亞洲
高壓氧
中心
適用對象
This supportive protocol is for people being treated for necrotizing soft tissue infection — necrotizing fasciitis and its relatives — whose surgical and intensive care teams recommend hyperbaric oxygen as an adjunct to their management [1].
The profile this page serves:
Confirmed or suspected NSTI under surgical management: Debridement is underway or complete, and the team is fighting to preserve viable tissue between operations.
Infections involving anaerobic bacteria: The organisms behind gas gangrene and many mixed necrotizing infections cannot tolerate oxygen — hyperbaric pressures directly suppress their growth and toxin production [1] [3].
Cases with spreading infection or threatened limbs: Where demarcation — the line between living and dying tissue — is still being decided, oxygen-supported tissue changes what can be saved [1] [4].
People whose condition is stabilised enough for chamber sessions: Coordination with the treating team decides timing, every time [1].
The sequence is absolute: emergency surgery and antibiotics first, hyperbaric oxygen as their partner — started as early as the team judges safe, never at the cost of a surgical minute [1] [2]. A doctor's referral is required, and for this condition it comes from the surgical or intensive care team managing the case.
As soon as the surgical team says the condition allows — and never a moment before. NSTI is one of the few diagnoses where the first treatment decision is never ours [1].
Hyperbaric oxygen enters the conversation when:
Emergency debridement has begun and the team is managing serial operations, where better tissue condition between procedures changes what each operation can preserve [1] [4].
The infection involves anaerobic organisms — where oxygen under pressure works directly against the bacteria themselves, not just the tissue environment [1] [3].
Infection is spreading despite surgery and antibiotics, and the team wants every available adjunct on the field [1] [2].
A limb's viability is in question, where supporting marginal tissue may reduce the extent of amputation [4].
One rule, stated without compromise: hyperbaric oxygen must never delay debridement. If the chamber and the operating theatre compete for an hour, the theatre wins. Every time. That is not our policy — it is the position of the entire evidence base [1] [2] [5].
何時考慮高壓氧療程
Three Fights, One Chamber
Necrotizing infection wins by speed and by chemistry. The bacteria multiply through oxygen-poor tissue, and many of the worst offenders — the clostridia behind gas gangrene — are anaerobes: oxygen itself is toxic to them. They also pump out toxins that kill tissue ahead of the infection, which is why the damage outruns what the eye can see [1] [3].
Inside the chamber, we change the physics — and the chemistry. At 2.0 to 2.5 ATA, 99.5% medical-grade oxygen dissolves directly into the blood plasma, raising tissue oxygen tension far beyond what infected, swollen vessels can deliver normally [1]. Three fights are won at once.
First, against the bacteria. At hyperbaric oxygen tensions, anaerobic organisms stop producing their key toxins, and their growth is directly suppressed — oxygen becomes a drug against the pathogen itself [1] [3].
Second, for the immune system. Neutrophils kill bacteria through oxygen-dependent chemistry; in the oxygen-starved environment of infected tissue, that machinery stalls. Restored oxygen tension switches it back on [1] [5].
Third, for the margin. Tissue at the border of the infection — swollen, half-starved, still alive — is kept oxygenated while the surgical team defines what can be saved. Demarcation improves. Less healthy tissue is lost to uncertainty [1] [4].
科學實證
We do not make promises. The research does that. Necrotizing soft tissue infection is an established UHMS indication for adjunctive hyperbaric oxygen [1] — and it happens to carry the largest dataset in all of hyperbaric medicine.
A 2021 systematic review and meta-analysis pooled 21 studies covering 48,744 patients [2]:
56% — the reduction in in-hospital mortality when hyperbaric oxygen was added to surgical and antibiotic management (odds ratio 0.44; 95% CI 0.33–0.58). — Hedetoft et al., 2021 [2]
Individual series point the same direction:
Reduced mortality and amputation — a widely cited prospective series reported significantly lower death and limb loss rates with adjunctive hyperbaric oxygen. — Escobar et al., Undersea & Hyperbaric Medicine, 2005 [6]
Increased survival — a national database analysis found hyperbaric oxygen independently associated with survival in necrotizing infections. — Shaw et al., Surgical Infections, 2014 [7]
Where we are honest with you: there are no randomized trials here — a Cochrane review found none meeting its criteria, so every conclusion rests on observational data [8]. Some of that data conflicts: a 2009 single-centre study found no improvement with hyperbaric oxygen [9], and older reviews noted mixed findings across series [5]. Patients referred for hyperbaric oxygen may also differ systematically from those who are not — selection effects run both ways in this literature. The honest summary: the largest and most recent analysis shows a substantial mortality association, the mechanism is well characterised, and the evidence is observational. Your surgical team weighs it exactly that way [1] [2] [8].
Our protocols follow UHMS guidance for necrotizing infections [1]. The schedule belongs to the surgical plan — debridements, dressing changes, intensive care requirements.
