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Journal of Neurorestoratology  2020, Vol. 8 Issue (4): 270-280    doi: 10.26599/JNR.2020.9040025
Review Article     
A meta-analysis on the efficiency of the time window of hyperbaric oxygen treatment on disorders of consciousness in China
Yi Yang1(),Long Xu1,2(),Rong Xie3(),Yuanyuan Dang4,Xiaoyu Xia4,Jianghong He1,(✉)(),Jizong Zhao1,2,(✉)()
1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
2 China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing 100050, China
3 Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu, China
4 Department of Neurosurgery, PLA General Hospital, Beijing 100700, China
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Abstract  Objective

To investigate the clinical effects of time window on hyperbaric oxygen treatment (HBOT) in patients with disorders of consciousness (DOC).

Methods

All the clinical research literature regarding HBOT for DOC published between January 2000 and November 2020 were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Standards Database (WFSD) and VIP Database using Chinese key words disorders of consciousness, the vegetable state, minimally conscious state, or hyperbaric oxygen followed by a comprehensive meta-analysis.

Results

The query gave rise to 348 results, in which 21 articles were eventually selected for meta-analysis. Among the selected 21 articles, 18 articles involved a time window comparison. All the patients were classified into < 60- (718 patients) and ≥ 60- (374 patients) day groups depending on the number of days from HBOT initiation. The Jadad scores for the included datasets were relatively low in general with 2 points as the highest score. Comparable baseline data were demonstrated in all of the articles. Datasets from different sources were pooled and analyzed, and the results suggested that the clinical curative effect rate in the treatment group was significantly higher compared with that in the control group (curative effect rate: 69.86% versus 42.30%; Z = 11.28, P = 0.000, odds ratio = 3.80, 95% CI = 3.02-4.80). Additionally, the adverse reaction rate of the < 60-day group was found to be significantly lower compared with that of the ≥ 60-day group (Z = 10.01, P = 0.000, odds ratio = 4.82, 95% CI = 3.54-6.56). The funnel diagram in articles related to curative effect analysis and time window evaluation is inverted and symmetrical, indicating that publication bias was not significant.

Conclusions

The clinical curative effect of the HBOT group is higher compared with that of the control group. However, the conclusions based on meta-analysis are limited because of the methodological problems of some studies. Therefore, the clinical efficacy needs to be further tested using carefully designed large sample trials (multicenter, randomized, controlled, and double-blind).



Key wordsdisorders of consciousness      hyperbaric oxygen treatment      time window      curative effect      meta-analysis     
Received: 19 November 2020      Published: 07 February 2021
Corresponding Authors: Jianghong He,Jizong Zhao     E-mail: yangyi_81nk@163.com;neurotrauma@vip.163.com;xierongnjucm@163.com;he_jianghong@sina.cn;zhaojz205@163.com
Cite this article:

Yi Yang,Long Xu,Rong Xie,Yuanyuan Dang,Xiaoyu Xia,Jianghong He,Jizong Zhao. A meta-analysis on the efficiency of the time window of hyperbaric oxygen treatment on disorders of consciousness in China. Journal of Neurorestoratology, 2020, 8: 270-280.

URL:

http://jnr.tsinghuajournals.com/10.26599/JNR.2020.9040025     OR     http://jnr.tsinghuajournals.com/Y2020/V8/I4/270

