Zhong
Hyperbaric oxygen was of unclear benefit for patients admitted with acute traumatic brain injury.
Clinical bottom line:
|
1. Some suggestion that HBO improves outcome but limited by poor reporting |
Citation/s:1. Zhong X, Shan A, Xu J, Liang J, Long Y, Du B. Hyperbaric oxygen for severe traumatic brain injury: a randomized trial. J Int Med Res. 2020 Oct;48(10):300060520939824
Lead author's name and fax: Bo Do Email: bodoyx@163.com
Three-part Clinical Question:For patients with severe traumatic brain injury, does the addition of hyperbaric oxygen to standard care result in any improved outcomes?
Search Terms: traumatic brain injury; Glasgo coma score; NIHSS
The Study:
Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Patients with traumatic brain injury with GCS between 3 and 8 on admission and who were stable at one week.
Control group (N = 44 ; 44 analysed): Depression craniectomy, monitored cerebral blood flow, oxygenation, ECG and intracranial pressure. All usual care including antibiotics, respiratory therapy and nutrition maintenance.
Experimental group (N = 44 ; 44 analysed): As above plus 30 sessions breathing 100% oxygen at between 2 and 2.5 ATA for 80 minutes daily BUT for only 2 weeks.*
The Evidence:
Measure |
Control Group |
HBOT Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
Intracranial pressure after HBO period (mmHg) |
13.7 |
3.7 |
11.2 |
4.0 |
-2.5 |
-8.9 to 3.7 |
|
Brain oxygen uptake at end of treatment (%) |
30.5 |
4.7 |
34.8 |
3.2 |
4.3 |
-2.6 to 11.2 |
|
Glasgow Coma Score after treatment |
9.2 |
2.8 |
12.1 |
2.8 |
2.9 |
- 0.4 to 6.2 |
|
NIHSS after treatment |
14.6 |
2.3 |
8.5 |
2.4 |
-6.2 |
-8.5 to -3.8 |
Comments:
1. Some poor reporting. HBO group said to have 30 daily treatments but that treatment only lasted 2 weeks. Also, the authors give us a 'prognostic analysis' that suggests a better prognosis in the HBO group, but it is not clear when this was measured and it is not described in methods as an outcome.
2. Outcomes poorly reported. Some comparisons quoted as 'statistically significant' when my analysis does not confirm this.
3. Multivariate analysis suggested presenting GCS, need for tracheostomy and length of first HBO treatment were important prognostic factors.
Appraised by:Mike Bennett m.bennett@unsw.edu.au ; Sunday, 15 August 2021
Kill or Update By: August 2024