Oxygen Purity: 99.5% Medical-Grade Oxygen — pharmaceutical-grade purity certified under the Pharmacy and Poisons Ordinance (Cap. 138) [10].
Chamber Pressure: 2.0 to 2.5 ATA (Atmospheres Absolute) — the range used across the clinical series [1] [2].
Session Duration: 90 minutes at depth.
Frequency (acute phase): Often twice daily in the first days where the team indicates, then once daily as the infection is controlled [1].
Total Course: Set by response and by the surgical team — commonly 10 to 15 sessions across the acute and early recovery phase, reviewed against each operative finding [1].
療程方案
療程體驗
我們理解首次進入高壓艙可能會感到陌生。我們的專業團隊將全程陪伴，確保您在整個過程中感到舒適、安全與安心。
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Step 1 — 諮詢與準備： 在首次療程前，我們的技術專員會詳細解釋安全守則。您將換上我們提供的100%純棉衣物，以消除靜電風險。高壓艙內嚴禁攜帶任何電子產品、手錶或塗抹油性化妝品。
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Step 2 — 升壓階段： 在起初的10至15分鐘升壓過程中，您的耳朵會產生類似飛機降落時的微脹感。專員會指導您簡單的吞嚥或捏鼻鼓氣動作以平衡耳壓。達到治療壓力（2.0-2.5 ATA）後，您將透過舒適的專用面罩或吸氧帳吸入99.5%醫療級純氧。在90分鐘的療程中，您可以看書、休息或觀看屏幕。
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Step 3 — 減壓與後續： 療程結束前，艙內會於10至15分鐘內緩慢減壓。出艙後，您可以立即恢復日常活動。我們的專員會評估您的傷口狀況，並與您的主治傷口護理團隊保持溝通，以追蹤修復進度。
FAQ
How many sessions before I notice a difference?
The acute course commonly runs 10 to 15 sessions, sometimes twice daily at the start, judged against each surgical finding [1]. In this condition the response is read by your surgical team at every operation and dressing change — not by feel. The chamber's job is to make each successive operation find better tissue than the last.
Will hyperbaric oxygen replace surgery for this infection?
Never — and this is the one condition where that answer is a matter of survival, not preference. Necrotizing infection is cured by debridement and antibiotics, started fast. Hyperbaric oxygen is an adjunct that the largest dataset associates with substantially lower mortality [2] — but every minute it ever delayed surgery would be a minute spent against the evidence. Surgery first. Always [1] [5].
The evidence has no randomized trials. Why consider it?
Fair question, and we answer it plainly. Randomized trials in this emergency are ethically near-impossible, so the evidence is observational — but it now includes nearly 49,000 patients with a 56% mortality association, a clear mechanism (oxygen directly suppresses anaerobic bacteria and their toxins), and consistent direction across most series [1] [2] [3]. Some studies disagree [9], and your surgical team will know them. The decision is theirs, with all of it on the table.
UHMS. Necrotizing Soft Tissue Infections. UHMS Hyperbaric Oxygen Therapy Indications, 15th Edition. Undersea and Hyperbaric Medical Society. UHMS Official Indications
Hedetoft M, et al. Hyperbaric oxygen therapy as an adjunct to surgery and antibiotics for necrotizing soft tissue infections: a systematic review and meta-analysis (21 studies, 48,744 patients; in-hospital mortality OR 0.44, 95% CI 0.33–0.58). 2021. [UNVERIFIED — journal/volume to be confirmed before publication]
Kindwall EP, et al. Hyperbaric oxygen and anaerobic infection: suppression of clostridial growth and alpha-toxin production (mechanism studies). As summarized in UHMS Indications.
Escobar SJ, Slade JB Jr, Hunt TK, et al. Adjuvant hyperbaric oxygen therapy (HBO2) for treatment of necrotizing fasciitis reduces mortality and amputation rate. Undersea Hyperb Med. 2005;32:437-443.
CMS. Hyperbaric Oxygen Therapy in Treatment of Hypoxic Wounds — Technology Assessment (mixed findings across necrotizing fasciitis series). 1999. CMS TA
— see reference 4 above (Escobar et al., 2005). (Editor: deduplicate before publishing)
Shaw JJ, Psoinos C, Emhoff TA, et al. Not just full of hot air: hyperbaric oxygen therapy increases survival in cases of necrotizing soft tissue infections. Surg Infect (Larchmt). 2014;15(3):328-335.
Levett D, Bennett MH, Millar I. Adjunctive hyperbaric oxygen for necrotizing fasciitis. Cochrane Database of Systematic Reviews. 2015;(1):CD007937.
George ME, Rueth NM, Skarda DE, et al. Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection. Surg Infect (Larchmt). 2009;10(1):21-28.
Hong Kong e-Legislation. Pharmacy and Poisons Ordinance (Cap. 138). Cap. 138 on e-Legislation
