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Adjunctive hyperbaric oxygen therapy for the treatment of Clostridium perfringens-associated liver abscess and septic shock complicated by hemolytic anemia.

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Presentation on theme: "Adjunctive hyperbaric oxygen therapy for the treatment of Clostridium perfringens-associated liver abscess and septic shock complicated by hemolytic anemia."— Presentation transcript:

1 Adjunctive hyperbaric oxygen therapy for the treatment of Clostridium perfringens-associated liver abscess and septic shock complicated by hemolytic anemia. LT Stephen Hughes, MD

2 Financial Relationship Disclosure I have no relevant financial relationships with any commercial supporters

3 The Case HPI: 68 yo M w/ pmh of chronic cholecystitis/cholelithiasis now 3 days s/p laparoscopic cholecystectomy presenting to the ER w/ hematuria, jaundice, diarrhea and back pain w/ continued RUQ pain. PMH/PSH: CAD, HLD, OSA,GI ulcers. Cholecystectomy 26Mar14 (3 days prior)

4 ICU Admission Physical Exam and Labs PE: – Gen: NAD, Intubated/sedated – ABD: S, Distended. Lap Chole incisions w/o erythema/induration/purulen ce – Skin: Jaundiced to bilat thighs LABS – WBC: 38.6 Hg 5.8  9.6 – Cr: 4.17 – Tbili: 15.8 (Ind 12.1) – Lactate: 4.3 – LDH: 3550, Haptoglobin: 52 U/A:

5 Imaging

6 Clostridium perfringens Ubiquitous, gram pos. spore forming rod Obligate anaerobe Synergistic α (Phospholipase C) and θ (Perfringolysin O) toxins

7 Clostridial Sepsis Simon, T. et. al, Journal of Intensive Care Medicine 2013 Mortality: 74% Median time to death of 9.6 hours TREATMENT Penicillin 3-4 million units IV q4h Clindamycin 600mg IV q6h Surgical Debridement Adjunctive Hyperbaric Oxygen

8 Adjunctive Hyperbaric Oxygen Therapy (HBOT) Historically used in treatment of Gas Gangrene Prior to this case, has been used 4 times for Clostridial septicemia. 0% Mortality in patients treated with HBOT in addition to standard therapies.

9 Back to the Case The pt was treated with 8 sessions of HBOT Course was complicated only by otic barotrauma The pt was discharged 2 ½ weeks following admission on OPAT and 3x/week hemodialysis Continues to improve despite the historically poor prognosis of this virulent condition.

10 Special Thanks/ Additional Authors CDR Ryan Maves, MD 1 Elizabeth Middleton, MD 2,3 Jonathan Stabile, DO 3,4 Matthew Hegewald, MD 2,3 James Orme, MD 2,3 1 Naval Medical Center, San Diego, CA 2 University of Utah School of Medicine, Salt Lake City, UT 3 Intermountain Medical Center, Murray, UT 4 Duke University School of Medicine, Durham, NC

11 References Simon, T., Bradley, J., Jones, A., & Carino, G. (2013). Massive Intravascular Hemolysis From Clostridium perfringens Septicemia: A Review. Journal of Intensive Care Medicine, 00(0), 1-7. Ng, H., Lam, S., Shum, H., & Yan, W. (2010). Clostridium perfringen liver abscess with massive haemolysis. Hong Kong Med J, 16(4), Fauci, A., et al (2008). Harrison's principles of internal medicine (17th ed., pp ). New York: McGraw-Hill Medical.

12 Questions?


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