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. 2016 Sep;13(3):198-202.
doi: 10.5114/kitp.2016.62604. Epub 2016 Sep 30.

Hyperbaric oxygen therapy as additional treatment in deep sternal wound infections - a single center's experience

Radosław Litwinowicz  1 , Magdalena Bryndza  1 , Anna Chrapusta  2 , Ewa Kobielska  2 , Bogusław Kapelak  1 , Grzegorz Grudzień  1
Affiliations

Hyperbaric oxygen therapy as additional treatment in deep sternal wound infections - a single center's experience

Radosław Litwinowicz et al. Kardiochir Torakochirurgia Pol. 2016 Sep.

Abstract
in English, Polish

Introduction: Deep sternal wound infection (DSWI) is one of the most serious complications after cardiac surgery procedures, observed in 5% of patients. Current standard medical therapy for DSWI includes antibiotics, surgical debridement, resuturing or negative pressure wound therapy (NPWT). Unfortunately, in some cases these methods are insufficient, and additional therapeutic options are needed.

Aim: To assess the effects and usefulness of additional hyperbaric oxygen therapy (HBO2) in patients with DSWI after cardiac surgery procedures.

Material and methods: A retrospective analysis of 10 patients after cardiac surgery who developed DSWI in the period 2010-2012 was performed. After 3 months of ineffective conventional therapy including targeted antibiotic, surgical sternal debridement and NPWT, patients were qualified for additional HBO2 therapy. A total of 20 sessions of HBO2 therapy were performed, each 92 minutes long.

Results: After 4 weeks of HBO2 treatment, 7 patients presented complete wound healing with fibrous scar formation. One patient was qualified for the another cycle of HBO2 therapy with 20 additional sessions, and complete wound healing was observed. In 2 cases, after 5 and 19 sessions, HBO2 was interrupted because of improper qualifications.

Conclusions: The HBO2 as an additional therapy in DSWI was successful in 80% of cases, and no complications were observed. However, due to the small number of published studies with a small number of patients, randomized, clinical trials are needed to assess the clinical results of HBO2 in DSWI after cardiac surgery procedures.

Wstęp: Pooperacyjne zapalenie śródpiersia (DSWI) będące najczęstszym powikłaniem kardiochirurgicznym występuje u ok. 5% pacjentów. Obecnie standardowym leczeniem DSWI jest antybiotykoterapia celowana, chirurgiczne opracowanie rany, resutura mostka oraz terapia podciśnieniowa (NPWT). Niestety w niektórych przypadkach terapia ta jest niewystarczająca i wymaga uzupełnienia o inne metody.

Cel: Ocena zastosowania tlenoterapii hiperbarycznej (HBO2) w leczeniu DSWI u pacjentów po operacjach kardiochirurgicznych.

Materiał i metody: Retrospektywna analiza została przeprowadzona u 10 pacjentów z rozpoznanym DSWI operowanych w latach 2010–2012. Po 3 miesiącach nieefektywnego leczenia DSWI z wykorzystaniem antybiotykoterapii celowanej, chirurgicznego opracowania rany oraz NPWT pacjentów zakwalifikowano do leczenia HBO2 w modelu 20 sesji, każda po 92 minuty.

Wyniki: Po 4 tygodniach HBO2 u 7 pacjentów nastąpiło całkowite zagojenie rany mostka. Jeden pacjent został skierowany na kolejny cykl zabiegów i także u niego nastąpiło zagojenie się rany. U dwóch pacjentów, po 5 i 19 sesjach, HBO2 została przerwana z powodu złej kwalifikacji do procedury.

Wnioski: Tlenoterapia hiperbaryczna okazała się skuteczna u 80% pacjentów z rozpoznanym DSWI. Wydaje się skuteczną, tanią oraz bezpieczną metodą wspomagającą w leczeniu szczególnie trudnych, głębokich infekcji ran mostka. Ze względu na małą liczbę opisywanych przypadków otrzymane wyniki powinny stanowić wstęp do dalszych badań.

Keywords: deep sternal wound infection; hyperbaric oxygen therapy.

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Figures

Fig. 1
Fig. 1
A – Male patient before HBO2 therapy, B – the same male patient after HBO2 therapy
Fig. 2
Fig. 2
A – Female patient before HBO2 therapy, B – the same female patient after HBO2 therapy
See this image and copyright information in PMC

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