Literature review.

<p>Literature review.</p

Characteristics of participating FPs (n = 523).

<p>Characteristics of participating FPs (n = 523).</p

Incentives to start and maintain teaching; benefits and barriers in teaching (5-point Likert scale from ‘strongly disagree’ = 1 to ‘strongly agree’ = 5).

<p>Incentives to start and maintain teaching; benefits and barriers in teaching (5-point Likert scale from ‘strongly disagree’ = 1 to ‘strongly agree’ = 5).</p

Flow-Chart.

<p>Flow-Chart.</p

Normobaric Hyperoxia for Treatment of Pneumocephalus after Posterior Fossa Surgery in the Semisitting Position: A Prospective Randomized Controlled Trial

<div><p>Background</p><p>Supratentorial pneumocephalus after posterior fossa surgery in the semisitting position may lead to decreased alertness and other symptoms. We here aimed to prove the efficacy of normobaric hyperoxia on the absorption of postoperative pneumocephalus according to a standardized treatment protocol.</p><p>Methods and Findings</p><p>We enrolled 44 patients with postoperative supratentorial pneumocephalus (> 30 ml) after posterior fossa surgery in a semisitting position. After randomisation procedure, patients received either normobaric hyperoxia at FiO₂ 100% over an endotracheal tube for 3 hours (treatment arm) or room air (control arm). Routine cranial CT scans were performed immediately (CT1) and 24 hours (CT2) after completion of surgery and were rated without knowledge of the therapy arm. Two co-primary endpoints were assessed: (i) mean change of pneumocephalus volume, and (ii) air resorption rate in 24 hours. Secondary endpoints were subjective alertness (Stanford Sleepiness Scale) postoperatively and attention (Stroop test), which were evaluated preoperatively and 24 hours after surgery. The mean change in pneumocephalus volume was higher in patients in the treatment arm as compared to patients in the control arm (p = 0.001). The air resorption rate was higher in patients in the treatment arm as compared to patients in the control arm (p = 0.0015). Differences were more pronounced in patients aged 52 years and older. No difference between patients in treatment arm and control arm was observed for the Stroop test. The distribution of scores in the Stanford Sleepiness Scale differed in the treatment arm as compared to the control arm, and there was a difference in mean values (p = 0.015).</p><p>Conclusions</p><p>Administration of normobaric hyperoxia at FiO₂ 100% via an endotracheal tube for 3 hours is safe and efficacious in the treatment of pneumocephalus after posterior fossa surgery in the semisitting position. Largest benefit was found in elderly patients and particularly in older men.</p><p>Trial Registration</p><p>German Clinical Trials Register <a href="https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006273" target="_blank">DRKS00006273</a></p></div

Box plots for the mean volume change of pneumocephalus (A) and air resorption rate (B) between CT1 and CT2.

<p>Box plots for the mean volume change of pneumocephalus (A) and air resorption rate (B) between CT1 and CT2.</p

Changes of intracranial air volume and air resorption rate (control—treatment) [ml].

<p>SE = standard error</p><p>* p<0.05 = significant; ANCOVA</p><p>Changes of intracranial air volume and air resorption rate (control—treatment) [ml].</p

Results of sensitivity analysis for mean change of pneumocephalus volume (control—treatment) [ml].

<p>SE = standard error</p><p>* p<0.05 = significant; ANCOVA</p><p>Results of sensitivity analysis for mean change of pneumocephalus volume (control—treatment) [ml].</p

Explorative arterial blood gas (ABG) analysis, obtained after closure of the craniotomy, and immediately after extubation.

<p>Hb = haemoglobin; SD = standard deviation</p><p>* p<0.05 = significant; two-sided t-test</p><p>Explorative arterial blood gas (ABG) analysis, obtained after closure of the craniotomy, and immediately after extubation.</p

Results of sensitivity analysis for air resorption rate (control—treatment) [ml/h].

<p>SE = standard error</p><p>* p<0.05 = significant; ANCOVA</p><p>Results of sensitivity analysis for air resorption rate (control—treatment) [ml/h].</p