Difference between revisions of "Bosco"

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='''A single hyperbaric oxygen exposure preoperatively may modulate inflammatory markers and clinical complications following pancreatodudenectomy'''=
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<div style="border-bottom:solid #0088dd 1.5pt; padding:0cm 0cm 0cm 0cm">
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<span style="background:white"><span style="background:white"><span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">A single hyperbaric oxygen exposure preoperatively may modulate inflammatory markers and clinical complications following pancreatodudenectomy</span></span></span>'''</span></span></span>
  
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=='''<span style="font-size: 10pt;">Clinical Bottom Line:</span>'''==  
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<span style="background:white"><span style="background:white"><span style="line-height:normal">'''<span style="font-size:16.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Clinical Bottom Line:</span></span></span>'''</span></span></span>
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**<span style="font-size: 10pt;">1. Some evidence that HBO exposure modulates the level IL-6 (down) and IL-10 (up)</span>'''
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</div>
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<span style="background:white"><span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">1. Some evidence that HBO exposure modulates the level IL-6 (down) and IL-10 (up)</span></span></span></span></span>
  
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**<span style="font-size: 10pt;"> 2. Fewer pulmonary complications with HBO exposure but not fistula development, bleeding or fever. </span>'''
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<span style="background:white"><span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">2. Fewer pulmonary complications with HBO exposure but not fistula development, bleeding or fever.</span></span></span></span></span>
  
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**<span style="font-size: 10pt;">Citation/s: </span>'''<span style="font-size: 10pt;">1. Bosco G, Casarotto A, Nasole E, Camporesi E, Salvia R, Giovinazzo F, Zanini S, Malleo G, Di Tano A, Rubini A, Zanon V, Mangar D, Bassi C. Preconditioning with hyperbaric oxygen in pancreatodudenectomy: a randomised double-blind pilot study</span>
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&nbsp;
  
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**<span style="font-size: 10pt;">Lead author's name and fax: </span>'''<span style="font-size: 10pt;">Bosco G: gerardo.bosco@unipd.it; vincenzo.zanon@gmail.com </span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Citation/s:</span></span></span>''' <span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">1. Bosco G, Casarotto A, Nasole E, Camporesi E, Salvia R, Giovinazzo F, Zanini S, Malleo G, Di Tano A, Rubini A, Zanon V, Mangar D, Bassi C. Preconditioning with hyperbaric oxygen in pancreatodudenectomy: a randomised double-blind pilot study.</span></span></span></span></span>
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**<span style="font-size: 10pt;">Three-part Clinical Question:</span>'''<span style="font-size: 10pt;"> Does preoperative hyperbaric oxygen exposure before pancreatoduodenectomy reduce the rate of postoperative complications?</span>
 
  
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<span style="font-size: 10pt;"> '''Search Terms:''' Preconditioning; pancreatectomy; surgery</span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Lead author's name and email:</span></span></span>''' <span style="font-size:12.0pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Bosco G:'''[mailto:gerardo.bosco@unipd.it gerardo.bosco@unipd.it]'''</span></span></span>'''&nbsp;'''</span></span>
  
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**<span style="font-size: 10pt;">The Study: </span>'''<span style="font-size: 10pt;">Double-blinded concealed randomised controlled trial with intention-to-treat.</span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Three-part Clinical Question:</span></span></span>''''''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Does preoperative hyperbaric oxygen exposure before pancreatoduodenectomy reduce the rate of postoperative complications?</span></span></span></span></span>
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<span style="font-size: 10pt;">'''The Study Patients:''' Adult patients scheduled for pancreatoduodenectomy for pancreatic ductal carcinoma.</span>
 
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**<span style="font-size: 10pt; line-height: 1.5;">Control group</span>'''<span style="font-size: 10pt; line-height: 1.5;"> (N = 11; 11 analysed): A single sham exposure breathing air at 1.15 ATA on a schedule lasting 116 minutes on the day prior to surgery.</span>
 
