Hyperbaric oxygen for COVID-19 patients with severe hypoxia prior to vaccine availability.

Introduction: Few treatments have demonstrated mortality benefits among hospitalized hypoxic COVID-19 patients. We evaluated the use of hyperbaric oxygen (HBO2) therapy as a therapeutic intervention among hospitalized patients with a high oxygen requirement prior to vaccine approval. Methods: We extracted data on patients with COVID-19 hypoxia who required oxygen supplementation ranging from a 6L nasal cannula up to a high-flow nasal cannula at 100% FiO2 at 60L/minute with a 100% non-rebreather mask at 15 L/minute and were eligible for off-label HBO2 therapy from October 2020 to February 2021. We followed the Monitored Emergency use of Unregistered and Investigational Interventions or (MEURI) in conjunction with the consistent re-evaluation of the protocol using the Plan-Do-Study-Act (PDSA) tool [1]. We compared patient characteristics and used Fisher's exact test and a survival analysis to assess the primary endpoint of inpatient death. Results: HBO2 therapy was offered to 36 patients, of which 24 received treatment and 12 did not receive treatment. Patients who did not receive treatment were significantly older (p ≺ 0.01) and had worse baseline hypoxia (p = 0.06). Three of the 24 (13%) patients who received treatment died compared to six of 12 (50%) patients who did not receive treatment (RR ratio: 0.25, p = 0.04, 95% CI: 0.08 to 0.83). In the survival analysis, there was a statistically significant reduction in inpatient mortality in the treatment group (HR: 0.19, p = 0.02, 95% CI: 0.05-0.74). However, after adjusting for age and baseline hypoxia, there was no difference in inpatient mortality (hazard ratio: 0.48, p = 0.42, 95% CI: 0.08-2.86). Conclusion: The survival benefit of HBO2 therapy observed in our unadjusted analysis suggests that there may be therapeutic benefits of HBO2 in treating COVID-19 hypoxia as an adjunct to standard care.

Hyperbaric oxygen therapy as a supportive therapy for COVID-19 patients: a narrative review.

The Coronavirus illness 2019 (COVID-19) was first observed to induce fever, dry cough, pneumonia, and dyspnea in the lower respiratory tract. Atypical manifestations, including digestive problems and cardiac symptoms, were also observed. The rate of mortality in the older population is greater than in the younger group, as well as in individuals suffering from comorbidities. Oxygen supplementation through a facemask, non-invasive ventilation, mechanical ventilation, and extracorporeal membrane oxygenation ECMO are some of the available supportive techniques. Hyperbaric oxygen treatment (HBOT) is thought to boost tissue oxygenation by increasing plasma soluble oxygen levels. HBOT also reduces inflammatory responses in COVID-19 patients, minimizing the negative impacts of the cytokine storm. Because the existing data on the efficacy of HBOT in COVID-19 patients is limited, the purpose of this article is to review the possible mechanisms of HBO, as well as data available on potential advantages, side effects and uses in the treatment of COVID-19 patients.

Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial.

Post-COVID-19 condition refers to a range of persisting physical, neurocognitive, and neuropsychological symptoms after SARS-CoV-2 infection. The mechanism can be related to brain tissue pathology caused by virus invasion or indirectly by neuroinflammation and hypercoagulability. This randomized, sham-control, double blind trial evaluated the effect of hyperbaric oxygen therapy (HBOT or HBO2 therapy) on post-COVID-19 patients with ongoing symptoms for at least 3 months after confirmed infection. Seventy-three patients were randomized to receive daily 40 session of HBOT (n = 37) or sham (n = 36). Follow-up assessments were performed at baseline and 1-3 weeks after the last treatment session. Following HBOT, there was a significant group-by-time interaction in global cognitive function, attention and executive function (d = 0.495, p = 0.038; d = 0.477, p = 0.04 and d = 0.463, p = 0.05 respectively). Significant improvement was also demonstrated in the energy domain (d = 0.522, p = 0.029), sleep (d = - 0.48, p = 0.042), psychiatric symptoms (d = 0.636, p = 0.008), and pain interference (d = 0.737, p = 0.001). Clinical outcomes were associated with significant improvement in brain MRI perfusion and microstructural changes in the supramarginal gyrus, left supplementary motor area, right insula, left frontal precentral gyrus, right middle frontal gyrus, and superior corona radiate. These results indicate that HBOT can induce neuroplasticity and improve cognitive, psychiatric, fatigue, sleep and pain symptoms of patients suffering from post-COVID-19 condition. HBOT's beneficial effect may be attributed to increased brain perfusion and neuroplasticity in regions associated with cognitive and emotional roles.

