Series treated by adjunctive HBO

At present, the authors have reported on 21 sequential patients with intracranial abscesses treated at their intensive care unit with adjunctive HBO from 1983 to 2003 (table 2.2.5-3).

The decision to provide HBO was based on at least one of the following criteria being met:

• multiple abscesses,

• abscess in a deep or dominant location0,

• early abscess stage (without need for surgery),

• poor patient's condition ("high risk" patient),

• anaerobic or miscellaneous bacteria found.

In severe cases, HBO therapy was provided twice a day; otherwise, we recommend one treatment per day at 2.5ata. The duration of each hyperbaric session was between 60 and 90 minutes. The total number of HBO sessions varied from 4 to 27, with an average of 13.4. Usually the number of treatments depended on the patient's recovery, including neurosurgical evaluation and repeated cranial CT scans. In two cases, the patient's compliance proved to be a problem, so that fewer treatments were given than medically indicated. Nevertheless, a 0.0 % mortality was observed with a complete recovery in 76 % of our patients (table 2.2.5-4).

Table 2.2.5-3. Data and diagnosis, underlying disorders and bacteriological findings in 21 unselected patients with intracranial abscesses (own cases)_

No.

Age

Sex

Diagnosis

Underlying Disorder

Bacterial Isolate

1

31

f

multiple abscesses left

septic

Bacteroides fragilis, peptostreptococci

hemisphere

tonsillectomy

2

22

m

epidural empyema

pansinusitis

Fusobacteria, streptococci

(microaerophilic)

3

34

m

parietal abscess

pulmonary

Bacteroides fragilis, peptostreptococci,

angioma

streptococci (microaerophilic)

4

13

m

frontal abscess

sinusitis frontalis

streptococci (microaerophilic)

5

15

f

frontal abscess

pansinusitis

peptostreptococci

6

26

m

frontal abscess

sinusitis frontalis

Veillonella parv., Bacteroides spp.

7

47

m

parietal abscess

apical ostitis tooth

peptostreptococci

3/5

8

36

m

frontal abscess

???

Staph. epidermidis

9

27

m

subdural empyema

sinusitis maxillaris

peptostreptococci (blood culture)

10

42

f

frontal abscess

progressive

Enterobacter,

osteomyelitis

Staph. aureus

11

48

m

multiple abscesses left

sinusitis frontalis

Staph. epidermidis, streptococci

hemisphere

(microaerophilic)

12

52

m

frontal abscess

sinusitis

streptococci (anaerobic)

maxillaris?

13

21

m

multiple abscesses right

pansinusitis

streptococci (microaerophilic)

hemisphere

14

5

m

frontal abscess

penetrating injury

Clostridium perfringens

15

45

m

subdural empyema

pansinusitis

----

16

47

f

subdural empyema

osteomyelitis

Fusobacteria, Staph. Sp.

femur (?)

17

17

m

epi-/subdural empyema

open skull base

Staph. epidermidis

fracture

Streptococci (anaerobic) Streptococci

(microaerophilic)

18

57

f

subdural empyema

mastoiditis

Streptococci (microaerophilic)

19

22

m

subdural empyema

pansinusitis

Bacteroides sp. Peptostreptococci

20

4

m

multiple abscesses both

pulmonary

Streptococci (anaerobic) Streptococci

hemispheres

abscess

(microaerophilic)

21

19

m

multiple abscesses

sinusitis maxillaris

Streptococci (microaerophilic)

Table 2.2.5-4. Number of HBO sessions and outcome in 21 patients with intracranial abscesses (own cases)

No.

Age

Sex

HBO'

Outcome

1

31

f

14

slightly disabled

*

2

22

m

4

complete recovery

*

3

34

m

10

severely disabled (lost follow-up)

4

13

m

16

complete recovery

*

5

15

f

10

complete recovery

*

6

26

m

10

complete recovery

*

7

47

m

6

brachio-facial hemiparesis (in recovery, lost follow-up)

8

36

m

27

complete recovery

*

9

27

m

7

moderate motor-dysphasia, minimal brachial hemiparesis (in recovery, lost follow-up)

10

42

f

19

complete recovery

*

11

48

m

12

complete recovery

*

12

52

m

13

complete recovery

*

13

21

m

12

complete recovery

*

14

5

m

17

complete recovery

*

15

45

m

22

complete recovery

*

16

47

f

16

persistent aphasia

17

17

m

20

complete recovery

*

18

57

f

7

complete recovery

*

19

22

m

20

complete recovery

*

20

4

m

6

complete recovery

*

21

19

m

14

complete recovery

*

* patients returned to his / her former occupational work or school

* patients returned to his / her former occupational work or school

Table 2.2.5-5. Mortality rates from intracranial abscesses, managed by adjunctive HBO (time span studied : 1976 - 2003)_

Author

Year

Country of Origin

Nb

deaths

Mortality

[Ref.]

Mathieu

2000

France

8

1

12.5 %

[52]

Sutter

1996

Austria

18

0

0.0%

[53]

Kemmer

2001

Germany

10

1

10.0 %

[54]

Kindwall

2001

USA

8

0

0.0 %

[55]

Lampl

2003

Germany

21

0

0.0 %

[56]

65

2

3.1 %

The favourable results of adjunctive HBO have been confirmed by other investigators (table 2.2.5-5). This is especially true for the series by Mathieu from Lille, France, in which the inclusion criterion was deterioration of the patient's neurological condition, due to the lack of response to conventional therapy52. Similarly the Graz team, in Austria, was able to offer a longitudinal perspective in mortality before and after the use of HBO53. The unpublished data from Kemmer, Germany54, also support the findings as do those of Kindwall55 and a number of individual case reports.

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