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Hyperbaric oxygen for COVID-19 patients with severe hypoxia prior to vaccine availability.
Jansen, Deepa; Dickstein, Daniel R; Erazo, Kasandra; Stacom, Ellen; Lee, David C; Wainwright, Sandra K.
  • Jansen D; Department of Internal Medicine, Yale New Haven Health - Greenwich Hospital.
  • Dickstein DR; Department of Internal Medicine, Yale New Haven Health - Greenwich Hospital.
  • Erazo K; Department of Internal Medicine, Yale New Haven Health - Greenwich Hospital.
  • Stacom E; Department of Hyperbaric Oxygen and Wound Care, Yale New Haven Health - Greenwich Hospital.
  • Lee DC; Department of Emergency Medicine, NYU Grossman School of Medicine.
  • Wainwright SK; Department of Population Health, NYU Grossman School of Medicine.
Undersea Hyperb Med ; 49(3): 295-305, 2022.
Article in English | MEDLINE | ID: covidwho-2146075
ABSTRACT

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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vaccines / COVID-19 / Hyperbaric Oxygenation Type of study: Experimental Studies / Prognostic study Topics: Vaccines Limits: Humans Language: English Journal: Undersea Hyperb Med Journal subject: Physiology Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vaccines / COVID-19 / Hyperbaric Oxygenation Type of study: Experimental Studies / Prognostic study Topics: Vaccines Limits: Humans Language: English Journal: Undersea Hyperb Med Journal subject: Physiology Year: 2022 Document Type: Article