Difference between revisions of "Li"

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==<span style="font-size: 140%;">Preconditioing 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="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'''"font-size: 130%;">1. ICU time was reduced following preconditioning with HBO for those patients requiring on-pump CABG</span>'''<br><br>**<span style'''"font-size: 130%;"> 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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{|
 
|-
 
|-
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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>'''
 
|}
 
|}
  
 
<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>
 
<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="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="font-size: 110%;">Lead author's name and fax:</span>'''<span style="font-size: 110%;">Lize Yiong lxiong@fmmu.edu.cn</span>'''
 +
**<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="font-size: 110%;">Search Terms:</span>''' <span style="font-size: 110%;">coronary artery bypass grafts; preconditioning, brain injury</span>
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*
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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="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: </span>'''<span style="font-size: 110%;">Single-blinded concealed randomised controlled trial with intention-to-treat.</span>''' 
  
 
<span style="font-size: 110%;">'''The Study Patients:''' Adult male patients for first time coronary arterial bypass grafting.</span>
 
<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="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%;">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>''' 
  
 
<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>
 
<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="font-size: 110%;">The Evidence:</span>'''
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**<span style="font-size: 110%;">The Evidence:</span>  
  
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{|  
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{|
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| <span style'''"display: block; text-align: center;">Measure</span> |||| <span style'''"display: block; text-align: center;">Control Group</span> |||| <span style'''"display: block; text-align: center;">HBO Group</span> || <span style'''"display: block; text-align: center;">Difference</span> || <span style="display: block; text-align: center;">95% CI</span>
 
 
|-
 
|-
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|^  || <span style'''"display: block; text-align: center;">Mean</span> || <span style'''"display: block; text-align: center;">SD</span> || <span style'''"display: block; text-align: center;">Mean</span> || <span style'''"display: block; text-align: center;">SD</span> ||^  ||^ 
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| <span>Measure</span>
 +
| &nbsp;
 +
| <span>Control Group</span>
 +
| &nbsp;
 +
| <span>HBO Group</span>
 +
| <span>Difference</span>
 +
| <span style="display: block; text-align: center;">95% CI</span>
 
|-
 
|-
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| '''<span style'''"font-size: 10pt;">Length of stay in ICU (hours) </span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">85.9</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">41.8</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">59.4</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">21.7</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">26.500</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 9pt; text-align: center;">0.84 to 52.16</span></span>
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| ^
 +
| <span>Mean</span>
 +
| <span>SD</span>
 +
| <span>Mean</span>
 +
| <span>SD</span>
 +
| ^
 +
| ^
 
|-
 
|-
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| '''<span style'''"font-size: 10pt;">Inotrope scores at 36 hours (microg/kg/min) </span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">9.6</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">4.3</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">6.7</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">3.0</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">2.900</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 9pt; text-align: center;">0.06 to 5.75</span></span>  
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| '''<span>Length of stay in ICU (hours)</span>'''
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| <span><span>85.9</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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| <span><span>21.7</span></span>
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| <span><span>26.500</span></span>
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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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|-
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| '''<span style'''"font-size: 10pt;">Serum S100B after 1 hr crossclamp time (pg/ml) </span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">138.2</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">37.4</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">82.2</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">42.8</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">56.000</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 9pt; text-align: center;">25.43 to 86.57</span></span>  
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| '''<span>Inotrope scores at 36 hours (microg/kg/min)</span>'''
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| <span><span>9.6</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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| <span><span>3.0</span></span>
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| <span><span>2.900</span></span>
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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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|-
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| '''<span style'''"font-size: 10pt;">Serum catalase activity at 24 hours (U/ml)</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">3.73</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">1.78</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">6.1</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">1.53</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 9pt; text-align: center;">2.27</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 9pt; text-align: center;">1.00 to 3.54</span></span>  
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| '''<span>Serum S100B after 1 hr crossclamp time (pg/ml)</span>'''
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| <span><span>138.2</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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| <span><span>42.8</span></span>
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| <span><span>56.000</span></span>
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| <span><span style="display: block; font-size: 9pt; text-align: center;">25.43 to 86.57</span></span>
 
|-
 
|-
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| '''<span>Serum catalase activity at 24 hours (U/ml)</span>'''
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| <span><span>3.73</span></span>
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| <span><span>1.78</span></span>
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| <span><span>6.1</span></span>
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| <span><span>1.53</span></span>
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| <span><span>2.27</span></span>
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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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**<span style="font-size: 110%;">Comments:</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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*
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**<span style="font-size: 110%;">Comments:</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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**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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*
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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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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>
  
 
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>
 
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>
  
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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%;">Appraised by:</span>'''<span style="font-size: 110%;">Mike Bennett, POWH m.bennett@unsw.edu.au; Monday, 13 November 2017</span>''' 
  
 
<span style="font-size: 110%;">'''Kill or Update By:''' November 2022</span>
 
<span style="font-size: 110%;">'''Kill or Update By:''' November 2022</span>
  
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Revision as of 03:53, 27 September 2021

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

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 fax: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 26.500 0.84 to 52.16
Inotrope scores at 36 hours (microg/kg/min) 9.6 4.3 6.7 3.0 2.900 0.06 to 5.75
Serum S100B after 1 hr crossclamp time (pg/ml) 138.2 37.4 82.2 42.8 56.000 25.43 to 86.57
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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