• Undersea Hyperbar M · Nov 2017

    Observational Study

    Hyperbaric oxygen therapy as an adjuvant to source control in necrotizing soft tissue infections.

    • António Pedro Pinto Ferreira, Sérgio Santos Vide, Tiago David Fonseca Fernandes, Pedro Miguel Barata de Silva Coelho, and Óscar Ferraz Camacho.
    • Department of Anesthesiology, Matosinhos Local Health Unit, Matosinhos, Portugal.
    • Undersea Hyperbar M. 2017 Nov 1; 44 (6): 535-542.

    IntroductionNecrotizing soft tissue infections (NSTI) are rare but potentially lethal disorders, and adequate management is time- and resource-demanding. This study aims to assess whether variations in the treatment modalities - surgery, hyperbaric oxygen (HBO₂) therapy and negative pressure wound therapy - had an impact on the length to definitive source control in NSTI patients who underwent HBO₂.MethodsThis is a retrospective study of all NSTI patients treated with hyperbaric oxygen therapy between March 2007 and May 2015 at Unidade Local de Saúde de Matosinhos (ULSM) Hyperbaric Unit. A multiple linear regression model was used to assess the impact of different treatment modalities in the posdiagnosis time until source control.Results58 patients were included; overall mortality was 13.8%. Mean time until source control was 10.4 days (±5.4). All patients were under empiric and broad-spectrum antibiotics on the day of diagnosis. Patients underwent an average of 0.62 (±0.29) surgical interventions and 1.06 (±0.52) HBO₂ sessions per day. The regression model (R2=0.86) showed that after adjusting for other covariates, doubling the number of HBO₂ sessions per day shortened source control by five days (? β = -5.25; 95% CI -6.49 to 4.01), and for each day that HBO₂ was delayed, source control was achieved one day later (β = 1.03; 95% CI 0.82 to 1.24).ConclusionsMore intensive HBO₂ protocols with earlier and more frequent sessions shorten the time until definitive source control in necrotizing soft tissue infections, potentially lowering the impact of systemic effects of infection and complications associated with organ dysfunction.

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