Li
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
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