Invasive Soft Tissue Infections and Hyperbaric Oxygen Therapy: A Historical Comment from Chicago.

Invasive soft tissue infections come with various bacteria, presentations, and underlying conditions. However, once established in full flesh-eating mode, death is usually imminent without aggressive surgical intervention that may include post-op emergency hyperbaric oxygen.

An 18-year-old basketball star saw his doctor after a fall on the court. He was evaluated and sent home with antibiotics, a bruised rump, and a low-grade temperature. A few days later, he was comatose in bed with a swollen right leg. A gas-forming infection was found at surgery, tracking all the way up into his spinal cord on imaging. Antibiotics and hyperbaric oxygen treatments were started immediately post-surgery. The patient received five hyperbaric oxygen treatments over three days and recovered consciousness after getting off life support.

He was left blind and with a paralyzed right lower extremity due to the aggressive advance of the infection. Having said that, repeat CT scanning showed the disappearance of all gas in the spinal column. Hyperbaric oxygen is a life-saving adjunct in these infections.

The bacteria in these infections thrive in the absence of oxygen. They are inhibited when the hyperbaric chamber delivers oxygen to the infected tissues.

Over a 10 period, we saw 17 life-threatening soft tissue infections at Edgewater Hospital. Nine of nine survived who got surgery within 24 hours of onset and HBO within 48 hrs. When surgery and HBO were delayed beyond 48 and 72 hours, respectively, the survival rate dropped to four of seven. The historical survival rates for this disease were about 35%. Most of the patients in our experience were over 50. They typically had underlying conditions like diabetes, renal disease, and a smoking history.

About a third required amputation, but two-thirds got by with a lower level below joint amputation in that subset. Additionally, animal studies support the benefit of HBO in these infections.

The French Columnist