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LT Stephen Hughes, MD

Adjunctive hyperbaric oxygen therapy for the treatment of Clostridium perfringens -associated liver abscess and septic shock complicated by hemolytic anemia. LT Stephen Hughes, MD. Financial Relationship Disclosure. I have no relevant financial relationships with any commercial supporters.

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LT Stephen Hughes, MD

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  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/purulence • 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. http://longbeachhyperbaricmedicine.com/files/HBO_chamber_1.JPG

  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, MD1 Elizabeth Middleton, MD2,3 Jonathan Stabile, DO3,4 Matthew Hegewald, MD2,3 James Orme, MD2,3 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), 310-312. • Fauci, A., et al (2008). Harrison's principles of internal medicine (17th ed., pp. 903-907). New York: McGraw-Hill Medical.

  12. Questions?

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