Hyperbaric oxygen therapy in the treatment of COVID-19 — severe cases

From Wuhan China — promising results have just been published in a preliminary report by Dr. Zhong Yangling for the treatment of 5 COVID-19 patients (2 of which were critical and 3 were severe) with hyperbaric therapy at the Department of Hyperbaric Oxygen in Wuhan Yangtze River Shipping General Hospital.

In this report, hyperbaric oxygen was added to the current comprehensive treatments being performed at the hospital for COVID-19 affected patients, with a dose of 90-120 minutes at treatment pressures of 1.4 to 1.6 ATA. The results were very encouraging as these 5 patients received significant therapeutic benefits, including rapid relief of symptoms after the first session. The rationale for adding this procedure is to help combat the progressive hypoxemia (low blood oxygen levels) that COVID-19 can cause. Hyperbaric oxygen has the ability to add a substantial supply of extra oxygen into the bloodstream and therefore can help during these times of hypoxemia.

Hypoxemia is the key determinant to the deterioration of patients seen with COVID-19. The virus attacks the lungs and causes inflammation and the body has a difficult time getting enough oxygen transferred from the lungs into the body. This progressive hypoxemia leads to an increase in mortality rates as patients can become critically ill. At this time, they are typically in complete reliance on ventilators to help restore oxygen levels, to keep them alive, while the body fights the virus and repairs the lung damage.

The advantage of hyperbaric oxygen for the treatment of progressive hypoxemia is that the higher pressure environment allows greater levels of oxygen to pass through the thickened and inflamed lung tissue into the bloodstream; thereby directly treating the hypoxemia. Add to this, the greater solubility of oxygen in the blood (in hyperbaric conditions) and it’s now easy to see why all 5 patients reported dramatic relief of their symptoms — Dr. Zhong reported that after the first session of hyperbaric oxygen, symptoms such as dyspnea (shortness of breath) and chest pain were reduced. After the second session, the respiratory rate decreased gradually and the shortness of breath (after movement) was relieved slowly. To correlate with these subjective results, Dr. Zhong was able to objectively chart a significant upward trend of oxygen levels, day by day. In addition, lung inflammation was re-evaluated through CT scan, and all 5 patients significantly improved.

It should be noted, that hyperbaric oxygen is not a treatment for the COVID-19 virus and this report should NOT lead people to look for hyperbaric chambers for treating the virus, particularly within private centers that are not equipped for treating infectious diseases. However, this is a very important paper outlining the potential clinical role that hyperbaric therapy can play in the symptomatic relief of hypoxemia that is seen in the COVID-19 affected population. Hopefully, this will lead the medical community to take a much harder look at integrating hyperbaric therapy and utilizing its key physiological benefits (ie, reducing hypoxia). In turn, this could lead to a much larger demand for the use of hyperbaric chambers in hospitals and infectious disease centers to coexist as a supportive therapy, during these critical stages. Deploying hyperbaric chambers in this manner could offer major lifeline support to patients, while aggressive medical treatments are being administered in the hospital setting. This applies to both current hospital-type chambers and portable hyperbaric chambers as these chambers can be performed in the open area of the hospital.

Hospital chambers — According to Dr. Zhong, these chambers can help “improve the treatment efficiency, reduce the medical pressure and the risk of infection, and decrease the mortality rate of critical patients”. With the limited supply of ventilators, hyperbaric chambers can offer valuable relief. Hyperbaric Oxygen Department of Wuhan Changjiang Shipping General Hospital has established complete infection control procedures and measures for the hyperbaric treatment of patients with coronavirus. If followed, this could lead to a widespread movement of hyperbaric chambers to help in areas where the local demand is too great from community infection. In Wuhan, Huoshenshan hospitals are not equipped with hyperbaric chambers so construction of a new hyperbaric oxygen chamber system started at Huoshenshan Hospital and is being installed and commissioned for use within 15 days!

