Adjunctive Hyperbaric Oxygen Research Articles

Adjunctive Hyperbaric Oxygen Therapy for Patients with Chronic Refractory Osteomyelitis: A Report of Treatment Outcomes and Risk Factors for Treatment Failure.

To evaluate the effect of hyperbaric oxygen (HBO) therapy on the outcomes of patients with chronic refractory osteomyelitis (CRO) when combined with modern antibiotics with modern delivery methods and/or surgical treatments. The authors conducted a retrospective review on 58 patients with CRO from a single institution who underwent HBO therapy along with standard treatment between January 2009 and December 2019. To investigate associations with binary outcomes of interest, they estimated logistic regression models. All models were adjusted for sex, smoking status, and pertinent comorbidities. Exponentiated logistic regression model coefficients were interpreted as odds ratios for each outcome of interest. Multivariable logistic regression was used to control for potential confounding variables. When controlling for multiple confounding factors, patients who completed HBO treatment had 7.76 times the odds of having improvement of their CRO compared with patients who started HBO treatment but did not complete it (P = .015). Further, patients who completed HBO treatment had 7.7 times the odds of experiencing CRO improvement when controlling for CRO stage (P = .006). However, completion of HBO did not statistically significantly impact the resolution of CRO or the odds of further surgery or amputation. Patients with diabetes, peripheral vascular disease, and congestive heart failure had increased odds of having an amputation (Ps = .026, .037, and .024, respectively). Patients who completed HBO treatment had increased odds of experiencing improvement of their CRO compared with patients who started HBO treatment but did not complete it. Patients with CRO who had diabetes and congestive heart failure had increased odds of undergoing an amputation.

The role of hyperbaric oxygen treatment in the management of spondylodiscitis.

This study analysed treatment outcomes in a patient cohort diagnosed with spondylodiscitis, who received adjunct hyperbaric oxygen treatment (HBOT) in addition to antibiotic therapy at our clinic. Important considerations included the timing of HBOT initiation on treatment success, and recurrence rates. We retrospectively reviewed the records of all patients diagnosed with spondylodiscitis who received HBOT at the Underwater and Hyperbaric Medicine Clinic in Gulhane Training and Research Hospital, between 1 November 2016 and 25 October 2022. The patients received HBOT at 243.2 kPa for a total of 120 minutes per session, once daily for five days a week for a total of 30 sessions. Twenty-five patients with spondylodiscitis were evaluated before and after combination HBOT and targeted antibiotic treatment. After treatment, patients had lower median (range) visual analogue pain scores (8 [4-10] vs 3 [0-7], P < 0.001) and C-reactive protein (22.3 [4.3-79.9] mg·L⁻¹ vs 6.8 [0.1-96.0] mg·L⁻¹, P = 0.002) and lower mean (standard deviation) white blood cell counts (8.8 [3.5] x 109·L⁻¹ vs 6.1 [1.6] x 109·L⁻¹, P = 0.002). When patients were examined (median) 48 months (2-156 months) after the completion of treatment, there were no persistent cases of spondylodiscitis. Combination HBOT with targeted antibiotic therapy effectively managed our cohort of patients diagnosed with spondylodiscitis. Hyperbaric oxygen treatment was safe, with no complications experienced. Moreover, HBOT may have helped to eliminate persistence and recurrence of symptoms with long term follow-up. A randomised controlled study with a larger number of patients is needed for more definitive conclusions.

Reconstruction of Lower Eyelid in Basal Cell Carcinoma Case with Adjunctive Hyperbaric Oxygen Therapy: A Case Report

Reconstruction of Lower Eyelid in Basal Cell Carcinoma Case with Adjunctive Hyperbaric Oxygen Therapy: A Case Report

Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers Based on Wagner Grading: A Systematic Review and Meta-analysis.

