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Current Emergency and Hospital Medicine Reports

, Volume 6, Issue 3, pp 101–109 | Cite as

Hyperbaric Oxygen Therapy and Utilization in Infectious Disease

  • Megan Bennett
  • Colin G. Kaide
  • Elizabeth Matheson
  • Vase Bari
Infectious Disease (J Glauser, Section Editor)
Part of the following topical collections:
  1. Infectious Disease

Abstract

Purpose of Review

This review explores the multiple infectious processes in which the Undersea and Hyperbaric Medicine Society recommends hyperbaric oxygen as an adjunct to standard treatment to determine the benefit of including hyperbaric oxygen in standard treatment protocols.

Recent Findings

While the utilization of hyperbaric oxygen (HBO) has been shown to improve outcomes, there is limited research comparing it to other therapies. There are numerous case reports and retrospective analyses of the use of HBO as adjunctive treatment, but randomized control trials are glaringly absent from recent literature.

Summary

The Undersea and Hyperbaric Medicine Society recommends the utilization of HBO as an adjunct to standard treatment for necrotizing fasciitis, clostridial myonecrosis, chronic refractory osteomyelitis, malignant otitis externa, intracranial abscesses, and diabetic foot ulcers. After review of recent literature, the utilization of HBO has been shown to improve patient outcomes in the previously mentioned infectious processes when added to standard antimicrobial and surgical treatment.

Keywords

Hyperbaric oxygen Infection Osteomyelitis Necrotizing fasciitis Gas gangrene Intracranial abscess 

