neuropsychiatric deficit and/or systemic inflammatory response?</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Cardiac surgical procedures, neuropsychology, inflammation mediators</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Cardiac surgical procedures, neuropsychology, inflammation mediators</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">The Study:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Double-blinded randomised controlled trial with intention-to-treat.</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">The Study:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Double-blinded randomised controlled trial with intention-to-treat.</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">The Study Patients:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Adults without cerebrovascular disease or immunosuppresion having routine cardiac procedures using CPB</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">The Study Patients:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Adults without cerebrovascular disease or immunosuppresion having routine cardiac procedures using CPB</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Control group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">(N = 31; 31 analysed): Sham procedure at 24, 12 and 4 hours before operation breathing air at 1.5 ATA for 60 minutes</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Control group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">(N = 31; 31 analysed): Sham procedure at 24, 12 and 4 hours before operation breathing air at 1.5 ATA for 60 minutes</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Experimental group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">(N = 33; 33 analysed): 100% oxygen at 2.4 ATA on the same schedule</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Experimental group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">(N = 33; 33 analysed): 100% oxygen at 2.4 ATA on the same schedule</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">The Evidence:</span></span>'''</span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">The Evidence:</span></span>'''</span>
  
 
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"="">Outcome</span>'''</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Outcome</span>'''</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"="">Time to Outcome</span>'''</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Time to Outcome</span>'''</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"="">Sham group</span>'''</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Sham group</span>'''</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"="">HBO group</span>'''</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">HBO group</span>'''</span></p>  
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| style="width:69.25pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"="">Relative risk reduction</span>'''</span></p>  
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| style="width:69.25pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Relative risk reduction</span>'''</span></p>  
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"="">Absolute risk reduction</span>'''</span></p>  
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">Absolute risk reduction</span>'''</span></p>  
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| style="width:44.8pt; border:solid windowtext 1.0pt" width="63" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"="">NNT</span>'''</span></p>  
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| style="width:44.8pt; border:solid windowtext 1.0pt" width="63" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-family:">NNT</span>'''</span></p>  
 
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">>1 SD deterioration in two or more NPTs</span></span>'''</span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">>1 SD deterioration in two or more NPTs</span></span>'''</span>
  
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| style="border:solid windowtext 1.0pt" | <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:" times="" new="" roman",serif"="">4 months</span></span></span></p>  
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| style="border:solid windowtext 1.0pt" | <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:">4 months</span></span></span></p>  
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| style="border:solid windowtext 1.0pt" | <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:" times="" new="" roman",serif"="">0.52</span></span></span></p>  
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| style="border:solid windowtext 1.0pt" | <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:">0.52</span></span></span></p>  
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| style="border:solid windowtext 1.0pt" | <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:" times="" new="" roman",serif"="">0.27</span></span></span></p>  
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| style="border:solid windowtext 1.0pt" | <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:">0.27</span></span></span></p>  
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| style="width:69.25pt; border:solid windowtext 1.0pt" width="94" | <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:" times="" new="" roman",serif"="">47%</span></span></span></p>  
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| style="width:69.25pt; border:solid windowtext 1.0pt" width="94" | <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:">47%</span></span></span></p>  
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <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:" times="" new="" roman",serif"="">0.24</span></span></span></p>  
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <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:">0.24</span></span></span></p>  
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| style="width:44.8pt; border:solid windowtext 1.0pt" width="63" | <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:" times="" new="" roman",serif"="">4</span></span></span></p>  
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| style="width:44.8pt; border:solid windowtext 1.0pt" width="63" | <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:">4</span></span></span></p>  
 
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| colspan="3" style="border:solid windowtext 1.0pt" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CIs:</span></span></span></p>  
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| colspan="3" style="border:solid windowtext 1.0pt" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">95% CIs:</span></span></span></p>  
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| style="width:69.25pt; border:solid windowtext 1.0pt" width="94" | <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:" times="" new="" roman",serif"="">2% to 92%</span></span></span></p>  
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| style="width:69.25pt; border:solid windowtext 1.0pt" width="94" | <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:">2% to 92%</span></span></span></p>  
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <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:" times="" new="" roman",serif"="">0.01 to 0.48</span></span></span></p>  
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <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:">0.01 to 0.48</span></span></span></p>  
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| style="width:44.8pt; border:solid windowtext 1.0pt" width="63" | <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:" times="" new="" roman",serif"="">2 to 95</span></span></span></p>  
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| style="width:44.8pt; border:solid windowtext 1.0pt" width="63" | <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:">2 to 95</span></span></span></p>  
 
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Comments:</span></span>'''</span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Comments:</span></span>'''</span>
  
