Ren
The addition of hyperbaric oxygenation to the care of severely brain injured patients was associated with improved morbidity at six months.
Clinical Bottom Line: 1. The addition of HBO improved outcome GCS, GOS and an assessment of brain electric activity in this group of severe brain injury patients compared to the standard therapy approach practiced in this institution. 2. This result excluded any deaths during the period of randomised treatment (no details given).
Citations: 1. Ren H, Wang W, Ge Z. Glasgow coma scale, brain electrical activity mapping and Glasgow outcome scale after hyperbaric oxygen treatment of severe brain injury. Chinese Journal of Traumatology 2001; 4(4):239-241. 2. Ren H, Wang W, Ge Z. Clinical, brain electric earth map, endothelin and transcranial ultrasonic doppler findings after hyperbaric oxygen treatment for severe brain injury. Chinese Medical Journal (Engl) 2001; 114(4):387-390.
Three-part Clinical Question: For patients with severe closed head injury, does the concurrent administration of hyperbaric oxygen, compared to a standard treatment regimen, result in any reduction in mortality or morbidity? Search Terms: Hyperbaric Oxygenation, Head Injuries, closed, Brain Injuries
The Study: Non-blinded randomised controlled trial without intention-to-treat. Patients admitted with isolated closed head injury with GCS of <9 in a stable condition on day 3 of admission. Control group (N = 20; 20 analysed): Usual intensive management of severe brain injury with dehydration, corticosteroids and antibiotics (no details). Experimental group (N = 35; 35 analysed): As above plus the addition of 100% oxygen breathing at 2.5ATA for 10 periods of 40 - 60 minutes broken by 10 minutes air breathing at 2.5ATA (total oxygen time 400 - 600 minutes). This exposure was then repeated every 4 days to a total of 3 or 4 cycles.
The Evidence:
| Outcome | Time to Outcome | Control group | HBO group | Relative risk reduction | Absolute risk reduction | NNT |
| Brain Electrical Activity Mapping failed to normalize | After 3 treatments | 0.800 | 0.371 | 54% | 0.43 | 2 |
| 95% CI: | 24% to 83% | 0.19 to 0.67 | 2 to 5 | |||
| Glasgow Outcome Scale moderately severe disability | 6 months | 0.650 | 0.171 | 74% | 0.48 | 2 |
| 95% CI: | 36% to 100% | 0.24 to 0.72 | 1 to 4 | |||
| Glasgow Outcome Scale failed to achieve good recovery or mild disability | 6 months | 0.700 | 0.171 | 76% | 0.53 | 2 |
| 95% CI: | 42% to 100% | 0.29 to 0.77 | 1 to 3 |
Non-Event Outcomes Time to outcome Control group HBO group P-value Mean Glasgow Coma Score After 3 treatments 9.5 14.6 P<0.01
Comments: 1. Generally poorly reported with loss of intention to treat by exclusion of deaths from analysis. 2. Why the two groups are so uneven in numbers is not addressed. 3. Very unusual HBO treatment course was employed. 4. No difference in treatment until day 3 following admission, so this treatment is not delivered in the acute situation. 5. The results of this trial are difficult to reconcile with other studies.
Appraised by: Mike Bennett and Juliette Leverment Email: [| m.bennett@unsw.edu.au] Prince of Wales Hospital, Sydney. Thursday, 5 December 2002 Kill or Update By: November 2021
