Xiang2017(2)

The addition of N-Butylphthalide to hyperbaric oxygen resulted in improved Mini-Mental State scores and lower NIHSS scores following administration to patients with carbon monoxide poisoning.

Clinical Bottom Line:

1. Mean MMSE scores and the proportion to recover above a score of 24 were both improved with the addition of N-Butylphthalide.

2. NIHSS scores were also favourable with the addition of N-Butylphthalide.

 

Citation/s: 1. Xiang W, Xue H, Wang B, Li Y, Zhang J, Jiang C, Pang J. Efficacy of N-Butylphthalide and hyperbaric oxygen therapy on cognitive dysfunction in patients with delayed encephalopathy after acute carbon monoxide poisoning. Medical science monitor: international medical journal of experimental and clinical research. 2017;23:1501.

Lead author's name and fax:BaojunWang25@163.com

Three-part Clinical Question:For adult patients with delayed encephalopathy following carbon monoxide poisoning, does the addition of N-Butylphthalide to hyperbaric oxygen result in any further improvement in cognitive function?

Search Terms:Carbon monoxide poisoning; delayed neurocognitive syndrome

 

The Study:Single-blinded randomised controlled trial with intention-to-treat.

The Study Patients:Patients following carbon monoxide poisoning with a mini mental state examination (MMSE) score of <25.

Control group(N = 90; 84 analysed): Standard care including ICU measures as required plus 100% oxygen breathing at 2.5 ATA for 80 minutes daily.

Experimental group(N = 94; 89 analysed): As above plus N-Butylphthalide 0.2 g orally three times per day, five days per week for eight weeks.

 

The Evidence:

Outcome	Time to Outcome	HBOT Group Rate	Dexameth Group rate	Relative risk Reduction	Absolute Risk Reduction	NNT
Remission	4 weeks	0.23	0.42	83%	0.19	5
			95% CIs:	11% to 154%	0.03 to 0.35	3 to 39

 

Outcome	Time to outcome	HBOT group	Dex. groups	P-value
Mean MMSE **(0 to 30 –higher is better)	4 weeks	13	18	0.04
Mean NIHSS **(0 to 42 – lower is better)	4 weeks	15	12.5	0.002

Comments:

1. It is not clear how soon after poisoning these patients were treated, nor what the course of hyperbaric oxygen was.

2. The authors did not justify the use of parametric statistics on mean MMSE or NIHSS here.

3. Complete recovery was defined as any MMSE score above 24 - a score of 25 is still an impaired individual.

4. It is not clear what the authors meant by 'delayed encephalopathy' as all these patients appeared to be significantly affected by COP with no clear period of normal neurocognitive function

5. The authors claim that both groups benefited from treatment, but there is no true control group to establish what would have happened without either intervention.

6. Figures for mean and standard deviation have been estimated from a graphical display.

 

Appraised by:Mike Bennett m.bennett@unsw.edu.au; Monday, 19 August 2019

Kill or Update By:August 2022

 

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