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| − | <span style="display: block; text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''Fewer patients with evidence of persistent neurological manifestations at 3 months following carbon monoxide intoxication following a single hyperbaric oxygen treatment.''' </span></span>
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| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Bottom Line:''' </span>
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| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Treatment with HBO resulted in fewer patients with persistent neurological manifestations at 3 months after exposure, but not 1 or 6 months. </span>
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| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Mike Bennett Dept. of Diving and Hyperbaric Medicine </span> | + | <span style="display: block; text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''Fewer patients with evidence of persistent neurological manifestations at 3 months following carbon monoxide intoxication following a single hyperbaric oxygen treatment.'''</span></span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Prince of Wales Hospital, Sydney; Thursday, 19 November, 1998 </span> | |
| | | | |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Scenario:''' Non-comatose patient with carbon monoxide intoxication. </span> | + | <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. Treatment with HBO resulted in fewer patients with persistent neurological manifestations at 3 months after exposure, but not 1 or 6 months.</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Question:''' In non-comatose patients with CO poisoning, does the application of hyperbaric oxygen as compared to normobaric oxygen result in fewer patients with neurological manifestations? </span> | |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Hyperbaric oxygenation, carbon monoxide </span>
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| − | <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%;">'''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; Thursday, 19 November, 1998</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%;">Adult, non-comatose patients presenting within 12 hours and with a measured HbCO of greater than 10%. Excluded if there was mixed poisoning, pregnancy or specific contraindication. </span> | |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Control group (N = 276; 276 analysed): 100% oxygen for 12 hours at 1ATA. </span>
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| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Experimental group (N = 299; 299 analysed): Hyperbaric oxygen at 2.5ATA for 90 minutes. </span>
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| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:''' </span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Scenario:''' Non-comatose patient with carbon monoxide intoxication. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Question:''' In non-comatose patients with CO poisoning, does the application of hyperbaric oxygen as compared to normobaric oxygen result in fewer patients with neurological manifestations? </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Hyperbaric oxygenation, carbon monoxide</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%;">Adult, non-comatose patients presenting within 12 hours and with a measured HbCO of greater than 10%. Excluded if there was mixed poisoning, pregnancy or specific contraindication. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Control group (N = 276; 276 analysed): 100% oxygen for 12 hours at 1ATA. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Experimental group (N = 299; 299 analysed): Hyperbaric oxygen at 2.5ATA for 90 minutes.</span> |
| − | | <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Outcome''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Time to Outcome''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''NBO''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''HBO''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Relative risk reduction''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Absolute risk reduction''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''NNT''' </span></span>
| + | |
| | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span> |
| | + | |
| | + | {| |
| | |- | | |- |
| − | | <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Persistent neurological manifestations''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">1 month </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.26 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.23 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">12% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.030 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">33 </span></span> | + | | <span><span>'''Outcome'''</span></span> |
| | + | | <span><span>'''Time to Outcome'''</span></span> |
| | + | | <span><span>'''NBO'''</span></span> |
| | + | | <span><span>'''HBO'''</span></span> |
| | + | | <span><span>'''Relative risk reduction'''</span></span> |
| | + | | <span><span>'''Absolute risk reduction'''</span></span> |
| | + | | <span><span>'''NNT'''</span></span> |
| | |- | | |- |
| − | | <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''95% CI''' </span></span> || || || || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-16% to 39% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-0.04 to 0.10 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">NNT'''10 to INF NNH'''25 to INF </span></span> | + | | <span><span>'''Persistent neurological manifestations'''</span></span> |
| | + | | <span><span>1 month</span></span> |
| | + | | <span><span>0.26</span></span> |
| | + | | <span><span>0.23</span></span> |
| | + | | <span><span>12%</span></span> |
| | + | | <span><span>0.030</span></span> |
| | + | | <span><span>33</span></span> |
| | |- | | |- |
| − | | <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''PNM''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">3 months </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.15 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.095 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">37% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.055 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">18 </span></span> | + | | <span><span>'''95% CI'''</span></span> |
| | + | | |
| | + | | |
| | + | | |
| | + | | <span><span>-16% to 39%</span></span> |
| | + | | <span><span>-0.04 to 0.10</span></span> |
| | + | | <span><span>NNT'''10 to INF NNH'''25 to INF</span></span> |
| | |- | | |- |