Diabetic foot ulcers (DFUs) are common complications of uncontrolled diabetes mellitus that can result in infection and amputation of the lower extremities. This study compared the benefits and risks of hyperbaric oxygen therapy with those of other DFU treatments, based on the Wagner grading system. Systematic searches for randomly controlled trials using hyperbaric oxygen therapy for DFUs were performed using PubMed, the Cochrane Library, and Embase. Data regarding demographics, wound healing, minor and major amputations, operative debridement, nonhealing wounds, and adverse effects were analyzed based on Wagner grades, using RevMan 5.4.1 and Microsoft Excel. Hyperbaric oxygen therapy was significantly superior to other treatments for wound healing rates 8 or more weeks after the final treatment (RR = 2.39; 1.87-3.05; P < 0.00001) minor/distal amputations (RR = 0.58; 0.43-0.80; P < 0.007), and major/proximal amputations (RR = 0.31; 0.18-0.52; P < 0.00001) for the 14 studies analyzed. In addition, this therapy increased the rate of complete wound healing for Wagner grades II (RR = 21.11; 3.05-146.03; P = 0.002), III (RR = 19.58; 2.82-135.94, P = 0.003), and IV (RR = 17.53; 2.45-125.44; P = 0.004); decreased the minor/distal amputation rate for grade III (RR = 0.06; 0.01-0.29; P = 0.0004) and the major/proximal amputation rate on for grade IV (RR = 0.08; 0.03-0.25; P < 0.0001); and decreased the operative debridement rate for Wagner grade II (RR = 0.09; 0.01-0.60; P = 0.01). Moderate-quality evidence revealed that adjunctive hyperbaric oxygen therapy improved DFU wound healing for Wagner grades II, III, and IV; prevented minor and major amputations for grades III and IV, respectively; and prevented operative debridement in grade II wounds.

Adjunctive hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries: a systematic review

PurposeTraumatic crush injuries of the lower limb often accompany severe complications. The incorporation of hyperbaric oxygen therapy to standard trauma care may have the potential to diminish injury-related complications and improve outcome in such cases. This systematic review aims to evaluate the effectiveness of hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries.MethodsThe electronic databases Medline, Embase and Cochrane Library were searched to identify studies involving patients with crush-associated sever lower limb soft tissue injuries who received hyperbaric oxygen therapy in conjunction with standard trauma care. Relevant data on type of injury, hyperbaric oxygen therapy protocol and outcome related to wound healing were extracted.ResultsIn total seven studies met the inclusion criteria, involving 229 patients. The studies included two randomized clinical trials, one retrospective cohort study, three case series and one case report. The randomized placebo-controlled clinical trial showed a significant increase in wound healing and decrease in the need for additional surgical interventions in the patient group receiving hyperbaric oxygen therapy when compared to those undergoing sham therapy. The randomized non-placebo-controlled clinical trial revealed that early hyperbaric oxygen therapy reduces tissue necrosis and the likelihood of long-term complications. The retrospective cohort study indicated that hyperbaric oxygen therapy effectively reduces infection rates and the need for additional surgical interventions. The case series and case report presented beneficial results with regard to wound healing when hyperbaric oxygen therapy was added to the treatment regimen.ConclusionHyperbaric oxygen therapy is generally considered a safe therapeutic intervention and seems to have a beneficial effect on wound healing in severe lower limb soft tissue injuries when implemented as an addition to standard trauma care.

Efficacy and safety of hyperbaric oxygen therapy in acute ischaemic stroke: a systematic review and meta-analysis

ObjectiveThis study aims to evaluate the efficacy and safety of adjunctive hyperbaric oxygen therapy (HBOT) in acute ischaemic stroke (AIS) based on existing evidence.MethodsWe conducted a comprehensive search through April 15, 2023, of seven major databases for randomized controlled trials (RCTs) comparing adjunctive hyperbaric HBOT with non-HBOT (no HBOT or sham HBOT) treatments for AIS. Data extraction and assessment were independently performed by two researchers. The quality of included studies was evaluated using the tool provided by the Cochrane Collaboration. Meta-analysis was conducted using Rev Man 5.3.ResultsA total of 8 studies involving 493 patients were included. The meta-analysis showed no statistically significant differences between HBOT and the control group in terms of NIHSS score (MD = -1.41, 95%CI = -7.41 to 4.58), Barthel index (MD = 8.85, 95%CI = -5.84 to 23.54), TNF-α (MD = -5.78, 95%CI = -19.93 to 8.36), sICAM (MD = -308.47, 95%CI = -844.13 to 13227.19), sVCAM (MD = -122.84, 95%CI = -728.26 to 482.58), sE-selectin (MD = 0.11, 95%CI = -21.86 to 22.08), CRP (MD = -5.76, 95%CI = -15.02 to 3.51), adverse event incidence within ≤ 6 months of follow-up (OR = 0.98, 95%CI = 0.25 to 3.79). However, HBOT showed significant improvement in modified Rankin score (MD = 0.10, 95%CI = 0.03 to 0.17), and adverse event incidence at the end of treatment (OR = 0.42, 95%CI = 0.19 to 0.94) compared to the control group.ConclusionWhile our findings do not support the routine use of HBOT for improving clinical outcomes in AIS, further research is needed to explore its potential efficacy within specific therapeutic windows and for different cerebral occlusion scenarios. Therefore, the possibility of HBOT offering clinical benefits for AIS cannot be entirely ruled out.

