Difference between revisions of "Hart"

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'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">The addition of hyperbaric oxygen to a burn care protocol resulted in a reduction in the time required for burn to heal.</span>'''
 
  
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<span style="border-color: windowtext; border-style: solid; border-width: 1.5pt; display: block; padding: 1pt 4pt;"><span style="padding-bottom: 0cm; padding-left: 0cm; padding-right: 0cm; padding-top: 0cm;">'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Clinical Bottom Line:</span>'''
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">The addition of hyperbaric oxygen to a burn care protocol resulted in a reduction in the time required for burn to heal.</span></span></span>'''</span></span>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">1. The addition of hyperbaric oxygen to a burn care protocol resulted in a reduction in the time required to heal burns.
 
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2. Any effect of the addition of hyperbaric oxygen on fluid requirements and graft success remains unclear.</span></span>
 
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</span>
 
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Appraised by:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;"> Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Sydney; Thursday, 22 April 1999</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Clinical Scenario:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;"> A patient presented with thermal burns and we wondered if the addition of hyperbaric oxygen would improve healing time.</span>
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<span style="background:white"><span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Clinical Bottom Line:</span></span></span>'''</span></span>
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Three-part Question:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;"> In patients with thermal burns, does the addition of hyperbaric oxygen to a standard burn care protocol result in any improvement in time required to heal, or the quality of healing?</span>
 
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Search Terms:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;"> Thermal burns</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">The Study:</span>'''
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<span style="background:white"><span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">1. The addition of hyperbaric oxygen reduced the time to burn healing.</span></span></span></span></span>
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Double-blinded concealed randomised controlled trial with intention-to-treat.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Patients with between 10 and 50% of body surface area thermal burns presenting to a burns centre within 24 hours of injury.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">'''Control group''' (N = 16; 16 analysed): A standard burns protocol with fluid resuscitation, dressings and surgical procedures. Sham hyperbaric exposures in a chamber compressed to 1.3ATA and returned to 1ATA gradually at beginning and end of time period.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">'''Experimental group''' (N = 16; 16 analysed): Protocol as above plus 100% oxygen breathing at 2ATA for 90 minutes every 8 hours in the first 24 hours, then 12 hourly until healed.</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">The Evidence:</span>'''
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<span style="background:white"><span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">2. Any effect on fluid requirements remains unclear</span></span></span></span></span>
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{|
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| <span style'''"line-height: normal; margin-bottom: 0pt;">'''Non-event outcomes'''</span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">'''Time to outcome'''</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">'''Air group'''</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">'''HBO group'''</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style="display: block; text-align: center;">'''P-value'''</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:" times="" new="" roman",serif"=""><span style="color:#001133">Citations:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">1. Hart GB, O'Reilly RR, Broussard ND, Goodman DB, Yanda RL. Treatment of burns with hyperbaric oxygen. Surgery, Gynaecology and Obstetrics 1974; 139:693-696.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Clinical Scenario:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">A patient presented with thermal burns and we wondered if the addition of hyperbaric oxygen would improve healing time.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Three-part Question:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">In patients with thermal burns, does the addition of hyperbaric oxygen to a standard burn care protocol result in any improvement in time required to heal, or the quality of healing?</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Search Terms:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Thermal burns</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">The Study:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Double-blinded concealed randomised controlled trial with intention-to-treat. Patients with between 10 and 50% of body surface area thermal burns presenting to a burns centre within 24 hours of injury.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Control group</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">(N = 16; 16 analysed): A standard burns protocol with fluid resuscitation, dressings and surgical procedures. Sham hyperbaric exposures in a chamber compressed to 1.3ATA and returned to 1ATA gradually at beginning and end of time period.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Experimental group</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">(N = 16; 16 analysed): Protocol as above plus 100% oxygen breathing at 2 ATA for 90 minutes every 8 hours in the first 24 hours, then 12 hourly until healed.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">The Evidence:</span></span></span>'''</span></span>
 +
 
 +
{| class="Table" style="background:white; border-collapse:collapse; border:solid windowtext 1.0pt"
 
|-
 
|-
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| <span style'''"line-height: normal; margin-bottom: 0pt;">'''Average volume of crystalloid required (mls/kg/%BSA)'''</span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">24 hours</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">3.4</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">2.2</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style="display: block; text-align: center;">Not tested</span></span>  
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| style="width:169.85pt; border:solid windowtext 1.0pt; background:white" width="226" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Non-event outcomes</span></span></span>'''</span></p>
 +
| style="width:92.15pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="123" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Time to outcome</span></span></span>'''</span></p>
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| style="width:63.8pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="85" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Air group</span></span></span>'''</span></p>
 +
| style="width:70.85pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="94" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">HBO group</span></span></span>'''</span></p>
 +
| style="width:54.15pt; border:solid windowtext 1.0pt; border-left:none; background:white" width="72" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">P-value</span></span></span>'''</span></p>  
 
|-
 
|-
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| <span style'''"line-height: normal; margin-bottom: 0pt;">'''Mean healing time (days)'''</span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">Healing</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">43.8</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style'''"display: block; text-align: center;">19.7</span></span> || <span style'''"display: block; line-height: normal; margin-bottom: 0pt; text-align: center;"><span style="display: block; text-align: center;"><0.005</span></span>  
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| style="width:169.85pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="226" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Average volume of crystalloid required (mls/kg/%BSA)</span></span></span>'''</span>
 +
 
