One Last Post Re: Success with Hyperbaric Oxygen Therapy for Necrotizing Infections

Before we take a break from this topic, here's one more quick but inspiring story about success with hyperbaric oxygen therapy for deadly soft tissue infections, or flesh-eating disease, sometimes including gas gangrene or bone infections.

Nurse manager Amy Pakes, RN, MS, says Nassau University Medical Center, a NuHealth hospital in East Meadow, New York, sees a dozen cases of necrotizing fasciitis every year:

At Nassau, as soon as a diagnosis is made, the patient receives powerful intravenous antibiotics. Surgical debridement of the infected tissue immediately follows. In addition, hyperbaric oxygen therapy is given to prevent further tissue loss and promote healing.

"We usually take patients right from surgery to the hyperbaric chamber, but they might have to go back for several more surgeries to remove dead tissues and such," Pakes said.

Monday's story on Nurses.com tells the story of one recent case:

"We used all of our resources—our surgical team, hyperbaric team and skilled nursing in the burn center, who did the complicated wound dressings that accompanied the wound care," Pakes said. "The patient was here for almost a month and we were able to save his arm, but it was a team effort."

Eileen Abruzzo, RN, MSN, CIC, director of infection prevention at Winthrop University Hospital in Mineola, New York, was also interviewed for the Nurses.com report.

[Photo: NuHealth website]

HBOT for Necrotizing Fasciitis: South Carolina Mother of Twins Going Home with All Her Limbs

Lana Kuykendall, this year's "other" high-profile victim of necrotizing fasciitis, or flesh-eating disease, underwent extensive hyperbaric oxygen therapy as part of her remarkable recovery at Greenville Memorial Hospital in Greenville, South Carolina. She also suffered with sepsis and endured more than 20 surgical procedures. Now the mother of twins born in May is heading home with all her limbs. This morning the Kuykendalls got the Today Show treatment, too. Click PLAY to watch the video below. Another heartwarming story with a cool HBOT twist.

Visit NBCNews.com for breaking news, world news, and news about the economy

Necrotizing Fasciitis Postcript: Aimee Copeland in Rehab, Set to Return Home Next Month

The young woman we wrote about in May has won her life-or-death battle against necrotizing fasciitis or flesh-eating disease. Hyperbaric oxygen therapy played some role—we don't know the details—in Aimee Copeland's recovery from a rare and serious bacterial infection. In June her family released a photo of her enjoying some outdoor time and preparing for rehabilitation. Yesterday they announced she will return home sometime in August. Pretty moving stuff after such a  trying ordeal. Cheers to the Copelands and congratulations to the entire staff at Doctors Hospital in Augusta, Georgia.

[Photo: CNN]

Necrotizing Infections: National Story Generates Some Local Interest in Omaha

Widespread coverage of the Georgia woman battling a necrotizing infection in an Augusta hospital has led health journalists across the country in search of the local angle. Of most interest: Doctors report an unusually high number of cases recently at Nebraska Medical Center in Omaha. Hyperbaric medical director Dr Jeff Cooper said his center has treated six patients with necrotizing fasciitis, or soft tissue infections caused by flesh-eating bacteria, in just the last month or so. He cannot account for the sharp increase but briefly explained to Omaha.com how hyperbaric oxygen works against the disease:

Cooper said hyperbaric oxygen therapy is an important part of treating the disease. “It forces oxygen into areas that aren't getting adequate oxygen because of the tissue damage and swelling,” he said. “This revives the immune system locally and causes the antibiotics to work more effectively.”

Today the medical center is holding a press conference on the subject. More on the web at WOWT Channel 6 and the Omaha World-Herald.

