Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

Summary
The studies collected looked at different populations, the sample sizes were small, and
information about the HBOT intervention was inadequate. Overall, there is little firm
evidence from well-conducted studies to support the use of hyperbaric oxygen therapy
for necrotising fasciitis.
Fournier’s gangrene
Summary
Only the study by Hollabaugh et al 57 met entry criteria. The study was a retrospective
cohort published in 1998 that retrospectively examined records of patients treated for
Fournier’s gangrene prior to 1990. The files of 26 patients were reviewed. The mean (±
SD) age of the total population was 54.85 ± 15.2 years and all were men. The patients
were divided into two groups based on their exposure to HBOT. The authors state
explicitly that while HBOT was considered in all cases, institutional availability was the
determining factor in a particular subject’s receipt of therapy. The authors were not clear
about methods used to mask participants. They reported complete follow-up of patients.
Fourteen patients were given HBOT and comparison therapy while 12 received the
comparison therapy alone. The latter therapy consisted of debridement, urinary and
faecal diversion, and gonadal preservation or orchidectomy. Lesions were dressed with
saline, potassium permanganate, or Dakin’s solution three times a day until granulation
tissue appeared. Broad spectrum antibiotics were given in the first instance, then
modified when the results of microbial sensitivity were known.
Patients were exposed to 2.4 ATA for 90 minutes twice a day for seven days, then daily
until granulation tissue was evident or until skin grafts had taken.
Patient survival following the diagnosis of Fournier’s gangrene was better if HBOT was
administered. Of the 14 patients who received HBOT, 13 (92.9%; 95% CI = 79.4, 100%)
survived. Of the 12 patients receiving the comparison therapy alone, seven (58.3%; 95%
CI = 30.4, 86.2%) survived. The difference of 34.5% (95% CI = 3.5, 65.5%), while based
on small samples, was statistically significant at the 5% level (p = 0.0373).
This study provided evidence of a beneficial effect on survival in patients with Fournier’s
gangrene exposed to HBOT. However, there is some concern about the possibility of
systematic differences affecting the outcome. For example, the research design used
cannot control for differences in the comparison treatment between locations or over
time. More rigorous studies in different settings and examining more varied outcomes are
required to provide more generalisable evidence of effect.
General summary of necrotising soft tissue infections
Overall, conflicting results due to inadequacies in the methodological design of studies
make it difficult to arrive at a common, quantitative estimate of effect for HBOT.
However, any final judgment should be reserved until more conclusive evidence is
available.
38 Hyperbaric oxygen therapy