Hedetoft

Meta-analysis suggests patients with necrotizing infections and treated with HBOT have reduced odds of dying and are possibly less likely to require a major amputation.

 

Citation: Hedetoft M, Bennett MH, Hyldegaard O. Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A systematic review and meta-analysis. Diving Hyperb Med. 2021 Mar 31;51(1):34-43. doi: 10.28920/dhm51.1.34-43. PMID: 33761539; PMCID: PMC8081587.

Correspondent: M Hedetoft: Department of Anaesthesia, Section 4231, Rigshospitalet, University Of Copenhagen, Blegdamsvej 8, 2100 Copenhagen, Denmark
E-mail: morten.friis.fiskbaek.hedetoft@regionh.dk
 

Summary

Background: Surgical intervention, broad-spectrum antibiotics and intensive care support are the standard of care in the treatment of necrotizing soft-tissue infections (NSTI). Hyperbaric oxygen therapy (HBOT) may be a useful adjunctive treatment and has been used for almost 60 years, but its efficacy remains unknown and has not been systematically appraised. The aim was to systematically review and synthesize the highest level of clinical evidence available to support or refute the use of hyperbaric oxygen therapy in the treatment of necrotizing soft-tissue infections.
 

Methods: We searched MEDLINE, Embase, CENTRAL and CINAHL for eligible studies that reported outcomes in both HBOT treated and non-HBOT treated individuals with NSTI. In-hospital mortality was the primary outcome. We pooled odds ratio (ORs) using random-effects models.
 

Results: We identified 486 papers of which 31 were included in the qualitative synthesis and 21 in the meta-analyses. Meta-analysis on 48 744 patients with NSTI (1 237 (2.5%) HBOT vs. 47 507 (97.5%) Non-HBOT) showed in-hospital mortality was 4 770 of 48 744 patients overall (9.8%) and the pooled Odds Ratio (OR) was 0.44 (95%CI 0.33—0.58) in favor of HBOT. For amputation the pooled OR was 0.60 (95%CI 0.28—1.28) in favor of HBOT. The dose of oxygen in these studies was poorly reported.  
 

Conclusions: Meta-analysis of the non-random comparative data suggests patients with NSTI treated with HBOT have reduced odds of dying during the sentinel event and may be less likely to require a major amputation. The most effective dose of oxygen remains unclear.