Difference between revisions of "Rasmussen"
 
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<span style="font-size: 22pt;">Evidence of a centrally mediated anti-inflammatory or direct anti-nociceptive effect of hyperbaric oxygen following a standard experimental thermal burn model</span>
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<span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" times="" new="" roman",serif"="">Evidence of a centrally mediated anti-inflammatory or direct anti-nociceptive effect of hyperbaric oxygen following a standard experimental thermal burn model</span></span>'''</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-size: 120%;">Clinical Bottom Line:</span>  
 
  
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<span style="font-size: 120%;">1. HBO reduced the area of secondary hyperalgesic response in this burn model</span> <span style="font-size: 120%;">2. There was no difference shown in the area of primary hyperalgesia</span> <span style="font-size: 120%;">3. Combined, these findings suggest the action of HBO is centrally mediated and may be anti-nociceptive or anti-infammatory.</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. HBO reduced the area of secondary hyperalgesic response in this burn model</span></span></span>
  
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<span style="font-size: 120%;">'''Citation/s:''' 1. Rasmussen VM, Borgen AE, Jansen EC, Rotbøll Nielsen PH, Werner MU. Hyperbaric oxygen therapy attenuates central sensitization induced by a thermal injury in humans. Acta Anaesthesiologica Scandinavica. 2015 Jul 1;59(6):749-62</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. There was no difference shown in the area of primary hyperalgesia</span></span></span>
  
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<span style="font-size: 120%;">'''Lead author's name:''' Per Rotboll Nielsen E-mail: per.rotboll.nielsen@regionh.dk</span>
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<span style="line-height:normal"><span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">3. Combined, these findings suggest the action of HBO is centrally mediated and may be anti-nociceptive or anti-infammatory.</span></span></span>
  
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<span style="font-size: 120%;">'''Three-part Clinical Question:''' For volunteers subjected to a thermal injury model, does a hyperbaric oxygen exposure, compared to no specific intervention, result in any evidence of an anti-nociceptive action? </span> <span style="font-size: 120%;">Search Terms: Thermal burn; volunteer; nociception</span>
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----
  
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<span style="font-size: 120%;">'''The Study:''' Non-blinded randomised cross-over trial with intention-to-treat.</span> <span style="font-size: 120%;">'''The Study Patients:''' Adult healthy male volunteers recruited from those previously volunteering for a thermal injury studies. </span> <span style="font-size: 120%;">Control group (N = 19; 17 analysed): Thermal injury to calf area by application of a probe at 47C, immediately followed by observation in a 1ATA air environment </span> <span style="font-size: 120%;">Experimental group (N = 19; 17 analysed): As above but injury followed immediately by one 90 minute session breathing 100% oxygen at 2.4 ATA</span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Citation/s:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Rasmussen VM, Borgen AE, Jansen EC, Rotbøll Nielsen PH, Werner MU. Hyperbaric oxygen therapy attenuates central sensitization induced by a thermal injury in humans. Acta Anaesthesiologica Scandinavica. 2015 Jul 1;59(6):749-62</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"="">Lead author's name:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Per Rotboll Nielsen E-mail: per.rotboll.nielsen@regionh.dk</span></span></span>
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**<span style="font-size: 120%;">The Evidence:</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"="">Three-part Clinical Question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">For volunteers subjected to a thermal injury model, does a hyperbaric oxygen exposure, compared to no specific intervention, result in any evidence of an anti-nociceptive action?</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"="">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Thermal burn; volunteer; nociception</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"="">Non-blinded randomised cross-over trial with intention-to-treat.</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 Patients:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Adult healthy male volunteers recruited from those previously volunteering for a thermal injury studies.</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</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">(N = 19; 17 analysed): Thermal injury to calf area by application of a probe at 47C, immediately followed by observation in a 1ATA air environment</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"="">Experimental group</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">(N = 19; 17 analysed): As above but injury followed immediately by one 90 minute session breathing 100% oxygen at 2.4 ATA</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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| <span>'''<span>Measure</span>'''</span>
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| rowspan="2" style="width:189.35pt; border:solid windowtext 1.0pt" width="252" | <p align="center" style="margin-bottom:0cm; 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"="">Measure</span></span>'''</span></p>  
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| &nbsp;
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| colspan="2" style="width:115.35pt; border:solid windowtext 1.0pt" width="154" | <p align="center" style="margin-bottom:0cm; 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"="">Control Group</span></span>'''</span></p>  
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| <span>'''<span>Control Group</span>'''</span>
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| colspan="2" style="width:108.75pt; border:solid windowtext 1.0pt" width="145" | <p align="center" style="margin-bottom:0cm; 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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| &nbsp;
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| rowspan="2" style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; 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"="">P-value</span></span>'''</span></p>  
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| <span>'''<span>HBO Group</span>'''</span>
 