Refractory Osteomyelitis in a Military Service Member Resolved With Adjunctive Hyperbaric Oxygen Therapy.

Refractory osteomyelitis is typically defined as a chronic infection that persists or recurs despite definitive surgical management and antibiotic therapy. Cases often involve complex wounds or fractures and can be challenging to treat, resulting in multiple courses of broad-spectrum antibiotic therapy and numerous surgeries over periods of months to years. Adjuncts to improve resolution of these complicated infections are sorely needed. Here, we describe the case of a 47-year-old active duty military member who sustained an open right ankle fracture during a skydiving accident that was subsequently complicated by refractory osteomyelitis. The patient failed more than three courses of combined medical and surgical management over a 9-month period before undergoing adjunctive hyperbaric oxygen therapy (HBOT), ultimately resulting in resolution of the infection. Adjunctive HBOT for treatment of conditions such as refractory osteomyelitis may be an underutilized resource in part because of a general paucity of high-quality data in the literature supporting its use, as well as a relative lack of availability of this resource. Nonetheless, the overall accumulating body of evidence indicates that the use of adjunctive HBOT in select patients with refractory osteomyelitis is safe and effective and further research may be warranted given its relevance and potential impact to military populations.

Adjunctive hyperbaric oxygen therapy for spinal cord ischemia after complex aortic repair

ObjectiveSpinal cord ischemia (SCI) with paraplegia or paraparesis is a devastating complication of complex aortic repair (CAR). Treatment includes cerebrospinal fluid drainage, maintenance of hemoglobin concentration (>10 g/L), and elevating mean arterial blood pressure. Animal and human case series have reported improvements in SCI outcomes with hyperbaric oxygen therapy (HBOT). We reviewed our center’s experience with HBOT as a rescue treatment for spinal cord ischemia post-CAR in addition to standard treatment. MethodsA retrospective review of the University Health Network’s Hyperbaric Medicine Unit treatment database identified HBOT sessions for patients with SCI post-CAR between January 2013 and June 2021. Mean estimates of overall motor function scores were determined for postoperative, pre-HBOT, post-HBOT (within 4 hours of the final HBOT session), and at the final assessment (last available in-hospital evaluation) using a linear mixed model. A subgroup analysis compared the mean estimates of overall motor function scores between improvement and non-improvement groups at given timepoints. Improvement of motor function was defined as either a ≥2 point increase in overall muscle function score in patients with paraparesis or an upward change in motor deficit categorization (para/monoplegia, paraparesis, and no deficit). Subgroup analysis was performed by stratifying by improvement or non-improvement of motor function from pre-HBOT to final evaluation. ResultsThirty patients were treated for SCI. Pre-HBOT, the motor deficit categorization was 10 paraplegia, three monoplegia, 16 paraparesis, and one unable to assess. At the final assessment, 14 patients demonstrated variable degrees of motor function improvement; eight patients demonstrated full motor function recovery. Seven of the 10 patients with paraplegia remained paraplegic despite HBOT. The estimated mean of overall muscle function score for pre-HBOT was 16.6 ± 2.9 (95% confidence interval [CI], 10.9-22.3) and for final assessment was 23.4 ± 2.9 (95% CI, 17.7-29.1). The estimated mean difference between pre-HBOT and final assessment overall muscle function score was 6.7 ± 3.1 (95% CI, 0.6-16.1). The estimated mean difference of the overall muscle function score between pre-HBOT and final assessment for the improved group was 16.6 ± 3.5 (95% CI, 7.5-25.7) vs −4.9 ± 4.2 (95% CI, −16.0 to 6.2) for the non-improved group. ConclusionsHBOT, in addition to standard treatment, may potentially improve recovery in spinal cord function following SCI post-CAR. However, the potential benefits of HBOT are not equally distributed among subgroups.

