Table 5.
Studies of Hyperbaric Oxygen in Necrotizing Soft Tissue Infections and Sepsis
| Author | Study design | Population | Sample size | Control | Intervention | Adjustment | Mortality or survival (HBO vs. none) |
|---|---|---|---|---|---|---|---|
| Meta-analyses/systematic reviews | |||||||
| Levett et al. (2015) | Meta-analysis | All | n = 673 studies reviewed; 0 studies included | N/A | Not described | N/A | Not described |
| Wang et al. (2003) | Systematic review | All | n = 17 studies for gas gangrene; n = 9 progressive necrotizing infection | N/A | n = 4 observational studies, 13 case series: 2–3 ATM, 4 to 44 tx; N = 6 observational studies, 3 case series: 2–3 ATM, usually 90 min/tx, for 5–7 tx | N/A | For gas gangrene, summary estimates could not be derived; for progressive necrotizing infection, there may be of benefit; in general, very difficult to generate conclusion because of poor quality of studies |
| Observational trials | |||||||
| Shaw et al. (2014) | Retrospective, multiple centers (n = 14), UHC | Predominantly Type I (FG, NF, gas gangrene) | 1,583 | n = 1,466 | n = 117, not described | Yes, multi-variable | In-hospital survival: aOR 10.6 (5.2–25.1); 95% vs. 88%, p = 0.028 |
| Li et al. (2014) | Retrospective | Type I (FG) | 28 | n = 12 | n = 16, 2.5 ATM, 90–120 min/tx, twice daily | None | In-hospital survival: 14/16 (87.5%) vs. 8/12(66%), p < 0.05 |
| Massey et al. (2012) | Retrospective | Mixed as extremity and perineum | 80 | n = 48 | n = 32, 2.8 ATM, 45 min/tx, 1–8 treatments | None | In-hospital survival: 84.4% vs. 81.2%, p = 0.77; no difference by location in perineum or extremity |
| Mehl et al. (2010) | Retrospective, single center | Predominantly Type I (FG, NF, gas gangrene) | 40 | n = 14 | n = 26, 2.0–2.8 ATM, 120 min/tx, 6–20 tx | None | In-hospital survival: 23/26 (88.5%) vs. 9/14 (64.3%), p = 0.07 |
| Hassan et al. (2010) | Retrospective, single center | Not determined | 67 | n = 38 | n = 29 | None | NS |
| Wolf et al. (2010) | Retrospective, single center | Head and neck | 17 | n = 4 | n = 13, not described | None | In-hospital: 17/17(100%) for entire cohort |
| George et al. (2009) | Retrospective, comparison of 2 centers | Type I (FG, mixed, poly-microbial) in 36%; Type II (strep) in 28%; Type III (clostridial in 5 patients) | 78 | n = 30 | n = 48, 3 ATM, 90 min/tx, 3 tx/d then 2 tx/d, until infection resolved | Yes, multi-variable | 44/48 (91.7%) vs. 26/30 (86.7%), p = 0.48; aOR 0.98 (0.18–5.42) |
| Krenk et al. (2007) | Retrospective, single center | Head and neck | 19 | n = 7 | n = 11, 2.8 ATM, 90 min/tx, 2–3 dives/day, until no necrosis | None | In-hospital survival: 11/11 (1005) vs. 2/8(25%), p < 0.001 |
| Ayan et al. (2005) | Retrospective, single center | Type 1 (FG) | 41 | n = 23 | n = 18, 2.5 ATM, 90 min/d, 3–10 d of treatment | None | In-hospital survival: 18/18 (100%) vs. 14/23 (61%), p = 0.013 |
| Mindrup et al. (2005) | Retrospective, single center | Type 1 (FG) | 42 | n = 16 | n = 26, 2.4–3 ATM, 30–90 min/tx, 1–3 dives/day, 2–26 treatments | None | In-hospital survival: 19/26 (72.1%) vs. 14/16 (87.5%), p = 0.44 |
| Sugihara et al. (2004) | Retrospective, single center | Not described, assumed to be all types | 23 | n = 9 | n = 14, 2.5 ATM, 90 min/tx, unknown daily frequency, until symptoms resolved | None | Not described |
| Wilkinson et al. (2004) | Retrospective, single center | Type I (FG, mixed, poly-microbial) | 44 | n = 11 | n = 33, 2.8 ATM, 60 min/tx, 3 tx/d then 2 tx/d, until infection resolved | Yes, multi-variable | In-hospital survival: 31/33 (94%) vs. 7/11 (64%), p = 0.03, univariable; aOR 8.9 (1.3–58) |
| Hollabaugh et al. (1998) | Retrospective, single center | Predominantly Type I (FG, NF, gas gangrene) | 26 | n = 12 | n = 12, 2.4 ATM, 90 min/tx, 2 tx/d for at least 7 d, then until therapy terminated | None | 13/14 (93%) vs. 7/12 (58%), p = 0.04; aOR 11, no 95% CI or p value provided |
| Shupak et al. (1997) | Retrospective, single center | ? | 37 | n = 12 | n = 25; 2.5 ATM, 45 min/t, 2 t/d, until infection resolved | None | In-hospital survival: 9/25 (67%) vs. 3/12 (75%), p = 0.71 |
HBO = hyperbaric oxygen; NA = not available; ATM = atmospheres; UHC = __________; FG = Fournier gangrene; NF = necrotizing fasciitis; aOR = adjusted odds ratio; CI = confidence interval.