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**<span style="font-size: 10pt; line-height: 1.5;">Experimental group</span>'''<span style="font-size: 10pt; line-height: 1.5;"> (N = 10; 10 analysed): A single exposure to 2.5 ATA breathing 100% oxygen for a total of 116 minutes on the day prior to surgery.</span>
 
  
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**<span style="font-size: 10pt;">The Evidence:</span>'''
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Search Terms:</span></span></span>''' <span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Preconditioning; pancreatectomy; surgery</span></span></span></span></span>
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{|
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Time to Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Control group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">HBO group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Relative Risk Reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Absolute risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style="font-size: 10pt;">NNT</span>'''</span></span>  
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">The Study:</span></span></span>''' <span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Double-blinded concealed randomised controlled trial with intention-to-treat.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">The Study Patients:</span></span></span>''' <span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Adult patients scheduled for pancreatoduodenectomy for pancreatic ductal carcinoma.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Control group:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">(N = 11; 11 analysed): A single sham exposure breathing air at 1.15 ATA on a schedule lasting 116 minutes on the day prior to surgery.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Experimental group:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">(N = 10; 10 analysed): A single exposure to 2.5 ATA breathing 100% oxygen for a total of 116 minutes on the day prior to surgery.</span></span></span></span></span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">The Evidence:</span></span></span>'''</span></span>
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{| class="Table" style="background:white; border-collapse:collapse; border:solid windowtext 1.0pt"
 
|-
 
|-
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Pulmonary complications </span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">?Discharge </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">0.55</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">0</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">0.55</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 9pt; text-align: center;">2</span></span>  
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| style="width:77.8pt; border:solid windowtext 1.0pt; background:white" width="104" |
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<span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Outcome</span></span>'''</span>
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| style="width:63.7pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Time to Outcome</span></span>'''</span></p>
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| style="width:39.65pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="54" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Control group</span></span>'''</span></p>
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| style="width:31.7pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="43" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">HBO group</span></span>'''</span></p>
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| style="width:77.5pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="103" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Relative Risk Reduction</span></span>'''</span></p>
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| style="width:77.95pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Absolute risk reduction</span></span>'''</span></p>
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| style="width:82.5pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="110" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">NNT</span></span>'''</span></p>  
 
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|-
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|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; font-size: 9pt; text-align: right;">95% CI:</span></span> ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">0.25 to 0.84</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">1 to 4</span></span>  
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| rowspan="2" style="width:77.8pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="104" |  
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<span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Pulmonary complications</span></span>'''</span>
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| style="width:63.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">?Discharge</span></span></span></p>
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| style="width:39.65pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="54" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">0.55</span></span></span></p>
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| style="width:31.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="43" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">0</span></span></span></p>
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| style="width:77.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="103" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">100%</span></span></span></p>
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| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">0.55</span></span></span></p>
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| style="width:82.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="110" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">2</span></span></span></p>  
 
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|-
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Postop bleeding </span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">?Discharge </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">0.18</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">0.30</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">-65%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">-0.12</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 9pt; text-align: center;">-8</span></span>  
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| style="width:63.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="85" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"="">95%CI:</span></span></p>  
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| style="width:39.65pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="54" |
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&nbsp;
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| style="width:31.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="43" | &nbsp;
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| style="width:77.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="103" | &nbsp;
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| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">0.25 to 0.84</span></span></span></p>
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| style="width:82.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="110" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">1 to 4</span></span></span></p>  
 
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|-
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|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; font-size: 9pt; text-align: right;">95% CI:</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">-265% to 100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">-0.48 to 0.25</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">NNT ''' 4 to INF; NNH ''' 2 to INF</span></span>  
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| rowspan="2" style="width:77.8pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="104" |  
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<span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Postop bleeding</span></span>'''</span>
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| style="width:63.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">?Discharge</span></span></span></p>
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| style="width:39.65pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="54" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">0.18</span></span></span></p>
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| style="width:31.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="43" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">0.30</span></span></span></p>
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| style="width:77.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="103" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">-65%</span></span></span></p>
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| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">-0.12</span></span></span></p>
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| style="width:82.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="110" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">-8</span></span></span></p>  
 
