What is the role of hyperbaric oxygen therapy (HBOT) in the treatment of an intracranial abscess?

Updated: Nov 16, 2020
  • Author: Emi Latham, MD, FACEP, FAAEM, UHM; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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The disorders considered in treatment of intracranial abscesses (ICA) include subdural and epidural empyema as well as cerebral abscess. [2] Studies from around the world have reviewed mortality from ICA with a resulting mortality of about 20%. [77] HBOT has multiple mechanisms that make it useful as an adjunctive therapy for ICA.

HBOT induces high oxygen tensions in tissue, which helps to prevent anaerobic bacterial growth, including organisms commonly found in ICA. [78, 79, 80, 81] HBOT can also help reduce increased intracranial pressure (ICP) and its effects are proposed to be more pronounced with perifocal brain swelling. [10, 12, 82, 83, 84] As discussed earlier, HBOT can enhance host immune systems and the treatment of osteomyelitis. [85] Candidates for adjunctive HBOT are patients who have multiple abscesses, who have an abscess that is in a deep or dominant location, whose immune systems are compromised, in whom surgery is contraindicated, who are poor candidates for surgery, and who exhibit inadequate response despite standard surgical and antibiotic treatment. [4]

HBOT is administered at 2.0-2.5 ATA for 60-90 minutes per treatment. HBOT may be 1-2 sessions per day. The optimized number of treatments has not been determined. [4]

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