A COVID-19 infection incidentally detected during hyperbaric oxygen treatment and preventive measures for COVID-19 transmission in a multiplace hyperbaric chamber.

INTRODUCTION: SARS-CoV-2 (COVID-19) was declared a global pandemic on 11 March 2020 and has become a serious threat to public health. As it can easily be transmitted through droplets and aerosols, there is an increased risk of transmission in enclosed environments such as hyperbaric oxygen treatment (HBOT) units if preventive measures are not taken. CASE REPORT: A 16-year-old female tested positive for SARS-CoV-2 during HBOT for idiopathic sudden sensorineural hearing loss. The other patients and the inside attendant who attended the sessions with her were regarded as contacts, tested for SARS-CoV-2, and quarantined until the test results were available. Ultimately, none of them tested positive. DISCUSSION: As HBOT in multiplace chambers entails a high risk of SARS-CoV-2 transmission, we strictly adapted our practice to consider that every patient could be a potential asymptomatic carrier. Therefore, the negative results of all contacts in this case and the fact that no confirmed cases of COVID-19 were reported suggests that these measures successfully prevented SARS-CoV-2 transmission in our HBOT clinic. SARS-CoV-2 transmission can be prevented if sufficient protective measures are taken.

The effects of hyperbaric oxygen therapy (HBOT) on coronavirus disease-2019 (COVID-19): a systematic review.

BACKGROUND: Oxygenation serves as a cornerstone in the treatment of COVID-19, and several methods have been extensively studied so far. Herein, we aimed to systematically review the studies discussing hyperbaric oxygen therapy (HBOT) to examine its reported efficacy and adverse events in patients with COVID-19. METHODS: We systematically searched and retrieved the relevant articles using keywords on the online databases, including PubMed, Scopus, Embase, Web of Science, and Cochrane databases up to April 11th, 2021. The retrieved records underwent a two-step title/abstract and full-text screening process, and the eligible papers were identified. National Institutes of health (NIH) quality assessment tool was used for this study. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID CRD42021269821. RESULTS: Eight articles from three countries were included. All the included studies had good and fair quality scores, with no poor studies included in this systematic review (Good: n = 5, Fair: n = 3). Studies were divided into clinical trials and case reports/series. Most of the studies used HBOT less than 1.5-2 absolute atmospheres (ATA) for 90 min sessions and thereafter sessions were decreased to 60 min. Trials demonstrated most of the patients recovered after receiving HBOT, and blood oxygen saturation increased after several sessions of HBOT. CONCLUSION: Overall, HBOT seems to be a safe and effective oxygenation method in patients with COVID-19. However, there is limited knowledge and evidence regarding the effects and mechanism of HBOT in COVID-19 treatment, and further evaluations require extensive well-designed studies.

The evolving use of hyperbaric oxygen therapy during the COVID-19 pandemic.

The Sars-CoV-2 (COVID-19) pandemic has resulted in significant and unprecedented shifts in the delivery of health care services in the United States. Although wound care remains an essential service during the COVID-19 pandemic, the financial consequences and infectious disease ramifications of the pandemic have resulted in closure or limitation of hours in many outpatient wound and hyperbaric oxygen therapy (HBOT) centers. As HBOT patients often require daily treatment sessions for a period of months, it is necessary for facilities providing HBOT services to adjust to the COVID-19 pandemic while still maintaining availability of this important service. Modification of HBOT session timing and chamber decontamination procedures, utilisation of telehealth services for initial patient evaluations, and acceptance of novel patient populations and diagnoses are mechanisms by which HBOT centers can adapt to the evolving model of health care delivery throughout a pandemic. While COVID-19 is not a currently accepted indication for HBOT, patients may be referred for HBOT consultation due to the post-infectious sequelae of the virus, and thus HBOT facilities must be aware of the potential uses of this treatment for post-viral complications. By redefining paradigms for health care delivery during the COVID-19 pandemic, HBOT and wound centers can continue to provide high-quality and uninterrupted care to vulnerable patient populations.