Portable chambers — These chambers are typically operated at lower pressures of 1.3 ATA and can have physiological benefits in reducing hypoxemia. Of note, Dr. Zhong also tested 1.2 to 1.4 ATA and found that the oxygen levels were still kept in a high level and this was even with ambient air application. Again, as a supportive therapy, this could be very valuable for helping to maintain oxygen levels. Here in the United States, these types of chambers have been making steady growth in the hyperbaric industry (over the past 20 years) and fueled lately by high-profile athletes promoting its benefits. As this industry grows, many private hyperbaric centers are now writing prescriptions for patients for home use. This may help during times of isolation and the early infection period when patients are told to stay at home until symptoms become severe and hypoxemia begins to take its toll.

To summarize, this publication by Dr. Zhong should encourage us to look into hyperbaric medicine in a new way, when it comes to severe respiratory diseases caused by a coronavirus. Since this study, Dr. Zhong has now treated a total of 35 COVID-19 cases. As this pandemic continues, we do not know how much of the public will be affected and the extra load that will impact our medical system. What we do know is that this virus primarily targets the lung tissue, causing severe inflammation and hypoxemia. Hyperbaric oxygen may offer a valuable therapeutic delivery of oxygenation during times of hypoxemia. More research should be looked into this.

Disclaimer — is very important that this article is not construed as an article that promotes treating COVID-19 with hyperbaric therapy. Anyone who has been diagnosed with COVID-19 or suspected of having this infection should follow the CDC guidelines (and not seek treatments in a hyperbaric chamber as an alternative). This is purely educational material on the new preliminary report published from Wuhan China <view report>

Hyperbaric oxygen therapy may be effective to improve hypoxemia in patients with severe COVID-2019 pneumonia: two case reports

Two male patients ages 57 and 64 years old were treated with a 1-week course of hyperbaric oxygen therapy at 1.5 ATA (60 minutes per session)

Shortness of breath subsided immediately with both patients after the first hyperbaric session and resolved by the end of the 7 days. More notably, neither patient became critically ill and the lung CT scans showed remarkable improvement in lung pathology.

The authors of this study concluded this report by suggesting that “hyperbaric oxygen therapy may promptly improve the progressive hypoxemia of patients with COVID-2019 pneumonia” <view study>

Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress

This is a single-center clinical trial of 20 COVID-19 patients aged 30 to 79 years being treated with 5 sessions of hyperbaric oxygen therapy at 2.0 ATA (90 minutes) at NYU Winthrop Hospital from March 31 to April 28, 2020.

“The results demonstrated the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multi-center randomized control trial” <view study>

Hyperbaric oxygen therapy shows benefit for pulmonary fibrosis

Pulmonary fibrosis is a chronic progressive lung disease that is becoming more prevalent and poses medical challenges due to the limited therapeutic options available. The rise in the aging process along with the rise in pulmonary complications from long COVID has led to new research studies to help identify potential treatment options. Hyperbaric oxygen therapy (HBOT) is emerging as one of them, showing good promise with clinical outcome measures.

To demonstrate HBOT’s influence on this disease, researchers in this study first exposed a group of rats to bleomycin (a chemotherapeutic agent that is known to cause acute pulmonary toxicity) directly into the trachea. This is to induce pulmonary fibrosis. They waited 7 days and then treated the rats with 14 days of HBOT at 2.5 ATA&nbsp; for 90 minutes.

The rats that were treated with this 2-week course of HBOT demonstrated a marked reduction in TGF-β, which is normally elevated and plays an active role in the development of fibrosis.

The findings in this study support the use of HBOT as a potential “life-changing” therapy for patients with pulmonary fibrosis <view study>

Hyperbaric therapy reduced long COVID related fatigue in just 10 sessions

Long COVID-related fatigue can be debilitating, and may affect young people who were previously in economic employment. All patients had been suffering from long COVID symptoms for over 3 months. The results presented here suggest potential benefits of HBOT, with statistically significant results following 10 sessions of HBOT at 2.4 ATA <view study>