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What is
Necrotizing Soft Tissue?
An intracranial abscess, also known as a brain abscess, is a serious and potentially life-threatening condition characterized by a localized collection of pus within the brain tissue. This infection can cause inflammation, swelling, and damage to surrounding brain structures.
Common Sources of
Necrotizing Soft Tissue
Include:
Key characteristics of necrotizing soft tissue infections include:
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Severe pain disproportionate to visible skin changes
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Rapid progression of symptoms
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Erythema (redness) and edema (swelling) extending beyond the visible infection area
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Skin discoloration (purple or bluish patches)
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Blisters or bullae formation
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Crepitus (crackling sensation when touching the skin)
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Systemic symptoms (fever, tachycardia, hypotension)
NSTIs can be categorized based on the causative organisms:
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Type I (polymicrobial): Caused by a mixture of aerobic and anaerobic bacteria
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Type II (monomicrobial): Usually caused by Group A Streptococcus, sometimes with Staphylococcus aureus
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Type III: Caused by Vibrio vulnificus or other marine organisms
Factors that increase the risk of necrotizing soft tissue infections include:
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Diabetes mellitus
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Obesity
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Immunosuppression
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Chronic alcohol abuse
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Intravenous drug use
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Recent surgery or trauma
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Chronic wounds or skin ulcers
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Advanced age
Early diagnosis and aggressive treatment of NSTIs are crucial for improving outcomes and reducing mortality rates.
How HBOT Helps with
Necrotizing Soft Tissue
Hyperbaric Oxygen Therapy (HBOT) can be a valuable adjunctive treatment for necrotizing soft tissue infections. Here’s how HBOT helps:
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Enhanced Tissue Oxygenation: HBOT dramatically increases oxygen levels in tissues, supporting healing and reducing hypoxia-induced damage.
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Improved Antibiotic Efficacy: HBOT can potentiate the effects of certain antibiotics, particularly aminoglycosides and vancomycin.
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Enhanced White Blood Cell Function: HBOT improves the oxygen-dependent killing capacity of leukocytes, aiding in infection control.
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Reduced Edema: The hyperbaric environment helps reduce tissue swelling, improving microcirculation and tissue perfusion.
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Promotion of Angiogenesis: HBOT stimulates the formation of new blood vessels, improving long-term blood supply to affected areas.
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Toxin Inhibition: HBOT can inhibit the production of certain bacterial toxins, particularly alpha-toxin produced by Clostridium perfringens.
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Preservation of Marginally Viable Tissue: By improving oxygenation, HBOT can help preserve tissue that might otherwise become necrotic.
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Enhanced Fibroblast Activity: Increased oxygen levels stimulate fibroblast proliferation and collagen production, crucial for wound healing.
What Happens in Our Bodies During HBOT for
Necrotizing Soft Tissue
During HBOT treatment for necrotizing soft tissue infections, several physiological processes occur:
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Hyperoxia Induction: Blood oxygen levels increase dramatically, with oxygen dissolved directly in the plasma, reaching levels up to 20 times normal.
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Tissue Oxygenation: The increased oxygen levels in the blood allow oxygen to penetrate deeper into tissues, reaching areas that may have been deprived due to the infection or compromised blood supply.
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Vasoconstriction and Edema Reduction: HBOT causes vasoconstriction in normal tissues, which can help reduce edema without compromising oxygen delivery to infected areas.
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Enhanced Phagocytosis: The hyperbaric environment enhances the ability of white blood cells to engulf and destroy bacteria.
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Antibiotic Synergy: HBOT can enhance the uptake and efficacy of certain antibiotics, particularly in hypoxic tissues.
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Modulation of Inflammatory Mediators: HBOT affects the production and activity of various cytokines and inflammatory mediators, helping to optimize the healing environment.
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Stimulation of Fibroblast Activity: Increased oxygen levels stimulate fibroblast activity, which is crucial for tissue repair and wound healing.
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Free Radical Scavenging: While HBOT increases oxygen levels, it also enhances the body’s antioxidant defenses, helping to mitigate oxidative stress.
Protocol
HBOT treatment for necrotizing soft tissue infections typically involves pressurizing the chamber to 2.0-2.5 atmospheres absolute (ATA) for about 90-120 minutes, with treatments repeated twice daily in severe cases. The exact protocol may vary based on the patient’s condition and response to treatment.
It’s important to note that while HBOT can be a valuable adjunctive therapy for necrotizing soft tissue infections, it should be used in conjunction with standard treatments, including prompt surgical debridement, broad-spectrum antibiotic therapy, and intensive supportive care. The effectiveness of HBOT may be most pronounced when used early in the course of treatment and in combination with other therapeutic modalities.
References
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Wilkinson, D., & Doolette, D. (2004). Hyperbaric oxygen treatment and survival from necrotizing soft tissue infection. Archives of Surgery, 139(12), 1339-1345.
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Shaw, J. J., & Psoinos, C. (2014). Necrotizing soft tissue infections: A review. Surgical Infections, 15(2), 133-138.
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Jallali, N., Withey, S., & Butler, P. E. (2005). Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis. The American Journal of Surgery, 189(4), 462-466.
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Korhonen, K. (2000). Hyperbaric oxygen therapy in acute necrotizing infections with a special reference to the effects on tissue gas tensions. Annales Chirurgiae et Gynaecologiae Supplementum, (214), 7-36.
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Thom, S. R. (2011). Hyperbaric oxygen: its mechanisms and efficacy. Plastic and Reconstructive Surgery, 127(Suppl 1), 131S-141S.
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Devaney, B., Frawley, G., Frawley, L., & Pilcher, D. V. (2015). Necrotising soft tissue infections: the effect of hyperbaric oxygen on mortality. Anaesthesia and Intensive Care, 43(6), 685-692.
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Mathieu, D., Marroni, A., & Kot, J. (2017). Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving and Hyperbaric Medicine, 47(1), 24-32.
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Stevens, D. L., & Bryant, A. E. (2017). Necrotizing soft-tissue infections. New England Journal of Medicine, 377(23), 2253-2265.