SARS-CoV-2 lung disease in a patient with pulmonary sarcoidosis - case report.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the recently identified cause of the current pandemic. In patients with chronic respiratory lung diseases, SARS-CoV-2 may result in significant morbidity and increased mortality. We present a case of a 69-year-old male with stage II pulmonary sarcoidosis who had been under observation for 30 months without immunosuppressive treatment. He then developed severe SARS-CoV-2 disease with typical radiological and laboratory findings. Therapy with oxygen, antibiotics, low-molecular-weight heparin in a prophylactic dose, and dexamethasone resulted in marked clinical improvement. We will discuss the rationale for corticosteroid use in both SARS-CoV-2 disease and in SARS-CoV-2 disease that is complicating comorbid sarcoidosis.

Does Hyperbaric Oxygen Improve Lower Extremity Ulcer Outcomes?

A person with a diabetic foot ulcer (DFU) requires multidisciplinary care, including moist wound healing, consistent offloading of insensate areas, glycemic control, and adequate circulation. This is especially important during the COVID-19 pandemic, as patients with diabetes are at a higher risk of mortality.1 Reviewed in a 2018 installment of Evidence Corner,2 a double-blind, randomized clinical trial (RCT) reported that topical oxygen continuously diffused to DFU tissue resulted in nonhealing DFUs healing more than 20 days faster than those that were similarly treated with standard therapy and a sham device.3 More than twice the DFUs closed in patients receiving continuously diffused topical oxygen in comparison with the sham arm completely healed in 12 weeks (P = .02). It has been hypothesized that intervals of hyperbaric oxygen (HBO)-breathing 100% oxygen at atmosphere absolute (ATA) greater than the 1.0 normal at sea level-may similarly improve lower extremity ulcer healing outcomes. This month's Evidence Corner summarizes 2 studies regarding patients receiving HBO. The first study focused on patients with a DFU on a non-ischemic limb.4 The second studied the effects of HBO on lower extremity ulcers on ischemic limbs in patients with or without diabetes mellitus (DM).5 Read on to discover how informative and beneficial each of these studies can be in furthering best practice as well as which patients may experience improved lower limb ulcer healing in response to interventions that increase tissue oxygenation.

Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls.

Objective: Given the high mortality and prolonged duration of mechanical ventilation of COVID-19 patients, we evaluated the safety and efficacy of hyperbaric oxygen for COVID-19 patients with respiratory distress. Methods: This is a single-center clinical trial of COVID-19 patients at NYU Winthrop Hospital from March 31 to April 28, 2020. Patients in this trial received hyperbaric oxygen therapy at 2.0 atmospheres of pressure in monoplace hyperbaric chambers for 90 minutes daily for a maximum of five total treatments. Controls were identified using propensity score matching among COVID-19 patients admitted during the same time period. Using competing-risks survival regression, we analyzed our primary outcome of inpatient mortality and secondary outcome of mechanical ventilation. Results: We treated 20 COVID-19 patients with hyperbaric oxygen. Ages ranged from 30 to 79 years with an oxygen requirement ranging from 2 to 15 liters on hospital days 0 to 14. Of these 20 patients, two (10%) were intubated and died, and none remain hospitalized. Among 60 propensity-matched controls based on age, sex, body mass index, coronary artery disease, troponin, D-dimer, hospital day, and oxygen requirement, 18 (30%) were intubated, 13 (22%) have died, and three (5%) remain hospitalized (with one still requiring mechanical ventilation). Assuming no further deaths among controls, we estimate that the adjusted subdistribution hazard ratios were 0.37 for inpatient mortality (p=0.14) and 0.26 for mechanical ventilation (p=0.046). Conclusion: Though limited by its study design, our results demonstrate the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multicenter randomized control trial.

Proactive COVID-19 Infection Prevention Measures in a Hyperbaric Oxygen Therapy Center.

Since the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China in December 2019 and its subsequent global spread, Taiwan has been combatting this pandemic. COVID-19 is caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As SARS-CoV-2 can be transmitted through droplets and aerosols, we cannot ignore the risk of transmission during hyperbaric oxygen therapy (HBOT). Our hyperbaric oxygen therapy center prioritizes preventing the spread of COVID-19 and maintaining operation for the patients during the pandemic. The aim of this article is to share the protocol that we have adopted in our hyperbaric oxygen therapy center to help prevent the spread of COVID-19.