A fast-moving infection can destroy skin, muscle, and deeper tissue, sometimes costing a person a limb or their life. This study asks whether breathing oxygen under pressure may improve those odds. Necrotizing soft tissue infection is a debilitating and potentially life-threatening condition that affects the skin, underlying tissue, muscle, and fascia.

The infection can move quickly, so established care centers on early diagnosis, surgery to remove damaged tissue, and broad-spectrum antibiotics. Oxygen under pressure has been used for nearly half a century alongside those treatments, but its role remains controversial because high-level clinical evidence has not been available.

Earlier research found that oxygen under pressure was associated with lower death rates, but that evidence came mainly from small studies looking back at past medical records. Because critical care has advanced, the researchers set out to investigate whether HBOT would continue to have a role in treating necrotizing soft tissue infections.

The review examined people hospitalized for this infection who had surgery, then compared those who also received oxygen under pressure with those who did not. The main outcome was death in the hospital; the review also tracked amputations, time in the hospital, and costs, while using a statistical model to account for differences between the groups.

The two groups were similar in age, sex, overall burden of other illnesses, kidney injury, and the organisms causing infection. But the treatment group had less sepsis and fewer urgent admissions, while also showing more truncal infections and private insurance than the comparison group.

After accounting for those baseline differences, oxygen under pressure was associated with a lower risk of death and a lower risk of amputation. The trade-off was a longer hospital stay and higher costs, with the study reporting both differences as associations between HBOT and outcomes.

The pattern continued among people who also had sepsis: oxygen under pressure was associated with lower death rates, fewer amputations, and fewer discharges to places other than home. The researchers also examined a subgroup consisting only of patients who had presented with sepsis at the time of their hospital admission.

After adjustment for differences between groups, neither hospital stay nor cost differed significantly between the HBOT and control groups in this analysis. The study concludes that oxygen under pressure, added to surgery and antibiotics, was associated with fewer deaths, amputations, and non-home discharges, with slightly longer stays and higher costs overall.

Because disagreement about HBOT's role remains widespread, the treatment's value still needs to be established with clearer evidence in NSTI. A well-designed randomized, controlled, multicenter trial is therefore needed to provide that broader understanding and guide evidence-based clinical practice.

In this national review, adding oxygen under pressure to surgery and antibiotics was linked with fewer deaths, amputations, and discharges away from home, though hospital stays and costs were higher overall. The finding supports a stronger clinical trial, not a guarantee of benefit.