Difference between revisions of "Thom"
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| − | <span style=" | + | <span style="display: block; text-align: center;">'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">Hyperbaric oxygenation prevents the development of delayed neuropsychological sequelae in mild/moderately severe carbon monoxide poisoning.</span>'''</span> |
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| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Bottom Line:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. HBO decreased the incidence of delayed neuropsychological sequelae. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. The entry level of COHb was not predictive of DNS. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. All patients with DNS recovered to base-line scores during further follow-up.</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;"> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;"> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">''' | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Prince of Wales Hospital Sydney; Friday 2nd October 1998</span> |
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| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">''' | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Scenario:''' Adult with mild to moderate carbon monoxide poisoning. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Question:''' In patients with carbon monoxide poisoning, does treatment with HBO in contrast to treatment with NBO, result in a reduction in the incidence of delayed neurological sequelae? </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Carbon monoxide poisoning/therapy, hyperbaric oxygenation</span> |
| − | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Non-blinded randomised controlled trial with intention-to-treat. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Exposure to products of combustion and/or high COHb level and/or symptoms and signs suggestive of CO poisoning. Excluded if unconscious at any time or evidence of myocardial compromise. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Control group (N = 32; 30 analysed): 100% oxygen via face mask until symptoms resolved, (ave 4.2 hours). </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Experimental group (N = 33; 30 analysed): 100% oxygen as above until HBO instituted at 2.8ATA for 30 mins, then 2.0ATA for 90 mins, (ave total time 2.1 hours).</span> | |
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| + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span> | ||
| + | |||
| + | {| | ||
|- | |- | ||
| − | | <span | + | | <span><span>'''Outcome'''</span></span> |
| + | | <span><span>'''Time to Outcome'''</span></span> | ||
| + | | <span><span>'''Control Group Rate'''</span></span> | ||
| + | | <span><span>'''HBO Group Rate'''</span></span> | ||
| + | | <span><span>'''Relative risk reduction'''</span></span> | ||
| + | | <span><span>'''Absolute risk reduction'''</span></span> | ||
| + | | <span><span>'''Number Needed to Treat'''</span></span> | ||
|- | |- | ||
| − | | <span | + | | <span><span>'''Diagnosis of DNS'''</span></span> |
| + | | <span><span>4 weeks</span></span> | ||
| + | | <span><span>0.233</span></span> | ||
| + | | <span><span>0</span></span> | ||
| + | | <span><span>100%</span></span> | ||
| + | | <span><span>0.233</span></span> | ||
| + | | <span><span>4</span></span> | ||
|- | |- | ||
| + | | <span><span>'''95% Confidence Intervals:'''</span></span> | ||
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| + | | | ||
| + | | | ||
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| + | | <span><span>0.082 to 0.384</span></span> | ||
| + | | <span><span>3 to 12</span></span> | ||
|} | |} | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif;">'''<span style="font-size: 16px;">Comments: </span>'''</span> | + | <span style="font-family: Arial,Helvetica,sans-serif;">'''<span style="font-size: 16px;">Comments:</span>'''</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">1. HBO given early (<6 hours from exposure in all cases). </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">2. All DNS patients eventually recovered. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">3. Greatest flaw of the study is that it was not blinded.</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">1. HBO given early (<6 hours from exposure in all cases). </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">2. All DNS patients eventually recovered. </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">3. Greatest flaw of the study is that it was not blinded. </span> | ||
| − | <span style="font-family: Arial,Helvetica,sans-serif;">'''<span style="font-size: 16px;">Expiry date:</span>'''<span style="font-size: 16px;"> | + | <span style="font-family: Arial,Helvetica,sans-serif;">'''<span style="font-size: 16px;">Expiry date:</span>'''<span style="font-size: 16px;">August 2022</span></span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif;">'''<span style="font-size: 16px;">References: </span>'''</span> | + | <span style="font-family: Arial,Helvetica,sans-serif;">'''<span style="font-size: 16px;">References:</span>'''</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">1. Thom SR, Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB. Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen.Ann Emerg Med. 1995 Apr;25(4):474-80.</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 16px;">1. Thom SR, Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB. Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen.Ann Emerg Med. 1995 Apr;25(4):474-80. </span> | ||
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| − | <span style="color: #7a00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 140%; text-align: center;">[[ | + | <span style="color: #7a00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 140%; text-align: center;">[[Carbon_monoxide|BACK]]</span> |
Latest revision as of 01:00, 30 August 2019
Hyperbaric oxygenation prevents the development of delayed neuropsychological sequelae in mild/moderately severe carbon monoxide poisoning.
Clinical Bottom Line: 1. HBO decreased the incidence of delayed neuropsychological sequelae. 2. The entry level of COHb was not predictive of DNS. 3. All patients with DNS recovered to base-line scores during further follow-up.
Appraised by: Mike Bennett, Dept of Diving and Hyperbaric Medicine Prince of Wales Hospital Sydney; Friday 2nd October 1998
Clinical Scenario: Adult with mild to moderate carbon monoxide poisoning. Three-part Question: In patients with carbon monoxide poisoning, does treatment with HBO in contrast to treatment with NBO, result in a reduction in the incidence of delayed neurological sequelae? Search Terms: Carbon monoxide poisoning/therapy, hyperbaric oxygenation
The Study: Non-blinded randomised controlled trial with intention-to-treat. Exposure to products of combustion and/or high COHb level and/or symptoms and signs suggestive of CO poisoning. Excluded if unconscious at any time or evidence of myocardial compromise. Control group (N = 32; 30 analysed): 100% oxygen via face mask until symptoms resolved, (ave 4.2 hours). Experimental group (N = 33; 30 analysed): 100% oxygen as above until HBO instituted at 2.8ATA for 30 mins, then 2.0ATA for 90 mins, (ave total time 2.1 hours).
The Evidence:
| Outcome | Time to Outcome | Control Group Rate | HBO Group Rate | Relative risk reduction | Absolute risk reduction | Number Needed to Treat |
| Diagnosis of DNS | 4 weeks | 0.233 | 0 | 100% | 0.233 | 4 |
| 95% Confidence Intervals: | 0.082 to 0.384 | 3 to 12 |
Comments: 1. HBO given early (<6 hours from exposure in all cases). 2. All DNS patients eventually recovered. 3. Greatest flaw of the study is that it was not blinded.
Expiry date:August 2022
References: 1. Thom SR, Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB. Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen.Ann Emerg Med. 1995 Apr;25(4):474-80.
