Difference between revisions of "Li"
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| − | <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family: | + | <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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| − | <span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family: | + | <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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| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">The Evidence:</span></span>'''</span> |
{| class="Table" style="border:solid windowtext 1.0pt" | {| class="Table" style="border:solid windowtext 1.0pt" | ||
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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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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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| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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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| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Length of stay in ICU (hours)</span></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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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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| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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: | + | | 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: | + | | 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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| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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: | + | | 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: | + | | 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> |
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| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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> |
| − | | 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: | + | | 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: | + | | 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: | + | | 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> |
|} | |} | ||
| − | <span style="line-height:normal">'''<span style="font-size:13.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.0pt"><span style="font-family:">Comments:</span></span>'''</span> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:13.0pt"><span style="font-family: | + | <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> |
| − | <span style="line-height:normal">'''<span style="font-size:13.0pt"><span style="font-family: | + | <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> | ||
| − | == <span style="font-size:xx-large;">[[ | + | == <span style="font-size:xx-large;">[[Preconditioning|BACK]]</span> == |
<p style="text-align: center;"> </p> | <p style="text-align: center;"> </p> | ||
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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 |
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
BACK
