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Hyperbaric Oxygen for Lower Limb Trauma (HOLLT): an international multi-centre randomised clinical trial
IL. Millar, FG. Lind, KÅ. Jansson, M. Hájek, DR. Smart, TD. Fernandes, RA. McGinnes, OD. Williamson, RK. Miller, CA. Martin, BJ. Gabbe, PS. Myles, PA. Cameron, HOLLT investigator group
Jazyk angličtina Země Austrálie
Typ dokumentu časopisecké články, randomizované kontrolované studie
PubMed
36100927
DOI
10.28920/dhm52.3.164-174
Knihovny.cz E-zdroje
- MeSH
- dolní končetina MeSH
- hyperbarická oxygenace * MeSH
- kvalita života MeSH
- lidé MeSH
- nekróza MeSH
- otevřené fraktury * terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
INTRODUCTION: Hyperbaric oxygen treatment (HBOT) is sometimes used in the management of open fractures and severe soft tissue crush injury, aiming to reduce complications and improve outcomes. METHODS: Patients with open tibial fractures were randomly assigned within 48 hours of injury to receive standard trauma care or standard care plus 12 sessions of HBOT. The primary outcome was the incidence of necrosis or infection or both occurring within 14 days of injury. RESULTS: One-hundred and twenty patients were enrolled. Intention to treat primary outcome occurred in 25/58 HBOT assigned patients and 34/59 controls (43% vs 58%, odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25 to 1.18, P = 0.12). Tissue necrosis occurred in 29% of HBOT patients and 53% of controls (OR 0.35, 95% CI 0.16 to 0.78, P = 0.01). There were fewer late complications in patients receiving HBOT (6/53 vs 18/52, OR 0.22, 95% CI 0.08 to 0.64, P = 0.007) including delayed fracture union (5/53 vs 13/52, OR 0.31, 95% CI 0.10 to 0.95, P = 0.04). Quality of life measures at one and two years were superior in HBOT patients. The mean score difference in short form 36 was 2.90, 95% CI 1.03 to 4.77, P = 0.002, in the short musculoskeletal function assessment (SMFA) was 2.54, 95% CI 0.62 to 4.46, P = 0.01; and in SMFA daily activities was 19.51, 95% CI 0.06 to 21.08, P = 0.05. CONCLUSIONS: In severe lower limb trauma, early HBOT reduces tissue necrosis and the likelihood of long-term complications, and improves functional outcomes. Future research should focus on optimal dosage and whether HBOT has benefits for other injury types.
Centre of Hyperbaric Medicine Ostrava City Hospital Ostrava Czech Republic
Department of Diving and Hyperbaric Medicine Royal Hobart Hospital Hobart Tasmania Australia
Department of Intensive Care and Hyperbaric Medicine Alfred Health Melbourne Victoria Australia
Department of Orthopaedic Surgery Alfred Health Mebourne Victoria Australia
Health Data Research UK Swansea University Swansea United Kingdom
Hyperbaric Medicine Unit Department of Anesthesia Hospital Pedro Hispano Matosinhos Portugal
School of Medicine University of Tasmania Tasmania Australia
Citace poskytuje Crossref.org
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- $a Millar, Ian L $u Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Victoria, Australia $u Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia $u Corresponding author: Dr Ian Millar, The Alfred Hyperbaric Service, PO Box 315, Prahran, Victoria 3181, Australia, i.millar@alfred.org.au
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- $a INTRODUCTION: Hyperbaric oxygen treatment (HBOT) is sometimes used in the management of open fractures and severe soft tissue crush injury, aiming to reduce complications and improve outcomes. METHODS: Patients with open tibial fractures were randomly assigned within 48 hours of injury to receive standard trauma care or standard care plus 12 sessions of HBOT. The primary outcome was the incidence of necrosis or infection or both occurring within 14 days of injury. RESULTS: One-hundred and twenty patients were enrolled. Intention to treat primary outcome occurred in 25/58 HBOT assigned patients and 34/59 controls (43% vs 58%, odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25 to 1.18, P = 0.12). Tissue necrosis occurred in 29% of HBOT patients and 53% of controls (OR 0.35, 95% CI 0.16 to 0.78, P = 0.01). There were fewer late complications in patients receiving HBOT (6/53 vs 18/52, OR 0.22, 95% CI 0.08 to 0.64, P = 0.007) including delayed fracture union (5/53 vs 13/52, OR 0.31, 95% CI 0.10 to 0.95, P = 0.04). Quality of life measures at one and two years were superior in HBOT patients. The mean score difference in short form 36 was 2.90, 95% CI 1.03 to 4.77, P = 0.002, in the short musculoskeletal function assessment (SMFA) was 2.54, 95% CI 0.62 to 4.46, P = 0.01; and in SMFA daily activities was 19.51, 95% CI 0.06 to 21.08, P = 0.05. CONCLUSIONS: In severe lower limb trauma, early HBOT reduces tissue necrosis and the likelihood of long-term complications, and improves functional outcomes. Future research should focus on optimal dosage and whether HBOT has benefits for other injury types.
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- $a Lind, Folke G $u Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
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