Difference between revisions of "Li"
 
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== <span style="font-size: 140%;">Preconditioning with hyperbaric oxygen reduced the ICU length of stay and inotrope requirements for patients having on-pump coronary bypass grafting.</span> ==
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<span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:">Preconditioning with hyperbaric oxygen reduced the ICU length of stay and inotrope requirements for patients having on-pump coronary bypass grafting.</span></span>'''</span>
  
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{|
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<span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:">Clinical Bottom Line:</span></span>'''</span>
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{| class="Table" style="border:undefined"
 
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| '''<span>1. ICU time was reduced following preconditioning with HBO for those patients requiring on-pump CABG</span>'''<br/> <br/> **<span>2. The requirement for inotropes post-operatively was reduced in the same group following preconditioning.</span><br/> <br/> '''**<span style="font-size: 130%;">3. No differences were note for those having off-pump surgery.</span>'''
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<span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:">1. ICU time was reduced following preconditioning with HBO for those patients requiring on-pump CABG</span></span><br/> <br/> <span style="font-size:14.0pt"><span style="font-family:">2. The requirement for inotropes post-operatively was reduced in the same group following preconditioning.<br/> <br/> 3. No differences were note for those having off-pump surgery.</span></span></span>
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|}
 
|}
  
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<span style="font-size: 110%;">'''Citation/s:''' 1. Li Y, Dong H, Chen M, Liu J, Yang L, Chen S, Xiong L. Preconditioning with repeated hyperbaric oxygen induces myocardial and cerebral protection in patients undergoing coronary artery bypass graft surgery: a prospective, randomized, controlled clinical trial. Journal of cardiothoracic and vascular anesthesia. 2011 Dec 31;25(6):908-16.</span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Citation/s:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">1. Li Y, Dong H, Chen M, Liu J, Yang L, Chen S, Xiong L. Preconditioning with repeated hyperbaric oxygen induces myocardial and cerebral protection in patients undergoing coronary artery bypass graft surgery: a prospective, randomized, controlled clinical trial. Journal of cardiothoracic and vascular anesthesia. 2011 Dec 31;25(6):908-16.</span></span></span>
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**<span style="font-size: 110%;">Lead author's name and fax:</span>'''<span style="font-size: 110%;">Lize Yiong lxiong@fmmu.edu.cn</span>'''  
 
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**<span style="font-size: 110%;">Three-part Clinical Question:</span>'''For patients requiring coronary artery bypass grafting (CABG) (on or off-pump), does preconditioning with hyperbaric oxygen result in protective cerebral or myocardial effects?''' 
 
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Lead author's name and email:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Lize Yiong, lxiong@fmmu.edu.cn</span></span></span>
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**<span style="font-size: 110%;">Search Terms:</span>'''<span style="font-size: 110%;">coronary artery bypass grafts; preconditioning, brain injury</span>''' 
 
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Three-part Clinical Question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">For patients requiring coronary artery bypass grafting (CABG) (on or off-pump), does preconditioning with hyperbaric oxygen result in protective cerebral or myocardial effects?</span></span></span>
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**<span style="font-size: 110%;">The Study: </span>'''<span style="font-size: 110%;">Single-blinded concealed randomised controlled trial with intention-to-treat.</span>''' 
 
  
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<span style="font-size: 110%;">'''The Study Patients:''' Adult male patients for first time coronary arterial bypass grafting.</span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">coronary artery bypass grafts; preconditioning, brain injury</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">The Study:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Single-blinded concealed randomised controlled trial with intention-to-treat.</span></span></span>
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**<span style="font-size: 110%;">Control group (N = 16; 15 analysed): </span>'''<span style="font-size: 110%;">Standard surgical procedures for on-pump CABGs. Anaesthesia with propofol infusion and no volatile agents or steroids. ACT maintained at >480 sec with heparin.</span>''' 
 
