Adjuvant Hyperbaric Oxygen Therapy (HBO2) for Treatment of Necrotizing Fasciitis Reduces Mortality and Amputation Rate
Undersea Hyperb Med. 2005 Nov-Dec;32(6):437-43
Escobar SJ, Slade JB Jr, Hunt TK, Cianci P.
OBJECTIVE: A retrospective analysis of 42 patients with necrotizing soft tissue infections treated with adjunctive HBO2 to ascertain efficacy and safety. Overall mortality was 11.9% and morbidity 5%.
SUMMARY BACKGROUND DATA: Necrotizing soft tissue infections have historically high rates of mortality and morbidity, including amputation. Common misconceptions that prevent widespread use of adjunctive HBO2 for this diagnosis include delays to surgery, increased morbidity, and significant complications.
METHODS: Forty-two consecutive patients (average age 56.1) with necrotizing fasciitis presenting to a major referral center were treated with adjunctive HBO2 as part of an aggressive program of surgery, antibiotics, and critical care. Involved areas included the lower abdomen (15 patients), thigh and perineum (9 patients), flank (4 patients), lower leg (3 patients), and arm, shoulder, and axilla (2 patients). Co-morbidities included diabetes mellitus, chronic renal failure, intravenous drug abuse, peripheral vascular disease, and malignancy.
RESULTS: Mortality was 11.9% (5 patients). Both amputations (a finger and a penis), occurred prior to transport to our facility. The average number of surgical debridements was 2.8 per patient; 1.25 performed prior to the start of HBO. The infectious process was controlled after an average of 7 HBO2 treatments were administered to ensure successful wound closure. Complications consisted of only mild ear barotrauma in 3 patients (7%), and confinement anxiety in 17 (41%) but did not prevent treatment.
CONCLUSION: Compared to national reports of outcomes with “standard” regimens for necrotizing fasciitis, our experience with HBO2, adjunctive to comprehensive and aggressive management, demonstrates reduced mortality (34% v. 11.9%), and morbidity (amputations 50% v. 0%). The treatments were safe and no delays to surgery or interference with standard therapy could be attributed to HBO2.
The Effect of Hyperbaric Oxygen Therapy on the Bout of Treatment for Soft Tissue Infections
J Infect. 2004 May;48(4):330-3
Sugihara A, Watanabe H, Oohashi M, Kato N, Murakami H, Tsukazaki S, Fujikawa K.
OBJECTIVES: Hyperbaric oxygen (HBO) therapy is often combined with antibiotic therapy for infections such as gas gangrene and osteomyelitis. Although numerous investigations have been undertaken to assess the effect of adjunctive HBO therapy on the treatment of infections, the bout of treatment has not been referred in the previous investigations. The purpose of this retrospective study was to evaluate the efficacy of HBO therapy on the bout of treatment for soft tissue infections.
PATIENTS AND METHODS: In the period between 1994 and 2001, we treated 23 patients with soft tissue infections. Nine patients were treated with antibiotic chemotherapy alone, and 14 patients were treated with a combination of antibiotic chemotherapy and HBO therapy. The mean bout of treatment was compared between these two groups.
RESULTS: The mean bout treated with a combination of antibiotic and HBO was significantly shorter than that with antibiotic alone.
CONCLUSION: Our result indicates that HBO therapy combined with antibiotic therapy is able to shorten the bout of treatment for soft tissue infections. Therefore, we recommend HBO therapy combined with antibiotic therapy for soft tissue infections.