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|-
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Postop fistula </span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">?Discharge </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">0.27</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">0.33</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">-22%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">-0.06</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 9pt; text-align: center;">-17</span></span>  
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| style="width:63.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="85" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"="">95%CI:</span></span></p>  
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| style="width:39.65pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="54" |
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&nbsp;
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| style="width:31.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="43" | &nbsp;
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| style="width:77.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="103" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">-265% to 100%</span></span></span></p>
 +
| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">-0.48 to 0.25</span></span></span></p>
 +
| style="width:82.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="110" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">NNT 4 to INF; NNH 2 to INF</span></span></span></p>  
 
|-
 
|-
−
|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; font-size: 9pt; text-align: right;">95% CI:</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">-166% to 100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">-0.45 to 0.33</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">NNT ''' 3 to INF; NNH ''' 2 to INF</span></span>  
+
| rowspan="2" style="width:77.8pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="104" |  
 +
<span style="line-height:normal">'''<span style="font-size:11.5pt"><span style="font-family:" helvetica",sans-serif"=""><span style="color:#001133">Postop fistula</span></span></span>'''</span>
 +
 
 +
| style="width:63.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">?Discharge</span></span></span></p>
 +
| style="width:39.65pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="54" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">0.27</span></span></span></p>
 +
| style="width:31.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="43" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">0.33</span></span></span></p>
 +
| style="width:77.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="103" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">-22%</span></span></span></p>
 +
| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">-0.06</span></span></span></p>
 +
| style="width:82.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="110" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">-17</span></span></span></p>  
 
|-
 
|-
 +
| style="width:63.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="85" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"="">95%CI:</span></span></p>
 +
| style="width:39.65pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="54" |
 +
&nbsp;
 +
 +
| style="width:31.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; padding:0cm 0cm 0cm 0cm; background:white" width="43" | &nbsp;
 +
| style="width:77.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="103" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">-166% to 100%</span></span></span></p>
 +
| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">-0.45 to 0.33</span></span></span></p>
 +
| style="width:82.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="110" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">NNT 3 to INF; NNH 2 to INF</span></span></span></p>
 +
|-
 +
| style="width:77.8pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="104" |
 +
&nbsp;
 +
 +
| style="width:63.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="85" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:0cm 0cm 0cm 0cm">&nbsp;</p>
 +
| style="width:39.65pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="54" |
 +
&nbsp;
 +
 +
| style="width:31.7pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="43" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>
 +
| style="width:77.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="103" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>
 +
| style="width:77.95pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>
 +
| style="width:82.5pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="110" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm">&nbsp;</p>
 
|}
 
|}
  
−
{|  
+
&nbsp;
−
| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Non-Event Outcomes</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Time to outcome/s</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Control group </span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Experimental group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style="font-size: 10pt;">P-value</span>'''</span></span>
+
 
 +
{| class="Table" style="background:white; border-collapse:collapse; border:solid windowtext 1.0pt"
 
|-
 
|-
−
| '''<span style'''"font-size: 10pt;">Serum cytokine IL-6 (no units given)</span>''' || <span style'''"font-size: 9pt;">Pre-HBO/ Post-HBO/ Day 1 Postop/ Day 7 Postop</span> || <span style'''"font-size: 9pt;">5.97/ 24.06/ 179.54 /24.5</span> || <span style'''"font-size: 9pt;">5.06/ 5.81/ 141.23/ 21.76 </span> || <span style="font-size: 9pt;">0.009 </span>  
+
| style="border:solid windowtext 1.0pt; background:white" |
 +
<span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Non-Event Outcomes</span></span>'''</span>
 +
 
