Adjunctive hyperbaric oxygen therapy for poststernotomy deep sternal wound infection, mediastinitis, and sternal...

Poststernotomy deep sternal wound infection (DSWI), mediastinitis, and sternal osteomyelitis are uncommon but serious complications of cardiac surgery. Hyperbaric oxygen therapy (HBOT) has been used as an adjunct in selected complex infections, but its incremental role within contemporary cardiac-surgery pathways is uncertain.

We conducted a scoping review according to JBI guidance and PRISMA-ScR reporting standards. MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched from 1 January 1999 to 2 June 2026. We included adult and pediatric clinical sources and relevant experimental mediastinitis models. Two reviewers independently screened sources and charted data. Design-matched appraisal tools were used only to contextualize methodological limitations. Because populations, infection phenotypes, cointerventions, comparators, and endpoints differed substantially, findings were stratified and synthesized narratively; no meta-analysis was performed.

Eleven sources met the inclusion criteria: six adult cohorts/series, one pediatric cohort, two single-patient reports, and two MRSA rat models (179 adults in cohorts/series, 53 pediatric patients, two additional adult single-patient reports, and 103 animals). These sources represent distinct evidence strata and were not interpreted as one clinical entity. HBOT was always embedded within multimodal care, including surgery, antibiotics, NPWT, and/or reconstruction. Only two small adult studies provided direct nonrandomized HBOT-versus-non-HBOT comparisons. Li et al. compared sequential treatment eras and was analyzed separately. The evidence cannot isolate an incremental HBOT effect.

Evidence for adjunctive HBOT remains sparse and highly heterogeneous. Current studies do not establish a causal or incremental benefit beyond surgery, source control, antibiotics, NPWT, and reconstruction. HBOT should not be routinely adopted or allowed to delay definitive surgical management. Its role, if any, is limited to carefully selected adjunctive use within multidisciplinary pathways and prospective evaluation.