 +
| style="width:92.15pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="123" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">24 hours</span></span></span></span></p>
 +
| style="width:63.8pt; 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:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">3.4</span></span></span></span></p>
 +
| style="width:70.85pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="94" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">2.2</span></span></span></span></p>
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| style="width:54.15pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="72" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Not tested</span></span></span></span></p>  
 
|-
 
|-
 +
| style="width:169.85pt; border:solid windowtext 1.0pt; border-top:none; background:white" width="226" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Mean healing time (days)</span></span></span>'''</span>
 +
 +
| style="width:92.15pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="123" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Healing</span></span></span></span></p>
 +
| style="width:63.8pt; 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:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">43.8</span></span></span></span></p>
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| style="width:70.85pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="94" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">19.7</span></span></span></span></p>
 +
| style="width:54.15pt; border-top:none; border-left:none; border-bottom:solid windowtext 1.0pt; border-right:solid windowtext 1.0pt; background:white" width="72" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:0cm 0cm 0cm 0cm"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133"><0.005</span></span></span></span></p>
 
|}
 
|}
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Comments:</span>'''
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">1. Small study with paired stratification by surface area burnt.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">2. Good randomisation and blinding.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">3. Power to detect a significant improvement in fluid requirements or graft success unknown, but likely to be low.</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">4. Some suggestion of improvement in proportion of grafts taking in hyperbaric group (1/2 controls, 2/2 HBO).</span>
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">4. Morbidity and mortality data in this paper do not relate to this RCT.</span>
 
  
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">Expiry date:</span>'''<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;"> December 2024</span>
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&nbsp;
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**<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">References: </span>'''
+
 
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<span style="font-family: &#39;Times New Roman&#39;,&#39;serif&#39;; font-size: 16px;">1. Hart GB, O'Reilly RR, Broussard ND, Goodman DB, Yanda RL. Treatment of burns with hyperbaric oxygen. Surgery, Gynaecology and Obstetrics 1974; 139:693-696.</span>
+
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Comments:</span></span></span>'''</span></span>
−
<span style="display: block; text-align: center;">
+
 
 +
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">1. Small study with paired stratification by surface area burnt.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">2. Good randomisation and blinding.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">3. Power to detect a significant improvement in fluid requirements or graft success unknown, but likely to be low.</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">4. Some suggestion of improvement in proportion of grafts taking in hyperbaric group (1/2 controls, 2/2 HBO).</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">4. Morbidity and mortality data in this paper do not relate to this RCT.</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:" times="" new="" roman",serif"=""><span style="color:#001133">Appraised by:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Thursday, 22 April 1999</span></span></span></span></span>
 +
 
 +
<span style="background:white"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">Expiry date:</span></span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:#001133">December 2024</span></span></span></span></span>
  
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</span>
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[[File:Sumhorsa.gif|center|Sumhorsa.gif]]
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[[File:sumhorsa.gif|center]]
 
  
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Burns | BACK]]'''</span>
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Burns|BACK]]'''</span>

Latest revision as of 21:17, 9 October 2021

The addition of hyperbaric oxygen to a burn care protocol resulted in a reduction in the time required for burn to heal.

Clinical Bottom Line:

1. The addition of hyperbaric oxygen reduced the time to burn healing.

2. Any effect on fluid requirements remains unclear

Citations:1. Hart GB, O'Reilly RR, Broussard ND, Goodman DB, Yanda RL. Treatment of burns with hyperbaric oxygen. Surgery, Gynaecology and Obstetrics 1974; 139:693-696.

Clinical Scenario:A patient presented with thermal burns and we wondered if the addition of hyperbaric oxygen would improve healing time.

Three-part Question:In patients with thermal burns, does the addition of hyperbaric oxygen to a standard burn care protocol result in any improvement in time required to heal, or the quality of healing?

Search Terms:Thermal burns

The Study:Double-blinded concealed randomised controlled trial with intention-to-treat. Patients with between 10 and 50% of body surface area thermal burns presenting to a burns centre within 24 hours of injury.

Control group(N = 16; 16 analysed): A standard burns protocol with fluid resuscitation, dressings and surgical procedures. Sham hyperbaric exposures in a chamber compressed to 1.3ATA and returned to 1ATA gradually at beginning and end of time period.

Experimental group(N = 16; 16 analysed): Protocol as above plus 100% oxygen breathing at 2 ATA for 90 minutes every 8 hours in the first 24 hours, then 12 hourly until healed.

The Evidence:

Non-event outcomes

Time to outcome

Air group

HBO group

P-value

Average volume of crystalloid required (mls/kg/%BSA)

24 hours

3.4

2.2

Not tested

Mean healing time (days)

Healing

43.8

19.7

<0.005

 

Comments:

1. Small study with paired stratification by surface area burnt.

2. Good randomisation and blinding.

3. Power to detect a significant improvement in fluid requirements or graft success unknown, but likely to be low.

4. Some suggestion of improvement in proportion of grafts taking in hyperbaric group (1/2 controls, 2/2 HBO).

4. Morbidity and mortality data in this paper do not relate to this RCT.

Appraised by:Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Thursday, 22 April 1999

Expiry date:December 2024

Sumhorsa.gif

BACK

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