Adjunctive hyperbaric oxygen improved the rate of healing and reduced requirements for re-operation in crush injuries of the limbs.


Clinical Bottom Line:
1. Hyperbaric oxygen administration was associated with improved rate of healing following a crush injury.
2. Fewer patients required re-operation when hyperbaric oxygen was used.


Appraised by: Abigail Fynn, Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Tuesday, 30 March 1999

Clinical Scenario: 40 year old patient presented with a crush injury to the leg following a motor bike crash. We wondered if hyperbaric oxygen would be of benefit.
Three-part Question: In patients with crush injuries of the limbs, does the adjunctive use of hyperbaric oxygen compared with standard treatment alone, result in any important improvements in healing or lower rates of re-operation?
Search Terms: Crush syndrome, extremities/*injuries

The Study:
Double-blinded concealed randomised controlled trial with intention-to-treat.
Moderate or severe crush injury to one or more limbs and no contraindication to hyperbaric therapy.
Control group (N = 18; 18 analysed): Standard care plus sham hyperbaric oxygen twice daily for 6 days as for HBO group.
Experimental group (N = 18; 18 analysed): As above, plus 100% oxygen at 2.4ATA for 90 minutes twice daily for 6 days.

The Evidence:
Outcome
Time to Outcome
Air group
HBO group
Relative risk reduction
Absolute risk reduction
NNT
Wound not healed
60 days
0.444
0.06
86%
0.384
3
95% CI:



29% to 100%
0.130 to 0.638
2 to 8
Repeat surgical procedure
60 days
0.333
0.06
82%
0.273
4
95% CI:



9% to 100%
0.029 to 0.517
2 to 34


Comments:
  1. Well organised and methodologically sound trial.
  2. Reductions in morbidity appear clinically important

Expiry date: November 2020
References:
1. Bouachour G, Cronier P, Gouello J, Toulemonde J, Talha A, Alquier P. Hyperbaric oxygen therapy in the management of crush injuries: a randomised double-blind placebo-controlled clinical trial. The Journal of Trauma, Injury, Infection and Critical Care 1996; 41:333-339.



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