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

Introduction: Necrotizing 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, hyper baric oxygen (HBO2)therapy and negative pressure wound therapy – had an impact on the length to definitive source control in NSTI patients who underwent HBO2.Methods: This 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 post diagnosis time until source control.Results: 58 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).Conclusion: More 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.