Emergency Indication
Hyperbaric Oxygen Therapy for Necrotizing Soft Tissue Infections
Necrotizing fasciitis, gas gangrene and Fournier's gangrene can spread within hours. Treatment is emergency surgery and IV antibiotics, so call 911. Some hospitals add hyperbaric oxygen as an adjunct. Generations Wellness is an outpatient center and does not provide emergency hyperbaric treatment.
This is a medical emergency. Call 911 or go to the nearest emergency room for a skin infection that spreads quickly, with pain far worse than it looks, fever, swelling, blisters, dark patches or crackling under the skin. Treatment is emergency surgery and IV antibiotics; hyperbaric oxygen is only an add-on. Emergency hyperbaric treatment is delivered at hospital-based chambers. Generations Wellness is an outpatient center in Modesto and does not provide emergency HBOT.
The Basics
Two Infections, One Indication
"Necrotizing" means causing tissue to die. These infections destroy skin, fat, the tissue covering muscles (fascia) and sometimes muscle itself, and they can move faster than antibiotics alone can stop them. Doctors separate them into two groups.
Gas gangrene (clostridial myonecrosis)
Gas gangrene is caused by Clostridium bacteria, which grow where oxygen is low, often in deep wounds or damaged muscle. They release toxins that kill tissue rapidly and can produce gas bubbles under the skin. High oxygen levels stop these bacteria from making their main toxin, which is why gas gangrene is the oldest infection-related reason for hyperbaric oxygen.
Necrotizing soft tissue infections, including necrotizing fasciitis
Necrotizing fasciitis is often caused by group A Streptococcus or by a mix of bacteria that do and do not need oxygen. Fournier's gangrene is a necrotizing infection of the genital and perineal area. In these infections, HBOT may be added to repeated surgery and antibiotics.
Both gas gangrene and necrotizing soft tissue infections are FDA-cleared indications for hyperbaric chambers and are on the Undersea and Hyperbaric Medical Society (UHMS) indications list. Medicare's coverage rules also list gas gangrene and progressive necrotizing infections. Bone infection is a separate topic, covered on our page about bone infection (osteomyelitis).
Act Fast
Warning Signs of a Necrotizing Infection
The CDC describes early symptoms as:
- A red, warm or swollen area of skin that spreads quickly
- Severe pain, including pain beyond the area that looks red or swollen
- Fever
Later signs include changes in skin color, blisters, ulcers or black spots on the skin, pus or oozing, dizziness, tiredness, nausea or diarrhea. People with diabetes, weakened immune systems, kidney or liver disease, or recent surgery or wounds are at higher risk, but healthy people can be affected too.
According to the CDC, even with treatment, up to 1 in 5 people with necrotizing fasciitis die from the infection. Speed matters. Do not wait to see whether it gets better overnight.
The Mechanism
Why Oxygen Matters in Severe Infections
Infected, swollen tissue has very little oxygen. That helps the infection in several ways, and hyperbaric oxygen aims to push back:
- Direct effect on anaerobic bacteria. Bacteria that thrive without oxygen are slowed by high oxygen levels, and clostridial toxin production stops.
- Stronger white blood cells. White blood cells use oxygen to kill bacteria. When tissue oxygen is very low, they work poorly. Read more about oxygen and white-cell bacterial killing.
- Less swelling. Reducing swelling can help blood flow reach the edges of the infection.
- Clearer boundaries. Some surgeons report that HBOT may make it easier to see which tissue is dead and which can be saved, which can help during repeat operations.
None of this replaces surgery. Dead tissue must be removed surgically, and antibiotics must reach the infection. Hyperbaric oxygen is only ever an adjunct.
Hospital Protocol
How Hospitals Use HBOT for Necrotizing Infections
| Step | What happens |
|---|---|
| First | Emergency surgery to remove dead tissue, plus IV antibiotics and critical care. HBOT must never delay surgery. |
| Early HBOT | Often about 2.5 to 3.0 ATA for about 90 minutes, commonly twice a day at first |
| Following days | Once a day, alongside repeat surgery as needed |
| Total | Often about 5 to 10 sessions or more, decided by the surgical and hyperbaric teams |
Patients with these infections are often in intensive care, on breathing machines or blood-pressure medicines. Only hospital hyperbaric programs able to care for critically ill patients can provide HBOT safely in this setting, and not every hospital has one. HBOT also has its own risks, such as ear and sinus pressure injury and, rarely, oxygen toxicity seizures.
Honest Evidence
What the Evidence Shows
If your family member is in the ICU, you deserve a straight answer about the research. Here it is: the studies we have are observational, and no randomized trial has yet reported results.
| Study | Design | Finding | Limitation |
|---|---|---|---|
| Systematic review and meta-analysis, World J Emerg Surg 2023 | Retrospective cohort and case-control studies; 49,152 patients, 1,448 of whom received HBOT | Lower mortality in the HBOT group (RR 0.52, 95% CI 0.40 to 0.68); fewer cases of multiple organ failure; no difference in amputation; more debridement operations in the HBOT group | Observational only; the authors describe the evidence as weak. Patients who reach a chamber may differ from those who do not |
| Systematic review, Infect Dis (Lond) 2019 | Review of published studies | Concluded the evidence for HBOT in necrotizing infections is poor and biased, and called for randomized trials | Limited by the same observational studies |
| HOT-NSTI trial (NCT07489274) | International multicenter randomized trial, currently recruiting | No results yet | Will take time to report |
In plain terms: observational studies consistently link HBOT with lower death rates, but they cannot rule out that healthier or better-resourced patients were the ones who received it. A randomized trial is now under way to answer the question properly. Meanwhile, UHMS lists these infections as indications, and hospitals that have the capability may add HBOT after surgery.
