Necrotizing fasciitis

Frequency

Rare, only 5,500 cases across Europe in 2003-4, however in increase.

Characteristics

Begins with a common streptococcal infection of the skin or throat. The infection quickly develops into toxic shock syndrome. The infection is often recognized too late. High mortality 20% (5% -44%) unchanged in the past 60 years.

Purpose of processing

Avoid amputation and death by rapid surgery.

Clinical studies

The use of HBOT is controversial. 5 studies have been published, 3 show a decrease in mortality if HBOT is added to standard treatment. If all the patients are added, the mortality is 28% with and 48% without OHB. The careful work of Wilkinson and Doolette shows that we must treat 3 patients to save one and that the number of amputations is reduced. A more recent study finds that HBOT tends to decrease mortality and amputations . A review of 14 HBOT centers offering advanced hyperbaric intensive care find a superior efficacy of HBOT for severe cases .

Practical use of HBO

In general, 2-3 treatments of 90 minutes are made during the first 24 to 48 hours. We continue with 1-2 treatments per day until the infection is under control. We treat at 250-300 kPa. The average number of treatments is around 8 treatments per patient.