Difference between revisions of "Bouachour"

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'''<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Adjunctive hyperbaric oxygen improved the rate of healing and reduced requirements for re-operation in crush injuries of the limbs. </span>'''
 
  
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<span style="border: 1.5pt solid windowtext; display: block; padding: 1pt 4pt;">
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<span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" times="" new="" roman",serif"="">Adjunctive hyperbaric oxygen improved the rate of healing and reduced requirements for re-operation in crush injuries of the limbs.</span></span>'''</span>
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<span style="padding-bottom: 0cm; padding-left: 0cm; padding-right: 0cm; padding-top: 0cm;">'''<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Clinical Bottom Line:</span>'''
 
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<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">1. Hyperbaric oxygen administration was associated with improved rate of healing following a crush injury.
 
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2. Fewer patients required re-operation when hyperbaric oxygen was used.</span></span>
 
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</span>
 
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**<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Appraised by:</span>'''<span style="font-family: 'Times New Roman','serif'; font-size: 15px;"> Abigail Fynn, Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Tuesday, 30 March 1999</span>
 
  
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**<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Clinical Scenario: </span>'''<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">40 year old patient presented with a crush injury to the leg following a motor bike crash. We wondered if hyperbaric oxygen would be of benefit.</span>
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<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="font-family: 'Times New Roman','serif'; font-size: 15px;">Three-part Question:</span>'''<span style="font-family: 'Times New Roman','serif'; font-size: 15px;"> In patients with crush injuries of the limbs, does the adjunctive use of hyperbaric oxygen compared with standard treatment alone, result in any important improvements in healing or lower rates of re-operation?</span>
 
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**<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Search Terms:</span>'''<span style="font-family: 'Times New Roman','serif'; font-size: 15px;"> Crush syndrome, extremities/*injuries</span>
 
  
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**<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">The Study:</span>'''
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<span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Hyperbaric oxygen patients had an improved rate of healing.</span></span></span>
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<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Double-blinded concealed randomised controlled trial with intention-to-treat.</span>
 
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<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Moderate or severe crush injury to one or more limbs and no contraindication to hyperbaric therapy.</span>
 
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<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Control group (N = 18; 18 analysed): Standard care plus sham hyperbaric oxygen twice daily for 6 days as for HBO group.</span>
 
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<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Experimental group (N = 18; 18 analysed): As above, plus 100% oxygen at 2.4ATA for 90 minutes twice daily for 6 days.</span>
 
  
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**<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">The Evidence:</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. Fewer hyperbaric patients needed re-operation</span></span></span>
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{|
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: 'Times New Roman','serif'; font-size: 15px;">Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: 'Times New Roman','serif'; font-size: 15px;">Time to Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: 'Times New Roman','serif'; font-size: 15px;">Air group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: 'Times New Roman','serif'; font-size: 15px;">HBO group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: 'Times New Roman','serif'; font-size: 15px;">Relative risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: 'Times New Roman','serif'; font-size: 15px;">Absolute risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">NNT</span>'''</span></span>  
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----
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Citations:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Bouachour G, Cronier P, Gouello J, Toulemonde J, Talha A, Alquier P. Hyperbaric oxygen therapy in the management of crush injuries: a randomised double-blind placebo-controlled clinical trial. The Journal of Trauma, Injury, Infection and Critical Care 1996; 41:333-339.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Clinical Scenario:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">40 year old patient presented with a crush injury to the leg following a motor bike crash. We wondered if hyperbaric oxygen would be of benefit.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Three-part Question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">In patients with crush injuries of the limbs, does the adjunctive use of hyperbaric oxygen compared with standard treatment alone, result in any important improvements in healing or lower rates of re-operation?</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Crush syndrome, extremities/*injuries</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 Study:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Double-blinded concealed randomised controlled trial with intention-to-treat. Moderate or severe crush injury to one or more limbs and no contraindication to hyperbaric therapy.</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"="">Control group (N = 18; 18 analysed):</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Standard care plus sham hyperbaric oxygen twice daily for 6 days as for HBO group.</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Experimental group (N = 18; 18 analysed):</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">As above, plus 100% oxygen at 2.4ATA for 90 minutes twice daily for 6 days.</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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|-
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| '''<span style'''"font-family: 'Times New Roman','serif'; font-size: 15px;">Wound not healed</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">60 days</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">0.444</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">0.06</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">86%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">0.384</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">3</span></span>  
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| style="width:82.6pt; border:solid windowtext 1.0pt" width="113" | <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:" times="" new="" roman",serif"="">Outcome</span></span>'''</span></p>
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| style="width:49.2pt; border:solid windowtext 1.0pt" width="68" | <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:" times="" new="" roman",serif"="">Time to Outcome</span></span>'''</span></p>
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| style="width:39.9pt; border:solid windowtext 1.0pt" width="55" | <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:" times="" new="" roman",serif"="">Air group</span></span>'''</span></p>
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| style="width:48.1pt; border:solid windowtext 1.0pt" width="66" | <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:" times="" new="" roman",serif"="">HBO group</span></span>'''</span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <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:" times="" new="" roman",serif"="">Relative risk reduction</span></span>'''</span></p>
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| style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <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:" times="" new="" roman",serif"="">Absolute risk reduction</span></span>'''</span></p>
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| 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:11.5pt"><span style="font-family:" times="" new="" roman",serif"="">NNT</span></span>'''</span></p>  
 