Notes

Compliance with Ethical Standards

Conflict of Interest

Megan Bennett, Colin G. Kaide, Elizabeth Matheson, and Vase Bari declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Henshaw IN, Simpson A. Compressed air as a therapeutic agent in the treatment of consumption, asthma, chronic bronchitis and other diseases. Edinburgh: Sutherland and Knox; 1857.Google Scholar
  2. 2.
    Churchill-Davidson I, Sanger C, Thomlinson RH. High-pressure oxygen and radiotherapy. Lancet. 1955;1:1091–5.CrossRefGoogle Scholar
  3. 3.
    •• Weaver, Lindell K. Hyperbaric oxygen therapy indications: the hyperbaric oxygen therapy committee report. 13th ed., undersea and hyperbaric medical Society, 2014. Updated guidelines for utilization of HBO published by the UHMS. Google Scholar
  4. 4.
    Hyperbaric oxygen 2013: indications and results: the hyperbaric oxygen therapy committee report. Dunkirk: undersea and hyperbaric medical society; 2013.Google Scholar
  5. 5.
    Macfarlane C, et al. Hyperbaric oxygen in trauma and surgical emergencies. J R Army Med Corps. 2000;146:85–190.CrossRefGoogle Scholar
  6. 6.
    Gottlieb SF, Solosky JA, Aubrey R, et al. Synergistic action of increased oxygen tensions and PABA-folic acid antagonists on bacterial growth. Aerosp Med. 1974;45:829.PubMedGoogle Scholar
  7. 7.
    Park M, Muhvich K, Myers R, et al. Hyperoxia prolongs the aminoglycoside-induced post antibiotic effect in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1991;35:691.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Jensen LK, et al. Suppurative inflammation and local tissue destruction reduce the penetration of cefuroxime to infected bone implant cavities. J Comp Pathol. 2017;1574:308–16.CrossRefGoogle Scholar
  9. 9.
    Norden CW, Shaffer M. Treatment of experimental chronic osteomyelitis due to staphylococcus aureus with vancomycin and rifampin. J Infect Dis. 1983;147:352.CrossRefPubMedGoogle Scholar
  10. 10.
    Smith J, Lewin C. Chemistry and mechanisms of action of the quinolone antibacterials. In: Andriole V, editor. The quinolones. New York: Acad Press; 1988. p. 23.CrossRefGoogle Scholar
  11. 11.
    Hohn D, MacKay R, Halliday B, et al. Effect of oxygen tension on microbicidal function of leukocytes in wounds and in vitro. Surg Forum. 1976;27:18.PubMedGoogle Scholar
  12. 12.
    Badwey JA, Karnovsky ML. Active oxygen species and the functions of phagocytic leucocytes. Annu Rev Biochem. 1980;49:695.CrossRefPubMedGoogle Scholar
  13. 13.
    Babior B. Oxygen-dependent microbial killing by phagocytes. NEJM. 1978;298:659.CrossRefPubMedGoogle Scholar
  14. 14.
    Kivisaari J, Niinikoski J. Effects of hyperbaric oxygenation and prolonged hypoxia on the healing of open wounds. Acta Chir Scan. 1975;141:14.Google Scholar
  15. 15.
    Quirinia A, Viidik A. The effect of hyperbaric oxygen on different phases of healing of Ischaemic flap wounds and incisional wounds in skin. Br J Plast Surg. 1995;48(8):583–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Fridovich I. Superoxide Dismutase. Molecular Mechanisms of Oxygen Activation, 1974;453–477.Google Scholar
  17. 17.
    Jonsson K, Hunt TK. Oxygen as an isolated variable influences resistance to infection. Ann Surg. 1988;208(6):783.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Calderon W, Chang N, Mathes SJ. Comparison of the effect of bacterial inoculation in Musculocutaneous and Fasciocutaneous flaps. Plast Reconstr Surg. 1986;77:785–92.CrossRefPubMedGoogle Scholar
  19. 19.
    Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51(8):344–62.  https://doi.org/10.1067/j.cpsurg.2014.06.001.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Baraket O, Triki W, Ayed K, Hmida SB, Amine M, Baccar A, et al. Facteurs thérapeutiques affectant la cicatrisation au cours des gangrènes du périnée. The Pan African Medical Journal. 2018;29:70.  https://doi.org/10.11604/pamj.2018.29.70.14669.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Flanagan CE, Daramola OO, Maisel RH, Adkinson C, Odland RM. Surgical debridement and adjunctive hyperbaric oxygen in cervical necrotizing fasciitis. Otolaryngol Head Neck Surg. 2009;140(5):730–4.  https://doi.org/10.1016/j.otohns.2009.01.014.CrossRefPubMedGoogle Scholar
  22. 22.