  
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<span style="font-size: 110%;">'''Experimental group (N = 15; 14 analysed):''' As above, plus HBO at 2.0 ATA for 70 minutes daily for five days prior to operation.</span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">The Study Patients:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Adult male patients for first time coronary arterial bypass grafting.</span></span></span>
  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Control group (N = 16; 15 analysed):</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">Standard surgical procedures for on-pump CABGs. Anaesthesia with propofol infusion and no volatile agents or steroids. ACT maintained at >480 sec with heparin.</span></span></span>
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**<span style="font-size: 110%;">The Evidence:</span>  
 
  
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{|
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Experimental group (N = 15; 14 analysed):</span></span>'''<span style="font-size:12.0pt"><span style="font-family:">As above, plus HBO at 2.0 ATA for 70 minutes daily for five days prior to operation.</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">The Evidence:</span></span>'''</span>
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{| class="Table" style="border:solid windowtext 1.0pt"
 
|-
 
|-
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| <span>Measure</span>
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| rowspan="2" style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Measure</span></span>'''</span></p>  
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| &nbsp;
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| colspan="2" style="width:63.15pt; border:solid windowtext 1.0pt" width="86" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Control Group</span></span>'''</span></p>  
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| <span>Control Group</span>
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| colspan="2" style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">HBO Group</span></span>'''</span></p>  
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| &nbsp;
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| rowspan="2" style="width:55.2pt; border:solid windowtext 1.0pt" width="77" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Difference</span></span>'''</span></p>  
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| <span>HBO Group</span>
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| rowspan="2" style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">95% CI</span></span>'''</span></p>  
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| <span>Difference</span>
 
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| <span style="display: block; text-align: center;">95% CI</span>
 
 
|-
 
|-
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| ^
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| style="width:34.6pt; border:solid windowtext 1.0pt" width="48" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Mean</span></span>'''</span></p>  
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| <span>Mean</span>
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| style="width:27.05pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">SD</span></span>'''</span></p>  
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| <span>SD</span>
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| style="width:33.95pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Mean</span></span>'''</span></p>  
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| <span>Mean</span>
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| style="width:26.85pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">SD</span></span>'''</span></p>
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| <span>SD</span>
 
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| ^
 
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| ^
 
 
|-
 
|-
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| '''<span>Length of stay in ICU (hours)</span>'''
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| style="border:solid windowtext 1.0pt" |
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| <span><span>85.9</span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Length of stay in ICU (hours)</span></span>'''</span>
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| <span><span>41.8</span></span>
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| <span><span>59.4</span></span>
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| style="width:34.6pt; border:solid windowtext 1.0pt" width="48" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">85.9</span></span></span></p>  
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| <span><span>21.7</span></span>
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| style="width:27.05pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">41.8</span></span></span></p>  
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| <span><span>26.500</span></span>
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| style="width:33.95pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">59.4</span></span></span></p>  
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| <span><span style="display: block; font-size: 9pt; text-align: center;">0.84 to 52.16</span></span>
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| style="width:26.85pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">21.7</span></span></span></p>  
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| style="width:55.2pt; border:solid windowtext 1.0pt" width="77" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">26.5</span></span></span></p>
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| style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.8 to 52.2</span></span></span></p>  
 
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|-
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| '''<span>Inotrope scores at 36 hours (microg/kg/min)</span>'''
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| style="border:solid windowtext 1.0pt" |
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| <span><span>9.6</span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Inotrope at 36 hours (microg/kg/min)</span></span>'''</span>
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| <span><span>4.3</span></span>
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| <span><span>6.7</span></span>
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| style="width:34.6pt; border:solid windowtext 1.0pt" width="48" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">9.6</span></span></span></p>  
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| <span><span>3.0</span></span>
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| style="width:27.05pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">4.3</span></span></span></p>  
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| <span><span>2.900</span></span>
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| style="width:33.95pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">6.7</span></span></span></p>  
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| <span><span style="display: block; font-size: 9pt; text-align: center;">0.06 to 5.75</span></span>
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| style="width:26.85pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3.0</span></span></span></p>  
 +
| style="width:55.2pt; border:solid windowtext 1.0pt" width="77" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">2.9</span></span></span></p>
 +
| style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.1 to 5.8</span></span></span></p>  
 
