Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark.
Department of Anaesthesia and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, Australia.
Diving Hyperb Med. 2021 Mar 31;51(1):34-43. doi: 10.28920/dhm51.1.34-43.
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.
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.
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.
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.
外科干预、广谱抗生素和重症监护支持是治疗坏死性软组织感染（NSTI）的标准治疗方法。高压氧治疗（HBOT）可能是一种有用的辅助治疗方法，已经使用了近 60 年，但它的疗效仍不清楚，也没有进行系统评价。本研究旨在系统回顾和综合现有最高水平的临床证据，以支持或反驳 HBOT 治疗 NSTI 的应用。
本研究前瞻性注册（PROSPERO；CRD42020148706）。检索 MEDLINE、EMBASE、CENTRAL 和 CINAHL 数据库，以确定报告 NSTI 患者接受 HBOT 与未接受 HBOT 治疗结局的研究。院内死亡率是主要结局。使用随机效应模型汇总比值比（OR）。
共检索到 486 篇文献，其中 31 篇纳入定性分析，21 篇纳入荟萃分析。对 48744 例 NSTI 患者的荟萃分析（1237 例（2.5%）HBOT 与 47507 例（97.5%）非 HBOT）显示，共有 48744 例患者发生院内死亡（47844 例），院内死亡率为 9.8%，HBOT 组的合并 OR 为 0.44（95%CI 0.33-0.58）。对于主要截肢，HBOT 组的合并 OR 为 0.60（95%CI 0.28-1.28）。这些研究中氧气剂量的报告不完全。
对非随机对照数据的荟萃分析表明，接受 HBOT 治疗的 NSTI 患者在主要事件中死亡的可能性降低，并且可能不太需要进行主要截肢。最有效的氧剂量仍不清楚。