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| <span>'''<span>P-value</span>'''</span>
 
 
|-
 
|-
−
| ^
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| style="width:48.45pt; border:solid windowtext 1.0pt" width="65" | <p align="center" style="margin-bottom:0cm; 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"="">Median</span></span>'''</span></p>  
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| <span>'''<span>Median</span>'''</span>
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| style="width:65.4pt; border:solid windowtext 1.0pt" width="87" | <p align="center" style="margin-bottom:0cm; 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"="">95% CI</span></span>'''</span></p>  
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| <span>'''<span>95% CI</span>'''</span>
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| style="width:40.3pt; border:solid windowtext 1.0pt" width="54" | <p align="center" style="margin-bottom:0cm; 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"="">Median</span></span>'''</span></p>  
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| <span>'''<span>Median</span>'''</span>
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| style="width:66.95pt; border:solid windowtext 1.0pt" width="89" | <p align="center" style="margin-bottom:0cm; 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"="">95%CI</span></span>'''</span></p>
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| <span>'''<span>95%CI</span>'''</span>
 
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| ^
 
 
|-
 
|-
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| '''<span>Area under curve of secondary hyperalgesia per min (cm2) over 237 minutes</span>'''
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| style="width:189.35pt; border:solid windowtext 1.0pt" width="252" |
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| <span><span>42</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"="">Area under curve of secondary hyperalgesia per min (cm2) over 237 minutes</span></span>'''</span>
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| <span><span>31.1 to 71.4</span></span>
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| <span><span>34.6</span></span>
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| style="width:48.45pt; border:solid windowtext 1.0pt" width="65" | <p align="center" style="margin-bottom:0cm; 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"="">42</span></span></span></p>  
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| <span><span>22.9 to 39.8</span></span>
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| style="width:65.4pt; border:solid windowtext 1.0pt" width="87" | <p align="center" style="margin-bottom:0cm; 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"="">31.1 to 71.4</span></span></span></p>  
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| <span><span style="font-size: 110%;">0.01</span></span>
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| style="width:40.3pt; border:solid windowtext 1.0pt" width="54" | <p align="center" style="margin-bottom:0cm; 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"="">34.6</span></span></span></p>  
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| style="width:66.95pt; border:solid windowtext 1.0pt" width="89" | <p align="center" style="margin-bottom:0cm; 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"="">22.9 to 39.8</span></span></span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; 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"="">0.01</span></span></span></p>  
 
|-
 
|-
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| '''<span>Area under curve of secondary hyperalgesia per min (mN) over 237 minutes</span>'''
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| style="width:189.35pt; border:solid windowtext 1.0pt" width="252" |
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| <span><span>124</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"="">Area under curve of secondary hyperalgesia per min (mN) over 237 minutes</span></span>'''</span>
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| <span><span>55 to 209</span></span>
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| <span><span>155</span></span>
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| style="width:48.45pt; border:solid windowtext 1.0pt" width="65" | <p align="center" style="margin-bottom:0cm; 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"="">124</span></span></span></p>  
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| <span><span>101 to 226</span></span>
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| style="width:65.4pt; border:solid windowtext 1.0pt" width="87" | <p align="center" style="margin-bottom:0cm; 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"="">55 to 209</span></span></span></p>  
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| <span><span style="font-size: 110%;">0.01</span></span>
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| style="width:40.3pt; border:solid windowtext 1.0pt" width="54" | <p align="center" style="margin-bottom:0cm; 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"="">155</span></span></span></p>  
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| style="width:66.95pt; border:solid windowtext 1.0pt" width="89" | <p align="center" style="margin-bottom:0cm; 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"="">101 to 226</span></span></span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:0cm; 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"="">0.01</span></span></span></p>  
 
|}
 
|}
  
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&nbsp;
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**<span style="font-size: 120%;">Comments:</span> 
 