Role of Hyperbaric Oxygen in Treatment of Invasive Fungal Sinusitis

Abstract Background Invasive fungal infections are a major cause of morbidity and mortality in immunodeficient individuals (such as AIDS patients) and in transplant recipients or tumor patients undergoing immunosuppressive chemotherapy. The most widely accepted therapy is the multimodal approach of using intravenous (IV) anti-fungal therapy in combination with sinus debridement, and hyperbaric oxygen (HBO) for the management of invasive fungal sinusitis. HBO has an important role in management of those patients; there is a significant survival benefit with adjunctive HBO use, as HBO has a fungistatic effect, decrease growth rate of fungus, and decrease the morbidity. Objective to assess the use of Hyperbaric oxygen in treatment of invasive fungal sinusitis and evaluate its efficacy as HBO has a fungistatic effect, decrease growth rate of fungus, and decrease the morbidity. Patients and Methods The pertinent role of hyperbaric oxygen therapy in treatment of invasive fungal sinusitis has been popularized over the past decade, to approve the important role of HBOT we established our systematic review which include 15 studies and 98 patients. Results We assess the beneficial effect of adding HBOT in the protocol treatment of invasive fungal rhinosinusitis, which illustrate the favorable results supporting adding HBOT, as survival rate among patients treated with HBOT 66% against 42% survival rate among patients treated without HBOT. Conclusion Hyperbaric oxygen therapy is an attractive option in treatment of invasive fungal rhinosiusitis as an adjunctive therapy.

Real-world evidence of hyperbaric oxygen therapy on cardiovascular outcomes in patients with chronic osteomyelitis

BackgroundThe effectiveness of hyperbaric oxygen (HBO) therapy for chronic osteomyelitis remains inconclusive. In particular, recent studies have shown that chronic osteomyelitis is a crucial risk factor for cardiovascular diseases. However, the preventive effect of HBO on cardiovascular events has not been reported in patients with chronic osteomyelitis. MethodsWe conducted a population-based cohort study to evaluate the impact of HBO on patients with chronic osteomyelitis. Overall, 5312 patients with chronic osteomyelitis were selected from the Taiwan National Health Insurance Database to evaluate the impact of HBO in patients with chronic osteomyelitis. Propensity-score (PS) matching and inverse probability weighting (IPTW) were employed to balance covariates between the HBO and non-HBO groups. The primary outcome was all-cause mortality. The secondary outcomes were myocardial infarction (MI) and stroke hospitalisation. Furthermore, we evaluated the appropriate timing for HBO intervention by the restricted cubic spline (RCS) functions. ResultsAfter 1:4 PS-matching, the HBO group (n = 265) was associated with lower 1-year mortality (hazard ratio [HR], 0.49; 95 % confidence interval [CI], 0.25–0.95) than the non-HBO group (n = 994); this was consistent with the IPTW weighting results (HR, 0.25; 95 % CI, 0.20–0.33). The risk of stroke was lower in the HBO group (HR, 0.46; 95 % CI, 0.34–0.63) than that in the non-HBO group. However, HBO therapy failed to reduce the risk of MI. Using the RCS model, patients with intervals within 90 days (HR, 1.38; 95 % CI, 1.04–1.84) presented a significant risk of 1-year mortality. After 90 days, as the length of interval increased, the risk gradually decreased and became insignificant. ConclusionThe present study revealed that adjunctive HBO could benefit the 1-year mortality and stroke hospitalisation in patients with chronic osteomyelitis. HBO was recommended to be initiated within 90 days of chronic osteomyelitis hospitalisation.