[Photo: Nebraska Medical Center]

Hyperbaric Oxygen for Necrotizing Fasciitis: Georgia Woman Loses Limbs and Fights for Life

Our thoughts today with Aimee Copeland, the 24-year-old University of West Georgia graduate student who is fighting a very public battle against necrotizing fasciitis at Doctors Hospital in Augusta. Copeland suffered a deep gash to her leg in a zip-lining accident on May 1. By May 4 the wound had become infected with the rare flesh-eating bacterium Aeromonas hydrophila. She was rushed to the hospital, where doctors amputated most of her left leg and worked to stop the potentially deadly infection from spreading. Hyperbaric oxygen therapy, begun last Wednesday, failed to salvage her remaining foot and both hands. Copeland remains in critical condition.

In the treatment of necrotizing fasciitis, hyperbaric oxygen inhibits bacteria from replicating, spreading, and releasing damaging toxins. It may also boost the effect of antibiotics, enhance the body’s natural defenses against flesh-eating bacteria, and help resolve or delay the onset of sepsis, a deadly blood poisoning. From the commentary section of our necrotizing infections page:

Hyperbaric oxygen can be a potent bactericide and also treats the hypoxia at the root of soft tissue necrosis. One analysis [Undersea Hyperb. Med. 2005 Nov-Dec; 32(6):437-43] showed significantly fewer deaths and amputations with HBOT. As the [UHMS] writeup concludes: “With such strong case series evidence of reductions in morbidity and mortality for necrotizing fasciitis and the subset of Fournier's Gangrene, it is difficult to envision ever seeing a controlled, double-blinded study of hyperbaric oxygen therapy.” In other words, considering the deadly seriousness of necrotizing infection and the demonstrated effectiveness of HBOT, withholding treatment from a control group for comparative study would not be medically or ethically acceptable. As antibiotics and other traditional weapons against these worrisome microscopic invaders begin to weaken, HBOT provides a vital backstop.

Keep track of Aimee's condition on Facebook.

[Photo: Copeland family Facebook page]

Limb Salvage Testimonial: Genesis Wound and Hyperbaric Institute in Davenport, Iowa

Genesis Wound and Hyperbaric Institute in Davenport, Iowa, has published an uplifting patient testimonial worth sharing. It's a story of clinical excellence, yes, but also a reminder of how much emotional and physical endurance chronic wounds and especially diabetic ulcers may require of patient and physician alike.

A small abrasion on Jim Keenan's heel developed into an infected wound that exposed his Achilles tendon. Keenan, who has Type 2 diabetes and vascular problems in his legs, received specialized dressings, bioengineered grafts, and vascular surgery in addition to 40 hyperbaric oxygen treatments. Healing required almost two full years. About his experience in the chamber Keenan recalls:

I gained substantial, measurable improvement in the flow of oxygen to my feet and the hyperbaric treatment contributed significantly to my healing. I also got a two-hour nap in every day, which is a habit I would have cheerfully continued.

Dr Brad DeWall adds:

At Genesis, we consider amputation to be a "treatment failure" not a "treatment option." Our goal is to save the extremity.

So he and the Genesis nurses did. And it's a story happening every day at advanced wound care and hyperbaric medicine centers from coast to coast. Let's see that more people read all about it.

Lee Memorial Hospital: Local Plug for Fort Myers, Florida, Wound Care Center a Model of Brevity, Clarity

Sometimes just a bit of just the right information communicates best. Hats off to Lee Memorial Hospital in Fort Myers, Florida, for landing the kind of local coverage every hyperbaric oxygen treatment center should covet. This little gem from the local NBC affiliate hits all the basics with minimum effort:

• A stirring tale of a 2-year-old girl recovering from burns.
• A short explanation of what wound centers do and how hyperbaric oxygen therapy works.
• A strong case for adapting to meet the public healthcare demands of a rapidly aging population.
• A believable connection to success with advanced, specialized wound care centers.

No doubt the hospital marketing and public relations team and clinical experts played this one clear and straight. That's why this reporter got a great story, this hospital got some great ink, and these readers got another great reason to look into this great new movement in American medicine. All in about 390 words.