  
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<span style="font-size: 120%;">1. Warm detection threshold, cool threshold and heat pain thresholds were not different between groups</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-size: 120%;">2. There was a statistically evident reduction in secondary hyperalgesia in the control group who had previously had the HBO exposure. (A crossover effect).</span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Warm detection threshold, cool threshold and heat pain thresholds were not different between groups</span></span></span>
  
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<span style="font-size: 120%;">3. There is a possibility of bias due to the lack of blinding.</span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">2. There was a statistically evident reduction in secondary hyperalgesia in the control group who had previously had the HBO exposure. (A crossover effect).</span></span></span>
  
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<span style="font-size: 120%;">'''Appraised by:''' Mike Bennett Friday, 18 January 2019</span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">3. There is a possibility of bias due to the lack of blinding.</span></span></span>
  
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<span style="font-size: 120%;">Email: [[mailto:m.bennett@unsw.edu.au| m.bennett@unsw.edu.au]]</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"="">Mike Bennett Friday, 18 January 2019 Email: [[mailto:m.bennett@unsw.edu.au| <span style="color:blue">m.bennett@unsw.edu.au</span>]]</span></span></span>
  
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<span style="font-size: 120%;">Kill or Update By: December 2024</span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Kill or Update By:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">December 2024</span></span></span>
  
 
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&nbsp;

Latest revision as of 22:08, 9 October 2021

Evidence of a centrally mediated anti-inflammatory or direct anti-nociceptive effect of hyperbaric oxygen following a standard experimental thermal burn model

Clinical Bottom Line:

1. HBO reduced the area of secondary hyperalgesic response in this burn model

2. There was no difference shown in the area of primary hyperalgesia

3. Combined, these findings suggest the action of HBO is centrally mediated and may be anti-nociceptive or anti-infammatory.

Citation/s:1. Rasmussen VM, Borgen AE, Jansen EC, Rotbøll Nielsen PH, Werner MU. Hyperbaric oxygen therapy attenuates central sensitization induced by a thermal injury in humans. Acta Anaesthesiologica Scandinavica. 2015 Jul 1;59(6):749-62

Lead author's name:Per Rotboll Nielsen E-mail: per.rotboll.nielsen@regionh.dk

Three-part Clinical Question:For volunteers subjected to a thermal injury model, does a hyperbaric oxygen exposure, compared to no specific intervention, result in any evidence of an anti-nociceptive action?

Search Terms:Thermal burn; volunteer; nociception

The Study:Non-blinded randomised cross-over trial with intention-to-treat.

The Study Patients:Adult healthy male volunteers recruited from those previously volunteering for a thermal injury studies.

Control group(N = 19; 17 analysed): Thermal injury to calf area by application of a probe at 47C, immediately followed by observation in a 1ATA air environment

Experimental group(N = 19; 17 analysed): As above but injury followed immediately by one 90 minute session breathing 100% oxygen at 2.4 ATA

The Evidence:

Measure

Control Group

HBO Group

P-value

Median

95% CI

Median

95%CI

Area under curve of secondary hyperalgesia per min (cm2) over 237 minutes

42

31.1 to 71.4

34.6

22.9 to 39.8

0.01

Area under curve of secondary hyperalgesia per min (mN) over 237 minutes

124

55 to 209

155

101 to 226

0.01

 

Comments:

1. Warm detection threshold, cool threshold and heat pain thresholds were not different between groups

2. There was a statistically evident reduction in secondary hyperalgesia in the control group who had previously had the HBO exposure. (A crossover effect).

3. There is a possibility of bias due to the lack of blinding.

Appraised by:Mike Bennett Friday, 18 January 2019 Email: [m.bennett@unsw.edu.au]

Kill or Update By:December 2024

 

 

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