HBOT for Necrotizing Infections

The principal treatment for Progressive Necrotizing Infections (Necrotizing Fasciitis) is surgical debridement and systemic antibiotics. HBO therapy is recommended as an adjunct only in those settings where mortality and morbidity are expected to be high despite aggressive standard treatment. Progressive necrotizing fasciitis is a relatively rare infection. It is usually a result of a group A streptococcal infection beginning with severe or extensive cellulitis that spreads to involve the superficial and deep fascia, producing thrombosis of the subcutaneous vessels and gangrene of the underlying tissues. A cutaneous lesion usually serves as a portal of entry for the infection, but sometimes no such lesion is found. It may be confused with Clostridial infection though seldom produces gas in the tissues. The histologic hallmark is extensive inflammation and necrosis of the subcutaneous fat, fascia and muscle. Numerous bacterial types may produce bullous lesions with foul or fermented aroma. HYPERBARIC oxygen may be a beneficial adjunct for a subset of patients with anaerobic gram negative necrotizing fasciitis. The recommended HBO treatment protocol is 90 minutes at 2.5 ATA every 8 hours for the first day in conjunction with surgical debridement of infected and necrotic tissue, and then twice daily for a maximum of 10 treatments.