[Photo: Lee Memorial Hospital website]

National Healing: Leading Advanced Wound Care Provider Puts Limb Salvage in Perspective

We are happy to see someone in the advanced wound care community take some credit, where credit is due, for the remarkable decline in lower-limb amputations among Americans with diabetes. In a news release subtitled "National Healing Corporation Wound Care Centers Offer Alternative to Amputation" we learn the company's more than 500 centers treated more than one million wounds in 2011, with a healing rate of 89% and overall amputation rate of just 1%. CLICK HERE to read the January 24 report from the CDC. See also our February 1 post, "Diabetes Amputation Rates Declined Sharply in US Between 1998 and 2008." Access to accredited hyperbaric facilities with certified hyperbaric physicians and technicians is still very much a public health problem. “It is imperative that we educate patients and families about the advanced treatments available to prevent amputation,” said National Healing EVP medical affairs Scott Covington, MD, FACS, CHWS. We wholeheartedly agree.

Diabetes Amputation Rates Declined Sharply in US Between 1988 and 2008

Researchers from the Centers for Disease Control and Prevention (CDC) report a dramatic reduction in amputations due to diabetes over the last two decades. Read "Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: US, 1988-2008" in Diabetes Care, the journal of the American Diabetes Association. In related press coverage (see Newsday) the authors attribute the decline to earlier diagnosis and preventive foot care. We might suggest advanced wound care centers had an awful lot to do with it, too. From the HyperbaricLink Commentary on our diabetic ulcers page:

Hyperbaric oxygen plays an increasingly important role in the treatment of problem wounds and limb salvage. But access to accredited hyperbaric facilities and certified hyperbaric physicians and technicians is a public health problem. In 2004 as many as two-thirds of nursing home patients with NPUAP Stage II or worse pressure ulcers were not enrolled in wound care treatment programs [NCHS, 2011]. In diabetes-related wounds alone, US hospitals performed 66,000 toe, foot, and leg amputations in 2006 [CDC, 2011], for which health economists have estimated a cost of $3 billion per year [ACA, 2008]. More and more hospitals and health networks today are opening advanced wound care and hyperbaric centers to serve this unmet clinical need. Even if chronic wounds were its only indicated use, HBOT would be assured a place in evidence-based medicine for quality and cost-effective healthcare.

That's our story, and we're sticking to it.

[Image: American Diabetes Association, Diabetes Care website]

Update: Hyperbaric Oxygen for Gas Gangrene

Today we have updated and upgraded our Gas Gangrene (Myositis or Myonecrosis) page. Gas gangrene is a severe and rapidly spreading infection of muscle and other soft tissue. The bacteria that cause gas gangrene, most commonly Clostridium perfringens, produce liquid and gaseous toxins that surround the microorganisms and undermine the body's natural immune response. The advancing infection can threaten life and limb in mere hours.

Hyperbaric oxygen plays a central role in standard treatment. From our new page:

Hyperbaric oxygen therapy, combined with antibiotics and surgical removal of dead tissue, is an effective treatment for gas gangrene. Clostridia are anaerobic, meaning they thrive in low-oxygen environments. HBOT stops toxin production and inhibits bacteria from replicating and spreading. Hyperbaric oxygen may also boost the effect of antibiotics, enhance the body’s natural defenses against bacteria, and help resolve or delay the onset of sepsis, a deadly blood poisoning.

Clostridium perfringens are everywhere around us. For the most part we safely share our planet with these and other potentially harmful microbes. Salt rising bread rises by natural fermentation of the very same bacterium, found in potatoes, flour, or cornmeal. Watch our expert bakers concoct the starter mix. Just add hot water and let set and bubble overnight. Fascinating and (apparently) delicious. And we may never again share a recipe with our readers.

