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Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injuryBennett MH, Trytko B, Jonker B
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SummaryDoes hyperbaric oxygen therapy improve the survival and quality of life in patients with traumatic brain injury?Traumatic brain injury is a major cause of death and disability. Not all damage to the brain occurs at the moment of injury; reduction of the blood flow and oxygen supply to the brain can occur afterwards and cause further secondary brain damage, which is itself an important cause of avoidable death and disability. In the early stages after injury it is therefore important that efforts are made to minimise secondary brain damage to provide the best chances of recovery. Hyperbaric oxygen therapy (HBOT) has been proposed as a treatment for minimising secondary brain damage by improving the oxygen supply to the brain. Patients undergoing HBOT are placed inside a specially designed chamber in which 100% oxygen is delivered at a greater than normal atmospheric pressure. It is sometimes used as a treatment to increase the supply of oxygen to the injured brain, in an attempt to reduce the area of brain that will die. The effectiveness of HBOT on the recovery of brain-injured patients is uncertain. There is also concern regarding potential adverse effects of the therapy, including damage to the ears, sinuses and lungs from the effects of pressure, temporary worsening of short-sightedness, claustrophobia and oxygen poisoning. In an attempt to address the uncertainty surrounding the use of HBOT, the authors of this review identified all high quality trials investigating the effectiveness of HBOT in traumatically brain-injured patients of all ages. The authors found four eligible studies involving 382 patients. The combined results suggest that HBOT reduces the risk of death, however there is no evidence that these survivors have improved outcome in terms of quality of life. It is possible, therefore, that the overall effect of hyperbaric oxygen is to make it more likely that people will survive severely disabled after such injuries. The authors conclude that the routine use of HBOT in brain-injured patients cannot be justified by the findings of this review. Due to the small number of trials with a limited number of participants, it is not possible to be confident in the findings; further large, high quality trials are required to define the true extent of benefit from HBOT.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 18. 2004 AbstractBackgroundTraumatic brain injury is common and presents a health problem with significant effect on quality of life. Hyperbaric oxygen therapy (HBOT) has been suggested to improve oxygen supply to the injured brain and, therefore, to reduce the volume of brain that will ultimately perish. It is postulated that the addition of HBOT to the standard intensive care regimen may result in a reduction in patient death and disability as a result of these additional brain-preserving effects. ObjectivesTo assess the benefits and harms of adjunctive HBOT for treating traumatic brain injury. Search strategyWe searched CENTRAL, MEDLINE, EMBASE, CINAHL and DORCTHIM eletronic databases; the searches were last updated in April 2006. We also searched the reference lists of eligible articles, handsearched relevant journals and contacted researchers in the field. Selection criteriaRandomised studies comparing the effect of therapeutic regimens which include HBOT with those that exclude HBOT (with or without sham therapy) on patients with traumatic brain injury. Data collection and analysisThree authors independently evaluated the quality of the relevant trials using the validated Oxford-Scale and extracted the data from the included trials. Main resultsFour trials contributed to this review (382 patients, 199 receiving HBOT and 183 control). There was a trend towards, but no significant increase in, the chance of a favourable outcome when defined as full recovery, Glasgow outcome score 1 or 2, or return to normal activities of daily living (relative risk [RR] for good outcome with HBOT 1.94, 95% confidence interval [CI] 0.92 to 4.08, P=0.08). Pooled data from the three trials with 327 patients that reported mortality, showed a significant reduction in the risk of dying when HBOT was added to the treatment regimen (RR 0.69, 95% CI 0.54 to 0.88, P=0.003). Heterogeneity between studies was low (I2 =0%), and sensitivity analysis for the allocation of dropouts did not affect that result. This analysis suggests we would have to treat seven patients to avoid one extra death (number needed to treat [NNT] 7, 95% CI 4 to 22). One trial suggested intracranial pressure was favourably lower in those patients receiving HBOT in whom myringotomies had been performed (WMD with myringotomy -8.2 mmHg, 95% CI -14.7 mmHg to -1.7 mmHg, P=0.01), while in two trials there was a reported incidence of 13% for significant pulmonary impairment in the group receiving HBOT versus 0% in the non-HBOT group (P=0.007). Authors' conclusionsIn people with traumatic brain injury, the addition of HBOT significantly reduced the risk of death however, there is little evidence that more survivors have a good outcome. The routine application of HBOT to these patients cannot be justified from this review. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously. An appropriately powered trial of high methodological rigour is required to define those patients (if any) who can be expected to derive most benefit from HBOT. |