1 - Unidade de Infeciologia Pediátrica, Área de Pediatria, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Centro de Medicina Subaquática e Hiperbárica da Marinha Portuguesa, Lisboa
- Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2020)
Resumo:
Background: Hyperbaric Oxygen Therapy (HBOT) is increasingly used in the pediatric population due to its immunomodulatory properties combining hyperoxia and hyperbaric pressure which promote tissue oxygenation and mitochondrial metabolism, with bactericidal and pro-healing anti-inflammatory effects. This study aims to analyze the indications, outcomes, and complications of HBOT in children with infection.
Methods: Descriptive analysis of pediatric patients with infectious pathology, hospitalized in a tertiary care hospital, who underwent adjunctive therapy with HBOT, between January 2010 and December 2019 (10 years). Epidemiological, clinical, and laboratory data were collected.
Results: Thirty-two patients were included: median age of 10.4 years, 53% males, average of 34 sessions/patient. 40% had chronic disease, most commonly sickle cell disease (n=6). Indications were refractory osteomyelitis (n=14), chronic infected ulcers (n=9), necrotizing soft tissue infections (n=8), skeletal muscle-compartment syndrome (n=2), and acute thermal burn injury (n=2). Most frequently isolated pathogens were Staphylococcus aureus (n=9) – MSSA(n=6) and MRSA(n=3), and Pseudomonas aeruginosa (n=8). All patients had antibiotics and surgical interventions. In 93% of cases, there was improvement and cure without recurrence. Middle ear barotrauma was the only reported side effect (12.5%).
Conclusions: Available evidence supports a beneficial role of adjunctive HBOT when combined with culture-directed antibiotics and thorough surgical treatment, especially in refractory cases of chronic osteomyelitis and enhancement of healing in problem wounds. By creating a sustained increase in the arterial perfusion of previously hypoxic bone and soft tissues, HBOT can also reduce the susceptibility to recurrence. Although there is strong evidence of synergic results, there is still a pressing need for well-defined protocols.
Palavras Chave: hyperbaric oxygen therapy