Near Modesto
Where Acute Treatment Happens Near Modesto
- Call 911 or go to the nearest emergency department. The emergency team starts antibiotics, fluids and urgent surgical evaluation.
- Surgery is the priority. Surgeons remove infected, dead tissue, often in several operations.
- Emergency physicians and surgeons coordinate transfer to a hospital-based hyperbaric facility if they decide HBOT is indicated and the patient is stable enough to move.
Families should not try to arrange HBOT themselves. If you want to know whether it was considered, it is reasonable to ask the surgical team.
Recovery
After the Hospital: Caring for the Wound
Surviving a necrotizing infection is often the start of a long recovery. After surgery, many patients have large open wounds. Follow-up care, led by the surgical and wound-care teams, can include:
- Regular wound care and dressing changes, sometimes with negative-pressure wound therapy
- Skin grafts or flaps to close large wounds
- Physical therapy to regain strength and movement
- Careful control of blood sugar and other health conditions
- Emotional support; recovery after a life-threatening illness is hard, and it is common to need help
Some wounds heal slowly, especially in people with diabetes or poor circulation. Those later wound problems are different questions from the original infection. Our pages on non-healing surgical wounds, grafts placed after debridement and diabetic foot infections and ulcers explain how those separate cleared indications work.
Generations Wellness
Our Outpatient Role, Honestly
Generations Wellness is a physician-directed outpatient center under Dr. Rajwinder Singh Bahia, MD. We do not provide emergency hyperbaric treatment, and we do not treat necrotizing infections. If you suspect one, call 911.
Once you or your loved one is stable and home, our team is glad to talk. We can answer general questions about hyperbaric oxygen therapy and tell you honestly whether anything we offer is relevant, always in coordination with your surgeon. Surgeons and infectious disease physicians can find information for referring physicians.
Important
Hyperbaric oxygen never replaces surgery or antibiotics for a necrotizing infection. A physician assessment is required before beginning any HBOT at Generations Wellness, and HBOT complements, and never replaces, the treatment prescribed by your doctors.
Questions
Necrotizing Infections and HBOT: Frequently Asked Questions
Can hyperbaric oxygen replace surgery for necrotizing fasciitis?
No. Emergency surgery to remove dead tissue and IV antibiotics are the treatment. HBOT is an add-on some hospitals use after surgery.
Does HBOT reduce deaths from necrotizing infections?
A 2023 meta-analysis of observational studies found roughly half the mortality in patients who received HBOT, but the authors called the evidence weak. No randomized trial has confirmed this, and one is now recruiting.
How many hyperbaric sessions are used?
Often twice a day at first, then daily, for roughly 5 to 10 sessions or more. The surgical and hyperbaric teams decide.
Is Fournier's gangrene treated with HBOT?
Fournier's gangrene is a necrotizing infection of the genital and perineal area. It is managed the same way: emergency surgery and antibiotics, with HBOT as an adjunct in some hospitals.
Can I get HBOT after I leave the hospital?
Not for the infection itself. If a wound or graft is not healing later, talk with your surgeon about the options; our team is glad to answer general questions once you are stable.
Sources
- Undersea and Hyperbaric Medical Society. Hyperbaric Oxygen Therapy Indications (clostridial myonecrosis; necrotizing soft tissue infections). uhms.org
- The effect of hyperbaric oxygen therapy on the clinical outcomes of necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg. 2023;18(1):23. wjes.biomedcentral.com
- Scarce evidence of efficacy of hyperbaric oxygen therapy in necrotizing soft tissue infection: a systematic review. Infect Dis (Lond). 2019. pubmed.ncbi.nlm.nih.gov
- Adjunctive Hyperbaric Oxygen Treatment for Patients With Necrotizing Soft-Tissue Infection (HOT-NSTI Trial), NCT07489274. clinicaltrials.gov
- Centers for Disease Control and Prevention. Necrotizing Fasciitis. cdc.gov
- U.S. Food and Drug Administration. Hyperbaric Oxygen Therapy: Get the Facts. fda.gov
- Centers for Medicare & Medicaid Services. National Coverage Determination 20.29, Hyperbaric Oxygen Therapy. cms.gov
This page is educational and not medical advice. For a suspected necrotizing infection, call 911. Generations Wellness does not provide emergency hyperbaric treatment. See our full medical disclaimer, including emergency numbers.
If This Is an Emergency
Call 911 First
Emergency hyperbaric treatment happens in hospital settings. For follow-up questions once you are stable, our team is glad to talk.
Prefer to talk? (369) 222-0979