Difference between revisions of "Yang"
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| − | + | <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:black">Pre-conditioning with HBO may induce cerebral and cardiac protection in patients undergoing on-pump CABG surgery</span></span></span>'''</span> | |
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| − | <span style=" | + | <span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">Clinical Bottom line:</span></span>'''</span> |
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| − | <span style=" | + | <span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Pre-conditioning with HBO resulted in improved clinical outcomes for patients undergoing 'on-pump' CABG surgery.</span></span></span> |
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| − | + | <span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">2. There were also potential cerebral and cardiac protective effects as determined by proxy outcomes.</span></span></span> | |
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| − | + | <span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">3. No protective effects were noted in off-pump CABG</span></span></span> | |
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Citation/s:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Yang L, Dong H, Chen M et al. 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;25(6):908-916.</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Lead author's name and email:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Yang Li: [mailto:lxiong@fmmu.edu.cn lxiong@fmmu.edu.cn]</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Three-part Clinical Question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">For patients undergoing CABG, does the addition of hyperbaric oxygen to standard care confer any myocardial and cerebral protection?</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">CABG, preconditioning, cardiopulmonary bypass</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">The Study:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Single-blinded randomised controlled trial without intention-to-treat.</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">The Study Patients:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Male patients under 80 years having CAG either on cardiopulmonary bypass or off-pump.</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Control group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">(N = 16; 15 analysed): Full orthodox pre-operative care for CABG. No sham treatment.</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Experimental group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">(N = 15; 14 analysed): As above, but patients were given 5 daily sessions of HBOT at 2ATA breathing 100% ATA for 70 minutes.</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The Evidence:</span></span>'''</span> | ||
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| + | {| class="Table" style="border:solid windowtext 1.0pt" | ||
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| − | | | + | | rowspan="2" style="width:181.8pt; border:solid windowtext 1.0pt" width="245" | |
| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Outcome</span></span>'''</span> | ||
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| + | | 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:12.0pt"><span style="font-family:" arial",sans-serif"="">Control Group</span></span>'''</span></p> | ||
| + | | 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:" arial",sans-serif"="">HBOT Group</span></span>'''</span></p> | ||
| + | | rowspan="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:" arial",sans-serif"="">Difference</span></span>'''</span></p> | ||
| + | | rowspan="2" style="width:66.05pt; border:solid windowtext 1.0pt" width="91" | <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:" arial",sans-serif"="">95% CI</span></span>'''</span></p> | ||
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| − | | | + | | style="width:41.0pt; 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:12.0pt"><span style="font-family:" arial",sans-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:12.0pt"><span style="font-family:" arial",sans-serif"="">SD</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:12.0pt"><span style="font-family:" arial",sans-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:12.0pt"><span style="font-family:" arial",sans-serif"="">SD</span></span></span></p> | ||
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| − | | '''<span style | + | | style="width:181.8pt; border:solid windowtext 1.0pt" width="245" | |
| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Length of ICU Stay in on-pump patients (hrs)</span></span>'''</span> | ||
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| + | | style="width:41.0pt; 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:12.0pt"><span style="font-family:" arial",sans-serif"="">85.9</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:12.0pt"><span style="font-family:" arial",sans-serif"="">40.3</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:12.0pt"><span style="font-family:" arial",sans-serif"="">59.4</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:12.0pt"><span style="font-family:" arial",sans-serif"="">20.9</span></span></span></p> | ||
| + | | 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:" arial",sans-serif"="">26.5</span></span></span></p> | ||
| + | | style="width:66.05pt; border:solid windowtext 1.0pt" width="91" | <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:" arial",sans-serif"="">1.8 to 51.2</span></span></span></p> | ||
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| − | | '''<span style | + | | style="width:181.8pt; border:solid windowtext 1.0pt" width="245" | |
| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Serum S100B concentration of on-pump patients at time of ICU arrival (pg/ml)</span></span>'''</span> | ||
