Difference between revisions of "Sansone"
(Imported from Wikispaces) |
|||
| Line 1: | Line 1: | ||
| − | |||
| − | + | == <span style="font-size:x-large;">'''Some evidence that early hyperbaric oxygen may improve recovery after ischaemic stroke'''</span> == | |
| − | {| | + | |
| − | + | '''<span style="font-size: 12pt;">Clinical bottom line:</span>''' | |
| + | |||
| + | {| | ||
|- | |- | ||
| + | | '''<span style="font-size:medium;">1. Early hyperbaric oxygenation was associated with improved recovery score at 12 months after ischaemic stroke but not after six month</span>s''' | ||
|} | |} | ||
| − | + | '''<span style="font-size: 11pt;">Citation/s: </span>'''<span style="font-size: 11pt;">1. Sansone A, Gulotta G, Sparacia B, Alongi A, Savola G. Efect of hyperbaric oxygen therapy on neurologic recovery after focal cerebral ischaemia.British Journal of Anaesthesia 1997;78(Suppl1):73-74.</span> | |
| − | <span style="font-size: 11pt;"> 1. Sansone A, Gulotta G, Sparacia B, Alongi A, Savola G. Efect of hyperbaric oxygen therapy on neurologic recovery after focal cerebral ischaemia.British Journal of Anaesthesia 1997;78(Suppl1):73-74.</span> | + | |
| + | <span style="font-size: 11pt;">'''Lead author's name and fax:''' Sansone G. No contact.</span> | ||
| + | |||
| + | <span style="font-size: 11pt;">T'''hree-part Clinical Question:''''''<span style="font-size: 11pt;"></span>'''For patients within 24 hours of a stroke, does the application of hyperbaric oxygen compared to a sham exposure, lead to improved neurological recovery?</span> | ||
| − | <span style="font-size: 11pt;"> ''' | + | <span style="font-size: 11pt;">'''Search Terms:''' Focal cerebral ischaemia, stroke, cerebrovascular accident</span> |
| − | + | '''<span style="font-size: 11pt;">The Study:</span>'''<span style="font-size: 11pt;">Double-blinded randomised controlled trial with intention-to-treat.</span> | |
| − | <span style="font-size: 11pt;"> ''' | + | <span style="font-size: 11pt;">'''The Study Patients:''' Adult patients presenting within 24 hours of a CT confirmed cerebrovascular event (stroke) due to occlusion of the middle or anterior cerebral artery.</span> |
| − | |||
| − | <span style="font-size: 11pt;"> ''' | + | <span style="font-size: 11pt;">'''Control group''' (N = 8; 8 analysed): Sham exposure in a chamber without pressure for 66 minutes daily for eight to ten days. Other standard therapy not known.</span> |
| − | <span style="font-size: 11pt;"> ''' | + | '''<span style="font-size: 11pt;">Experimental group</span>''''''<span style="font-size: 11pt;"></span>'''<span style="font-size: 11pt;">(N = 9; 9 analysed): 100% oxygen breathing at 1.5 to 1.8 ATA for 60 minutes with air breaks for the same total time in chamber as the sham</span> |
| − | |||
| − | + | '''<span style="font-size: 11pt;">The Evidence:</span>''' | |
| − | {| | + | {| class="Table" style="border:solid windowtext 1.0pt" |
| − | |||
|- | |- | ||
| − | | | + | | rowspan="2" style="width:188.75pt; border:solid windowtext 1.0pt" width="255" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Measure</span></span>'''</span></p> |
| + | | colspan="2" style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Sham Group</span></span>'''</span></p> | ||
| + | | colspan="2" style="width:69.4pt; border:solid windowtext 1.0pt" width="95" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">HBOT Group</span></span>'''</span></p> | ||
| + | | rowspan="2" style="width:55.2pt; border:solid windowtext 1.0pt" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Difference</span></span>'''</span></p> | ||
| + | | rowspan="2" style="width:58.8pt; border:solid windowtext 1.0pt" width="81" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI</span></span>'''</span></p> | ||
|- | |- | ||
| − | | | + | | style="width:33.9pt; 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:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Mean</span></span>'''</span></p> |
| + | | 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:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">SD</span></span>'''</span></p> | ||
| + | | style="width:41.05pt; border:solid windowtext 1.0pt" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Mean</span></span>'''</span></p> | ||
| + | | 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:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">SD</span></span>'''</span></p> | ||
|- | |- | ||
| − | | '''<span style | + | | style="width:188.75pt; border:solid windowtext 1.0pt" width="255" | |
| + | <span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Neurological Recovery Score at six months (0 (no disability) to 10 (dead))</span></span>'''</span> | ||
| + | |||
| + | | style="width:33.9pt; 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:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">6.1</span></span></span></p> | ||
| + | | 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:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.7</span></span></span></p> | ||
| + | | style="width:41.05pt; border:solid windowtext 1.0pt" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">5.3</span></span></span></p> | ||
| + | | 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:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">6.1</span></span></span></p> | ||
| + | | style="width:55.2pt; border:solid windowtext 1.0pt" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.80</span></span></span></p> | ||
| + | | style="width:58.8pt; border:solid windowtext 1.0pt" width="81" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">-3.84 to 5.44</span></span></span></p> | ||
|- | |- | ||
| + | | style="width:188.75pt; border:solid windowtext 1.0pt" width="255" | | ||