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">1. Clinical significance of the effects demonstrated is not clear</span></span></span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1. Clinical significance of the effects demonstrated is not clear</span></span></span>
  
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">2. There are logistic difficulties with three pre-operative hyperbaric sessions</span></span></span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">2. There are logistic difficulties with three pre-operative hyperbaric sessions</span></span></span>
  
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">3. The zero time for inflammatory mediators is after HBOT, making interpretation difficult</span></span></span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3. The zero time for inflammatory mediators is after HBOT, making interpretation difficult</span></span></span>
  
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">4. Those with previous myocardial infarction were over-represented in the HBOT group (31% versus 10%) which may bias outcome, direction unknown.</span></span></span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">4. Those with previous myocardial infarction were over-represented in the HBOT group (31% versus 10%) which may bias outcome, direction unknown.</span></span></span>
  
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">5. There is information in the abstract that does not appear in the main text and no units for the inflammatory markers</span></span></span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">5. There is information in the abstract that does not appear in the main text and no units for the inflammatory markers</span></span></span>
  
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">6. Overall good methodological study with a result that is difficult to interpret</span></span></span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">6. Overall good methodological study with a result that is difficult to interpret</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Appraised by</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">: Antonia Edge & Mike Bennett, Prince of Wales Hospital, Sydney ; Friday, 26 May 2006</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Appraised by</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">: Antonia Edge & Mike Bennett, Prince of Wales Hospital, Sydney&nbsp;; Friday, 26 May 2006</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Email:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">[mailto:m.bennett@unsw.edu.au| <span style="color:blue">m.bennett@unsw.edu.au</span>]</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Email:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">[mailto:m.bennett@unsw.edu.au| <span style="color:blue">m.bennett@unsw.edu.au</span>]</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Kill or Update By:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">June 2024</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Kill or Update By:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">June 2024</span></span></span>
  
 
<span style="display: block; text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</span>
 
<span style="display: block; text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</span>
  
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== <span style="color: #7c00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 170%; text-align: center;">[[Acute_ischaemia|BACK]]</span> ==
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== <span style="color: #7c00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 170%; text-align: center;">[[Myocardial_ischaemia|BACK]]</span> ==
  
 
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Revision as of 23:02, 15 September 2021

Preoperative hyperbaric oxygenation reduced psychometric dysfunction and some systemic inflammatory markers following cardiac bypass and surgery

Clinical Bottom Line:

1.Pre-operative HBOT was associated with a reduced chance of neuropsychiatric deficit when defined as a reduction of >1 standard deviation in two of seven tests
2. HBOT reduced the increase in some markers of systemic inflammation, including ICAM-1, CD-18 and heat shock protein 70, but not others.

Citation:1. Alex J, Laden G, Cale A, Bennett S, Flowers K, Madden L, Gardiner E, McCollum T, Griffin S. Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass: A prospective randomised double-blind trial. Journal of Thoracic and Cardiovascular Surgery 2005;130(6):1623-30.

Lead author's name and fax:Joseph Alex mrjosephalex@yahoo.co.uk

Three-part Clinical Question:For patients having cardiac operations using cardiopulmonary bypass, does pre-treatment with hyperbaric oxygen versus a standard approach result in a reduction in neuropsychiatric deficit and/or systemic inflammatory response?

Search Terms:Cardiac surgical procedures, neuropsychology, inflammation mediators

The Study:Double-blinded randomised controlled trial with intention-to-treat.

The Study Patients:Adults without cerebrovascular disease or immunosuppresion having routine cardiac procedures using CPB

Control group(N = 31; 31 analysed): Sham procedure at 24, 12 and 4 hours before operation breathing air at 1.5 ATA for 60 minutes

Experimental group(N = 33; 33 analysed): 100% oxygen at 2.4 ATA on the same schedule

The Evidence:

Outcome

Time to Outcome

Sham group

HBO group

Relative risk reduction

Absolute risk reduction

NNT

>1 SD deterioration in two or more NPTs

4 months

0.52

0.27

47%

0.24

4

95% CIs:

2% to 92%

0.01 to 0.48

2 to 95

 

Comments:

1. Clinical significance of the effects demonstrated is not clear

2. There are logistic difficulties with three pre-operative hyperbaric sessions

3. The zero time for inflammatory mediators is after HBOT, making interpretation difficult

4. Those with previous myocardial infarction were over-represented in the HBOT group (31% versus 10%) which may bias outcome, direction unknown.

5. There is information in the abstract that does not appear in the main text and no units for the inflammatory markers

6. Overall good methodological study with a result that is difficult to interpret

Appraised by: Antonia Edge & Mike Bennett, Prince of Wales Hospital, Sydney ; Friday, 26 May 2006

Email:m.bennett@unsw.edu.au

Kill or Update By:June 2024

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