 +
| style="border:solid windowtext 1.0pt; border-left:none; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Time to outcome/s</span></span>'''</span></p>
 +
| style="border:solid windowtext 1.0pt; border-left:none; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Control group</span></span>'''</span></p>  
 +
| style="border:solid windowtext 1.0pt; border-left:none; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Experimental group</span></span>'''</span></p>  
 +
| style="border:solid windowtext 1.0pt; border-left:none; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">P-value</span></span>'''</span></p>  
 
|-
 
|-
−
| '''<span style'''"font-size: 10pt;">Serum cytokine IL'''10 (no units given)</span>''' || <span style'''"font-size: 9pt;">Pre-HBO/ Post-HBO/ Day 1 Postop/ Day 7 Postop</span> || <span style'''"font-size: 9pt;">4.04/ 4.43/ 7.76/ 4.14 </span> || <span style'''"font-size: 9pt;">2.01/ 2.41/ 5.6/ 3.34 </span> || <span style'''"font-size: 9pt;">0.034 </span>  
+
| style="border:solid windowtext 1.0pt; border-top:none; background:white" |
 +
<span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Serum cytokine IL-6 (no units given)</span></span>'''</span>
 +
 
 +
| style="border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Pre-HBO/ Post-HBO/ Day 1 Postop/ Day 7 Postop</span></span></span></p>
 +
| style="border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">5.97/ 24.06/ 179.54 /24.5</span></span></span></p>
 +
| style="border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">5.06/ 5.81/ 141.23/ 21.76</span></span></span></p>
 +
| style="border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">0.009</span></span></span></p>  
 
|-
 
|-
 +
| style="border:solid windowtext 1.0pt; border-top:none; background:white" |
 +
<span style="line-height:normal">'''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Serum cytokine IL</span></span>''''''<span style="font-family:" arial",sans-serif"=""><span style="color:#001133">10 (no units given)</span></span>'''</span>
 +
 +
| style="border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Pre-HBO/ Post-HBO/ Day 1 Postop/ Day 7 Postop</span></span></span></p>
 +
| style="border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">4.04/ 4.43/ 7.76/ 4.14</span></span></span></p>
 +
| style="border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">2.01/ 2.41/ 5.6/ 3.34</span></span></span></p>
 +
| style="border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">0.034</span></span></span></p>
 
|}
 
|}
  
−
**<span style="font-size: 10pt;">Comments:</span>'''
+
&nbsp;
 +
 
 +
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Comments:</span></span></span>'''</span></span>
  
−
<span style="font-size: 10pt;"> 1. Small study underpowered for some outcomes.</span>
+
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">1. Small study underpowered for some outcomes.</span></span></span></span></span>
  
−
<span style="font-size: 10pt;"> 2. There was a statistically significant relationship between IL-6 and post-operative fistula. Not clear if there is a causal relationship between serum IL-6 reduction and HBO, or between the development of fistula and serum IL-6 increase.</span>
+
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">2. There was a statistically significant relationship between IL-6 and post-operative fistula. Not clear if there is a causal relationship between serum IL-6 reduction and HBO, or between the development of fistula and serum IL-6 increase.</span></span></span></span></span>
  
−
<span style="font-size: 10pt;"> 3. Reduction in post-operative pneumonia in HBO patients should be confirmed in larger studies </span>
+
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">3. Reduction in post-operative pneumonia in HBO patients should be confirmed in larger studies</span></span></span></span></span>
  
−
**<span style="font-size: 10pt;">Appraised by</span>'''<span style="font-size: 10pt;">: M. Bennett, POWH, m.bennett@unsw.edu.au; Friday, 2 January 2015</span>
+
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Appraised by:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">M. Bennett, POWH, m.bennett@unsw.edu.au; Friday, 2 January 2015</span></span></span></span></span>
  