    Rosa, Isabel, and Francisco Guerreiro. Hyperbaric oxygen therapy for the treatment of Fournier’s gangrene: a review of 34 cases. Acta Médica Portuguesa 2015, www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6300.Google Scholar
  23. 23.
    •• Devaney B, Frawley G, Frawley L, Pilcher DV. Necrotising soft tissue infections: the effect of hyperbaric oxygen on mortality. Anaesth Intensive Care. 2015;43(6):685–92. Single study, retrospective, case controlled study which revealed significant reduction in mortality with use of HBO to treat necrotizing soft-tissue infections. PubMedGoogle Scholar
  24. 24.
    Awad MM, Bryant AE, Stevens DL, Rood JI. Virulence studies on chromosomal alpha-toxin and theta-toxin mutants constructed by allelic exchange provide genetic evidence for the essential role of alpha-toxin in Clostridium perfringens-mediated gas gangrene. Mol Microbiol. 1995;15:191–202.CrossRefPubMedGoogle Scholar
  25. 25.
    Sison-Martinez J, Cooper JS. Hyperbaric, Clostridial Myositis And Myonecrosis. StatPearls. StatPearls Publishing; 2018.Google Scholar
  26. 26.
    Peirce EI. Gas gangrene: a critique of therapy. Surg Rounds. 1984;7:17.Google Scholar
  27. 27.
    Tibbles PM, Edelsberg JS. Hyperbaric-oxygen therapy. N Engl J Med. 1996;334:1642.CrossRefPubMedGoogle Scholar
  28. 28.
    WHO. WHO Fact Sheet 312: diabetes [Internet] [cited 5/28]. Available from: http://www.who.int/nmh/publications/fact_sheet_diabetes_en.pdf.
  29. 29.
    Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.Google Scholar
  30. 30.
    Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJM. A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound Classification systems. Diabetes Care. 2001;24(1):84–8.  https://doi.org/10.2337/diacare.24.1.84.CrossRefPubMedGoogle Scholar
  31. 31.
    Huang ET, et al. A clinical practice guideline for the use of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers. Undersea Hyperb Med. 2015;42(3):2015.Google Scholar
  32. 32.
    Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12)  https://doi.org/10.1093/cid/cis346.
  33. 33.
    Hingorani A, et al. The Management of Diabetic Foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016;63((2)  https://doi.org/10.1016/j.jvs.2015.10.003.
  34. 34.
    Hinchliffe RJ, Andros G, Apelqvist J, Bakker K, Friederichs S, Lammer J, et al. A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease. Diabetes Metab Res Rev. 2012;28:179–217.CrossRefPubMedGoogle Scholar
  35. 35.
    Barnes RC. Point: hyperbaric oxygen is beneficial for diabetic foot wounds. Clin Infect Dis. 2006;43:188–92.CrossRefPubMedGoogle Scholar
  36. 36.
    Cianci P. Advances in the treatment of the diabetic foot: is there a role for adjunctive hyperbaric oxygen therapy? Wound Repair Regen. 2004;12:2–10.CrossRefPubMedGoogle Scholar
  37. 37.
    Niinikoski JH. Clinical hyperbaric oxygen therapy, wound perfusion, and transcutaneous oximetry. World J Surg. 2004;28:307–11.CrossRefPubMedGoogle Scholar
  38. 38.
    • Stoekenbroek Rm, et al. Hyperbaric oxygen for the treatment of diabetic foot ulcers: a systematic review. Eur J Vasc Endovasc Surg. 2014;47(6):647–55.  https://doi.org/10.1016/j.ejvs.2014.03.005. Systematic review of 7 RCTs comprising a total of 376 patients concluding that HBOT may be useful in treatment of diabetic foot ulcers with concomitant ischemia. CrossRefPubMedGoogle Scholar
  39. 39.
    Londahl M, Katzman P, Nilsson A, Hammarlund C. Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care. 2010;33:998–1003.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Abidia A, Laden G, Kuhan G, Johnson BF, Wilkinson AR, Renwick PM, et al. The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: a double-blind randomised-controlled trial. Eur J Vasc Endovasc Surg. 2003;25:513–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Wagner FW. The dysvascular foot: a system for diagnosis and treatment. Foot & Ankle. 1981;2(2):64–122.  https://doi.org/10.1177/107110078100200202.CrossRefGoogle Scholar
  42. 42.
    Data from Feldmeier JJ, editor. Hyperbaric oxygen 2003: indications and results: the Hyperbaric Oxygen Therapy Committee Report. Kensington (MD): Undersea and Hyperbaric Medical Society; 2003.Google Scholar
  43. 43.
