A single hyperbaric oxygen exposure preoperatively may modulate inflammatory markers and clinical complications following pancreatodudenectomy


Clinical Bottom Line:

1. Some evidence that HBO exposure modulates the level IL-6 (down) and IL-10 (up)

2. Fewer pulmonary complications with HBO exposure but not fistula development, bleeding or fever.

Citation/s: 1. Bosco G, Casarotto A, Nasole E, Camporesi E, Salvia R, Giovinazzo F, Zanini S, Malleo G, Di Tano A, Rubini A, Zanon V, Mangar D, Bassi C. Preconditioning with hyperbaric oxygen in pancreatodudenectomy: a randomised double-blind pilot study

Lead author's name and fax: Bosco G: gerardo.bosco@unipd.it; vincenzo.zanon@gmail.com
Three-part Clinical Question: Does preoperative hyperbaric oxygen exposure before pancreatoduodenectomy reduce the rate of postoperative complications?

Search Terms: Preconditioning; pancreatectomy; surgery

The Study: Double-blinded concealed randomised controlled trial with intention-to-treat.
The Study Patients: Adult patients scheduled for pancreatoduodenectomy for pancreatic ductal carcinoma.
Control group (N = 11; 11 analysed): A single sham exposure breathing air at 1.15 ATA on a schedule lasting 116 minutes on the day prior to surgery.
Experimental group (N = 10; 10 analysed): A single exposure to 2.5 ATA breathing 100% oxygen for a total of 116 minutes on the day prior to surgery.

The Evidence:
Outcome
Time to Outcome
Control group
HBO group
Relative Risk Reduction
Absolute risk reduction
NNT
Pulmonary complications
?Discharge
0.55
0
100%
0.55
2
95% CI:

0.25 to 0.84
1 to 4
Postop bleeding
?Discharge
0.18
0.30
-65%
-0.12
-8
95% CI:
-265% to 100%
-0.48 to 0.25
NNT = 4 to INF; NNH = 2 to INF
Postop fistula
?Discharge
0.27
0.33
-22%
-0.06
-17
95% CI:
-166% to 100%
-0.45 to 0.33
NNT = 3 to INF; NNH = 2 to INF

Non-Event Outcomes
Time to outcome/s
Control group
Experimental group
P-value
Serum cytokine IL-6 (no units given)
Pre-HBO/ Post-HBO/ Day 1 Postop/ Day 7 Postop
5.97/ 24.06/ 179.54 /24.5
5.06/ 5.81/ 141.23/ 21.76
0.009
Serum cytokine IL=10 (no units given)
Pre-HBO/ Post-HBO/ Day 1 Postop/ Day 7 Postop
4.04/ 4.43/ 7.76/ 4.14
2.01/ 2.41/ 5.6/ 3.34
0.034

Comments:

1. Small study underpowered for some outcomes.

2. There was a statistically significant relationship between IL-6 and post-operative fistula. Not clear if there is a causal relationship between serum IL-6 reduction and HBO, or between the development of fistula and serum IL-6 increase.

3. Reduction in post-operative pneumonia in HBO patients should be confirmed in larger studies

Appraised by: M. Bennett, POWH, m.bennett@unsw.edu.au; Friday, 2 January 2015

Kill or Update By: 01/012017





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