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|-
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| '''<span>Serum S100B after 1 hr crossclamp time (pg/ml)</span>'''
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| style="border:solid windowtext 1.0pt" |
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| <span><span>138.2</span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Serum S100B after 1 hr crossclamp time (pg/ml)</span></span>'''</span>
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| <span><span>37.4</span></span>
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| <span><span>82.2</span></span>
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| style="width:34.6pt; border:solid windowtext 1.0pt" width="48" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">138.2</span></span></span></p>  
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| <span><span>42.8</span></span>
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| style="width:27.05pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">37.4</span></span></span></p>  
−
| <span><span>56.000</span></span>
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| style="width:33.95pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">82.2</span></span></span></p>  
−
| <span><span style="display: block; font-size: 9pt; text-align: center;">25.43 to 86.57</span></span>
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| style="width:26.85pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">42.8</span></span></span></p>  
 +
| style="width:55.2pt; border:solid windowtext 1.0pt" width="77" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">56.0</span></span></span></p>
 +
| style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">25.4 to 86.6</span></span></span></p>  
 
|-
 
|-
−
| '''<span>Serum catalase activity at 24 hours (U/ml)</span>'''
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| style="border:solid windowtext 1.0pt" |
−
| <span><span>3.73</span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Serum catalase activity at 24 hours (U/ml)</span></span>'''</span>
−
| <span><span>1.78</span></span>
+
 
−
| <span><span>6.1</span></span>
+
| style="width:34.6pt; border:solid windowtext 1.0pt" width="48" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3.73</span></span></span></p>  
−
| <span><span>1.53</span></span>
+
| style="width:27.05pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1.78</span></span></span></p>  
−
| <span><span>2.27</span></span>
+
| style="width:33.95pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">6.1</span></span></span></p>  
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| <span><span style="display: block; font-size: 9pt; text-align: center;">1.00 to 3.54</span></span>
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| style="width:26.85pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1.53</span></span></span></p>  
 +
| style="width:55.2pt; border:solid windowtext 1.0pt" width="77" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">2.27</span></span></span></p>
 +
| style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1.00 to 3.54</span></span></span></p>  
 
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|}
  
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*
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<span style="line-height:normal">'''<span style="font-size:13.0pt"><span style="font-family:">Comments:</span></span>'''</span>
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**<span style="font-size: 110%;">Comments:</span>  
 
  
−
*
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">1.</span></span>''' <span style="font-size:13.0pt"><span style="font-family:">Results indicate some clinical benefit with preconditioning and these findings are supported by differences in a marker of cerebral injury (S100B) and a number of others in the paper.</span></span></span>
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**1.'''<span style="font-size: 110%;">Results indicate some clinical benefit with preconditioning and these findings are supported by differences in a marker of cerebral injury (S100B) and a number of others in the paper.</span>''' 
 
  
−
*
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">2.</span></span>''' <span style="font-size:13.0pt"><span style="font-family:">Any benefit of HBO may reflect a combination of anti-inflammatory and/or antioxidant actions.</span></span></span>
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**2.'''<span style="font-size: 110%;">Any benefit of HBO may reflect a combination of anti-inflammatory and/or antioxidant actions.</span>''' 
 
  
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3.<span style="font-size: 110%;">There were no differences shown on the same analysis of off-pump CABG implying the crucial exposure is to CPB.</span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3.</span></span><span style="font-size:13.0pt"><span style="font-family:">There were no differences shown on the same analysis of off-pump CABG implying the crucial exposure is to CPB.</span></span></span>
  
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4. <span style="font-size: 110%;">A small study with wide 95% CIs and no longer-term follow-up means we should interpret cautiously.</span>
+
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">4.</span></span><span style="font-size:13.0pt"><span style="font-family:">A small study with wide 95% CIs and no longer-term follow-up means we should interpret cautiously.</span></span></span>
  