    Park MK, Myers RA, Marzella L. Oxygen tensions and infections: modulation of microbial growth, activity of antimicrobial agents, and immunologic responses. Clin Infect Dis. 1992;14:720.CrossRefPubMedGoogle Scholar
  44. 44.
    Slack WK. Hyperbaric oxygen therapy in anaerobic infections. Med Times. 1978;106(10):15d(82)–6d(82). 21d(82)Google Scholar
  45. 45.
    •• Bartek J, Jakola AS, Skyrman S, Förander P, Alpkvist P, Schechtmann G, et al. Hyperbaric oxygen therapy in spontaneous brain abscess patients: a population-based comparative cohort study. Acta Neurochir (Wien). 2016;158(7):1259–67. Cohort study consisting of 40 patients with spontaneous brain abscess treated surgically; half received standard therapy (surgery and antibiotics) and half received adjuvant HBO in addition to standard therapy. Concluded that the HBO group was associated with less treatment failure and need for reoperation and improved long-term outcomes. CrossRefGoogle Scholar
  46. 46.
    Kutlay M, Colak A, Yildiz S, Demircan N, Okin ON. Stereotactic aspiration and antibiotic treatment combined with hyperbaric oxygen therapy in the management of bacterial brain abscesses. Neurosurgery. 2005;57:1140–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Chandler JR. Pathogenesis and treatment of facial paralysis due to malignant otitis externa. Ann Otol Rhinol Laryngol. 1972;81:648–58.CrossRefPubMedGoogle Scholar
  48. 48.
    Giamarellou H. Malignant otitis externa: the therapeutic evolution of a lethal infection. J Antimicrob Chemother. 1992;30:745–51.CrossRefPubMedGoogle Scholar
  49. 49.
    Gupta S, Koirala J, Khardori R, Khardori N. Infections in diabetes mellitus and hyperglycemia. Infect Dis Clin N Am. 2007;21(3):617–38. viiCrossRefGoogle Scholar
  50. 50.
    Strauss M, Aber RC, Conner GH, Baum S. Malignant external otitis: long-term (months) antimicrobial therapy. Laryngoscope. 1982;92:397–406.PubMedGoogle Scholar
  51. 51.
    Reines JM, Schindler RA. The surgical management of recalcitrant malignant external otitis. Laryngoscope. 1980;90:369–78.CrossRefGoogle Scholar
  52. 52.
    Resouly A, Payne DJH, Shaw KM. Necrotizing otitis externa and diabetes control. Lancet. 1982;1:805–6.CrossRefPubMedGoogle Scholar
  53. 53.
    Mader JT, Love JT. Malignant external otitis: cure with adjunctive hyperbaric oxygen therapy. Arch Otolaryngol. 1982;108(1):38–40.  https://doi.org/10.1001/archotol.1982.00790490040011.CrossRefPubMedGoogle Scholar
  54. 54.
    Hohn DC, MacKay RD, Halliday B, Hunt TK. The effect of O2 tension on the microbicidal function of leukocytes in wounds and in vitro. Surg Forum. 1976;27:18–20.PubMedGoogle Scholar
  55. 55.
    Hunt TK, Pai MP. The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surgery, Gynecology and Obstetrics. 1972;135:561–7.PubMedGoogle Scholar
  56. 56.
    • Davis JC, et al. Adjuvant hyperbaric oxygen in malignant external otitis. Arch Otolaryngol Head Neck Surg. 1992;118(1):89–93. Case series of 17 patients. CrossRefPubMedGoogle Scholar
  57. 57.
    Narozny W, Kuczkowski J, Stankiewicz C, Kot J, Mikaszewski B, Przewozny T. Value of hyperbaric oxygen in bacterial and fungal malignant external otitis treatment. Eur Arch Otorhinolaryngol. 2006;263(7):680–4.CrossRefPubMedGoogle Scholar
  58. 58.
    Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004;364:369.CrossRefPubMedGoogle Scholar
  59. 59.
    • Mader JT, Shirtliff ME, Bergquist SC, et al. Antimicrobial treatment of chronic osteomyelitis. Clin Orthop Relat Res 1999;47. Discusses HBO as a legitimate adjunct treatment option for osteomyelitis. Google Scholar
  60. 60.
    Mader JT, Brown GL, Guckian JC, Wells CH, Reinarz JA. A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis. 1980;142:915.CrossRefPubMedGoogle Scholar
  61. 61.
    Niinikoski J, Hunt TK. Oxygen tensions in healing bone. Surg Gynecol Obstet. 1972;134:746.PubMedGoogle Scholar
  62. 62.
    Verklin RM Jr, Mandell GL. Alteration of effectiveness of antibiotics by anaerobiosis. J Lab Clin Med. 1977;89:65.PubMedGoogle Scholar
  63. 63.
    Hart BB. Refractory Osteomyelitis. In: Feldmeier JJ, editor. Hyperbaric Oxygen 2003: Indications and Results: The Hyperbaric Oxygen Therapy Committee Report, vol. 2003. Kensington: Undersea and Hyperbaric Medical Society. p. 81.Google Scholar
  64. 64.
