Xu2017
Hyperbaric oxygen therapy improved the proportion good outcomes in diabetic patients following haemorrhagic stroke
|
1. More individuals who had HBOT were deemed to have a good outcome at six months following the haemorrhagic stroke |
Citation/s:1. Xu Q, Fan SB, Wan YL, Liu XL, Wang L. The potential long-term neurological improvement of early hyperbaric oxygen therapy on haemorrhagic stroke in the diabetics. Diabetes research and clinical practice. 2018 Apr 1;138:75-80.
Lead author's name and fax: xuqian6521@126.com
Three-part Clinical Question:For patients with diabetes and suffering a haemorrhagic stroke, does the application of hyperbaric oxygen improve outcome?
Search Terms: intracerebral haemorrhage; stroke; diabetes
The Study:Double-blinded concealed randomised controlled trial with intention-to-treat.
The Study Patients: Adult patients with a history of diabetes and presenting to the emergency department within 24 hours of a CT-confirmed haemorrhagic stroke. Excluded if severe (NIHSS >22) or died over the next six months.
Control group (N = 32; 32 analysed): All standard care plus air breathing in a chamber at 1.5 ATA for 60 minutes daily for 30 days.
Experimental group (N = 47; 47 analysed): As above but breathing 100% oxygen at 2.5 ATA.
The Evidence:
Outcome |
Time to Outcome |
1.5 ATA group |
2.5 ATA group |
Relative risk reduction |
Absolute risk reduction |
NNT |
|
Modified Rankin Score </= 1 (Good outcome) |
6 months |
.69 |
.89 |
30% |
0.2 |
5 |
95% CIs: |
3% to 57% |
0.02 to 0.39 |
3 to 44 | |||
|
NIHSS </= 2 (Good outcome) |
6 months |
.56 |
.81 |
44% |
0.25 |
4 |
95% CIs: |
7% to 80% |
0.04 to 0.45 |
2 to 24 | |||
|
1.5 ATA Group |
2.5 ATA Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
Fasting blood sugar (mmol/L) at 1 month |
10.9 |
0.93 |
9.6 |
0.81 |
1.3 |
0.96 to 1.64 |
|
HbA1c (%) at 1 month |
8.8 |
0.92 |
7.8 |
0.8 |
1.0 |
0.67 to 1.33 |
|
Insulin (microU/ml) at one month |
19.4 |
1.75 |
17.8 |
1.31 |
1.6 |
0.57 to 2.63 |
Comments:
1. Intriguing study with interesting outcomes. It should be reproduced elsewhere sooner rather than later as the results seem very important
2. Note planned retrospective exclusion of patients who died within 6 months, but none died.
3. Patients were randomised on a 1 Control :1.5 HBO schedule.
4. Modified Rankin <2 is no symptoms or no significant disability, NIHSS <3 similar and Barthel Index suggests fully independent functioning
Appraised by: Mike Bennett m.bennett@unsw.edu.au; Thursday, 23 January 2020
Kill or Update By: January 2023
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