The addition of hyperbaric oxygenation therapy to thermal burns patients did not result in improved outcome.

Clinical Bottom Line:
1. The addition of hyperbaric oxygen did not affect mortality, length of stay or number of surgical procedures required. (LOS and mortality analysed by logistic regression)
2. No important benefit of HBO in thermal burns was identified.


Appraised by: Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Friday, 04 December, 1998

Clinical Scenario: A patient with thermal burns presenting for early treatment in a specialist burns centre.
Three-part Question: In patients with thermal burns, does the addition of hyperbaric oxygen therapy to a standard care protocol result in any improvement in the time taken to heal, or quality of scarring?
Search Terms: Hyperbaric oxygenation, burns/thermal.

The Study:
Non-blinded randomised controlled trial with intention-to-treat.
Adult patients with skin burns, with or without airway /inhalation injury, referred to a tertiary care burns centre in the first 24 hours.
Control group (N = 62; 62 analysed): Usual burn care.
Experimental group (N = 63; 63 analysed): Usual burn care plus oxygen at 2ATA for 90 minutes twice daily for a minimum of 5 days and a maximum number of treatments equal to % burn area.

The Evidence:
Outcome
Time to Outcome
Normal care rate
Hyperbaric care rate
Relative risk reduction
Absolute risk reduction
NNT
Death
As required
0.113
0.111
2%
0.002
500
95% CI



-96% to 100%
-0.12 to 0.11
NNT=9 to INF NNH=9 to INF

Comments:
1. Potential for selection bias as randomization depended on availability of HBO facility.
2. No attempt to blind patients or staff.
3. No analysis of graft survival or long-term outcome.
4. No analysis of the modification of acute care that may have accompanied HBO treatment.
5. Most were quite small burn areas and these results may not apply to larger burns.

Expiry date: April 2003
References:
1. Brannen AL, Still J, Haynes M, Orlet H, Rosenblum F, Law E, Thompson W. A randomized prospective trial of hyperbaric oxygen in a referral burn centre population. The American Surgeon 1997; 63:205-208.

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