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| '''<span style'''"font-family: 'Times New Roman','serif'; font-size: 15px;">95% CI:</span>''' ||  ||  ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">29% to 100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">0.130 to 0.638</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">2 to 8</span></span>  
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| rowspan="2" style="width:82.6pt; border:solid windowtext 1.0pt" width="113" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Wound not healed</span></span>'''</span>
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 +
| style="width:49.2pt; border:solid windowtext 1.0pt" width="68" | <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:" times="" new="" roman",serif"="">60 days</span></span></span></p>
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| style="width:39.9pt; border:solid windowtext 1.0pt" width="55" | <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:" times="" new="" roman",serif"="">0.44</span></span></span></p>
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| style="width:48.1pt; border:solid windowtext 1.0pt" width="66" | <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:" times="" new="" roman",serif"="">0.06</span></span></span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <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:" times="" new="" roman",serif"="">86%</span></span></span></p>
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| style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <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:" times="" new="" roman",serif"="">0.38</span></span></span></p>
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| 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:11.5pt"><span style="font-family:" times="" new="" roman",serif"="">3</span></span></span></p> <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" times="" new="" roman",serif"="">2 to 8</span></span></span></p>  
 
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| '''<span style'''"font-family: 'Times New Roman','serif'; font-size: 15px;">Repeat surgical procedure</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">60 days</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">0.333</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">0.06</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">82%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">0.273</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">4</span></span>  
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| colspan="3" style="width:140.2pt; border:solid windowtext 1.0pt" width="189" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI:</span></span></span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <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:" times="" new="" roman",serif"="">29% to 100%</span></span></span></p>
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| style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <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:" times="" new="" roman",serif"="">0.13 to 0.64</span></span></span></p>  
 
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|-
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| '''<span style'''"font-family: 'Times New Roman','serif'; font-size: 15px;">95% CI:</span>''' ||  ||  ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">9% to 100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">0.029 to 0.517</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-family: 'Times New Roman','serif'; font-size: 15px; text-align: center;">2 to 34</span></span>  
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| rowspan="2" style="width:82.6pt; border:solid windowtext 1.0pt" width="113" |
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Repeat surgical procedure</span></span>'''</span>
 +
 
 +
| style="width:49.2pt; border:solid windowtext 1.0pt" width="68" | <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:" times="" new="" roman",serif"="">60 days</span></span></span></p>
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| style="width:39.9pt; border:solid windowtext 1.0pt" width="55" | <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:" times="" new="" roman",serif"="">0.33</span></span></span></p>
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| style="width:48.1pt; border:solid windowtext 1.0pt" width="66" | <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:" times="" new="" roman",serif"="">0.06</span></span></span></p>
 +
| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <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:" times="" new="" roman",serif"="">82%</span></span></span></p>
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| style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <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:" times="" new="" roman",serif"="">0.27</span></span></span></p>
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| 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:11.5pt"><span style="font-family:" times="" new="" roman",serif"="">4</span></span></span></p> <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:11.5pt"><span style="font-family:" times="" new="" roman",serif"="">2 to 34</span></span></span></p>  
 
