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[Hyperbaric oxygen therapy for necrotizing soft tissue infections: contra].
1Abteilung Unfallchirurgie und Orthopädie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland. ChristianWilly@Bundeswehr.org
Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|November 10, 2012
Summary
Hyperbaric oxygen therapy (HBOT) shows no confirmed therapeutic benefit for necrotizing fasciitis (NF) patients. Delaying surgical treatment for HBOT is not advisable due to lack of evidence and limited access in Germany.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Hyperbaric Medicine
Context:
- Necrotizing soft tissue infections (NSTI) are severe bacterial infections requiring prompt treatment.
- Hyperbaric oxygen therapy (HBOT) is considered an adjuvant treatment for certain NSTIs.
- German health insurance covers HBOT for clostridial myonecrosis but not for necrotizing fasciitis (NF) or Fournier's gangrene.
Purpose:
- To evaluate the clinical benefits and cons of HBOT for necrotizing fasciitis (NF).
- To assess the availability of intensive care hyperbaric oxygen chambers (HOC-IC) in Germany for NSTI treatment.
- To review existing literature and German healthcare policy regarding HBOT for NF.
Summary:
- A literature review of 250 articles (2,556 NSTI patients) found limited evidence, with only ten retrospective studies comparing HBOT to non-HBOT, none verifying HBOT benefit in NF.
- Germany has only nine HOC-ICs, and patient data is not consistently collected in studies, despite a long-standing need for higher evidence levels.
- Published studies do not confirm HBOT's therapeutic benefit for NF; delaying surgery for HBOT is unacceptable, and comprehensive care is not feasible in Germany.
Impact:
- Current evidence does not support the use of HBOT for necrotizing fasciitis, potentially leading to delayed surgical intervention.
- Limited availability of intensive care hyperbaric oxygen facilities in Germany restricts widespread HBOT application for NF.
- High costs associated with HBOT (8,000-25,000 €/patient) and lack of insurance reimbursement further challenge its adoption for NF treatment.
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