    Slack WK, Thomas DA, Perrins D. Hyperbaric oxygenation chronic osteomyelitis. Lancet. 1965;1:1093.CrossRefPubMedGoogle Scholar
  65. 65.
    Bingham EL, Hart GB. Hyperbaric oxygen treatment of refractory osteomyelitis. Postgrad Med. 1977;61:70.CrossRefPubMedGoogle Scholar
  66. 66.
    Morrey BF, Dunn JM, Heimbach RD, et al. Hyperbaric oxygen and chronic osteomyelitis. Clin Orthop Relat Res 1979 121.Google Scholar
  67. 67.
    Chen CY, Lee SS, Chan YS, et al. Chronic refractory tibia osteomyelitis treated with adjuvant hyperbaric oxygen: a preliminary report. Changgeng Yi Xue Za Zhi. 1998;21:165.PubMedGoogle Scholar
  68. 68.
    Maynor ML, Moon RE, Camporesi EM, et al. Chronic osteomyelitis of the tibia: treatment with hyperbaric oxygen and autogenous microsurgical muscle transplantation. J South Orthop Assoc. 1998;7:43.PubMedGoogle Scholar
  69. 69.
    Esterhai JL Jr, Pisarello J, Brighton CT, et al. Adjunctive hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis. J Trauma. 1987;27:763.CrossRefPubMedGoogle Scholar
  70. 70.
    •• Goldman RJ. Hyperbaric oxygen therapy for wound healing and limb salvage: a systematic review. PM&R. 2009;5:471–89. Systematic review discussing the strength of evidence for HBO. CrossRefGoogle Scholar
  71. 71.
    Barili F, Polvani G, Topkara VK, Dainese L, Cheema FH, Roberto M, et al. Role of hyperbaric oxygen therapy in the treatment of postoperative organ space sternal surgical site infections. World J Surg. 2007;31(8):1702–6.CrossRefPubMedGoogle Scholar
  72. 72.
    Ahmed R, Severson MA, Traynelis VC. Role of hyperbaric oxygen therapy in the treatment of bacterial spinal osteomyelitis. Journal of Neurosurgery Spine. 2009;10(1):16–20.CrossRefPubMedGoogle Scholar
  73. 73.
    • Goerger E, Honnorat E, Savini H, Coulange M, Bergmann E, Simon SP, et al. Anti-infective therapy without antimicrobials: apparent successful treatment of multidrug resistant osteomyelitis with hyperbaric oxygen therapy. ID Cases. 2016;6:60–4. Report of a case using HBO without antimicrobials in multidrug resistant osteomyelitis. PubMedGoogle Scholar
  74. 74.
    Chen CE, Shih ST, Fu TH, Wang JW, Wang CJ. Hyperbaric oxygen in the treatment of chronic refractory osteomyelitis: a preliminary report. Chang Gung Med J. 2003;26(2):114–21.PubMedGoogle Scholar
  75. 75.
    Cierny G, Mader J, Pennick J. A clinical staging system for adult osteomyelitis. Contemp Orthop. 1985;10:17.Google Scholar
  76. 76.
    Mader J, Davis J. General concept of osteomyelitis. New York: Churchill Livingston; 1995.Google Scholar
  77. 77.
    Strauss M. The role of hyperbaric oxygen in the surgical management of chronic refractory osteomyelitis. In Hyperbaric surgery. Flagstaff: Best Publishing, 2002.Google Scholar
  78. 78.
    Bakker D. Clostridial Myonecrosis. In: Bakker D, Cramer F, editors. Hyperbaric surgery. Flagstaff: Best Publ. p. 2002.Google Scholar
  79. 79.
    Davis JC, Heckman JD, DeLee JC, et al. Chronic non-hematogenous osteomyelitis treated with adjuvant hyperbaric oxygen. J Bone Joint Surg Am. 1986;68:1210.CrossRefPubMedGoogle Scholar
  80. 80.
    Mandell GL, Douglas RG, Bennett JE, et al. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. ed 6th ed. Philadelphia: Elsevier/Churchill Livingstone; 2005.Google Scholar
  81. 81.
    Priest D, Peacock JE Jr. Hematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes. South Med J. 2005;98(9):854–62.CrossRefPubMedGoogle Scholar
  82. 82.
    Warriner R, Hopf H. Enhancement of healing in selected problem wounds. In: Feldmeier J, editor. Hyperbaric oxygen 2003: indications and results: the hyperbaric oxygen therapy committee report. Kensington: Undersea and Hyperbaric Medical Society; 2003. p. 41.Google Scholar
  83. 83.
    •• Kaide C, Khandelwal S. Hyperbaric oxygen: applications in infectious disease. Emerg Med Clin North Am. 2008;26(2):571–95. Original review article written by coauthor, Dr. Kaide. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Megan Bennett
    • 1
  • Colin G. Kaide
    • 2
  • Elizabeth Matheson
    • 1
  • Vase Bari
    • 1
  1. 1.MetroHealth/CCF/CWRU Emergency Medicine ResidencyClevelandUSA
  2. 2.Department of Emergency Medicine, Wexner Medical CenterThe Ohio State UniversityColumbusUSA

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