| − | | <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''95% CI''' </span></span> || || || || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">1% to 72% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.001 to 0.11 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">9 to 746 </span></span> | + | | <span><span>'''PNM'''</span></span> |
| | + | | <span><span>3 months</span></span> |
| | + | | <span><span>0.15</span></span> |
| | + | | <span><span>0.095</span></span> |
| | + | | <span><span>37%</span></span> |
| | + | | <span><span>0.055</span></span> |
| | + | | <span><span>18</span></span> |
| | |- | | |- |
| − | | <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''PNM''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">12 months </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.05 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.043 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">16% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.007 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-143 </span></span> | + | | <span><span>'''95% CI'''</span></span> |
| | + | | |
| | + | | |
| | + | | |
| | + | | <span><span>1% to 72%</span></span> |
| | + | | <span><span>0.001 to 0.11</span></span> |
| | + | | <span><span>9 to 746</span></span> |
| | |- | | |- |
| − | | <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''95% CI''' </span></span> || || || || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-64% to 96% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-0.03 to 0.04 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">NNT'''37 to INF NNH'''24 to INF </span></span> | + | | <span><span>'''PNM'''</span></span> |
| | + | | <span><span>12 months</span></span> |
| | + | | <span><span>0.05</span></span> |
| | + | | <span><span>0.043</span></span> |
| | + | | <span><span>16%</span></span> |
| | + | | <span><span>0.007</span></span> |
| | + | | <span><span>-143</span></span> |
| | |- | | |- |
| | + | | <span><span>'''95% CI'''</span></span> |
| | + | | |
| | + | | |
| | + | | |
| | + | | <span><span>-64% to 96%</span></span> |
| | + | | <span><span>-0.03 to 0.04</span></span> |
| | + | | <span><span>NNT'''37 to INF NNH'''24 to INF</span></span> |
| | |} | | |} |
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| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:''' </span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Interim report only with insufficient detail of outcome measures, randomisation, blinding or numbers of patients who reached final follow-up. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. There does not appear to have been any sham treatment. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">4. The effect shown is probably unreliable given nature of report.</span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Interim report only with insufficient detail of outcome measures, randomisation, blinding or numbers of patients who reached final follow-up. </span> | + | |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. There does not appear to have been any sham treatment. </span> | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Expiry date:''' August 2022 </span> |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">4. The effect shown is probably unreliable given nature of report. </span> | + | |
| | + | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''References:''' 1. Mathieu D, Wattel F, Mathieu-Nolf M, Durak C, Tempe JP, Bouachour G, Sainty JM. Randomized prospective study comparing the effect of HBO versus 12 hours NBO in non-comatose CO poisoned patients: results of the interim analysis. In: Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine, Marroni A, Oriani G, Wattel F eds. Grafica Victoria, Bolognia 1996; 331.</span> |
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| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Expiry date:''' September 2004 </span>
| + | |
| − | <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''References:''' 1. Mathieu D, Wattel F, Mathieu-Nolf M, Durak C, Tempe JP, Bouachour G, Sainty JM. Randomized prospective study comparing the effect of HBO versus 12 hours NBO in non-comatose CO poisoned patients: results of the interim analysis. In: Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine, Marroni A, Oriani G, Wattel F eds. Grafica Victoria, Bolognia 1996; 331. </span>
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Fewer patients with evidence of persistent neurological manifestations at 3 months following carbon monoxide intoxication following a single hyperbaric oxygen treatment.
Clinical Bottom Line: 1. Treatment with HBO resulted in fewer patients with persistent neurological manifestations at 3 months after exposure, but not 1 or 6 months.
Appraised by: Mike Bennett Dept. of Diving and Hyperbaric Medicine Prince of Wales Hospital, Sydney; Thursday, 19 November, 1998
Clinical Scenario: Non-comatose patient with carbon monoxide intoxication. Three-part Question: In non-comatose patients with CO poisoning, does the application of hyperbaric oxygen as compared to normobaric oxygen result in fewer patients with neurological manifestations? Search Terms: Hyperbaric oxygenation, carbon monoxide
The Study: Non-blinded randomised controlled trial with intention-to-treat. Adult, non-comatose patients presenting within 12 hours and with a measured HbCO of greater than 10%. Excluded if there was mixed poisoning, pregnancy or specific contraindication. Control group (N = 276; 276 analysed): 100% oxygen for 12 hours at 1ATA. Experimental group (N = 299; 299 analysed): Hyperbaric oxygen at 2.5ATA for 90 minutes.
The Evidence:
| Outcome
|
Time to Outcome
|
NBO
|
HBO
|
Relative risk reduction
|
Absolute risk reduction
|
NNT
|
| Persistent neurological manifestations
|
1 month
|
0.26
|
0.23
|
12%
|
0.030
|
33
|
| 95% CI
|
|
|
|
-16% to 39%
|
-0.04 to 0.10
|
NNT10 to INF NNH25 to INF
|
| PNM
|
3 months
|
0.15
|
0.095
|
37%
|
0.055
|
18
|
| 95% CI
|
|
|
|
1% to 72%
|
0.001 to 0.11
|
9 to 746
|
| PNM
|
12 months
|
0.05
|
0.043
|
16%
|
0.007
|
-143
|
| 95% CI
|
|
|
|
-64% to 96%
|
-0.03 to 0.04
|
NNT37 to INF NNH24 to INF
|
Comments: 1. Interim report only with insufficient detail of outcome measures, randomisation, blinding or numbers of patients who reached final follow-up. 3. There does not appear to have been any sham treatment. 4. The effect shown is probably unreliable given nature of report.
Expiry date: August 2022
References: 1. Mathieu D, Wattel F, Mathieu-Nolf M, Durak C, Tempe JP, Bouachour G, Sainty JM. Randomized prospective study comparing the effect of HBO versus 12 hours NBO in non-comatose CO poisoned patients: results of the interim analysis. In: Proceedings of the International Joint Meeting on Hyperbaric and Underwater Medicine, Marroni A, Oriani G, Wattel F eds. Grafica Victoria, Bolognia 1996; 331.