[Photo: C. perfringens bacteria, Visuals Unlimited]

Update: Hyperbaric Oxygen for Refractory Osteomyelitis (Bone Infection)

Today we have upgraded and updated our Osteomyelitis page. Osteomyelitis is a bone infection, an all-too-common and serious complication of chronic wounds and necrotizing infections and a distinctive feature of Wagner Grade 3 diabetic ulcers. Hyperbaric oxygen therapy is approved and clinically indicated when the going gets really tough. From our new commentary:

Hyperbaric oxygen can be a potent bactericide and also treats the hypoxia at the root of osteomyelitis and surrounding soft tissue necrosis. The approved clinical indication is limited to refractory (persistent or recurring) bone infections that do not respond to accepted surgical and antibiotic treatment. UHMS guidelines recommend daily treatments of 90-120 minutes at 2.0-3.0 atmospheres of absolute pressure (ATA), starting soon after surgical debridement and continuing 4 to 6 weeks. Osteomyelitis, like necrotizing infections, involves some rather frightening germs. As antibiotics and other traditional weapons against these worrisome microscopic invaders begin to weaken, HBOT provides a vital backstop. 

Who are these microbial troublemakers? Round up the usual suspects: MRSA and other antibiotic-resistant bacteria, mixed with various fungi. 

Our expanded page now includes many more suggestions and links to helpful patient and clinical resources. And we are especially fond of Sherwin B. Nuland's book, The Doctors' Plague, a must-read for anyone concerned about proper healthcare facility and staff hygiene.

[Image: bone 6 by chrisharvey from Fotolia.com]

Update: Hyperbaric Oxygen for Necrotizing Infections

Today we have upgraded our Necrotizing Infections page. Flesh-eating disease and other soft tissue infections may be caused by a number of different bacteria, in a single strain or mixed, originating within the body, in chronic or traumatic wounds, or from foreign matter. We list many of the bacteria and associated diseases under Related Terms on our new page.

One increasingly common cause of flesh-eating disease is MRSA, or methicillin-resistant Staphylococcus aureus, a particularly troublesome hospital- and healthcare-acquired infection (HAI). Each year, 90,000 Americans suffer from invasive MRSA infection. About 20,000 die. Many are children. [MRSA Research Center, University of Chicago]

Necrosis means death. Skin, muscle, and connective tissue infected with flesh-eating bacteria die because they are starved of oxygen. Only hospital-affiliated advanced wound care centers provide hyperbaric oxygen therapy for MRSA or other necrotizing infections. Time is tissue, the experts say, and hyperbaric oxygen kills bacteria, boosts the effect of antibiotics, enhances the body’s natural defenses against flesh-eating bacteria, and helps resolve or delay the onset of sepsis, a deadly blood poisoning.

From our new commentary:

Hyperbaric oxygen can be a potent bactericide and also treats the hypoxia at the root of soft tissue necrosis. One analysis [Undersea Hyperb. Med. 2005 Nov-Dec; 32(6):437-43] showed significantly fewer deaths and amputations with HBOT. As the [UHMS] writeup concludes: “With such strong case series evidence of reductions in morbidity and mortality for necrotizing fasciitis and the subset of Fournier's Gangrene, it is difficult to envision ever seeing a controlled, double-blinded study of hyperbaric oxygen therapy.” In other words, considering the deadly seriousness of necrotizing infection and the demonstrated effectiveness of HBOT, withholding treatment from a control group for comparative study would not be medically or ethically acceptable. As antibiotics and other traditional weapons against these worrisome microscopic invaders begin to weaken, HBOT provides a vital backstop.

Again, we do not consider it unreasonable for the US healthcare community to demand access to an emergency-ready and professionally staffed hyperbaric chamber in every hospital.

[Photo: Staphylococcus aureus]

Hyperbaric Food: Like Pasteurizing With Pressure

Who knew? The foodservice industry uses hyperbaric chambers to kill harmful bacteria, too. And apparently you can shuck a whole lot of shellfish with a whole lot of pressure. Make that 87,000 pounds per square inch, about 5,920 atmospheres. No added oxygen required.

Get a load of the fascinating history of high-pressure food processing, "Warning! Contents Under Extremely High Pressure," in GOOD. And who can resist the continuing adventures of Wholly Guacamole and the Big Mother Shucker? Not us.