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*
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<span style="line-height:normal">'''<span style="font-size:13.0pt"><span style="font-family:">Appraised by:</span></span>'''<span style="font-size:13.0pt"><span style="font-family:">Mike Bennett, POWH m.bennett@unsw.edu.au; Monday, 13 November 2017</span></span></span>
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**<span style="font-size: 110%;">Appraised by:</span>'''<span style="font-size: 110%;">Mike Bennett, POWH m.bennett@unsw.edu.au; Monday, 13 November 2017</span>''' 
 
  
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<span style="font-size: 110%;">'''Kill or Update By:''' November 2022</span>
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<span style="line-height:normal">'''<span style="font-size:13.0pt"><span style="font-family:">Kill or Update By:</span></span>'''<span style="font-size:13.0pt"><span style="font-family:">November 2022</span></span></span>
  
 
<span style="display: block; text-align: center;">[[File:Sumhorsa.gif|sumhorsa.gif]]</span>
 
<span style="display: block; text-align: center;">[[File:Sumhorsa.gif|sumhorsa.gif]]</span>
  
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== [[Acute_ischaemia|BACK]] ==
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== <span style="font-size:xx-large;">[[Preconditioning|BACK]]</span> ==
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<p style="text-align: center;">&nbsp;</p>
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&nbsp;
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<br/> &nbsp;
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&nbsp;
 
  
 
&nbsp;
 
&nbsp;

Latest revision as of 04:07, 27 September 2021

Preconditioning with hyperbaric oxygen reduced the ICU length of stay and inotrope requirements for patients having on-pump coronary bypass grafting.

Clinical Bottom Line:

1. ICU time was reduced following preconditioning with HBO for those patients requiring on-pump CABG

2. The requirement for inotropes post-operatively was reduced in the same group following preconditioning.

3. No differences were note for those having off-pump surgery.

Citation/s:1. Li Y, Dong H, Chen M, Liu J, Yang L, Chen S, Xiong L. Preconditioning with repeated hyperbaric oxygen induces myocardial and cerebral protection in patients undergoing coronary artery bypass graft surgery: a prospective, randomized, controlled clinical trial. Journal of cardiothoracic and vascular anesthesia. 2011 Dec 31;25(6):908-16.

Lead author's name and email:Lize Yiong, lxiong@fmmu.edu.cn

Three-part Clinical Question:For patients requiring coronary artery bypass grafting (CABG) (on or off-pump), does preconditioning with hyperbaric oxygen result in protective cerebral or myocardial effects?

Search Terms:coronary artery bypass grafts; preconditioning, brain injury

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

The Study Patients:Adult male patients for first time coronary arterial bypass grafting.

Control group (N = 16; 15 analysed):Standard surgical procedures for on-pump CABGs. Anaesthesia with propofol infusion and no volatile agents or steroids. ACT maintained at >480 sec with heparin.

Experimental group (N = 15; 14 analysed):As above, plus HBO at 2.0 ATA for 70 minutes daily for five days prior to operation.

The Evidence:

Measure

Control Group

HBO Group

Difference

95% CI

Mean

SD

Mean

SD

Length of stay in ICU (hours)

85.9

41.8

59.4

21.7

26.5

0.8 to 52.2

Inotrope at 36 hours (microg/kg/min)

9.6

4.3

6.7

3.0

2.9

0.1 to 5.8

Serum S100B after 1 hr crossclamp time (pg/ml)

138.2

37.4

82.2

42.8

56.0

25.4 to 86.6

Serum catalase activity at 24 hours (U/ml)

3.73

1.78

6.1

1.53

2.27

1.00 to 3.54

Comments:

1. Results indicate some clinical benefit with preconditioning and these findings are supported by differences in a marker of cerebral injury (S100B) and a number of others in the paper.

2. Any benefit of HBO may reflect a combination of anti-inflammatory and/or antioxidant actions.

3.There were no differences shown on the same analysis of off-pump CABG implying the crucial exposure is to CPB.

4.A small study with wide 95% CIs and no longer-term follow-up means we should interpret cautiously.

Appraised by:Mike Bennett, POWH m.bennett@unsw.edu.au; Monday, 13 November 2017

Kill or Update By:November 2022

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