Hart BB
Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc. Date of publication 2021 Jan 1;volume 48(3):297-321.
1. Undersea Hyperb Med. 2021 Third Quarter;48(3):297-321.
Hyperbaric oxygen for refractory osteomyelitis.
Hart BB(1).
Author information:
(1)Department of Emergency Medicine and Research Institute of Hyperbaric Medicine
and Science, Yonsei University Wonju College of Medicine, Wonju, Republic of
Korea.
Refractory osteomyelitis is defined as a chronic osteomyelitis that persists or
recurs after appropriate interventions have been performed or where acute
osteomyelitis has not responded to accepted management techniques [1]. To date,
no randomized clinical trials examining the effects of hyperbaric oxygen (HBO2)
therapy on refractory osteomyelitis exist, and the number of new osteomyelitis
clinical trials conducted over the past decade has been limited. However, based
on a comprehensive review of the scientific literature, the addition of HBO2
therapy to routine surgical and antibiotic treatment of previously refractory
osteomyelitis appears to be both safe and ultimately improves infection
resolution rates. In most cases, the best clinical results are obtained when HBO2
treatment is administered in conjunction with culture-directed antibiotics and
initiated soon after clinically indicated surgical debridement. Where extensive
surgical debridement or removal of fixation hardware is relatively
contraindicated (e.g., cranial, spinal, sternal, or pediatric osteomyelitis), a
trial of culture-directed antibiotics and HBO2 therapy prior to undertaking more
than limited surgical interventions provides a reasonable prospect for
osteomyelitis cure. HBO2 therapy is ordinarily delivered on a once daily basis,
five-seven days per week, for 90-120 minutes using 2.0-3.0 atmospheres absolute
(ATA) pressure. Where prompt clinical improvement is seen, the existing regimen
of antibiotics and HBO2 therapy should be continued for approximately four to six
weeks. Typically, 20-40 HBO2 sessions are required to achieve sustained
therapeutic benefit. In contrast, if prompt clinical response is not noted or
osteomyelitis recurs after this initial treatment period, then continuation of
the current antibiotic and HBO2 treatment regimen is unlikely to be effective.
Instead, clinical management strategies should be reassessed and additional
surgical debridement and/or modification of antibiotic therapy considered.
Subsequent reinstitution of HBO2 therapy will again help maximize the overall
chances for treatment success in these persistently refractory patients.
Copyright© Undersea and Hyperbaric Medical Society.
PMID: 34390634 [Indexed for MEDLINE]
Conflict of interest statement: The author of this paper declares no conflicts of
interest exist with this submission.
