The Role of Hyperbaric Oxygen Therapy in the Treatment of Surgical Site Infections: A Narrative Review

Abstract

Surgical site infections (SSIs) are among the most prevalent postoperative complications, with significant morbidity and mortality worldwide. In the past half century, hyperbaric oxygen therapy (HBOT), the administration of 100% oxygen intermittently under a certain pressure, has been used as either a primary or alternative therapy for the management or treatment of chronic wounds and infections. This narrative review aims to gather information and evidence supporting the role of HBOT in the treatment of SSIs. We followed the Scale for the Quality Assessment of Narrative Review Articles (SANRA) guidelines and scrutinized the most relevant studies identified in Medline (via PubMed), Scopus, and Web of Science. Our review indicated that HBOT can result in rapid healing and epithelialization of various wounds and has potential beneficial effects in the treatment of SSIs or other similar infections following cardiac, neuromuscular scoliosis, coronary artery bypass, and urogenital surgeries. Moreover, it was a safe therapeutic procedure in most cases. The mechanisms related to the antimicrobial activity of HBOT include direct bactericidal effects through the formation of reactive oxygen species (ROS), the immunomodulatory effect of HBOT that increase the antimicrobial effects of the immune system, and the synergistic effects of HBOT with antibiotics. We emphasized the essential need for further studies, especially randomized clinical trials and longitudinal studies, to better standardize HBOT procedures as well as to determine its full benefits and possible side effects.

Lower Extremity Trauma: A Multidimensional Reconstructive Approach with Hyperbaric Oxygen Therapy

“…HBO therapy, applied according to the Amsterdam Protocol, has been shown to be effective in limiting the incidence of wound infection and the spread of refractory infections. The ischemic environment after trauma and cell death poses a risk for the development of anaerobic infection [ 20 , 21 ]; HBOT promotes aerobic metabolism by providing a high supply of oxygen and resistance to anaerobic bacteria [ 22 ]. Delaying the start of HBO therapy is also associated with a significantly higher infection rate and highly complex reconstructions.…”

Reactive Oxygen Species (ROS)-Mediated Antibacterial Oxidative Therapies: Available Methods to Generate ROS and a Novel Option Proposal

“…Very recently, it has been reported that wild strains of Pseudomonads, Burkholderias, and Stenotrophomonads stopped growing under hyperbaric conditions at a pressure of 2.8 ATA of 100% oxygen [230]. HBOT is used as a primary or alternative method for the treatment of infections such as diabetic foot infection, surgical site infections, gas gangrenes, osteomyelitis, and necrotizing compartments [229]. In addition to the bactericidal effects, HBOT suppresses the production of clostridia alpha toxin in gas gangrene diseases.…”

“…Studies finalized to investigating the application of HBOT in treatment of different surgical site infections (SSI)[229].…”

Chronic suppurative osteomyelitis secondary to endodontic treatment and posterior extraction of mandibular third molars: An uncommon case

“…As a result, there is an increase in the formation of oxygen radicals, resulting in the elimination of anaerobic and facultative anaerobic microorganisms. 16 Besides, this process favours angiogenesis and the restoration of blood flow in the tissues. 17 Several factors should be considered as potential complications of the treatment, such as the patient's agreement, cooperation with the treatment and the degree of compromised bone.…”