Necrotising Soft Tissue Infections: The Effect of Hyperbaric Oxygen on Mortality

Abstract

In a single-centre, retrospective, case-controlled study of patients attending the Alfred Hospital in Prahran, Victoria, we assessed the effect of hyperbaric oxygen therapy (HBOT) in reducing mortality or morbidity in patients with necrotising fasciitis (NF) over a 13-year period from 2002 to 2014. A total of three hundred and forty-one patients with NF were included in the study, of whom 275 received HBOT and 66 did not. The most commonly involved sites were the perineum (33.7%), lower limb (29.9%) and trunk (18.2%). The commonest predisposing factor was diabetes mellitus (34.8%). Polymicrobial NF (type 1 NF) occurred in 50.7% and Group A streptococcal fasciitis (type 2 NF) occurred in 25.8% of patients. Mortality was 14.4% overall, 12% in those treated with, and 24.3% in those not treated with, HBOT. ICU support was required in 248 (72.7%) patients. Independent factors impacting on mortality included HBOT (odds ratio [OR] 0.42 [0.22 to 0.83], P=0.01), increased age (OR 1.06 [1.03 to 1.08], P=0.001) and immunosuppression (OR 2.6 [1.23 to 5.51], P=0.01). Mortality was linked to illness severity at presentation, however when adjusted for severity score and need for intensive care management, HBOT was associated with significant reduction in mortality.

Management of Necrotizing Fasciitis: Single centre experience. Retrospective analytical study

“…13 NF may present by classic manifestations such as soft-tissue oedema (in 75% of cases), erythema (72%), severe pain (72%), tenderness (68%), fever (60%), and skin bullae and necrosis (38%) however the following symptoms and signs are highly suggestive for NF; pain out of proportion to clinical signs, hypotension, skin necrosis, and hemorrhagic bullae. [14][15] In the present study; we used Evangelos classi cation 8 were Type II infections (38.3%) had been more prevalent followed by type III (28%) then type I (20.6%) and nally type IV (13.1%). These ndings were similar to data in other studies where Type II was the commonest in contrary to other reports that experienced a similar incidence of type I and II and the other types vary considerably.…”

Importance of early detection and management of necrotising myositis as demonstrated by the case of an 8‐year‐old female

“…Hyperbaric oxygen therapy is often suggested as an adjunctive therapy for necrotising infections, although again the evidence is quite limited. A review of available studies into the use of hyperbaric oxygen therapy for this indication, all of which were uncontrolled observational and retrospective studies, found inconsistent results . However, once again, the rationale for use is based on the probability that potential benefit is likely to outweigh harm.…”

The diagnosis and management of Fournier's gangrene

“…7,28 Indeed, HBOT has been found to reduce mortality in a study of 341 patients. 29 However, overall the evidence is inconsistent and HBOT is not recommended in the EUA guidelines. 18…”