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Can preventive hyperbaric oxygen therapy optimise surgical outcome?: A systematic review of randomised controlled
Sylvain Boet1, Leonardo Martin, Olivia Cheng-Boivin
1From the Department of Anaesthesiology and Pain Medicine, The Ottawa Hospital (SB), Clinical Epidemiology Program, The Ottawa Hospital Research Institute (SB, ME, NE), Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (LM, OCB), Department of Diving and Hyperbaric Medicine, Sainte Anne's Military Hospital, Toulon, France (PL), Diving and hyperbaric Unit, University hospitals of Geneva, Geneva, Switzerland (PL, RP, MP, MAM), Department of Anaesthesiology and Acute Medicine, University Hospitals of Geneva, Geneva, Switzerland (MP), Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital and the University of New South Wales, Randwick, New South Wales, Australia (MB).
Background:
A primary underlying cause of postoperative complications is related to the surgical stress response, which may be mitigated by hyperbaric oxygen therapy (HBOT), the intermittent administration of oxygen at a pressure higher than the atmospheric pressure at sea level. Promising clinical studies have emerged suggesting HBOT's efficacy for reducing some postoperative complications. Notwithstanding, the effectiveness (if any) of HBOT across a range of procedures and postoperative outcomes has yet to be clearly quantified.
Objective:
This systematic review aimed to summarise the existing literature on peri-operative HBOT to investigate its potential to optimise surgical patient outcome.
Design:
A systematic review of randomised controlled trials (RCTs) with narrative summary of results.
Data Sources:
MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were searched without language restrictions through to 19 June 2018.
Eligibility Criteria:
Studies were included if they involved patients of any age undergoing any surgical procedure and provided with at least one HBOT session in the peri-operative period. Two independent reviewers screened the initial identified trials and determined those to be included. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs.
Results:
The search retrieved 775 references, of which 13 RCTs were included (627 patients). Ten RCTs (546 patients) reported treatment was effective for improving at least one of the patient outcomes assessed, while two studies (55 patients) did not find any benefit and one study (26 patients) found a negative effect. A wide range of patient outcomes were reported, and several other methodological limitations were observed among the included studies, such as limited use of sham comparator and lack of blinding.
Conclusion:
Peri-operative preventive HBOT may be a promising intervention to improve surgical patient outcome. However, future work should consider addressing the methodological weaknesses identified in this review.
Trial Registration:
The protocol (CRD42018102737) was registered with the International ProspectiveRegister of Systematic Reviews (PROSPERO).
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