Fig. 1Flow diagram of the literature search.
No.Publication yearResearcherCase numberTimes of treatmentEffective rate (%)Jadad scale
Treatment groupControl groupTreatment groupControl group
12001Wang HJ, et al. [4]845010-10089552
22002Gao CH, et al. [5]215220-12076.232.71
32002Li CH [6]132310-8061.534.81
42003Pan XR [7]181730-10077.841.22
52003Wang QS [8]525030-10063.4262
62003Shen CG, et al. [9]562630-20082541
72003Li Z, et al. [10]323210-10068.837.52
82004Xu YD, et al. [11]11812-3663.236.81
92004Chen LZ, et al. [12]755015-4546.7202
102005Geng SM, et al. [13]523030-14057.712.52
112005Chen D, et al. [14]262420-12081542
122005Sun L, et al. [15]525020-16057.7262
132005Chen H, et al. [16]683030-15073.536.72
142007Gao Y, et al. [17]161420-10043.864.31
152008Yu RH, et al. [18]683410-10082.347.12
162010Chen YH, et al. [19]363410-6091.773.52
172010Li JW [20]4040309072.52
182012Li AP [21]756240-16030.717.72
192016Chen JX, et al. [22]312540-12077.4442
202019Peng ZY, et al. [23]25256068522
212020Chao B, et al. [24]45454095.684.42
Table 1The basic characteristics in the literature of the treatment vs. control groups of the hyperbaric oxygen effect study.
NumPublication yearReseacherCase numberTimes of treatmentEffective rate (%)Jadad scale
≥ 60 days< 60 days≥ 60 days< 60 days
12002Gao CH, et al. [5]582520-12053151
22002Tang SQ, et al. [25]38930-1201821
32002Pan HR [7]305920-2101112
42002Li CH [6]221410-801631
52003Wang PQ, et al. [26]231240-240712
62003Li Z, et al. [10]24820-1002022
72004Zhi H, et al. [27]161220-1601042
82005Geng SM, et al. [13]481230-1402832
92005Chen H, et al. [16]551330-1504642
102007Wang Q, et al. [28]282220-1101132
112008Wang M, et al. [29]38830-1303021
122008Yu RH, et al. [30]681710-1005612
132010Chen YH, et al. [19]191710-601282
142012Li AP , et al.[21]511140-1604662
152012Zhao ZR, et al. [31]263640-601892
162013Wang YF, et al. [32]683420-12056162
172015Li Ll, et al.[33]771925-1605142
182018Zhang Y, et al.[34]294645-904182
Table 2The basic characteristics of the therapeutic time window and effect in the literature.
Fig. 2The funnel plot analysis of the literature publication bias on the effect of hyperbaric oxygen treatment. X-axis is odd ratio (OR), and Y-axis is standard error (SE).
Fig. 3The funnel plot analysis of the literature publication bias on the time window of hyperbaric oxygen treatment. X-axis is odd ratio (OR), and Y-axis is standard error (SE).
Fig. 4The forest plot of the effect of hyperbaric oxygen treatment.
Fig. 5The forest plot of the time window of hyperbaric oxygen treatment.
[1]   Bareham CA, Allanson J, Roberts N, et al. Longitudinal assessments highlight long-term behavioural recovery in disorders of consciousness. Brain Commun. 2019, 1(1): fcz017.
[2]   Wannez S, Gosseries O, Azzolini D, et al. Prevalence of coma-recovery scale-revised signs of consciousness in patients in minimally conscious state. Neuropsychol Rehabil. 2018, 28(8): 1350-1359.
[3]   Giacino J, Fins JJ, Machado A, et al. Central thalamic deep brain stimulation to promote recovery from chronic posttraumatic minimally conscious state: challenges and opportunities. Neuromodulation. 2012, 15(4): 339-349.
[4]   Wang HJ, Weng QB, Wu QP, et al. Analysis of hyperbaric oxygen synthetic treatment on disorders of consciousness in 84 patients (in Chinese). Chin J Naut Med & Hyperbar Med. 2001, 8(2): 108-110.
[5]   Gao CH, Hou L, Yao SR, et al. Efficacy of hyperbaric oxygen treatment on disorders of consciousness (in Chinese). J Ningxia Med Coll. 2002, 24(3): 208-209 .
[6]   Li CH. Analysis of hyperbaric oxygen treatment on disorders of consciousness in 36 patients (in Chinese). Clin Med. 2002, 22(6): 29-30.
