Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter XI: Infection
United States Department of Defense
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In 1963, Brummelkamp and associates in Amsterdam reported the first use of hyperbaric oxygen in the treatment of infections caused by gas-producing microorganisms. The patients were placed in a room-sized chamber in which the air pressure was raised to three atmospheres. During the course of three days, the patient inhaled 100% oxygen from a face mask for one-and-a-half hours on seven occasions. This increased the oxygen tension in plasma, lymph, and tissue fluids by 15-20 fold. Dramatic clinical improvement was described for most patients within the first day. Large pressure chambers are available at only a few medical centers in the world and at special military and marine industrial facilities. Much less expensive single patient chambers are now available. Therapy with hyperbaric oxygen, antibiotic administration, and surgical debridement has been reported as effective in patients with clostridial myonecrosis who evidenced toxicity. Hyperbaric oxygen appears to reduce toxemia and diminish the amount of tissue requiring excision. However, patients with gasproducing infections due to anaerobic Streptococci, Escherichi coli, and Klebsiella species showed no improvement after exposure to high-pressure oxygen. All of the foregoing notwithstanding, the use of hyperbaric oxygen is not feasible in the theater of operations. Even in referral centers, it is advocated only as an adjunct to the surgical treatment of clostridial infections, and not as a substitute for conventional modes of therapy, including early surgical debridement and the administration of antibiotics.
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