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Meta-Analysis
. 2021 Mar 31;51(1):34-43.
doi: 10.28920/dhm51.1.34-43.

Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A systematic review and meta-analysis

Morten Hedetoft  1   2   3 , Michael H Bennett  2 , Ole Hyldegaard  1
Affiliations
Meta-Analysis

Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A systematic review and meta-analysis

Morten Hedetoft et al. Diving Hyperb Med. .

Abstract

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.

Keywords: Evidence; Necrotizing infections; Systematic review.

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Conflict of interest statement

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).

Figures

Figure 1
Figure 1
PRISMA flowchart for the review. HBOT – hyperbaric oxygen treatment
Figure 2
Figure 2
Forrest plot of the pooled effect of HBOT on in-hospital mortality. A random-effects model was used for meta-analysis
Figure 3
Figure 3
Funnel plot on primary outcome; in-hospital mortality
Figure 4
Figure 4
Forrest plot of the pooled effect of HBOT on risk of major amputation. A random-effects model was used for meta-analysis
Appendix 7 – In-hospital mortality by date of study
Appendix 7 – In-hospital mortality by date of study
Appendix 8 – Historical controls VS. Contemporary controls
Appendix 8 – Historical controls VS. Contemporary controls
Appendix 9 – Number of surgical debridements
Appendix 9 – Number of surgical debridements
Appendix 10 – Hospital length of stay
Appendix 10 – Hospital length of stay
See this image and copyright information in PMC

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