Which Role for Hyperbaric Oxygen Therapy in the Treatment of Fournier's Gangrene? A Retrospective Study

Tutino, Roberta; Colli, Francesco; Rizzo, Giovanna; Bonventre, Sebastiano; Scerrino, Grégorio; Salamone, Giuseppe; Melfa, Giuseppina; Orlando, G.; Gallo, Gaetano; Santarelli, Mauro; Massani, Marco; Cocorullo, Gianfranco

doi:10.3389/fsurg.2022.850378

Cited by 7 publications

(7 citation statements)

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“…Of the ten studies, Creta et al and Feres et al have notable significance in the analysis due to the larger number of samples compared to other studies (7,10). Only two studies reported an increase in mortality in patients treated with HBOT (13,18).…”

Section: Meta-analysis Results On Mortalitymentioning

confidence: 98%

“…Based on the analysis of ten included studies (7,(10)(11)(12)(13)(14)(15)(16)(17)(18), patients with HBOT have a significantly lower mortality rate than patients without HBOT (OR 0.29; 95%CI 0.12, 0.69; p=0.005) (Figure-2). The random-effects model was used due to high heterogeneity between studies (P = 0.03; I 2 = 51%).…”

Section: Meta-analysis Results On Mortalitymentioning

confidence: 99%

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The role of hyperbaric oxygen therapy in Fournier’s Gangrene: A systematic review and meta-analysis of observational studies

et al. 2022

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Purpose: Purpose: Management of Fournier's Gangrene (FG) includes broad-spectrum antibiotics Management of Fournier's Gangrene (FG) includes broad-spectrum antibiotics with adequate surgical debridement, which should be performed within the first 24 hours with adequate surgical debridement, which should be performed within the first 24 hours of onset. However, this treatment may cause significant loss of tissue and may delay of onset. However, this treatment may cause significant loss of tissue and may delay healing with the presence of ischemia. Hyperbaric oxygen therapy (HBOT) has been healing with the presence of ischemia. Hyperbaric oxygen therapy (HBOT) has been proposed as adjunctive therapy to assist the healing process. However, its benefit is still proposed as adjunctive therapy to assist the healing process. However, its benefit is still debatable. Therefore, this systematic review and meta-analysis aimed to evaluate the debatable. Therefore, this systematic review and meta-analysis aimed to evaluate the effect of HBOT as an adjunct therapy for FG. effect of HBOT as an adjunct therapy for FG. Materials and Methods: Materials and Methods: This study complied with the Preferred Reporting Items forThis study complied with the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol to obtain studies investigating the Systematic Reviews and Meta-analyses protocol to obtain studies investigating the effect of HBOT on patients with FG. The search is systematically carried out on different effect of HBOT on patients with FG. The search is systematically carried out on different databases such as MEDLINE, Embase, and Scopus based on population, intervention, databases such as MEDLINE, Embase, and Scopus based on population, intervention, control, and outcomes criteria. A total of 10 articles were retrieved for qualitative and control, and outcomes criteria. A total of 10 articles were retrieved for qualitative and quantitative analysis. quantitative analysis. Results: Results: There was a significant difference in mortality as patients with FG who received There was a significant difference in mortality as patients with FG who received HBOT had a lower number of deaths compared to patients who received conventional HBOT had a lower number of deaths compared to patients who received conventional therapy (Odds Ratio 0.29; 95% CI 0.12 -0.69; p = 0.005). However, the mean length therapy (Odds Ratio 0.29; 95% CI 0.12 -0.69; p = 0.005). However, the mean length of stay with Mean Difference (MD) of -0.18 (95%

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Section: Meta-analysis Results On Mortalitymentioning

confidence: 98%

Section: Meta-analysis Results On Mortalitymentioning

confidence: 99%

The role of hyperbaric oxygen therapy in Fournier’s Gangrene: A systematic review and meta-analysis of observational studies

et al. 2022

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“…All 23 studies [ 3 , 7 , 19 – 39 ] included were retrospective studies with a total of 49,152 patients, and 1448 patients were treated HBO, versus 47,704 patients treated without HBO. Ten studies came from North America (8 from USA, 2 from Canada).…”

Section: Resultsmentioning

confidence: 99%

“…We did a subgroup analysis with pathological entity into two categories: FG subgroup and Non-FG subgroup. The FG subgroup consisted of 10 studies [ 7 , 19 – 21 , 24 , 25 , 30 , 33 , 35 , 36 ]. The Non-FG consisted of 13 studies [ 3 , 22 , 23 , 26 – 29 , 31 , 32 , 34 , 37 – 39 ].…”

