Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

Table 23 Patient criteria of included studies focusing on the use of HBOT in necrotising soft tissue
infections.
First Author and
Year of Publication
Brown 1994 52
Patient Criteria
Patients diagnosed with necrotising faciitis, crepitant anaerobic cellulitis, gangrene, Fournier’s
gangrene, or nonclostridial/clostridial myonecrosis.
Exclusions: complications of radiotherapy, primary peripheral vascular disease with dry gangrene,
gangrene as a single diagnosis, joint reconstruction complications, or an infection only involving
an extremity.
Riseman 1990 53 Patients diagnosed with necrotising fasciitis, gas gangrene, or Fournier’s gangrene.
Interventions examined
Exposure to hyperbaric oxygen was different in both studies (Table 24). In the study by
Brown et al, 52 pressures were higher and the frequency of therapy was unstated. Riseman
et al53 made use of a treatment regimen that called for frequent exposure to HBOT in the
first 24 hours of therapy. Comparison therapies were standard.
Table 24 Therapeutic protocols used in intervention and comparison groups in included studies
focusing on the use of HBOT in necrotising soft tissue infections.*
First Author and
Year of Publication
Brown 1994 52
Riseman 1990 53
Intervention Group Comparison Group
n=30
Comparison therapy plus treatment in an
unstated chamber HBO device at 2.5 to 3.0
ATA for 90 minutes.†
n=17
Comparison therapy plus treatment in a
monoplace chamber HBO device. At 2.5 ATA
for 90 minutes every 8 hours for the first 24
hours, the twice a day, for a total of 10
treatments.
* Abbreviations: ATA = atmosphere absolute, n = sample size.
† Duration of therapy not described.
n=24
Debridement, antibiotics, laparotomy.
n=12
Intravenous fluids, debridement, broad
spectrum antibiotics (aminoglycoside,
clindamycin, and penicillin G or
cephalosporin).
Assessment of heterogeneity
Differences in patient criteria and study designs made it difficult to compare clinical and
epidemiological outcomes in the two studies. For this reason, the review undertook no
statistical analysis of heterogeneity and made no attempt to arrive at a statistically pooled
effect estimate through meta-analysis.
Review of published clinical experience
Both studies looked at the proportion of patients who survived following the diagnosis
of necrotising soft tissue infections (Table 25). Both studies showed that HBOT was
associated with survival, but only Riseman et al53 reached commonly accepted levels of
statistical significance.
34 Hyperbaric oxygen therapy