Necrotizing Soft Tissue Infection
Conditions
Keywords
NSTI, Sepsis, clinical trial, Hyperbaric Oxygen Treatment, Hyperbaric Oxygen Therapy, Necrotizing soft tissue infection
Brief summary
Necrotizing soft-tissue infection (NSTI) is a rare, severe, fast-progressing bacterial infection within the soft tissue compartment. The NSTI mortality rate remain high and largely unaltered in the last decades. The standard of care in NSTI is multidisciplinary and includes surgery, intensive care, and broad-spectrum antibiotics. Hyperbaric oxygen (HBO2) treatment is an adjunctive treatment potentially improving survival, but is not standard of care in many centres, presumably as no evidence of its benefit from randomized clinical trial exists. The primary objective of this trial, HOT-NSTI, is to investigate the effect of adjunctive HBO2 treatment on 30-day all-cause mortality in patients with NSTI.
Interventions
Patients will be randomized to either standard of care or standard of care + adjunctive sessions of HBO2 treatment consisting of 60-90 minutes (according to local protocols) 2.8ATA (284 kPa (≈18 m' seawater equivalent)) 100% oxygen breathing. The first session will be performed as soon as possible after randomization at the trial site, and at least within 12 hours from randomization. A minimum of three sessions will be performed within 48 hours after randomization. If the patient is considered clinical unstable after the initial three sessions (e.g. ongoing progression of the necrotising process or requiring intravenous blood pressure support in a dosage considered not related to sedation agents) additional sessions must be administered at a rate of one per approximately 24 hours, up to a maximum of five treatments. All sessions must be completed within a total timeframe of 96 hours from randomization.
Standard of care (e.g. intensive care, surgery, antibiotics)
Sponsors
Ole Hyldegaard
Københavns Universitet
AZ Sint-Lucas Brugge
Ziekenhuis Oost-Limburg
University Hospital, Antwerp
Rigshospitalet, Denmark
Oslo University Hospital
Haukeland University Hospital
Turku University Hospital
Karolinska University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Investigator-initiated, international, multicentre, superiority, randomized, open-label, clinical trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults (age ≥18 years) * Surgical confirmed NSTI (defined by perioperative tissue characteristics observed by the surgeon. The diagnosis is based on sign as necrotic or deliquescent soft tissue with widespread undermining of the surrounding tissue)
Exclusion criteria
* Contraindications for HBO2 treatment according to local protocol (e.g., undrained pneumothorax) * Confirmed pregnancy * Referred to palliative care * Previously randomized into the HOT-NSTI trial * Known objection by the patient to participate in the trial * Allergy against study drug
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mortality | 30-day post-randomization | 30-day all-cause mortality post-randomization |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mortality | 90-day post-randomization | 90-day all-cause mortality post-randomization |
| Amputations | 7 days post-randomization | Amputation (y/n) within 7 days post-randomization |
Outcome results
None listed