−
<span style="font-size: 10pt;"> '''Kill or Update By:''' 01/012017</span>
+
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">Kill or Update By:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"=""><span style="color:#001133">01/2022</span></span></span></span></span>
  
−
<span style="display: block; text-align: center;">
+
&nbsp;
−
</span>
 
  
−
[[File:sumhorsa.gif|center]]
+
[[File:Sumhorsa.gif|center|Sumhorsa.gif]]
  
−
<span style="display: block; text-align: center;">[[Preconditioning | BACK]]</span>
+
<span style="display: block; text-align: center;"><span style="font-size:xx-large;">[[Preconditioning|BACK]]</span></span>

Revision as of 03:59, 21 September 2021

A single hyperbaric oxygen exposure preoperatively may modulate inflammatory markers and clinical complications following pancreatodudenectomy

Clinical Bottom Line:

1. Some evidence that HBO exposure modulates the level IL-6 (down) and IL-10 (up)

2. Fewer pulmonary complications with HBO exposure but not fistula development, bleeding or fever.

 

Citation/s: 1. Bosco G, Casarotto A, Nasole E, Camporesi E, Salvia R, Giovinazzo F, Zanini S, Malleo G, Di Tano A, Rubini A, Zanon V, Mangar D, Bassi C. Preconditioning with hyperbaric oxygen in pancreatodudenectomy: a randomised double-blind pilot study.

Lead author's name and email: Bosco G:gerardo.bosco@unipd.it 

Three-part Clinical Question:'Does preoperative hyperbaric oxygen exposure before pancreatoduodenectomy reduce the rate of postoperative complications?

Search Terms: Preconditioning; pancreatectomy; surgery

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

The Study Patients: Adult patients scheduled for pancreatoduodenectomy for pancreatic ductal carcinoma.

Control group:(N = 11; 11 analysed): A single sham exposure breathing air at 1.15 ATA on a schedule lasting 116 minutes on the day prior to surgery.

Experimental group:(N = 10; 10 analysed): A single exposure to 2.5 ATA breathing 100% oxygen for a total of 116 minutes on the day prior to surgery.

The Evidence:

Outcome

Time to Outcome

Control group

HBO group

Relative Risk Reduction

Absolute risk reduction

NNT

Pulmonary complications

?Discharge

0.55

0

100%

0.55

2

95%CI:

 

   

0.25 to 0.84

1 to 4

Postop bleeding

?Discharge

0.18

0.30

-65%

-0.12

-8

95%CI:

 

 

-265% to 100%

-0.48 to 0.25

NNT 4 to INF; NNH 2 to INF

Postop fistula

?Discharge

0.27

0.33

-22%

-0.06

-17

95%CI:

 

 

-166% to 100%

-0.45 to 0.33

NNT 3 to INF; NNH 2 to INF

 

 

 

 

 

 

 

 

Non-Event Outcomes

Time to outcome/s

Control group

Experimental group

P-value

Serum cytokine IL-6 (no units given)

Pre-HBO/ Post-HBO/ Day 1 Postop/ Day 7 Postop

5.97/ 24.06/ 179.54 /24.5

5.06/ 5.81/ 141.23/ 21.76

0.009

'Serum cytokine IL'10 (no units given)

Pre-HBO/ Post-HBO/ Day 1 Postop/ Day 7 Postop

4.04/ 4.43/ 7.76/ 4.14

2.01/ 2.41/ 5.6/ 3.34

0.034

 

Comments:

1. Small study underpowered for some outcomes.

2. There was a statistically significant relationship between IL-6 and post-operative fistula. Not clear if there is a causal relationship between serum IL-6 reduction and HBO, or between the development of fistula and serum IL-6 increase.

3. Reduction in post-operative pneumonia in HBO patients should be confirmed in larger studies

Appraised by:M. Bennett, POWH, m.bennett@unsw.edu.au; Friday, 2 January 2015

Kill or Update By:01/2022

 

Sumhorsa.gif

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