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|-
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| colspan="3" style="width:140.2pt; border:solid windowtext 1.0pt" width="189" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI:</span></span></span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <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:" times="" new="" roman",serif"="">9% to 100%</span></span></span></p>
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| style="width:76.45pt; border:solid windowtext 1.0pt" width="104" | <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:" times="" new="" roman",serif"="">0.03 to 0.52</span></span></span></p>
 
|}
 
|}
  
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**<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Comments:</span>'''
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Comments:</span></span>'''</span>
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# <span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Well organised and methodologically sound trial.</span>
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# <span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Reductions in morbidity appear clinically important</span>
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#<span style="line-height:normal"><span style="tab-stops:list 36.0pt"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Well organised and methodologically sound trial.</span></span></span></span>  
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#<span style="line-height:normal"><span style="tab-stops:list 36.0pt"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Reductions in morbidity appear clinically important</span></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"="">Appraised by:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Abigail Fynn, Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Tuesday, 30 March 1999</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Expiry date:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">November 2022</span></span></span>
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&nbsp;
  
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**<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">Expiry date:</span>'''<span style="font-family: 'Times New Roman','serif'; font-size: 15px;"> November 2020</span>
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<span style="display: block; text-align: center;">[[File:Sumhorsa.gif|center|sumhorsa.gif]]</span>
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**<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">References: </span>'''
 
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<span style="font-family: 'Times New Roman','serif'; font-size: 15px;">1. Bouachour G, Cronier P, Gouello J, Toulemonde J, Talha A, Alquier P. Hyperbaric oxygen therapy in the management of crush injuries: a randomised double-blind placebo-controlled clinical trial. The Journal of Trauma, Injury, Infection and Critical Care 1996; 41:333-339.</span>
 
  
−
<span style="display: block; text-align: center;">
+
== <span style="color: #7c00ff; display: block; text-align: center;"><span style="font-size:xx-large;">[[Crush_injuries|BACK]]</span></span> ==
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</span><span style="display: block; text-align: center;">
 
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Revision as of 04:28, 27 September 2021

Adjunctive hyperbaric oxygen improved the rate of healing and reduced requirements for re-operation in crush injuries of the limbs.

Clinical Bottom Line:

1. Hyperbaric oxygen patients had an improved rate of healing.

2. Fewer hyperbaric patients needed re-operation

Citations:1. Bouachour G, Cronier P, Gouello J, Toulemonde J, Talha A, Alquier P. Hyperbaric oxygen therapy in the management of crush injuries: a randomised double-blind placebo-controlled clinical trial. The Journal of Trauma, Injury, Infection and Critical Care 1996; 41:333-339.

Clinical Scenario:40 year old patient presented with a crush injury to the leg following a motor bike crash. We wondered if hyperbaric oxygen would be of benefit.

Three-part Question:In patients with crush injuries of the limbs, does the adjunctive use of hyperbaric oxygen compared with standard treatment alone, result in any important improvements in healing or lower rates of re-operation?

Search Terms:Crush syndrome, extremities/*injuries

The Study:Double-blinded concealed randomised controlled trial with intention-to-treat. Moderate or severe crush injury to one or more limbs and no contraindication to hyperbaric therapy.

Control group (N = 18; 18 analysed):Standard care plus sham hyperbaric oxygen twice daily for 6 days as for HBO group.

Experimental group (N = 18; 18 analysed):As above, plus 100% oxygen at 2.4ATA for 90 minutes twice daily for 6 days.

The Evidence:

Outcome

Time to Outcome

Air group

HBO group

Relative risk reduction

Absolute risk reduction

NNT

Wound not healed

60 days

0.44

0.06

86%

0.38

3

2 to 8

95% CI:

29% to 100%

0.13 to 0.64

Repeat surgical procedure

60 days

0.33

0.06

82%

0.27

4

2 to 34

95% CI:

9% to 100%

0.03 to 0.52

Comments:

  1. Well organised and methodologically sound trial.
  2. Reductions in morbidity appear clinically important

Appraised by:Abigail Fynn, Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Tuesday, 30 March 1999

Expiry date:November 2022

 

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