PMID- 33761539
OWN - NLM
STAT- MEDLINE
DCOM- 20210326
LR  - 20210516
IS  - 1833-3516 (Print)
IS  - 2209-1491 (Electronic)
IS  - 1833-3516 (Linking)
VI  - 51
IP  - 1
DP  - 2021 Mar 31
TI  - Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A 
      systematic review and meta-analysis.
PG  - 34-43
LID - 10.28920/dhm51.1.34-43 [doi]
AB  - INTRODUCTION: Surgical intervention, broad-spectrum antibiotics and intensive 
      care support are the standard of care in the treatment of necrotising soft-tissue 
      infections (NSTI). Hyperbaric oxygen treatment (HBOT) may be a useful adjunctive 
      treatment and has been used for almost 60 years, but its efficacy remains unknown 
      and has not been systematically appraised. The aim was to systematically review 
      and synthesise the highest level of clinical evidence available to support or 
      refute the use of HBOT in the treatment of NSTI. METHODS: The review was 
      prospectively registered (PROSPERO; CRD42020148706). MEDLINE, EMBASE, CENTRAL and 
      CINAHL were searched for eligible studies that reported outcomes in both HBOT 
      treated and non-HBOT treated individuals with NSTI. In-hospital mortality was the 
      primary outcome. Odds ratio (ORs) were pooled using random-effects models. 
      RESULTS: The search identified 486 papers of which 31 were included in the 
      qualitative synthesis and 21 in the meta-analyses. Meta-analysis on 48,744 
      patients with NSTI (1,237 (2.5%) HBOT versus 47,507 (97.5%) non-HBOT) showed 
      in-hospital mortality was 4,770 of 48,744 patients overall (9.8%) and the pooled 
      OR was 0.44 (95% CI 0.33-0.58) in favour of HBOT. For major amputation the pooled 
      OR was 0.60 (95% CI 0.28-1.28) in favour of HBOT. The dose of oxygen in these 
      studies was incompletely reported. CONCLUSIONS: Meta-analysis of the non-random 
      comparative data indicates patients with NSTI treated with HBOT have reduced odds 
      of dying during the sentinel event and may be less likely to require a major 
      amputation. The most effective dose of oxygen remains unclear.
CI  - Copyright: This article is the copyright of the authors who grant Diving and 
      Hyperbaric Medicine a non-exclusive licence to publish the article in electronic 
      and other forms.
FAU - Hedetoft, Morten
AU  - Hedetoft M
AD  - Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, 
      University of Copenhagen, Denmark.
AD  - Department of Anaesthesia and Hyperbaric Medicine, Prince of Wales Hospital, 
      Sydney, Australia.
AD  - Corresponding author: Dr Morten Hedetoft, Department of Anaesthesia, 
      Rigshospitalet, University of Copenhagen, Blegdamsvej 8, 2100 Copenhagen, 
      Denmark, morten.friis.fiskbaek.hedetoft@regionh.dk.
FAU - Bennett, Michael H
AU  - Bennett MH
AD  - Department of Anaesthesia and Hyperbaric Medicine, Prince of Wales Hospital, 
      Sydney, Australia.
FAU - Hyldegaard, Ole
AU  - Hyldegaard O
AD  - Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, 
      University of Copenhagen, Denmark.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - Australia
TA  - Diving Hyperb Med
JT  - Diving and hyperbaric medicine
JID - 101282742
RN  - 0 (Anti-Bacterial Agents)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Anti-Bacterial Agents
MH  - Debridement
MH  - Humans
MH  - *Hyperbaric Oxygenation
MH  - Oxygen
MH  - *Soft Tissue Infections/therapy
PMC - PMC8081587
OTO - NOTNLM
OT  - Evidence
OT  - Necrotizing infections
OT  - Systematic review
COIS- Conflict of interest and funding: No conflicts of interest were declared. MH was 
      granted by Rigshospitalet's Research Foundation (grant no. R167-A7352-B3897), 
      Knud and Edith Eriksen's Foundation, Wedellsborg Foundation and King Christian 
      X's Foundation. Moreover, the study was supported by the projects of PERMIT 
      (grant number 8113-00009B) funded by Innovation Fund Denmark and EU Horizon 2020 
      under the frame of ERA PerMed (project 2018-151) and PERAID (grant number 
      8114-00005B) funded by Innovation Fund Denmark and Nordforsk (project no. 90456).
EDAT- 2021/03/25 06:00
MHDA- 2021/03/27 06:00
PMCR- 2021/03/31
CRDT- 2021/03/24 20:25
PHST- 2020/09/07 00:00 [received]
PHST- 2020/10/29 00:00 [accepted]
PHST- 2021/03/24 20:25 [entrez]
PHST- 2021/03/25 06:00 [pubmed]
PHST- 2021/03/27 06:00 [medline]
PHST- 2021/03/31 00:00 [pmc-release]
AID - 10.28920/dhm51.1.34-43 [doi]
PST - ppublish
SO  - Diving Hyperb Med. 2021 Mar 31;51(1):34-43. doi: 10.28920/dhm51.1.34-43.