Foodborne illness is no laughing matter. Neither are gas gangrene, intracranial abscess, necrotizing infections, osteomyelitis, diabetic foot ulcers, and other chronic wounds and bacterial infections treated with HBOT, where oxygen plays a central role. Lately we're reading like crazy to update our Diseases and Conditions pages for these indications. So please excuse us. But this slightly off-topic discovery was just too good not to share.

[Illustration: Avure Technologies]

O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.

Getting Serious About Antibiotic-resistant Bacteria

As we were enjoying last month's io9 feature (see "Fun With Flesh-eating Bacteria"), our friends across town at American Medical News were covering the real war against the antibiotic-resistant bacteria that cause necrotizing fasciitis and other troublesome healthcare-acquired infections (HAIs). Research and development of new antibiotics has stalled. And the prudent use of available drugs has become the new focus of educational efforts spearheaded by the Infectious Diseases Society of America (IDSA). Particularly sobering are the words of IDSA president James M. Hughes, MD: "The way we've managed our antibiotics for the past 70 years has failed." Click here to read the full article. Again we are comforted to know that hyperbaric oxygen therapy offers at least one nonpharmaceutical backstop against a runaway public health calamity. Surely we need more alternatives.

O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.

Fun With Flesh-eating Bacteria

We enjoyed the flip, funny, and only slightly misinformative post about hyperbaric oxygen for necrotizing fasciitis on io9 yesterday. You'll find "How to use a hyperbaric chamber to treat flesh eating bacteria" in the site's Mad Science department. Safety is paramount, but "a spark could blow them up at any moment" is laying it on a bit thick. Still, hyperbaric medicine could use more pop journalism like this. And goodness knows the world needs HBOT and other nonpharmaceutical backup plans against antibiotic-resistant bacteria.

O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.
 

Weekly Web Roundup: 27 November 2010

We hope our readers in the United States are having a pleasant Thanksgiving holiday and that those elsewhere in the world are enjoying whatever non-stuffed-turkey-involved events are appropriate to their locale. The luxury of few days off has given us the opportunity to relight the boilers and get the weekly roundup moving again.

SCIENCE

Surgeons in the department of thoracic surgery, Ondokuz Mayis University Medical School, Samsun, Turkey, report in the December 2010 issue of The Thoracic and Cardiovascular Surgeon that a week of hyperbaric oxygen therapy helps healing of anastomosis surgery wounds after irradiation and resection of the trachea in an animal study.

Preliminary results from a 24-patient study in China suggest that hyperbaric oxygen therapy may be effective for improving recovery from erectile dysfunction after posterior urethral reconstruction.

Medscape Today provides a case report of a rare necrotizing infection involving an intraperitoneal rupture of an infected urachal cyst. Apparently, HBOT wasn't available in this case.

PRESS/BUSINESS

On December 10th, from noon to 1:00 pm, Dr Thomas Serena, medical director of the Snyder Institute for Vascular Health and Research, will discuss how the Snyder Institute is utilizing hyperbaric oxygen to prevent amputation in diabetics. His presentation is part of a free seminar at the Alle-Kiski Medical Center Hospital in Kittanning, Pennsylvania.

Check out this video tour of McMurdo General Hospital in Antarctica. Conducted by Major Greg Richert, flight surgeon, the tour includes the continent's hyperbaric chamber.

One of the miners who escaped from the Pike River mine in New Zealand after the initial explosion was treated with HBOT for carbon monoxide poisoning according to the New Zealand Herald.

Perry Baromedical has been selected to supply hyperbaric chambers to Restorix Health. Headquartered in Bellevue, Washington, Restorix Health is a community-based center for advanced wound care affiliated with the Restorix Research Institute.

The story in the Pittsburgh Tribune Review on carbon monoxide poisoning reports numerous incidents and insight from Dr. Kevin S. O'Toole, director of the University of Pittsburgh Medical Center's hyperbaric medicine department.