| + | <span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Neurological Recovery Score at 12 months (0 (no disability) to 10 (dead))</span></span>'''</span> | ||
| + | |||
| + | | style="width:33.9pt; 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:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">6.4</span></span></span></p> | ||
| + | | 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:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.7</span></span></span></p> | ||
| + | | style="width:41.05pt; border:solid windowtext 1.0pt" width="57" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">4.2</span></span></span></p> | ||
| + | | 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:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.6</span></span></span></p> | ||
| + | | style="width:55.2pt; border:solid windowtext 1.0pt" width="76" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">2.20</span></span></span></p> | ||
| + | | style="width:58.8pt; border:solid windowtext 1.0pt" width="81" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">1.53 to 2.87</span></span></span></p> | ||
|} | |} | ||
| + | | ||
| + | '''<span style="font-size: 11pt;">Comments:</span>''' | ||
| − | + | <span style="font-size: 11pt;">1. Very small study with a considerable risk of bias. Patients were blinded but it is not clear if the outcome assessor was blinded.</span> | |
| − | <span style="font-size: 11pt;"> 1. Very small study with a considerable risk of bias. Patients were blinded but it is not clear if the outcome assessor was blinded.</span> | ||
| − | <span style="font-size: 11pt;"> 2. The treated group improved between six months and 12 months after treatment and the reason for this late effect is not clear.</span> | + | <span style="font-size: 11pt;">2. The treated group improved between six months and 12 months after treatment and the reason for this late effect is not clear.</span> |
| − | <span style="font-size: 11pt;"> 3. The Neurological Recovery Score is not explained, does not appear to have been validated and is not a commonly used index of recovery after stroke The base values of the recovery score were non-significantly worse in the sham group. It is not clear what the NRS means at presentation, nor the importance of the small difference in scores.</span> | + | <span style="font-size: 11pt;">3. The Neurological Recovery Score is not explained, does not appear to have been validated and is not a commonly used index of recovery after stroke The base values of the recovery score were non-significantly worse in the sham group. It is not clear what the NRS means at presentation, nor the importance of the small difference in scores.</span> |
<span style="font-size: 11pt;">'''Appraised by:''' Mike Bennett m.bennett@unsw.edu.au; Tuesday, 9 October 2018</span> | <span style="font-size: 11pt;">'''Appraised by:''' Mike Bennett m.bennett@unsw.edu.au; Tuesday, 9 October 2018</span> | ||
| − | + | <span style="font-size: 11pt;">Kill or Update By:</span>'''<span style="font-size: 11pt;">July 2022</span>''' | |
| − | [[File: | + | [[File:Sumhorsa.gif|center|Sumhorsa.gif]] |
| − | =<span style="display: block; text-align: center;"><span style="color: #7c00ff; font-size: 140%;">[[Stroke | + | = <span style="display: block; text-align: center;"><span style="color: #7c00ff; font-size: 140%;">[[Stroke|BACK]]</span></span> = |
Latest revision as of 03:35, 23 January 2020
Some evidence that early hyperbaric oxygen may improve recovery after ischaemic stroke
Clinical bottom line:
| 1. Early hyperbaric oxygenation was associated with improved recovery score at 12 months after ischaemic stroke but not after six months |
Citation/s: 1. Sansone A, Gulotta G, Sparacia B, Alongi A, Savola G. Efect of hyperbaric oxygen therapy on neurologic recovery after focal cerebral ischaemia.British Journal of Anaesthesia 1997;78(Suppl1):73-74.
Lead author's name and fax: Sansone G. No contact.
T'hree-part Clinical Question:'For patients within 24 hours of a stroke, does the application of hyperbaric oxygen compared to a sham exposure, lead to improved neurological recovery?
Search Terms: Focal cerebral ischaemia, stroke, cerebrovascular accident
The Study:Double-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Adult patients presenting within 24 hours of a CT confirmed cerebrovascular event (stroke) due to occlusion of the middle or anterior cerebral artery.
Control group (N = 8; 8 analysed): Sham exposure in a chamber without pressure for 66 minutes daily for eight to ten days. Other standard therapy not known.
'Experimental group'(N = 9; 9 analysed): 100% oxygen breathing at 1.5 to 1.8 ATA for 60 minutes with air breaks for the same total time in chamber as the sham
The Evidence:
Measure |
Sham Group |
HBOT Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
Neurological Recovery Score at six months (0 (no disability) to 10 (dead)) |
6.1 |
0.7 |
5.3 |
6.1 |
0.80 |
-3.84 to 5.44 |
|
Neurological Recovery Score at 12 months (0 (no disability) to 10 (dead)) |
6.4 |
0.7 |
4.2 |
0.6 |
2.20 |
1.53 to 2.87 |
Comments:
1. Very small study with a considerable risk of bias. Patients were blinded but it is not clear if the outcome assessor was blinded.
2. The treated group improved between six months and 12 months after treatment and the reason for this late effect is not clear.
3. The Neurological Recovery Score is not explained, does not appear to have been validated and is not a commonly used index of recovery after stroke The base values of the recovery score were non-significantly worse in the sham group. It is not clear what the NRS means at presentation, nor the importance of the small difference in scores.
Appraised by: Mike Bennett m.bennett@unsw.edu.au; Tuesday, 9 October 2018
Kill or Update By:July 2022