Adjunctive hyperbaric oxygen therapy with reconstruction of lower eyelid for basal cell carcinoma: A case series

IntroductionBasal cell carcinoma (BCC) is among the most widespread non-melanoma skin cancers, with an incidence of around 80 % worldwide. Surgery is the main therapy of choice. High-pressure oxygen is used in hyperbaric oxygen therapy (HBO) to treat hypoxic tissue conditions. By using this technique, the tissue oxygen tensions increase. This is used to treat a wide range of diseases and disorders brought on by hypoxic states, circulation issues, inadequate tissue oxygenation due to vascular damage, tissue damage from infections or accidents, and impairment of tissue healing. Cases presentationThis paper presents five cases of HBO used in the healing BCC surgery. All patients underwent wide and deep excisions with eight adjunctive sessions of HBO therapy. Clinical discussionThe five cases of post-surgery wound healing improved significantly with HBO. ConclusionBCC is a condition that is frequently identified in the outpatient department. Prerequisites for a better prognosis include early diagnosis based on sound information and prompt, structured, and sufficient therapy. Our study reveals the benefit of HBO in increasing wound healing and preventing complications after surgery for BCC.

Does Adjunct Hyperbaric Oxygen Therapy and Methylene Blue Contain Further Spread of COVID Associated Sinomaxillary Mucormycosis? A Retrospective Study

The aim of the study was to assess the role of post-debridement HBO therapy along with local application and steam inhalation with methylene blue as an adjunct in the management of COVID-associated sino-maxillary mucormycosis cases.

Potential Advances of Adjunctive Hyperbaric Oxygen Therapy in Infective Endocarditis.

Patients with infective endocarditis (IE) form a heterogeneous group by age, co-morbidities and severity ranging from stable patients to patients with life-threatening complications with need for intensive care. A large proportion need surgical intervention. In-hospital mortality is 15-20%. The concept of using hyperbaric oxygen therapy (HBOT) in other severe bacterial infections has been used for many decades supported by various preclinical and clinical studies. However, the availability and capacity of HBOT may be limited for clinical practice and we still lack well-designed studies documenting clinical efficacy. In the present review we highlight the potential beneficial aspects of adjunctive HBOT in patients with IE. Based on the pathogenesis and pathophysiological conditions of IE, we here summarize some of the important mechanisms and effects by HBOT in relation to infection and inflammation in general. In details, we elaborate on the aspects and impact of HBOT in relation to the host response, tissue hypoxia, biofilm, antibiotics and pathogens. Two preclinical (animal) studies have shown beneficial effect of HBOT in IE, but so far, no clinical study has evaluated the feasibility of HBOT in IE. New therapeutic options in IE are much needed and adjunctive HBOT might be a therapeutic option in certain IE patients to decrease morbidity and mortality and improve the long-term outcome of this severe disease.

The contribution of preconditioning hyperbaric oxygen for complex re-operative surgery of bladder exstrophy and epispadias. A case study of 11patients

Multiple surgeries on patients born with bladder exstrophy and epispadias (BEE) especially when complicated by postoperative infections results in varying degrees of scarring of the tissues and decreased vascularity. When further surgery for these patients is contemplated the tissue ischemia may result in poor healing and additional complications. Problem wounds due to arterial insufficiency mainly in diabetic ulcers and following therapeutic radiation are commonly treated with hyperbaric oxygen therapy (HBOT). It was hypothesized that the pathologic features of severe fibrosis and tissue ischemia in repeat BEE surgery are similar to those of post radiotherapy patients and would therefore benefit from HBOT. Examine the role of preconditioning and postoperative adjunctive hyperbaric oxygen therapy in repeat surgery of complex cases of bladder exstrophy and epispadias who underwent multiple failed surgical repairs (6-10 operations). Review of the records of selected eleven patient (9 males and 2 females), the ages varying between 2 and 30 years, 9 patients were born with bladder exstrophy and 2 with epispadias. All patients underwent multiple surgeries often complicated by postoperative wound infection and break down of their repairs. They were referred by other experienced surgeons for further correction of abnormalities which included recurrent abdominal wall hernias following wound dehiscence and repeat repairs of the scarred and deformed genitalia (figure) following multiple surgical failures. For this high morbidity group of patients, the protocol which was adopted included pre-operative 20 dives of HBOT at 1.5 for the young child and 2 atmospheric pressures for the older patients followed by 5-10 dives postoperatively. All patients tolerated the HBO without side effects, and all achieved a satisfactory surgical outcome of the repairs of the large recurrent abdominal hernias, and reconstruction of the external genitalia (figure). Postoperative evaluation was conducted by the parents or patient and the surgeon using a modified scoring system. 3/11 encountered minor complications, suture tracks (2 pts.) and hypertrophic scar which faded over one year (1pt) CONCLUSIONS: Preconditioning HBO may be utilized as an adjunctive treatment and preventive strategy to activate the protective mechanisms of neovascularization which would reduce the potential morbidity and improve wound healing of compromised and less vascularized tissues of selected patients born with BEE who endured multiple surgical complication.

Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A systematic review and meta-analysis.

Surgical intervention, broad-spectrum antibiotics and intensive care support are the standard of care in the treatment of necrotising soft-tissue infections (NSTI). Hyperbaric oxygen treatment (HBOT) may be a useful adjunctive treatment and has been used for almost 60 years, but its efficacy remains unknown and has not been systematically appraised. The aim was to systematically review and synthesise the highest level of clinical evidence available to support or refute the use of HBOT in the treatment of NSTI. The review was prospectively registered (PROSPERO; CRD42020148706). MEDLINE, EMBASE, CENTRAL and CINAHL were searched for eligible studies that reported outcomes in both HBOT treated and non-HBOT treated individuals with NSTI. In-hospital mortality was the primary outcome. Odds ratio (ORs) were pooled using random-effects models. The search identified 486 papers of which 31 were included in the qualitative synthesis and 21 in the meta-analyses. Meta-analysis on 48,744 patients with NSTI (1,237 (2.5%) HBOT versus 47,507 (97.5%) non-HBOT) showed in-hospital mortality was 4,770 of 48,744 patients overall (9.8%) and the pooled OR was 0.44 (95% CI 0.33-0.58) in favour of HBOT. For major amputation the pooled OR was 0.60 (95% CI 0.28-1.28) in favour of HBOT. The dose of oxygen in these studies was incompletely reported. Meta-analysis of the non-random comparative data indicates patients with NSTI treated with HBOT have reduced odds of dying during the sentinel event and may be less likely to require a major amputation. The most effective dose of oxygen remains unclear.

Is Adjunctive Hyperbaric Oxygen Treatment Alone or with Surgery the Proper Management for Active and Persistent Osteoradionecrosis?

This study enrolled patients with stage 3 osteoradionecrosis. There were three treatment modalities: antibiotics, hyperbaric oxygen therapy (HBOT), and surgery. Complete healing was the primary outcome. Multiple logistic regression analysis demonstrated that surgery with HBOT improved wound healing better than HBOT alone.

The History and Development of Hyperbaric Oxygenation (HBO) in Thermal Burn Injury.

Background and Objectives: Hyperbaric oxygenation (HBO) denotes breathing of 100% oxygen under elevated ambient pressure. Since the initiation of HBO for burns in 1965, abundant experimental and clinical work has been done. Despite many undisputedly positive and only a few controversial results on the efficacy of adjunctive HBO for burn injury, the method has not yet been established in clinical routine. Materials and Methods: We did a retrospective analysis of the literature according to PRISMA—guidelines, from the very beginning of HBO for burns up to present, trying to elucidate the question why HBO is still sidelined in the treatment of burn injury. Results: Forty-seven publications (32 animal experiments, four trials in human volunteers and 11 clinical studies) fulfilled the inclusion criteria. Except four investigators who found little or no beneficial action, all were able to demonstrate positive effects of HBO, most of them describing less edema, improved healing, less infection or bacterial growth and most recently, reduction of post-burn pain. Secondary enlargement of burn was prevented, as microvascular perfusion could be preserved, and cells were kept viable. The application of HBO, however, concerning pressure, duration, frequency and number of treatment sessions, varied considerably. Authors of large clinical studies underscored the intricate measures required when administering HBO in severe burns. Conclusions: HBO unquestionably has a positive impact on the pathophysiological mechanisms, and hence on the healing and course of burns. The few negative results are most likely due to peculiarities in the administration of HBO and possibly also to interactions when delivering the treatment to severely ill patients. Well-designed studies are needed to definitively assess its clinical value as an adjunctive treatment focusing on relevant outcome criteria such as wound healing time, complications, length of hospital stay, mortality and scar quality, while also defining optimal HBO dosage and timing.