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| + | | style="width:41.0pt; 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:12.0pt"><span style="font-family:" arial",sans-serif"="">89.7</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:12.0pt"><span style="font-family:" arial",sans-serif"="">14.6</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:12.0pt"><span style="font-family:" arial",sans-serif"="">60.4</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:12.0pt"><span style="font-family:" arial",sans-serif"="">26.4</span></span></span></p> | ||
| + | | 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:" arial",sans-serif"="">29.3</span></span></span></p> | ||
| + | | style="width:66.05pt; border:solid windowtext 1.0pt" width="91" | <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:" arial",sans-serif"="">13.2 to 45.4</span></span></span></p> | ||
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| + | | style="width:181.8pt; border:solid windowtext 1.0pt" width="245" | | ||
| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Serum NSE concentration of on-pump patients at 24hrs post-op (ng/ml)</span></span>'''</span> | ||
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| + | | style="width:41.0pt; 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:12.0pt"><span style="font-family:" arial",sans-serif"="">38.0</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:12.0pt"><span style="font-family:" arial",sans-serif"="">8.4</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:12.0pt"><span style="font-family:" arial",sans-serif"="">30.3</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:12.0pt"><span style="font-family:" arial",sans-serif"="">6.1</span></span></span></p> | ||
| + | | 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:" arial",sans-serif"="">7.7</span></span></span></p> | ||
| + | | style="width:66.05pt; border:solid windowtext 1.0pt" width="91" | <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:" arial",sans-serif"="">2.1 to 13.3</span></span></span></p> | ||
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| − | <span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Comments:</span></span>'''</span> |
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| − | <span style="font-family: | + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">1. Exclusion of female subjects and small numbers may limit external validity of the study</span></span></span> |
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| + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">2. Only 2 biochemical markers were analyzed to measure cerebral injury; it may not be fully representative of actual cerebral damage.</span></span></span> | ||
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| + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">3. Early post-operative outcomes may not be representative of long-term morbidity and mortality</span></span></span> | ||
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| + | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">4. Values of mean and standard deviation were not provided for non-significant results in off-pump patients.</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Appraised by:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Bryan Hui and Michael Bennett, Tuesday, 23 April 2013</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Email:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">[mailto:bryan.hui@student.unsw.edu.au bryan.hui@student.unsw.edu.au]</span></span></span> | ||
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| + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">Kill or Update By</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" arial",sans-serif"="">: April 2024</span></span></span> | ||
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| − | [[ | + | = <span style="display: block; text-align: center;"><span style="font-size: 130%;">[[Myocardial_ischaemia|BACK]]</span></span> = |
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Revision as of 23:24, 15 September 2021
Pre-conditioning with HBO may induce cerebral and cardiac protection in patients undergoing on-pump CABG surgery
Clinical Bottom line:
1. Pre-conditioning with HBO resulted in improved clinical outcomes for patients undergoing 'on-pump' CABG surgery.
2. There were also potential cerebral and cardiac protective effects as determined by proxy outcomes.
3. No protective effects were noted in off-pump CABG
Citation/s:Yang L, Dong H, Chen M et al. 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;25(6):908-916.
Lead author's name and email:Yang Li: lxiong@fmmu.edu.cn
Three-part Clinical Question:For patients undergoing CABG, does the addition of hyperbaric oxygen to standard care confer any myocardial and cerebral protection?
Search Terms:CABG, preconditioning, cardiopulmonary bypass
The Study:Single-blinded randomised controlled trial without intention-to-treat.
The Study Patients:Male patients under 80 years having CAG either on cardiopulmonary bypass or off-pump.
Control group(N = 16; 15 analysed): Full orthodox pre-operative care for CABG. No sham treatment.
Experimental group(N = 15; 14 analysed): As above, but patients were given 5 daily sessions of HBOT at 2ATA breathing 100% ATA for 70 minutes.
The Evidence:
|
Outcome |
Control Group |
HBOT Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
Length of ICU Stay in on-pump patients (hrs) |
85.9 |
40.3 |
59.4 |
20.9 |
26.5 |
1.8 to 51.2 |
|
Serum S100B concentration of on-pump patients at time of ICU arrival (pg/ml) |
89.7 |
14.6 |
60.4 |
26.4 |
29.3 |
13.2 to 45.4 |
|
Serum NSE concentration of on-pump patients at 24hrs post-op (ng/ml) |
38.0 |
8.4 |
30.3 |
6.1 |
7.7 |
2.1 to 13.3 |
Comments:
1. Exclusion of female subjects and small numbers may limit external validity of the study
2. Only 2 biochemical markers were analyzed to measure cerebral injury; it may not be fully representative of actual cerebral damage.
3. Early post-operative outcomes may not be representative of long-term morbidity and mortality
4. Values of mean and standard deviation were not provided for non-significant results in off-pump patients.
Appraised by:Bryan Hui and Michael Bennett, Tuesday, 23 April 2013
Email:bryan.hui@student.unsw.edu.au
Kill or Update By: April 2024
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