PATIENT STORIES

From the Twin Cities Pioneer Press comes a wonderful success story. The combined efforts of The Hennepin County Medical Center, an Undersea & Hyperbaric Medical Society Accredited Facility, and the renowned Mayo Clinic saved a woman's foot and even seem to have eliminated her migraine headaches. She's published a book and is donating the proceeds to hyperbaric research. Osteomyelitis, or bone infection, is one of the FDA-cleared conditions for hyperbaric oxygen therapy. Migraine and other conditions await more research.

Have news you'd like to share? E-Mail it to us at: press@hyperbariclink.com.

Postscript: HBOT And H. Pylori

Since posting our A. Stone Freedberg obit Monday, a few astute O2.0 readers hasten to add the bacterium H. pylori is anaerobic—microaerophilic, to be precise—and proved susceptible to hyperbaric oxygenation in a 1989 Russian study. Borrelia burgdorferi, the spirochete that causes Lyme Disease, falls in the same category. See also our July 6 post, "Of Dog Days And Deer Ticks...," and expect our continued fascination with this topic.

Evidence: Enough To Give You An Ulcer

A. Stone Freedberg died last week. His story is a sobering reminder that evidence-based medicine advances only by hard work and good luck, by fits and starts, past deep chasms and long cul-de-sacs. Were history any kinder, and clinical research any fairer, Freedberg surely would have won the Nobel Prize for discovering that the bacterium Helicobacter pylori causes peptic ulcers. He made his discovery in the 1940s. A pair of Australians, Marshall and Warren, didn't confirm Freedberg's findings until the 1980s and nabbed the prize in 2005. (To add irony to insult, Alfred Nobel himself died of a duodenal ulcer some 110 years earlier.) Doctors today diagnose H. pylori infection with a breath test and treat ulcers with antibiotics instead of milk and stress management.

HAIs: Fighting A Pandemic Already In Progress

Yesterday we doubted whether HBOT has any role in treating H1N1, the so-called swine flu, poised for a comeback this fall and winter. But we have no doubt hyperbaric oxygen is a powerful weapon against the baddest bugs our healthcare community is fighting right here right now. Antibiotic-resistant bacteria.

Turns out most of these tiny culprits find life real hard in pure oxygen under high pressure. Researchers have shown us the proof in the petri dish. Clinicians have borne out the evidence in treating chronic wounds and several other approved conditions, including necrotizing infections, intracranial abscess, osteomyelitis, and gas gangrene, where HBOT helps control methicillin-resistant Staphylococcus aureus (MRSA) and other troublesome bacteria.

There's plenty hospitals can do to prevent hospital-acquired infections (HAIs), sometimes also called healthcare-acquired or nosocomial infections. And there's plenty they're not doing. A recent CNN report sings the praises of some of this war's unsung heroes. Our question is, What's the best course of treatment when prevention fails and attacking bacteria outmatch our best antibiotics? We think you'll be seeing HBOT in the mix and in the news more and more.

Of Dog Days And Deer Ticks...

Don't fret. That's a centimeter, not an inch, in the photo. Be more afraid that the hyperbaric medical community's view on Lyme disease has at least as many legs and lurks in a thicket where your pleasant stroll may end with a sharp bite.

As we busily prepare new site content and links for self-guided research, we started waffling about how to handle this indication. We were relieved the National Institutes of Health shares our confusion about chronic Lyme disease (CLD) and post-Lyme disease syndrome (PLDS). Meanwhile, the Infectious Diseases Society of America lists HBOT among its

therapeutic modalities not recommended [for Lyme disease]...because of a lack of biologic plausibility, lack of efficacy, absence of supporting data, or the potential for harm to the patient....

So how's this for biologic plausability? When a blacklegged tick (or any insect or spider) bite becomes seriously infected by bacteria, the wound then enters a clinical realm shared by a number of approved HBOT indications—namely, chronic wounds, necrotizing infections, intracranial abscess, osteomyelitis, and gas gangrene—all well supported by clinical data on efficacy and safety.

Change that scale from centimeters to nanometers. Now we're ready to talk.