[7]   Pan XR. Hyperbaric oxygen synthetic treatment on disorders of consciousness following severe cerebral trauma in 18 cases (in Chinese). Guangxi Med J. 2003, 25(7): 1280-1281.
[8]   Wang QS. Effect of hyperbaric oxygen treatment on disorders of consciousness in 52 cases (in Chinese). Chin J Neurosurg Dis Res. 2003, 2(2): 175-176.
[9]   Shen GY, Lu X. Promotion effect of hyperbaric oxygen with rehabilitation on the consciousness recovery of disorders of consciousness patients (in Chinese). Chin J Clin Rehab. 2003, 7(25): 3534.
[10]   Li Z, Guo KH. Efficacy of hyperbaric oxygen treatment on disorders of consciousness (in Chinese). Chin J Rehab. 2003, 18(1): 33-34.
[11]   Xu YD, Wang MX, Zhang ZS, et al. Effect and EEG analysis of hyperbaric oxygen synthetic treatment on disorders of consciousness (in Chinese). J Clin Neurol. 2004, 11(3): 180.
[12]   Chen LZ, Mu GF, Weng QB, et al. The computerized tomography manifestation of the patients with brain trauma in persistent vegetative state after treated by hyperbaric oxygen (in Chinese). Chongqing Med J. 2004, 33(6): 866-868,870.
[13]   Geng SM, Jiao BH, Lu SK, et al. Effiicacy and influence factors of hyperbaric oxygenation combining treatment on patients with persistent state (in Chinese). J Brain Nerv Dis. 2005, 13(1): 37-38,49.
[14]   Chen D, Yang DJ, Xu FY, et al. Evaluation of the recovery effect of hyperbaric oxygen treatment on disorders of consciousness (in Chinese). Chin J Clin Rehab. 2005, 9(1): 170.
[15]   Sun L, Sun X. Hyperbaric oxygen synthetic treatment for 52 cases of disorders of consciousness (in Chinese). Modern Hospital. 2005, 5(8): 55-57.
[16]   Chen H, Chen MS, Sun CF, et al. Hyperbaric oxygen synthetic treatment on disorders of consciousness following cerebral trauma (in Chinese). Zhejiang Clin Med J. 2005, 7(12): 1271.
[17]   Gao Y, Gao CJ, Ge Huan. Effect of hyperbaric oxygen combined treatment on disorders of consciousness in 30 patients (in Chinese). Chin J Naut Med & Hyperbar Med. 2007, 14(1): 23-25.
[18]   Yu RH, Xie QY, Huang H, et al. Effect of hyperbaric oxygen combined treatment on persistent vegetative state following cerebral trauma in 102 patients (in Chinese). Mil Med J South China. 2008, 22(6): 13-15.
[19]   Chen YH, Feng DK, Shang FJ, et al. Efficacy of auxiliary use of hyperbaric oxygen treatment on persistent vegetative state in 28 patients (in Chinese). Chongqing Med. 2010, 39(20): 2841-2842.
[20]   Li JW. Study on the therapeutic effect of hyperbaric oxygen on severe craniocerebral injury (in Chinese). ZH J J Traumatic. 2010, 15(6): 725-727.
[21]   Li AP. Hyperbaric oxygen treatment on disorders of consciousness following cerebral trauma (in Chinese). Chin Manipulat & Rehab Med. 2012, 3(3): 214-215.
[22]   Chen JX, Li LP, Liang YM, et al. Effect of hyperbaric oxygen on persistent vegetative state after brain injury and its influencing factors (in Chinese). J Shanxi Med Univ. 2016, 47(1): 93-96.
[23]   Peng ZY, Li MQ, Ye PY, et al. Clinical study of hyperbaric oxygen combined with cerebral circulation in the treatment of persistent vegetative state (in Chinese). Chin J Conval Med. 2019, 28(7): 673-675.
[24]   Chao B, Ta N, Sun B, et al. Effect of early hyperbaric oxygen treatment in treating patients with severe craniocerebral trauma (in Chinese). J Trauma Surg. 2020, 22(5): 336-339,344.
[25]   Tang SQ, Xia DR. The clinical efficacy of hyperbolic oxygenation combining treatment on persistent vegetative state (in Chinese). Chin Med Fact Mine. 2002, 15(1): 7-8.
[26]   Wang PQ, Luo YW, Luo WH, et al. Effect of hyperbaric oxygen combined treatment and its influence factor on persistent vegetative state (in Chinese). Chin J Phys Med Rehab. 2003, 25(3): 167-168.
