Hyperbaric Oxygen Therapy for Necrotizing Soft Tissue Infections: A Retrospective Cohort Analysis of Clinical Outcomes

Background: Hyperbaric oxygen therapy (HBOT) is an adjunctive therapy for necrotizing soft tissue infections (NSTIs) that remains controversial due to lack of quality clinical evidence. This retrospective cohort examines the impact of HBOT on clinical outcomes from NSTI at a single center where evaluation for HBOT is standard of care. Methods: The COVID-19 pandemic disrupted HBOT service and NSTI cases went without HBOT treatment, allowing for a comparison of treatment groups. The clinical outcomes of 253 patients with NSTI that were evaluated for HBOT were compared; 143 (56.3%) received HBOT and 110 (43.3%) did not. Results: Baseline characteristics were similar except for surface area of the wounds and distribution on the extremities. More patients in the non-HBOT group died within 90 days of admission than those in the HBOT group (5.8% vs. 15.4%, p = 0.015). Further, patients with large wounds (≥450 cm2) and those with high APACHE II scores (≥18) who underwent HBOT had significantly lower risk of death than patients who did not (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.02-0.72). Conclusion: Our study shows that there was a mortality benefit in patients with NSTI that was more significant in patients with large wounds and higher APACHE II scores.