Hyperbaric oxygen treatment and survival from necrotizing soft tissue infection

Wilkinson, D and Doolette, D (2004) Hyperbaric oxygen treatment and survival from necrotizing soft tissue infection. JAMA Surgery, 139 12: 1339-1345. doi:10.1001/archsurg.139.12.1339


Author Wilkinson, D
Doolette, D
Title Hyperbaric oxygen treatment and survival from necrotizing soft tissue infection
Journal name JAMA Surgery   Check publisher's open access policy
ISSN 2168-6254
2168-6262
Publication date 2004-12-01
Sub-type Article (original research)
DOI 10.1001/archsurg.139.12.1339
Open Access Status DOI
Volume 139
Issue 12
Start page 1339
End page 1345
Total pages 7
Place of publication Chicago, IL, United States
Publisher American Medical Association
Language eng
Abstract Hypothesis: Necrotizing soft tissue infection (NSTI) refers to a spectrum of infective diseases characterized by necrosis of the deep soft tissues. Features of manifestation and medical management have been analyzed for association with outcome. The use of hyperbaric oxygen (HBO2) therapy has been recommended as an adjunctive treatment but remains controversial. Design: Retrospective cohort study. Setting: A major tertiary hospital. Patients: All patients admitted with a diagnosis of NSTI across a 5-year period. Intervention: Features of manifestation and medical management were analyzed for their association with survival to hospital discharge. Long-term survival was analyzed for the intervention of HBO2 therapy. Main Outcome Measures: Primary outcome was survival to hospital discharge. Secondary outcomes were limb salvage and long-term survival after hospital discharge. Results: Forty-four patients were reviewed, with 6 deaths (14%). Survival was less likely in those with increased age, renal dysfunction, and idiopathic etiology of infection and in those not receiving HBO2 therapy. Logistic regression determined the strongest association with survival was the intervention of HBO2 therapy (P=.02). Hyperbaric oxygen therapy increased survival with an odds ratio of 8.9 (95% confidence interval, 1.3-58.0) and a number needed to treat of 3. For NSTI involving an extremity, HBO2 therapy significantly reduced the incidence of amputation (P=.05). Survival analysis revealed an improved long-term outcome for the HBO2 group (P=.002). Conclusion: Hyperbaric oxygen therapy was associated with improved survival and limb salvage and should be considered in the setting of NSTI.
Keyword Surgery
Fasciitis
Therapy
Mortality
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Wed, 17 Oct 2007, 13:15:24 EST