Section: Resultsmentioning

confidence: 99%

The effect of hyperbaric oxygen therapy on the clinical outcomes of necrotizing soft tissue infections: a systematic review and meta-analysis

et al. 2023

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Background To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the available evidence. Methods Data sources were PubMed, Embase, Web of Science, Cochrane Library, and reference lists. The study included observational trials that compared HBO with non-HBO, or standard care. The primary outcome was the mortality rate. Secondary outcomes were the number of debridement, amputation rate and complication rate. Relative risks or standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively. Results A total of retrospective cohort and case-control studies were included, including 49,152 patients, 1448 who received HBO and 47,704 in control. The mortality rate in the HBO group was significantly lower than that in the non-HBO group [RR = 0.522, 95% CI (0.403, 0.677), p < 0.05]. However, the number of debridements performed in the HBO group was higher than in the non-HBO group [SMD = 0.611, 95% CI (0.012, 1.211), p < 0.05]. There was no significant difference in amputation rates between the two groups [RR = 0.836, 95% CI (0.619, 1.129), p > 0.05]. In terms of complications, the incidence of MODS was lower in the HBO group than in the non-HBO group [RR = 0.205, 95% CI (0.164, 0.256), p < 0.05]. There was no significant difference in the incidence of other complications, such as sepsis, shock, myocardial infarction, pulmonary embolism, and pneumonia, between the two groups (p > 0.05). Conclusion The current evidence suggests that the use of HBO in the treatment of NSTI can significantly reduce the mortality rates and the incidence rates of complications. However, due to the retrospective nature of the studies, the evidence is weak, and further research is needed to establish its efficacy. It is also important to note that HBO is not available in all hospitals, and its use should be carefully considered based on the patient's individual circumstances. Additionally, it is still worthwhile to stress the significance of promptly evaluating surgical risks to prevent missing the optimal treatment time.

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“…HBOT can increase the oxygen partial pressure of tissues and organs, and promote wound recovery through various mechanism. 100 HBOT is especially suitable for FG patients who are unresponsive to conventional treatment, complicated with Clostridium or anaerobes and deep tissue involvement. 101 Although few studies reported an increase in mortality, most studies showed that HBOT has a beneficial effect in the prognosis of FG.…”

Section: Hyperbaric Oxygen Therapy (Hbot)mentioning

confidence: 99%

Progress in Multidisciplinary Treatment of Fournier’s Gangrene

Zhang¹,

Shi²,

Chen³

et al. 2022

IDR

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Fournier's gangrene (FG) is a life-threatening and special form of necrotizing fasciitis, characterized by occult onset, rapid progress and high mortality, occurring mainly in men over 50 years of age. Risk factors of FG include diabetes, HIV infection, chronic alcoholism and other immunosuppressive state. FG was previously considered as an idiopathic disease, but in fact, three quarters of the infections originated from the skin, urethra and gastrointestinal tract. Initial symptoms of FG are often inconsistent with severity and can progress promptly to fatal infection. Although the treatment measures of FG have been improved in recent years, the mortality does not seem to have decreased significantly and remains at 20% -30%. The time to identify FG and the waiting period before surgical debridement are directly related to the prognosis. Therefore, in addition to the combination of intensive fluid resuscitation and broad-spectrum antibiotics, treatment of FG should particularly emphasize the importance of early surgical debridement assisted with fecal diversion and skin reconstruction when necessary. This paper is to briefly summarize the progress in the definition, epidemiology, clinical manifestations, diagnosis, treatment and prognosis of Fournier's gangrene in recent years, more importantly, illustrates the importance of multidisciplinary cooperation in the management of FG.

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Which Role for Hyperbaric Oxygen Therapy in the Treatment of Fournier's Gangrene? A Retrospective Study

Cited by 7 publications

References 34 publications

The role of hyperbaric oxygen therapy in Fournier’s Gangrene: A systematic review and meta-analysis of observational studies

The role of hyperbaric oxygen therapy in Fournier’s Gangrene: A systematic review and meta-analysis of observational studies

The effect of hyperbaric oxygen therapy on the clinical outcomes of necrotizing soft tissue infections: a systematic review and meta-analysis

Progress in Multidisciplinary Treatment of Fournier’s Gangrene

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