Hart
The addition of hyperbaric oxygen to a burn care protocol resulted in a reduction in the time required for burn to heal.
Clinical Bottom Line:
1. The addition of hyperbaric oxygen reduced the time to burn healing.
2. Any effect on fluid requirements remains unclear
Citations:1. Hart GB, O'Reilly RR, Broussard ND, Goodman DB, Yanda RL. Treatment of burns with hyperbaric oxygen. Surgery, Gynaecology and Obstetrics 1974; 139:693-696.
Clinical Scenario:A patient presented with thermal burns and we wondered if the addition of hyperbaric oxygen would improve healing time.
Three-part Question:In patients with thermal burns, does the addition of hyperbaric oxygen to a standard burn care protocol result in any improvement in time required to heal, or the quality of healing?
Search Terms:Thermal burns
The Study:Double-blinded concealed randomised controlled trial with intention-to-treat. Patients with between 10 and 50% of body surface area thermal burns presenting to a burns centre within 24 hours of injury.
Control group(N = 16; 16 analysed): A standard burns protocol with fluid resuscitation, dressings and surgical procedures. Sham hyperbaric exposures in a chamber compressed to 1.3ATA and returned to 1ATA gradually at beginning and end of time period.
Experimental group(N = 16; 16 analysed): Protocol as above plus 100% oxygen breathing at 2 ATA for 90 minutes every 8 hours in the first 24 hours, then 12 hourly until healed.
The Evidence:
Non-event outcomes |
Time to outcome |
Air group |
HBO group |
P-value |
|
Average volume of crystalloid required (mls/kg/%BSA) |
24 hours |
3.4 |
2.2 |
Not tested |
|
Mean healing time (days) |
Healing |
43.8 |
19.7 |
<0.005 |
Comments:
1. Small study with paired stratification by surface area burnt.
2. Good randomisation and blinding.
3. Power to detect a significant improvement in fluid requirements or graft success unknown, but likely to be low.
4. Some suggestion of improvement in proportion of grafts taking in hyperbaric group (1/2 controls, 2/2 HBO).
4. Morbidity and mortality data in this paper do not relate to this RCT.
Appraised by:Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Thursday, 22 April 1999
Expiry date:December 2024
