TY - JOUR
T1 - Hyperbaric oxygen therapy for traumatic brain injury
T2 - A systematic review of the evidence
AU - McDonagh, Marian
AU - Helfand, Mark
AU - Carson, Susan
AU - Russman, Barry S.
N1 - Funding Information:
Supported by the Oregon Health & Science University Evidence-Based Practice Center through the Agency for Healthcare Research and Quality (AHRQ; contract no. 290-97-0018, task order no. 8). The authors are responsible for the contents of the article, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the AHRQ or the US Department of Health and Human Services.
PY - 2004/7
Y1 - 2004/7
N2 - McDonagh M, Helfand M, Carson S, Russman BS. Hyperbaric oxygen therapy for traumatic brain injury: a systematic review of the evidence. Arch Phys Med Rehabil 2004;85:1198-204. Objective To identify the benefits and harms of hyperbaric oxygen therapy (HBOT) to treat traumatic brain injury (TBI). Data sources MEDLINE, EMBASE, the Cochrane Library, HealthSTAR, CINAHL, MANTIS, professional society databases, and reference lists. Databases were searched from inception through December 2003. Study selection We included English-language studies of patients with TBI given HBOT and evaluating functional health outcomes. Data extraction Data were abstracted by 1 reviewer and checked by a second. Study quality was rated as good, fair, or poor. Data synthesis Two fair-quality randomized controlled trials of patients with severe brain injury reported conflicting results. One found no difference in mortality (48% HBOT vs 55% control) or morbidity at 1 year. In young patients with brainstem contusion, significantly more regained consciousness at 1 month with HBOT (67%) than control (11%) (P<.03). The other found a significant decrease in mortality in the HBOT group at 1 year (17%) compared with controls (31%) (P=.037). This decrease in mortality was accompanied by an increase in proportion of patients with severe disability. Patients with intracranial pressure (ICP) greater than 20mmHg or a Glasgow Coma Scale score of 4 to 6 had significantly lower mortality at 1 year than controls. Five observational studies did not provide better evidence of effectiveness or adverse events. Two indicated a potential for initially reducing elevated ICP in some patients. However, rebound elevations higher than pretreatment levels occurred in some patients. Adverse events, including seizures, pulmonary symptoms, and neurologic deterioration, were reported; however, no study systematically assessed adverse events, and none reported adverse events in control groups. Conclusions The evidence for HBOT for TBI is insufficient to prove effectiveness or ineffectiveness, and more high-quality studies are needed. The evidence indicates that there is a small chance of a mortality benefit, which may depend on subgroup selection. The effect on functional status and the incidence and clinical significance of adverse effects are unclear.
AB - McDonagh M, Helfand M, Carson S, Russman BS. Hyperbaric oxygen therapy for traumatic brain injury: a systematic review of the evidence. Arch Phys Med Rehabil 2004;85:1198-204. Objective To identify the benefits and harms of hyperbaric oxygen therapy (HBOT) to treat traumatic brain injury (TBI). Data sources MEDLINE, EMBASE, the Cochrane Library, HealthSTAR, CINAHL, MANTIS, professional society databases, and reference lists. Databases were searched from inception through December 2003. Study selection We included English-language studies of patients with TBI given HBOT and evaluating functional health outcomes. Data extraction Data were abstracted by 1 reviewer and checked by a second. Study quality was rated as good, fair, or poor. Data synthesis Two fair-quality randomized controlled trials of patients with severe brain injury reported conflicting results. One found no difference in mortality (48% HBOT vs 55% control) or morbidity at 1 year. In young patients with brainstem contusion, significantly more regained consciousness at 1 month with HBOT (67%) than control (11%) (P<.03). The other found a significant decrease in mortality in the HBOT group at 1 year (17%) compared with controls (31%) (P=.037). This decrease in mortality was accompanied by an increase in proportion of patients with severe disability. Patients with intracranial pressure (ICP) greater than 20mmHg or a Glasgow Coma Scale score of 4 to 6 had significantly lower mortality at 1 year than controls. Five observational studies did not provide better evidence of effectiveness or adverse events. Two indicated a potential for initially reducing elevated ICP in some patients. However, rebound elevations higher than pretreatment levels occurred in some patients. Adverse events, including seizures, pulmonary symptoms, and neurologic deterioration, were reported; however, no study systematically assessed adverse events, and none reported adverse events in control groups. Conclusions The evidence for HBOT for TBI is insufficient to prove effectiveness or ineffectiveness, and more high-quality studies are needed. The evidence indicates that there is a small chance of a mortality benefit, which may depend on subgroup selection. The effect on functional status and the incidence and clinical significance of adverse effects are unclear.
KW - Brain injuries
KW - Hyperbaric oxygenation
KW - Intracranial pressure
KW - Rehabilitation
KW - Review (publication type)
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U2 - 10.1016/j.apmr.2003.12.026
DO - 10.1016/j.apmr.2003.12.026
M3 - Article
C2 - 15241774
AN - SCOPUS:3242705223
SN - 0003-9993
VL - 85
SP - 1198
EP - 1204
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 7
ER -