[27]   Zhi H, Pang P, Qian XW, et al. Observation on therapeutic effect of hyperbaric oxygen on 28 cases of persistent vegetative state after brain injury (in Chinese). Shandong Med. 2006, 46(21): 79 .
[28]   Wang Q, Liu XY, Qiu YC. Evaluation of consciousness-promoted effect on persistent vegetative state treated with hyperbaric oxygen and blood magnetic treatment (in Chinese). J Taishan Med Coll. 2007, 28(3): 212-214.
[29]   Wang M, Ran CF, Li JQ, et al. Effect of hyperbaric oxygen combined treatment on persistent vegetative state in 46 patients (in Chinese). J Prac Med. 2008, 24(8): 1370-1372.
[30]   Yu RH, Xie QY, Huang H, et al. Study of hyperbaric oxygen combining treatment on traumatic vegetative state (in Chinese). Mod J Integr Tradit Chin West Med. 2008, 17(26): 4054-4055, 4211.
[31]   Zhao ZR, Pan LF, Wu AP, et al. Clinical study of hyperbaric oxygen combining conventional treatment on traumatic brain injury with disorders of consciousness (in Chinese). Clin Med China. 2012, 28(6): 639-641.
[32]   Wang YF, Wang JL, Liu F, et al. Effect of hyperbaric oxygen on 102 patients with persistent vegetative state after traumatic brain injury (in Chinese). Chin J Naut Med & Hyperbar Med. 2013, 20(5): 343-344.
[33]   Zhang LL, Hu SQ, Hong X, et al. Application of hyperbaric oxygen treatment in coma patients after severe craniocerebral trauma (in Chinese). J Prac Med Tech. 2015, 22(7): 762-765.
[34]   Zhang Y, Ma LL, Li Z, et al. Analysis of influential factors on the prognosis of cerebral hemorrhage patients in vegetative state after comprehensive hyperbaric oxygen treatment (in Chinese). Chin J Naut Med & Hyperbar Med. 2018, 25(6): 354-358.
[35]   Wang M, Ran CF, Li JQ, et al. Effect of hyperbaric oxygen combined treatment on persistent vegetative state in 46 patients (in Chinese). J Prac Med. 2008. 24(8): 1370-1372.
[36]   Meng J, Pan XW, Zhang Y, et al. Hyperbaric oxygen treatment for 280 cases of persistent vegetative state (in Chinese). Chin J Clin Rehab. 2004, 8(25): 5371.
[37]   Meng XE, Zhang Y, Li N, et al. Hyperbaric oxygen alleviates secondary brain injury after trauma through inhibition of TLR4/NF-κB signaling pathway. Med Sci Monit. 2016, 22: 284-288.
[38]   Gill AL, Bell CN. Hyperbaric oxygen: its uses, mechanisms of action and outcomes. QJM. 2004, 97(7): 385-395.
[39]   Gamdzyk M, Ma?ek M, Bratek E, et al. Hyperbaric oxygen and hyperbaric air preconditioning induces ischemic tolerance to transient forebrain ischemia in the gerbil. Brain Res. 2016, 1648(Pt A): 257-265.
[40]   Yang LM, Tang J, Chen QW, et al. Hyperbaric oxygen preconditioning attenuates neuroinflammation after intracerebral hemorrhage in rats by regulating microglia characteristics. Brain Res. 2015, 1627: 21-30.
[41]   André-Lévigne D, Modarressi A, Pignel R, et al. Hyperbaric oxygen therapy promotes wound repair in ischemic and hyperglycemic conditions, increasing tissue perfusion and collagen deposition. Wound Repair Regen. 2016, 24(6): 954-965.
[42]   Dougherty JE. The role of hyperbaric oxygen therapy in crush injuries. Crit Care Nurs Q. 2013, 36(3): 299-309.
[43]   Bhutani S, Vishwanath G. Hyperbaric oxygen and wound healing. Indian J Plast Surg. 2012, 45(2): 316-324.
[44]   Stoekenbroek RM, Santema TB, Legemate DA, et al. Hyperbaric oxygen for the treatment of diabetic foot ulcers: a systematic review. Eur J Vasc Endovasc Surg. 2014, 47(6): 647-655.
[45]   Marroni A, Mathieu D, Wattel F. First European Consensus Conference on Hyperbaric Medicine, Lille 2004. Marroni A, Mathieu D, Wattel F, Eds. The ECHM collection. Flagstaff, AZ: Best Publishing Company, 2005.
[46]   Zhai WW, Sun L, Yu ZQ, et al. Hyperbaric oxygen therapy in experimental and clinical stroke. Med Gas Res. 2016, 6(2): 111-118.
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