Hyperbaric oxygen therapy decreases mortality due to Fournier's gangrene: a retrospective comparative study.

There is no consensus about the role of adjunctive hyperbaric oxygen therapy (HBOT) in the management of Fournier’s gangrene. The aim of this study was to compare the evolution of patients with Fournier’s gangrene treated with all classical measures with and without adjuvant HBOT. A retrospective comparative study regarding the evolution of patients treated for Fournier’s gangrene was conducted in two periods. In period I, from 1990 to 2002, patients received standard treatments for Fournier’s gangrene, which consisted of surgical debridement, antibiotic therapy and intensive care. In period II, from 2012 to 2019, adjunctive HBOT was added to the classical management strategy. All patients were assigned into four groups according to the anatomical severity classification and the area affected after the first debridement. This classification ensured that the groups could be comparable. The total number of patients in this study was 197, and these patients were divided into control group (118/59.9%) and HBOT group (79/40.1%). The mean age, comorbidities, and anatomical severity classification were similar between the two groups. In period I, 34 out of 118 (28.8%) patients died, while in the HBOT group, 3 out of 77 (3.7%) patients died (P < 0.001). The use of adjuvant HBOT in combination with classical treatment was associated with reduced mortality. This study was approved by the Institutional Review Board and the Ethics Committee of Ribeirão Preto Medical School, University of São Paulo, Brazil (No. 08/2018) on May 2, 2018.

S2235 Therapeutic Hyperbaric Oxygen Therapy Saves the Day in a Patient With Severe Refractory Pan-Ulcerative Colitis

INTRODUCTION: Despite current conventional treatments including steroids, immunomodulators, and anti-inflammatory medications, many patients with recurrent flares of ulcerative colitis (UC) often require more intensive therapy including biologics, and even colectomy. A dysregulated immune response to intestinal mucosal hypoxia contributes to the pathogenesis of UC, resulting in a loss of epithelial barrier function, translocation of luminal antigens into mucosa, and subsequent inflammation, making targeting of hypoxia-sensitive pathways a promising therapeutic approach.1 Recent literature supports the therapeutic potential of adjunctive hyperbaric oxygen therapy (HBOT).2 We present a case in which HBOT was used to help induce remission in an inpatient with severe refractory UC. CASE DESCRIPTION/METHODS: A 32-year-old male with a history of severe, chronic pan-UC presented to our clinic with a severe flare. Previously, he had a lack of response on multiple drug regimens to include azathioprine and infliximab. He was actively on vedolizumab therapy with minimal clinical and endoscopic response despite adequate levels and no antibodies detected. After missing an infusion, he developed an acute flare; presenting with >7 bloody bowel movements daily, fatigue, tenesmus, and a 20lb weight loss. Colonoscopy on hospital day (HD) 1 showed Mayo 3 pancolitis with biopsies negative for CMV. He received daily methylprednisolone and repeat induction dosing of vedolizumab with minimal clinical response. He subsequently underwent three 30-minute sessions of HBOT with significant symptomatic improvement. Tenesmus resolved and stools became non-bloody and semi-formed by the day of discharge. At 3-month follow-up, he remained in clinical remission with a normal fecal calprotectin on vedolizumab. DISCUSSION: Twenty-five percent of patients with UC will develop severe, acute exacerbations of disease during their lifetime. Despite advancements in treatment, half of these patients will fail subsequent medical rescue therapy, and an additional half of those will require colectomy within five years.3 Hyperbaric oxygen therapy is safe, well tolerated, and may play a role in inducing remission.4 The ability to increase tissue oxygen delivery to inflamed bowel to ultimately revert inflammatory pathways and promote healing may help avoid colectomy in select patients.5 Further research and ongoing clinical trials are necessary to investigate and better define the role of HBOT in inflammatory bowel disease.Figure 1.: Endoscopic view of the distal colon showing severe inflammation.Figure 2.: Endoscopic view of the sigmoid colon showing severe inflammation.Figure 3.: Endoscopic view of the rectum showing severe inflammation.

S2270 Crohn’s Disease Refractory to Medical Management Treated With Adjunct Hyperbaric Oxygen Therapy

S2270 Crohn’s Disease Refractory to Medical Management Treated With Adjunct Hyperbaric Oxygen Therapy