RESUMEN
INTRODUCTION: Necrotizing soft tissue infections (NSTI) are rare but potentially lethal disorders, and adequate management is time- and resource-demanding. This study aims to assess whether variations in the treatment modalities - surgery, hyperbaric oxygen (HBO2) therapy and negative pressure wound therapy - had an impact on the length to definitive source control in NSTI patients who underwent HBO2. METHODS: This is a retrospective study of all NSTI patients treated with hyperbaric oxygen therapy between March 2007 and May 2015 at Unidade Local de Saúde de Matosinhos (ULSM) Hyperbaric Unit. A multiple linear regression model was used to assess the impact of different treatment modalities in the posdiagnosis time until source control. RESULTS: 58 patients were included; overall mortality was 13.8%. Mean time until source control was 10.4 days (±5.4). All patients were under empiric and broad-spectrum antibiotics on the day of diagnosis. Patients underwent an average of 0.62 (±0.29) surgical interventions and 1.06 (±0.52) HBO2 sessions per day. The regression model (R2=0.86) showed that after adjusting for other covariates, doubling the number of HBO2 sessions per day shortened source control by five days (? ß = -5.25; 95% CI -6.49 to 4.01), and for each day that HBO2 was delayed, source control was achieved one day later (ß = 1.03; 95% CI 0.82 to 1.24). CONCLUSIONS: More intensive HBO2 protocols with earlier and more frequent sessions shorten the time until definitive source control in necrotizing soft tissue infections, potentially lowering the impact of systemic effects of infection and complications associated with organ dysfunction.
Asunto(s)
Oxigenoterapia Hiperbárica/métodos , Infecciones de los Tejidos Blandos/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Terapia Combinada , Desbridamiento , Femenino , Humanos , Oxigenoterapia Hiperbárica/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Necrosis , Portugal/epidemiología , Estudios Retrospectivos , Infecciones de los Tejidos Blandos/mortalidad , Resultado del Tratamiento , Adulto JovenRESUMEN
Freqüentemente recorre-se à produção de sistemas gastrorretentivos para modular a liberação de fármacos a partir de sistemas farmacêuticos com vistas ao aumento do tempo de permanência do fármaco no trato gastrointestinal. Umas das estratégias mais interessantes passa pela produção de sistemas flutuantes. Estes podem ser classificados em dois grupos: sistemas flutuantes efervescentes e sistemas flutuantes não-efervecentes. Neste artigo apresenta-se uma revisão bibliográfica do que tem sido produzido nesta área nos últimos anos.
Gastro-retentive systems are often produced in order to modulate drugs release from pharmaceutical forms and in this way to increase drug residence time in the gastrointestinal tract. One of the most interesting strategies consists in the preparation of floating devices. These can be classified into two groups: effervescent systems and non-effervescent systems. A review of what has been done in the last years is presented in this article.