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Hyperbaric Oxygen and cerebral protection
- Mark E Edsell (14 August 2007)
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Mark E Edsell St George's Hospital
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Editor – I would like to congratulate Fukuda and Warner on their excellent review of cerebral protection strategies and therapies.1 I would however like to comment on hyperbaric oxygen (HBO) therapy as a modality for cerebral protection. In their review, Fukuda and Warner describe HBO in humans as having “well-defined absence of benefit” in both pre- ischaemic cerebral protection and sustained protection. However, a recently published prospective, randomised, controlled, double-blinded trial by Alex et al did demonstrate its promise in this area.2 The authors randomised sixty-four patients into two groups. The treatment group (n=33) received three sessions of HBO at 2.4 atmospheres absolute and the control group (n=31) received three sessions of a ‘sham’ therapy, breathing room air at 1.5 atmospheres absolute (equivalent to 30% Oxygen at sea level). This was performed at 24, 12 and 2 hours prior to on -pump coronary artery bypass surgery. Those treated preoperatively with HBO had a significant reduction in postoperative neurocognitive dysfunction in neuropsychometric tests performed after four months. This was defined as more than one ‘standard deviation’ deterioration in more than two neuropsychometric tests. HBO also decreased the postoperative the rise in the inflammatory markers sE-selectin, CD18 and Heat Shock Protein- 70 compared with the control group. No other post-operative outcome differences were found. Whilst it is difficult to interpret the clinical significance of these findings, this study does support a possible protective effect of HBO prior to a cerebral insult. I concur with the authors of the study who conclude that larger, multicentre trials are needed. Mark Edsell, London, UK 1. Cerebral protection. Br J Anaesth 2007; 99 (1): 10-17 2. Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass: a prospective, randomized double-blind trial. J Thorac Cardiovasc Surg 2005; 130 (6): 1623-30 Conflict of Interest:None declared |
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