Ossigeno Terapia Iperbarica (OTI) nel trattamento della Gangrena di Fournier, un ulteriore conferma di efficacia

simsi-oti-midollo-spinale

E’ stata appena pubblicata questa interessante revisione sistematica della letteratura esistente su un’applicazione in urgenza/emergenza dell’Ossigeno Terapia Iperbarica (OTI) nel trattamento della Gangrena di Fournier.


Questa patologia che coinvolge il perineo e i genitali si presenta come una fascite necrotizzante su base infettiva che può esporre chi ne affetto al rischio di vita.
L’approccio terapeutico prevede chirurgia d’emergenza, terapie di sostegno e terapie antibiotiche.

L’OTI viene impiegata di norma nel post-operatorio e il prima possibile per le sue azioni antibatteriche dirette ed indirette, per migliorare l’ossigenazione e l’ischemia dei tessuti mortificati e per favorire i processi di guarigione.

In questo studio OTI è confermata essere una valida terapia adiuvante, nonostante la non numerosa letteratura a supporto presenti bias.

I risultati mostrano infatti, su 319 pazienti, un tasso di mortalità del 16.6% nel gruppo OTI (145 pazienti) mentre nel gruppo che non aveva fatto OTI del 25.9%.

Urol Int. 2020 Dec 7;1-10. doi: 10.1159/000511615.
Hyperbaric Oxygenation in the Treatment of Fournier’s Gangrene: A Systematic Review

Laila Schneidewind 1, Petra Anheuser 2, Sandra Schönburg 3, Florian M E Wagenlehner 4, Jennifer Kranz 3 5

Introduction: Fournier’s gangrene (FG) is a sporadic, life-threatening, necrotizing infection affecting the perineum, perineal region, and genitals. Hyperbaric oxygenation (HBO) improves tissue perfusion and promotes angiogenesis and collagen synthesis. Despite these positive effects of HBO, the indication and the effects on outcome as adjunct therapy in FG remain controversial. Consequently, we decided to perform a systematic review to compare the treatment of FG with or without the use of HBO as an adjunct therapy.

Materials and methods: We performed a systematic review following the recommendations provided in the Cochrane Handbook of systematic Reviews and the PRISMA reporting guidelines. Due to the paucity of data and a suspected lack of randomized controlled trials, we considered all the available information for this systematic review.

Results: The literature search for primary studies yielded 79 results. Finally, 13 studies were considered, which included a total of 376 patients with FG, of whom 202 received HBO therapy. Five of these studies had a retrospective case-control design. However, these 5 studies included a total of 319 patients; 145 of these patients were treated with adjunct HBO therapy. Overall, this leads to a mortality rate of 16.6% in the HBO group and 25.9% in the non-HBO group. Overall, risk of bias was assessed as moderate to high.

Conclusions: We conclude that despite the risk of bias, HBO has potential as an adjunct in FG treatment, but it is challenging to carry out further studies, mainly due to the rareness of FG and availability of HBO.

Condividi: